BEGINNING BIOETHICS

IntroductionIt is perhaps no accident that the medical profession was the first profession in history to provide itself with a code of ethics

Introduction ..New technologies produce new ethical problemsThese technologies raise disturbing questions about what we ought to do-they raise ethical questions about the limits and purposes of the practice of medicine

Three Main Ethical Principles

BeneficenceRespect for AutonomyJusticeThe principle that one should attempt to do good; that one should attempt to benefits othersThe principle that one should attempt to give due weight to the goals, preferences, and interests of othersThe principle that one should treat like cases alike: Differences in treatment must be justified by appeal to relevant differences between cases

BeneficenceComes from the Latin for doing goodIs an ethical principleThe aim to do good is often considered an essential part of any ethical perspective that hopes to suggest acceptable solutions to ethical dilemmas, of whatever kindWithout the desire to do good, health care would not exist

Respect for AutonomyAutonomy comes from the Greek words meaning self-governance, meaning the capacity to select your own fate, to rule yourself, to choose what you do and what is done to you

Respect for Autonomy..Conflicts between beneficence and respect for autonomyFor the moment we can sketch out two broad approaches to such conflict. These might be labeled paternalism and libertarianism

PaternalismA paternalist position is one that tends to give precedence to the demands of beneficence over those of respect for autonomy.The paternalist believes that it is more important to do people good than it is to deal with them as they wish to be dealt with.

Paternalism..Typical paternalist sentiments are captured in remarks such as:Doctor knows best; orI know whats good for you better than you know yourself; orBelieve me, I have your best interests at heart; orYou need to be saved from yourself

LibertarianismA libertarian position is one that prefers to respect autonomy at the cost of beneficence whenever the two come into conflict.The libertarian thinks that it is more important to allow people to do as they wish than it is to do them good.

Libertarianism..Typical libertarian sentiments are captured in remarks such as:To each his own; orLet them go to hell as they choose; orYoure mad, but Im not going to stand in your way; orIts your funeral

JusticeThe principles of justice, by contrast, invites us to survey our ethical behavior in a broader context.It invites us to ask if our behavior is consistent; to ask if we are behaving in an even-handed way; to ask if we are treating people fairly.

Informed ConsentIt is widely accepted that a patient should give informed consent to any nontrivial medical procedure before it may be performed

The Importance of Informed Consent The practice of seeking informed consent was designed to safeguard the interests of the professional. The professionals legal and insurance liabilities are much reduced, and the blame, if anything goes wrong, is shared by the patient.

The Importance of Informed ConsentThe value of informed consent lies in this relation to the patients interest, not the professionals.The grounds of that value surely lie in the patients autonomy.

The Patients ConsentSigning on the dotted line may be sufficient evidence of consent for legal purposes, but it is not sufficient for ethical purposes.The ethical justification for seeking informed consent, after all, is to ensure that the patients autonomy is respected.From an ethical point of view, consent is only of any worth if it is freely given by an autonomous person.

The Patients Consent..Cooling-off period before consent to serious, but non urgent, procedures is finally given.In the best scenario, the patient has time for as much reflection and discussion as he or she may need to arrive at a settled, considered decision

Patients Who Cannot ConsentExplicit informed consent may not always be necessary.The patient is still in no position to give fully autonomous consent. Such patients may be comatose, for instance, or elderly and confused, or they may be young children

Informed ConsentWhat is informed consent? What are the elements of full informed consent? How much information is considered "adequate"? What sorts of interventions require informed consent? When is it appropriate to question a patient's ability to participate in decision making? What about the patient whose decision making capacity varies from day to day? What should occur if the patient cannot give informed consent? Is there such a thing as presumed/implied consent?

What is informed consent? Informed consent is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care.

What are the elements of full informed consent?It is generally accepted that complete informed consentincludes a discussion of the following elements: the nature of the decision/procedure reasonable alternatives to the proposed intervention the relevant risks, benefits, and uncertainties related to each alternative assessment of patient understanding the acceptance of the intervention by the patient Consequently, the discussion should be carried on in layperson's terms and the patient's understanding should beassessed along the way.

How much information is considered "adequate"?reasonable patient standardreasonable physician standardsubjective standard

Reasonable Patient Standardreasonable patient standard: what would the average patient need to know in order to be an informed participant in the decision? This standard focuses on considering what a patient would need to know in order to understand the decision at hand.

