ETHICAL

DECESION MAKING

Setyoadi
Nursing Codes of Ethics (elements)

 Nurses have four

fundamental
responsibilities: to promote
health, to prevent illness, to
restore health, and alleviate
suffering.

• Nurses and people

• Nurses and practice
• Nurses and the
profession
• Nurses and the co-
workers
 Factors Contributing to the
Need for Ethics in Health Care
 Technological advances
 Changing fabric of our society
 Increased consumer demand for health
care information
 Decreasing allocation funds for health
care
 Factors that influence EDM

1. Codes for Nurses

2. The patient’s rights
3. Social and cultural attitudes
4. Science and technology
5. Legislation
6. Judicial decisions
7. Funding
8. Personal religious and philosophic viewpoint
Factors in the work environment that
affect EDM

1. Status as an employment
2. Collective bargaining
contracts
3. Collegial relationships
4. Authoritarian and
paternalistic background
5. Ethics committees in health
care
6. Consumer involvement in
health care
 Examples of Ethical Issues

 Newborns surviving at earlier gestational

ages with serious health problems
 People living longer than ever before
 Organ transplants and the use of bionic
body parts
 Experimental research
 Ethical Dilemmas

 Occur when there is a conflict between

two or more ethical principles.
 The most beneficial decision depends on
the circumstances.
 Ethical analysis is not an exact science.
DILEMA ETIK
Kondisi yang terjadi dalam pelayanan,
yang mengharuskan perawat untuk
menapis, melakukan analisa dan sintesa
serta menetapkan keputusan yang
“terbaik” bagi klien, terutama bagi
kesehatan dan integritasnya sebagai
manusia
 Ethical Dilemmas

 Frequently Occurring Ethical Dilemmas

• Informed Consent
• Refusal of Treatment
• Use of Scarce Resources
• Cost-Containment Initiatives that Negatively
Affect Client Well-Being
• Incompetent Health Care Providers
 Ethical Decision Making

 Ethical Reasoning
• Thinking through what one ought to do in an
orderly, systematic manner
• Justification of actions based on principles
KERANGKA PEMECAHAN DILEMA ETIK
(Kozier, 2004)
1. Mengembangkan data dasar
2. Mengidentifikasi konflik
3. Mengkaji berbagai alternatif tindakan
4. Menetapkan pengambil keputusan
5. Membuat keputusan
LANGKAH PENYELESAIAN (Poter & Perry,2005)

1. Menunjukkan maksud baik

2. Mengenali pentingnya eksistensi seseorang
3. Mengumpulkan informasi yang relevan
4. Mengidentifikasi prinsip etis yang sesuai
5. Mengusulkan tidakan
6. Melaksanakan tindakan
 What is Ethical Decision
Making?
 When faced with an ethical dilemma
the objective is to make a judgment
based on well-reasoned, defensible
ethical principles.
 The risk is poor judgment i.e. a low-
quality decision
 A low-quality decision can have a wide
range of negative consequences
Two Types of Ethical Choices

 Right vs wrong: choosing right

from wrong is the easiest
 Right vs right
• Situation contains shades of gray
i.e. all alternative have desirable
and undesirable results
• Choosing “the lesser of two evils”
• Objective: make a defensible
decision
 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
 A framework for Ethical Decision
Making (EDM)

1. Identify and clarify the ethical problem

2. Gather data
3. Identify options
4. Make a decision
5. Act and assess
 Making Moral Decisions--Some
Inappropriate Ways:
 Appeal to Authority
 Appeal to Law
 Appeal exclusively to self-interest
 AREA DILEMA ETIK

1. Kualitas vs kuantitas hidup

2. Pro pada pilihan lain vs pro hidup
3. Kebebasan vs pengendalian
4. Mengatakan apa adanya/ jujur vs bohong
5. Bertentangan dengan agama, politik,
ekonomi dll
6. Pengetahuan empiris vs keyakinan
individu
 Ethical Dilemmas

 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.
 PERAWAT ADALAH
“PROBLEM SOLVER”
 Fokus utama dalam menjalankan
tugasnya adalah menyelesaikan masalah
kesehatan yang dialami klien
 Metode pemecahan masalah ( Proses
keperawatan) digunakan dalam pemberian
asuhan keperawatan
 Maslah etik yang terjadi selama pelayanan
keperawatan harus diselesaikan dengan
pendekatan pengambilan keputusan etik
 Rujukan dalam penyelesaian
masalah etik:

1. Ungkapan yang pernah disampaikan klien

sebelumnya
2. Agama/ keyakinan klien
3. Pengaruh eksistensi klien terhadap keluarga
4. Kemungkinan tidak menyenangkan yang dapat
terjadi
5. Prognosis yang mungkin terjadi apabila
dilakukan atau bila tidak dilakukan suatu upaya
penyelesaian atau suatu tindakan
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
 Ethics Committees

With the increasing complexity of ethical issues in health care,

ethics committees have been created to assist in making
ethical decisions in clinical settings. Ethical committees
can:
1. Provide structure and guidelines for potential problems.
2. Serve as an open forum for discussion and debate.
3. Function as a patient advocate by placing the patient at the
core of the committee’s deliberations.
 KOMITE ETIK
KEPERAWATAN
Perlu dibentuk pada setiap tatanan, sbb:
1. Majelis kehormatan etik keperawatan (MKEK) PPNI
1.1.Tingkat Pusat
Bertanggung jawab dalam menjamin penerapan
Kode Etik bagi setiap perawat di Indonesia

1.2.Tingkat wilayah ( Propinsi)

Bertanggung jawab dalam menjamin penerapan
kode etik oleh semua anggota di wilayahnya
termasuk menyelesaikan kasus etik yang dialami
anggotanya
 2. Pada Institusi Pelayanan
Kesehatan

Komite Etik Institusi

yang beranggotakan berbagai perwakilan
profesi dan bidang terkait yang ada di
institusi. Perawat harus memastikan
keterwakilannya sebagai anggota tim
etik institusi.
Komite Etik Keperawatan
• Perlu dibentuk bila komite etik institusi
tidak ada
• Apabila tidak terdapat Komite Etik,
penyelesaian masalah etik
keperawatan harus dilakukan oleh
Manager Keperawatan/ kepala bidang
keperawatan
 TUGAS KOMITE ETIK
KEPERAWATAN

1. Mengedukasi perawat tentang etik

keperawatan dan bioetik pada umumnya
2. Mempersiapkan perawat untuk berperan
sebagai tim etik institusi
3. Melakukan penelaahan materi atau
dokumen etik keperawatan yang ada
4. Melakukan tetaah terhadap pelanggaran
etik yang dilakukan anggota