Issu Etis Dalam Keperawatan
Issu Etis Dalam Keperawatan
KEPERAWATAN
M.Fathoni, S.Kep, Ns.
Isu-isu etik khusus : hidup dan mati,
mempertahankan/mengakhiri pemberian makanan
dan minuman, mengakhiri bantuan kelangsungan
kehidupan, AIDS, AI (Avian Influenza) alokasi
sumber-sumber kesehatan
Tujuan pembelajaran
1. Teleologi
2. Deontologi
3. Etik kebajikan
4. Etik pluralisme
1. Teleologi
Pluralisme
WD. Ross (Inggris, 1930) Prima facie (kondisional atau semua
hal lain yg serupa) dan eksistensi aktual(keberadaan)
Contoh secara moral berkata bohong itu salah, namun kadang
membenarkan tindakan ini lebih mendesak karena menghindari
bahaya orang lain.
Prinsip etika secara mum
- Otonomi -Kemurahan hati
- Kerahasiaan -Efek ganda
- Kesetiaan -Keadilan
- Non maleficence(tidak membahayakan)
- Paternalisme -Respek Individu
- Kemulian hidup -Kejujuran
Ethics in Health Care
1. Kerahasiaan
2. Restrein
3. Hubungan saling percaya
4. Kematian dan sekarat
5. Menolak perawatan
Ethical Dilemma
Defined as making a
choice between two
or more equally
undesirable
alternatives
Lanjutan
1. Kerahasiaan
- Informasi Dx. Medis, keperawatan, diskusi Px ditempat
tertutup
2. Restrein (penggunaan pengikat)
- efek keselamatan, agitasi/bingung, menanyakan anggota
kluarga /relawan
3. Hubungan saling percaya
- Kejujuran, tidak berbohong kepada pasien, informasi yg
jelas prosedur dan diagnosa keperawatan,
mengkomunikasikan pada kluarga dan dokter permintaan
pasien akan informasi.
Ethical Decision Making
Ethical Reasoning
• Thinking through what one ought to do in an orderly,
systematic manner
• Justification of actions based on principles
Trial-and-Error
Decision Making
Euthanasia
Refusal of Treatment
Scarce Resources
Euthanasia
Ethics Committees
• One approach for facilitating dialogue regarding ethical
dilemmas
Nurse as Client Advocate
• Nurses are accountable for protecting the rights and
interests of the client.
Ethical Decision-Making Model
ANALYSIS
ASSESSMENT
AND DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION
ProblemAssessing
identification:
Consideration
Determination
Carryingthe
outoutcome
Statement
selected
ofofpriorities
claims
of
moral
of
moral
andof
theclaims;
actions
parties
ethical
actions;dilemma
Generation of“Were the actions
alternatives ethical?”the dilemma;
for resolving
“Whatofwere
Consideration the consequences?”
the consequences of alternatives
Web Resources,
2
Before I Die
With Bill Moyers
http://www.pbs.org/wnet/bid/
Web Resources, 3
Jeremy Bentham.
Hedonistic utilitarians: a good
death is a painless death.
Appendix 1
From whole to parts
Priest,
Minister
Soul Rabbi
Psychiatrist ENT
Ophthalmologist
Body Doctor Urologist
Oncologist
Appendix 2
Stakeholders in the Decision-making Process
Patient’s
Family
Physician Patient
Insurer/
HMO
Resustiasi
a. Dukungan hidup
b. Makanan dan cairan
c. Kontrol nyeri
Lanjutan
5. Menolak perawatan
- Konflik nilai
- Takut cedera
- Keterasingan
- Takut biaya
Pembuatan keputusan etis
1. Pengkajian :
Situasi etis/moral dari masalah
a.Dimensi etis, hukum, profesional
- Apakah situasi mengandung masalah
moral (konflik prisip etis dan kewajiban
profesional)
- Apakah ada konflik prosedural (siapa yg
harus membuat keputusan, apakah ada
konflik pemberi asuhan, kluarga, px)
- Identitas orang terpenting yg terlibat dan
mempengaruhi keputusan
Ethical Decision Making
ASSESSMENT
Determination of claims and parties
PLANNING
Consideration of priorities of claims
Consideration of consequences of alternatives
IMPLEMENTATION
Carrying out selected moral actions
EVALUATION
Evaluation of outcome of moral actions
"Were the actions ethical?" "What were the consequences?"
An Exciting Time
for Ethics
New technologies
Policy vacuums
Pendekatan utilitarisme
- Ramalkan konsekwensi dari alternatif
- Teliti nilai positi dan negatif tiap konsekwensi
- Pilih konsekwensi yg meramalkan nilai paling positif atau
yg terbaik bagi yg terbanyak
Lanjutan
Pendekatan deontologi (hak/kewjiban/alasan)
a. Identifikasi prisip moral yg relevan
b. Bandingkan alternatif dgn prinsip moral
c. Bandingkan ke prinsip moral tingkat yg lebih tinggi
jika terdapat konflik
Lanjutankeputusan
4. Menentukan dan mengevaluasi
a. Tindakan apa yang terbaik dan tepat secara
moral ?
b. Berikan alasan etis terhadap keputusan anda ?
c. Apa alasan etis dari keputusan anda
d. Bagaimana anda merespon terhadap penalaran
keputusan anda ?
To make appropriate
ethical decisions:
The manager must use a
professional approach
that eliminates trial and
error and focuses on
proven decision-making
models or problem-
solving processes.
The MORAL Decision Making Model (Crisham,
1985)
In an era of markedly
limited physical, human,
and fiscal resources, nearly
all decision making by
nurse–managers involves
some ethical component.
“If a structured approach to
problem solving is used, data
gathering is adequate, and
multiple alternatives are
analyzed, even with a poor
outcome, the manager should
accept that the best possible
decision was made at that time
with the information and
resources available.”
The following forces ensure that ethics will become an
even greater dimension in management decision
making in the future:
State licensure
Nurse Practice Act
Patient’s Bill of Rights
Code of Ethics for Nurses
Nursing Research
Informed Consent
Other Ethical Issues
Quality of life vs. Sanctity of Life
Euthanasia
Withholding or withdrawing Tx.
Abortion
Allocation of Resources
Restraints
Informed Consent
Confidentiality
Preventive Ethics
Advance Directives
*Living Will
*Durable Power of Attorney for Health
Care
Ethics Literature
Definitions
HIV/AIDS-Related Stigma:
“a ‘process of devaluation’ of people either living with or
associated with HIV/AIDS”. (UNAIDS)
Relations?
Stigma (marking/labelling) Discrimination (action)
Why Study HIV-related Stigma and
Discrimination in Asia?
Stigma and discrimination described as ‘the greatest
barriers’ to effective epidemic control
Asia described as “the next battlefield for AIDS”
Research gap
To provide a systematic situation Aim
analysis of structural forms of HIV
related discrimination in selected
sites in six countries:
• China (Beijing)
• India (Trivandrum)
• Indonesia (Bali & Jakarta)
• Philippines (Manila)
• Thailand (Bangkok)
• Vietnam (Hanoi)
Terimakasih
Wassalam