Reasonable Physician Standardreasonable physician standard: what would a typical physician say about this intervention? This standard allows the physician to determine what information is appropriate to disclose. Typical physician tells the patient very little. Generally considered inconsistent with the goals of informed consent as the focus is on the physician

Subjective Standardsubjective standard: what would this patient need to know and understand in order to make an informed decision? This standard is the most challenging to incorporate into practice, since it requires tailoring information to each patient.

What sorts of interventions require informed consent?

For a wide range of decisions, written consent is neither required or needed, butsome meaningful discussion is needed

When is it appropriate to question a patient's ability to participate in decision making?

Patients are under an unusual amount of stress during illness and can experience anxiety, fear, and depression. Precautions should be taken to ensure thepatient does have the capacity to make good decisions. There are several different standards of decision making capacity.

Understand his or her situation, understand the risks associated with the decision at hand, and communicate a decision based on that understanding.

What about the patient whose decision making capacity varies from day to day?

Patients can move in and out of a coherent state as their medications or underlyingdisease processes ebb and flow. You should do what you can to catch a patient in a lucid state - even lightening up on the medications if necessary - in order to include him in the decision making process.

What should occur if the patient cannot give informed consent?If the patient is determined to be incapacitated/incompetent to make health caredecisions, a surrogate decision maker must speak for her. If no appropriate surrogate decision maker isavailable, the physicians are expected to act in the best interest of the patient until a surrogate is foundor appointed.

Is there such a thing as presumed/implied consent ?

The patient's consent should only be "presumed", rather than obtained, in emergency situations when the patient is unconscious or incompetent and no surrogate decision maker is available. The patient's presence in the hospital ward, ICU or clinic does not represent implied consent to all treatment and procedures. While the principle of respect for person obligates you to do your best to include the patient in the health care decisions that affect his life and body, the principle of beneficence may require you to act on the patient's behalf when his life is at stake.

Truth-telling and Withholding InformationDo patients want to know the truth about their condition? How much do patients need to be told? What if the truth could be harmful? What if the patient's family asks me to withhold the truth from the patient? When is it justified for me to withhold the truth from a patient? What about patients with different specific religious or cultural beliefs? Is it justifiable to deceive a patient with a placebo?

Truth-telling and Withholding Information When physicians communicate with patients, being honest is an important way to foster trust and show respect for the patient. Yet there are situations in which the truth can be disclosed in too brutal a fashion, or may have a terrible impact on the occasional patient.

Do patients want to know the truth about their condition?

A number of studies have demonstrated that patients do want their physicians to tell them the truth about diagnosis, prognosis, and therapy. Similarly, a number of studies of physician attitudes reveal support for truthful disclosure. For example, whereas in 1961 only 10% of physicians surveyed believed it was correct to tell a patient of a fatal cancer diagnosis, by 1979 97% felt that such disclosure was correct.

How much do patients need to be told?

In addition to fostering trust and demonstratingrespect, giving patients truthful information helpsthem to become informed participants in importanthealth care decision. Complete and truthful disclosure need not be brutal; appropriate sensitivityto the patient's ability to digest complicated or badnews is important.

What if the truth could be harmful?

There are many physicians who worry about the harmful effects of disclosing too much informationto patients. If the physician has some compellingreason to think that disclosure would create a realand predictable harmful effect on the patient, it maybe justified to withhold truthful information.

What if the patient's family asks me to withhold the truth from the patient? Often families will ask the physician to withhold a terminal or serious diagnosis or prognosis from the patient. Usually, the family's motive is laudable; they want to spare their loved one the potentially painful experience of hearing difficult or painful facts. In unusual situations, family members may reveal something about the patient that causes the physician to worry that truthful disclosure may create real and predictable harm, in which case withholding may be appropriate.

When is it justified for me to withhold the truth from a patient?There are two main situations in which it is justified to withhold the truth from a patient. If the physicians has compelling evidence that disclosure will cause real and predictable harm, truthful disclosure may be withheld. This judgment, often referred to as the "therapeutic privilege," is important but also subject to abuse.The second circumstance is if the patient him- or herself states an informed preference not to be told the truth. If theychose to make an informed decision not to be informed,however, this preference should be respected.

