ISSU ETIS DALAM

KEPERAWATAN
PALIATIF
 Prinsip etika secara
mum
- Otonomi -Kemurahan hati
- Kerahasiaan -Efek ganda
- Kesetiaan -Keadilan
- Non maleficence(tidak membahayakan)
- Paternalisme -Respek Individu
- Kemulian hidup -Kejujuran
 Prinsip etika umum
1. Otonomi :
- Peraturan diri, hak individu, privacy, pilihan, kemampuan
membuat pilihan yang bebas dari eksternal
2. Kemurahan hati
- Melakukan hal yang baik, penuh kebajikan, kebaikan dan
kemurahan
3. Kerahasiaan
- Privasi, tidak menyebarkan utk org lain
Lanjutan

4. Efek ganda
- Tindakan dapat menghasilkan efek positif dan nengatif dg
kriteria :
a. Tindakan itu secara moral baik
b. Secara tulis berniat efek yang baik(efek buruk diramalkan tapi
tidak diminati)
c. Efek baik tidak diraih dg cara efek buruk
d. Terdapat keseimbangan proporsional yg baik dan buruk
5. Kesetiaan :
- Menepati janji (komitmen)
Lanjutan
6. Keadilan :
- Memperlakukan sesuai hak dan kewajiban individu dan sosial
antara lain (Kesetaraan, kebutuhan, upaya, kontribusi
masyakarakat, kebaikan, legal)
7. Non malificence :
- tidak membebankan utk mencegah dan menyingkirkan bahaya
8. Paternalisme
- Bekerjasama utk kemurahan hati, kesejahteraan / kebutuhan
orang lain, mencegah keburukan
Lanjutan

8. Paternalisme
- Bekerjasama utk kemurahan hati, kesejahteraan / kebutuhan
orang lain, mencegah keburukan
9. Respek utk individu :
- Mengotimalkan dan memampukan orang lain membuat pilihan
10. Kemuliaan hidup :
- Eksistensi biologis harus lebih penting diatas kriteria ekternal
11. Kejujuran
- Kewajiban mengatakan yg benar, tidak bohong, tidak menipu
orang lain
 Domain etika
keperawatan
1. Memberikan perawatan berkesinambungan
2. Tidak memandang penyakit /status sosial
3. Bertangung jawab
4. Bertindak sesuai kode etik profesi
Jenis masalah etis
keperawatan
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

Reflect for a minute on how

you make decisions…
Ethical Decision Making
Framework for Ethical Decision Making
◦ Which theories are involved?
◦ Which principles are involved?
◦ Who will be affected?
◦ What will be the consequences of the alternatives?
◦ What does the client desire?
Ethical Decision Making
Steps of Ethical Analysis
◦ Gathering of relevant data to identify the problem
◦ Consideration of all the people involved
◦ Selection of a course of action
◦ Evaluation of the resolution process
Ethical Issue
Euthanasia
Refusal of Treatment
Scarce Resources
Euthanasia
“Good or gentle death”
Mercy killing (deliberate ending of life as a humane action)
Euthanasia
Active euthanasia is taking deliberate action that will hasten the client’s
death.
◦ Assisted suicide is a form of active euthanasia.

Passive euthanasia is the omission of an action that would prolong

dying.
◦ Discontinuing the client’s tube feedings is a form of passive euthanasia.
Refusal of Treatment
The client’s right to refuse treatment is based on the principle of
autonomy.
A client’s right to refuse treatment and the right to die challenge the
values of some health care providers.
Scarce Resources
The availability of specialists and organs, is contributing to a scarcity of
resources.
The use of expensive services is influenced by social and political forces.
Health care reform is needed to ensure services to all.
Ethics and Nursing
Professional nurses’ actions are both legal and ethical.
Sound nursing practice involves making ethical decisions.
Ethics affects nurses in every health care setting.
Ethics and Nursing
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
and
of
theclaims;
actions
parties
ethical
actions;dilemma
Generation of“Were
alternatives
the actions
for resolving
ethical?”the dilemma;
Consideration
“Whatofwere
the consequences
the consequences?” of alternatives
 Web Resources,
2
Before I Die
With Bill Moyers

http://www.pbs.org/wnet/bid/
Web Resources, 3

The End of Life: Explaining Death in America

http://www.npr.org/programs/death/
What is a good death?
Eudaimonistic utilitarians: a
good death is a happy death.
John Stuart Mill

Jeremy Bentham.
Hedonistic utilitarians: a good
death is a painless death.
Lanjutan

4. Kematian dan sekaratul maut Tidak ada yg dapat dilakukan lagi

Teknologi akan memperpanjang hidup perlu biaya tinggi
Fokus peran asuh
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
ASSESSM EN T
D e t e r m in a t io n o f c la im s a n d p a r t ie s

A N A L Y S IS & D IA G N O S IS
I d e n t ific a t io n o f p r o b le m : S t a t e m e n t o f e t h ic a l d ile m m a

P L A N N IN G
C o n s id e r a t io n o f p r io r it ie s o f c la im s
C o n s id e r a t io n o f c o n s e q u e n c e s o f a lt e r n a t iv e s

IM P L E M E N T A T IO N
C a r r y in g o u t s e le c t e d m o r a l a c t io n s

E V A L U A T IO N
E v a lu a t io n o f o u t c o m e o f m o r a l a c t io n s
" W e r e t h e a c t io n s e t h ic a l? " " W h a t w e r e t h e c o n s e q u e n c e s ? "
Lanjutan

2. Perencanaan :
Kumpulkan informasi :
a. Fakta medis, pilihan pengobatan, Dx. Keperawatan, data
legal, nilai, keyakinan, komponen keagamaan
b. Buat perbedaan antara faktual dan nilai / keyakinan
c. Validasi kepastian pasien atau kurang kapasitasa membuat
keputusan
d. Indentitas informasi lain yg relevan
e. Identifikasi isu etis/ moral dan klaim persaingan
Lanjutan

3. Implementasi
a. Urutkan alternatif
Bedakan alternatif dg prinsip etis yg dapat diterapkan dan
kode etik profesi, dapat memilih salah satu atau keduanya
bandingkan :
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
 Lanjutan
4. Menentukan dan mengevaluasi keputusan
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 ?
The MORAL Decision Making Model
(Crisham, 1985)

M—Massage the dilemma.

O—Outline options.
R—Review criteria and resolve.
A—Affirm position and act.
L—Look back. Evaluate the
decision-making.
Murphy and Murphy (1976) Approach to
Ethical Problem Solving
1. Identify the problem.
2. Identify why the problem is an ethical problem.
3. Identify the people involved in the ultimate decision.
4. Identify the role of the decision maker.
5. Consider the short- and long-term consequences of each
alternative.
6. Make the decision.
7. Compare the decision with the decision maker’s philosophy of
ethics.
8. Follow up on the results of the decision to establish a baseline for
future decision making.