What about patients with different specific religious or cultural beliefs??

Patient with certain religious beliefs or ethnic or cultural backgrounds may have different views on the appropriateness of truthful disclosure. Thus, dialogue must be sensitive to deeply held beliefs of the patient.

Is it justifiable to deceive a patient with a placebo?

A placebo is any substance given to a patient with the knowledge that it has no specific clinical effect, yet with thesuggestion to the patient that it will provide some benefit. Ingeneral, the deceptive use of placebos is not ethicallyjustifiable. Specific exceptions should be rare and onlyconsidered if the following conditions are present: the condition is known to have a high placebo response rate the alternatives are ineffective and/or risky the patient has a strong need for some prescription

ConfidentialityWhere does the duty of confidentiality come from? What does the duty of confidentiality require? What kinds of disclosure are inappropriate? When can confidentiality be breached? What if a family member asks how the patient is doing? Confidentiality is one of the core tenets of medical practice. Yet daily physicians face challenges to thislong-standing obligation to keep all informationbetween physician and patient private.

Where does the duty of confidentiality come from?

Patients share personal information withphysicians. You have a duty as a physician torespect the patient's trust and keep thisinformation private. Creating a trustingenvironment by respecting patient privacy canencourage the patient to be as honest aspossible during the course of the visit.

What does the duty of confidentiality require ?The obligation of confidentiality both prohibits the physician from disclosing information about the patient's case to otherinterested parties and encourages the physician to takeprecautions with the information to ensure that onlyauthorized access occurs. Yet the context of medical practicedoes constrain the physician's obligation to protect patientconfidentiality. In the course of caring for patients, you willfind yourself exchanging information about your patientswith other physicians. These discussions are often critical forpatient care and are an integral part of the learningexperience in a teaching hospital.

What kinds of disclosure are inappropriate?

Inappropriate disclosure of information can occur in clinical settings. When pressed for time, thetemptation to discuss a case in the elevator may be great, butin that setting it is very difficult to keep others from hearingthe information exchanges. Similarly, extra copies ofhandouts from teaching conferences that contain identifiablepatients should be removed at the conclusion of the session.

When can confidentiality be breached ?

Confidentiality is not an absolute obligation. Situations arise where the harm in maintainingconfidentiality is greater than the harm brought aboutby disclosing confidential information. ? Legalregulations exist that both protect and limit yourpatient's right to privacy, noting specific exceptionsto that right. These exceptions follow.

Exception 1:Concern for the safety of other specific personsClinicians have a duty to protect identifiableindividuals from any serious threat of harm if theyhave information that could prevent the harm. Asmentioned above, the determining factor in justifyingbreaking confidentiality is whether there is goodreason to believe specific individuals (or groups) are placed in serious danger depending on the medicalinformation at hand.

Exception 2:Concern for public welfare

To report certain communicable/infectious diseases to the public health authorities. In these cases, theduty to protect public health outweighs the duty to maintain a patient's confidence.

What if a family member asks how the patient is doing?While there may be cases where the physician feelscompelled to share information regarding the patient's health and prognosis with, for instance, thepatient's inquiring spouse, without explicit permission from the patient it is generally unjustifiable to do so. Except in cases where the spouse is at specific risk of harm directly related tothe diagnosis, it remains the patient's, rather than thephysician's, obligation to inform the spouse.

THEORIES IN ETHICS

Theories in EthicsDEONTOLOGYACT UTILITARIASM

DEONTOLOGYDeontology is an ethical theory whose name is derived from he Greek word deon, meaning duty or obligationA very simple example of someone taking a deontological perspective on an issue is a person who thinks that you should always keep your promises, however inconvenient it might be to do soOnly an action undertaken in accordance with my duties and obligations is ethically correct

Deontology and ConsistencyOne very important quality of deontology is its consistencyA deontologist will tend to act in predictable and reliable wayA deontologist can be relied upon to take his or her promises seriously

Deontology and Special ObligationsAnother strength of deontology is that it can take account of what is often felt to be an extremely important kind of obligation-a special obligationExamples of special obligations:The obligations parents have to their childrenThe obligations nurses have to their patients

Deontology and SupererogationThe final strength of deontology that we will explore is that it has room for supererogationSupererogation actually means acting above and beyond the call of duty, or exceeding ones obligationsSuppose a hand-grenade is tossed into the middle of a crowded room. If someone does fling himself firmly upon the grenade, his action would count as a clear case of supererogation

Deontology and Rational JustificationOne of deontologys weakness is that there is nothing strikingly rational about it

Deontology and Conflicting Duties and ObligationsA second problem for deontology can be stated more quicklyBecause deontological ethics is concerned with sets of duties and obligations, usually of a fairly rigid kind, and because the real world tends to produce some rather complicated situations, it often turns out that in those situations a persons duties and obligations will come into conflict with each other

Deontology and Conflicting Duties and ObligationsA patients tells you in your consulting room that he intends to poison the citys water supply. Your obligations have come into conflict with each other

Deontology and Indifference to ConsequencesA final major problem for deontologyIf I have promised you $100, and later learn that you mean to spend it on a gun with which to shoot your parents, it would be unethical of me to break my promise to you, to go back on my obligation, whatever the consequences might be

ACT UTILITARIANISMThe opposite of deontology in this respect is the ethical theory known as act utilitarianism, which takes account of nothing except the consequences of actionsFor this reason, act utilitarianism is sometimes called a consequentialist theory of ethicsThe slogan: Act for the greatest good of the greatest number

ACT UTILITARIANISMFor the act utilitarian, the good is measured in terms of happiness or of satisfaction; the bad is measured in terms of suffering or of dissatisfactionThe act utilitarian seeks in every action to maximize the overall amount of happiness in the world and to minimize the overall amount of suffering

ACT UTILITARIANISMThe act utilitarian is concerned only with the results or consequences of actions; so that only an action which has good consequences, or which has the least bad consequences, will qualify as an ethically good action

ACT UTILITARIANISMHow does the act utilitarian decide which is the best action to perform in any given situation? There are three stagesFirst stage is to survey all of the possible courses of actionThe second stage is to predict what consequences, in terms of happiness and suffering, each of those courses of action will haveThe third stage is to calculate which course of actions consequences represent the best balance of good results over bad results

ACT UTILITARIANISM -An Example-Suppose that an expedition of ten botanists, led by an act utilitarian, is captured by bandits in a place far from help. Suppose that the bandit-chief tells the expedition that they will all be shot unless the leader of the expedition agrees personally to shoot four of the botanists, then the surviving six members of the expedition will be allowed to go free.

ACT UTILITARIANISM -An Example-Suppose in addition that the bandit-chief clearly means exactly what he says; suppose that there is no hope of escape; and suppose that there is no hope of rescue. What does the act utilitarian expedition leader do?

ACT UTILITARIANISMEssentially the theory has three main strength:It is well-meaningIt is rationalIt is situational

Act Utilitarianism and BenevolenceAct utilitarianism is well-meaning or benevolent.The central idea behind act utilitarianism is to maximize happiness, to act in every case so as to bring about the greatest amount of happiness at the expense of the smallest amount of suffering.The act utilitarian deplores nothing more than human misery and tries whatever possible to alleviate it

Act Utilitarianism and RationalityThe second advantage of act utilitarianism is that it is rationalWhich action to perform on the basis of a calculationAct for the greatest good of the greatest number

Act Utilitarianism and Situational Decision-MakingThe final strength of act utilitarianism is situational

Act Utilitarianism and SupererogationSupererogation-acting above and beyond the call of duty-also has no place in the act utilitarian scheme of thingsThere is nothing above and beyond themThere is nothing better than the bestFrom the act utilitarian perspective, supererogation is completely meaningless

Act Utilitarianism and InconsistencyThe act utilitarian is quite differentWill an act utilitarian keep a promise?Well, it dependsIf keeping the promise will bring about the most happiness, then yes. But, if not, then noIn other words, an act utilitarian will sometimes keep a promise, sometimes not, depending on what consequences keeping or not keeping a promise seem likely to have

CONFIDENTIALITY IN MEDICINEA DECREPIT CONCEPTMark SieglerMedical confidentiality, as it has traditionally been understood by patients and doctors, no longer exits. This ancient medical principle, which has been included in every physicians oath and code of ethics since Hippocratic times, has become old, worn-out, and useless; it is a decrepit concept. Efforts to preserve it appear doomed to failure and often give rise to more problems than solutions.

Two Aspects of Medical ConfidentialityConfidentiality and Third-Party InterestsTo reveal such confidences to third parties, such as families, employers, public-health authorities, or police authorities.Confidentiality and the Patients InterestFurther challenges to confidentiality arise because the patients personal interest in maintaining confidentiality comes into conflict with his personal interest in receiving the best possible health care.

Two Aspects of Medical ConfidentialityModern high-technology health care is available principally in hospitals (often, teaching hospitals), requires many trained and specialized workers (a healthcare team), and is very costly. The existence of such teams means that information that previously had been held in confidence by an individual physician will now necessarily be disseminated to many members of the teams.

The Role of Confidentiality in MedicineConfidentiality serves a dual purpose in medicineIn the first place, it acknowledges respect for the patients sense of individuality and privacySecondly, confidentiality is important in improving the patients health care-a basic goal of medicine. The promise of confidentiality permits people to trust (i.e., have confidence) that information revealed to a physician in the course of a medical encounter will not be disseminated further

Possible Solutions to The Confidentiality ProblemIn all non bureaucratic, non institutional medical encounters, meticulous care should be taken to guarantee that patients medical and personal information will be kept confidentialIn such settings as hospital or large-scale group practices, where many persons have opportunities to examine the medical record, we should aim to provide access only to those who have a need to know. Dividing the entire record into several sections-for example, a medical and financial section

Possible Solutions to The Confidentiality ProblemKeeping a psychiatric record separate from the general medical record. When separate records are kept, this information may not be available.Patients should be informed about what is meant by medical confidentiality. We should establish the distinction between information about the patient that generally will be kept confidential regardless of the interest of third parties and information that will be exchanged among members of the health-care team in order to provide care for the patient

Possible Solutions to The Confidentiality ProblemAt some point most patients should have an opportunity to review their medical record and to make informed choices about whether their entire record is to be available to everyone or whether certain portions of the record are privileged and should be accessible only to their principal physician or to others designed explicitly by the patients.

Afterthought: Confidentiality and IndiscretionThere is one additional aspect of confidentiality that is rarely included in discussions of the subject.I am referring here to the wanton, often inadvertent, but avoidable exchanges of confidential information that occur frequently in hospital rooms, elevators, cafeterias, doctors offices, and at cocktail parties.

ConclusionThe principle of medical confidentiality described in medical codes of ethics and still believed in by patients no longer exists. In this respect, it is a decrepit conceptRather than perpetuate the myth of confidentiality and invest energy vainly to preserve it, the public and the profession would be better served if they devoted their attention to determining which aspects of the original principle of confidentiality are worth retaining. Efforts could them be directed to salvaging

BIOETIKA(BEAUCHAMP AND CHILDRESS)Pada tahun 1960 masalah Etika Medik mulai mencuat ke permukaan. Secara umum dapat dikatakan terdapat tiga penyebabnya:Peledakan kemajuan dari teknologi di bidang medikBerubahnya hubungan antara dokter-pasien. Dulu dokter bersifat paternalistik dan the doctor always knows best. Kini dokter harus berhadapan dengan hak otonomi pasien yang bisa menentukan sendiri apa yang hendak dilakakukan terhadap dirinya.Faktor finansial

Principlism dari Beauchamp dan ChildressSejak tahun 1960 Etika Medik didominasi oleh apa yang dinamakan principlismPrinciples of Biomedical Ethics ditulis oleh Tom Beauchamp dan James Childress4 prinsip dasar:Prinsip menghormati otonomi (respect for autonomy)Prinsip tidak merugikan (non-maleficence)Prinsip harus berbuat baik (beneficence)Prinsip keadilan (justice)

Principlism dari Beauchamp dan ChildressPada intinya principlism adalah suatu alam pemikiran bahwa justifikasi bidang etika terletak pada norma moral yang lebih tinggi, yang oleh Beauchamp dan Childress ditekankan pada prinsip otonomi yang terutama harus dihormatiDi dalam prakteknya prinsip itu bisa saling bertentangan.Di negara Asia masih ada faktor dan nilai-nilai sosial-budaya yang masih harus diperhitungkan, seperti kebersamaan (community) dan demi kebaikan bersama (common good).Maka timbullah pertanyaan : apakah bioetika ala Amerika harus menjadi universal?

Prinsip Menghormati Otonomi (Respect for Autonomy)Bahwa seseorang berhak untuk melakukan atau memutuskan apa yang dikehendaki terhadap dirinya sendiriAutonomy berasal dari istilah bahasa Yunani: auto = sendiri dan nomos = memerintah

Prinsip Tidak Merugikan(Non-maleficence)Non-maleficence = do not harmPrinsip ini tampaknya sama dengan salah satu prinsip dari Hipocrates, yaitu Primum non nocere yang berarti bahwa yang terpenting adalah jangan sampai merugikan

Prinsip Harus Berbuat Baik(Beneficence)Prinsip berbuat baik merupakan segi positifnya dari prinsip tidak merugikan, bahkan memberi manfaat

Prinsip Keadilan(Justice)Prinsip keadilan bermaksud untuk menjelaskan bahwa dalam alokasi sumber daya sedapat mungkin harus diusahakan agar sampai merata pembagiannya.Keadilan di dalam pemberian pelayanan kesehatan adalah suatu bentuk keadilan, seperti pernah dikatakan oleh Aristoteles: berikan kepada setiap orang apa yang menjadi haknya (giving to each that which is his due)

Mempertimbangkan Prinsip Etika yang BertentanganPrinsip-prinsip yang sama pentingnya bisa saling bertentanganBeauchamp dan Childress telah mengembangkan teori dan metode mereka terhadap principlism tersebutPrinsip-prinsip tersebut tidak dianggap lagi sebagai sesuatu yang mutlak, tetapi harus dipertimbangkan lagi dan salah satu harus mengalah jika berhadapan dengan prinsip yang dianggap lebih pentingContoh : seorang pasien HIV tidak mau diberitahukan apabila tes yang dilakukan ternyata bersifat positif

Reproductive Rights and Abortion

IntroductionFew things affect us more intimately than reproduction.We are all a product of it, and many, if not most of us, have either already had children or are likely in due course to do so. The family, often thought to be the basic unit of human social life, depends upon reproduction.

Introduction.The future, which is the focus of all our hopes and aspirations and ambitions, will be peopled with our children, so some of our most fundamental drives are directed toward the propagation and the nurturing of generations yet to come.Given the centrality of reproduction to human life, then, it is not surprising that reproductive issues should also be of deep ethical concern to us.

Reproductive RightsOnce one understands the ethical principle of respect for autonomy, for example, and grasps its importance, one will be in no doubt that it is wrong to force someone into a reproductive partnership against his or her will.Now it has become technologically possible to alter the mechanics of reproduction almost beyond recognition.

Reproductive RightsJust as artificial insemination, in vitro fertilization, and surrogate motherhood have contributed to an opening up of our reproductive options, so have they complicated those options, and raised challenging, and sometimes unexpected, ethical questions

Reproductive Rights - NaturalnessThe natural way of reproducing is for a male and a female to have sexual intercourse, and for pregnancy and ultimately birth to ensue. Advances in our knowledge and skills, however, have made it possible to diverge from this pattern in some surprising ways.

Reproductive Rights NaturalnessIn artificial insemination (AI), a womans egg is fertilized by a mans sperm, within her body, but not by means of sexual intercourse.In in vitro fertilization (IVF), the fertilization of the egg takes place outside the womans body, with the resultant embryo or embryos then being transferred into her uterus (this is the process that results in so-called test-tube babies).

Reproductive Rights NaturalnessIn surrogate motherhood, where one woman bears a child for another, (the latter often known as the social mother), either AI or IVF may be used.If AI is used, the surrogate mothers own egg is fertilized by the sperm of the social mothers partner.If IVF is used, the egg of the social mother is fertilized by the sperm of her partner, and the resultant embryo or embryos are transferred to the uterus of the surrogate mother.

Reproductive Rights NaturalnessSurrogacy by AI is sometimes called full surrogacy; surrogacy by IVF, partial surrogacy.The phrase playing GOD often crops up in such contexts - the idea being that we humans are somehow getting above ourselves and are tinkering around with matters better left to a higher authority.

Reproductive Rights - Significant RelationshipsWhen a surrogate mother and a would-be social mother both lay claim to a child, who is more appropriately to be seen as the childs real mother?

Reproductive Rights - Significant RelationshipsWhat is it to stand in the ethically significant relation of motherhood to someone?There seem to be at least two possible answers to this questions.The first is that motherhood is a genetic matter: The (female) genetic progenitor of a child is its mother. The second is that motherhood is a behavioral matter: Whoever has behaved toward the child in the ways appropriate to motherhood is its mother.

Reproductive Rights - Significant RelationshipsIn cases where a surrogate mothers pregnancy has been induced by AI, it seems that the surrogate mother has a better claim to be regarded as the childs real mother on both counts: She is both its (female) genetic progenitor and also the one who has behaved toward the child, by bearing it and birthing it, in the obvious motherly ways.

Reproductive Rights - Significant RelationshipsWhere the pregnancy is by IVF, on the other hand, and the fertilized egg is that of the would-be social mother, it appears that both women might have a claim to be regarded as the childs real mother: the would-be social mother is the childs (female) genetic progenitor, while the surrogate mother has borne the child and seen it to term.Which of these claims, then, is the stronger ?

Abortion The Sanctity of LifeThe sanctity of life (or right to life) is one of the many phrases that tend, in the context of the abortion debate, to shed more darkness than light.Sanctity is the quality of being sacred or inviolable; so when one speaks of the sanctity of life, one is claiming that life itself is sacred, under no circumstances to be violated.On the face of it, this sounds reasonable enough, and people often seem to assume that once the sanctity of life is mentioned the abortion debate is as good as over.

Abortion The Sanctity of LifeIf a fetus is alive, they say, and life is sacred, then one ought not kill fetuses.If taken literally, the phrase the sanctity of life might just as well be used to show that eating things whether animals or vegetables is morally wrong.Proponents of the sanctity of life argument will of course claim that I have misrepresented their view. They dont just mean life in general. They mean human life, or potentially conscious life.

Abortion The Sanctity of LifeKilling is justifiable when the person to be killed has forfeited his or her right to remain alive. Lets call this the forfeiture position on killing. But two things need to be noted about this way of answering the question.First, all reference to the sanctity of life has become superfluous. On the forfeiture account, if it is wrong to kill someone then that is not because life is sacred, it is because the person has not forfeited his or her right to remain alive.

Abortion The Sanctity of LifeSecond, it provides a much better argument against abortion than the sanctity of life argument does. On the forfeiture account, after all, a human life may just justifiably be taken only if the human being in question has somehow forfeited his or her right to remain alive.

Abortion The Sanctity of LifeA strength of the forfeiture argument is that it captures something of what is meant when people say that abortion is wrong because it involves the taking of innocent life. Fetuses are innocent on this account because, being incapable of doing anything at all, they are certainly incapable of doing whatever it is that guilty people are held to have done when they forfeit their right to remain alive.

Abortion The Status of the FetusThe first question to clear up is whether fetuses are to be regarded as alive or not.Obviously they are alive.Inasmuch, then, as a fetus that is capable in principle of being brought to term and born plainly isnt dead, it is alive.

Abortion The Status of the FetusFetuses are alive, and abortions kill them. But merely saying this settles nothing.The fact that fetuses are alive doesnt show anything about the morality of killing them. Bacteria are alive, after all, and we kill them all the time with our soaps and bleaches and scourers. Vegetables are alive too, and they make good salads. So we need to ask whether individual fetuses have lives that are valuable in a way that individual bacterial and vegetable lives are not. Do fetuses, in other words, have lives that are deserving of ethical concern?

Abortion The Status of the FetusThe opponent of abortion would answer that they do have such lives, since the lives they have are human lives, and surely if any lives are worthy of ethical concern then human lives are. A defender of abortion might respond as follows: Lets admit that the fetus is alive; lets admit that the life it has is in some sense human. But exactly the same could be said of my appendix. Thats alive isnt it? After all, its not dead.

Abortion The Status of the FetusAnd given its role as a part of my body, the life it has is surely in some sense human (it doesnt have a vegetable life, or a fox life, does it?). Yet my appendix is not deserving of any particular ethical concern: indeed it may perfectly justifiably be removed from my body whenever I choose.Thus, if appendectomies justifiably cause the death of appendixes, why can we not say on the same grounds that abortions justifiably cause the death of fetuses?

Abortion The Status of the FetusThe defender of abortion claims, plausibly, that fetuses have a live which is no more than genetically human and that this puts them in the same boats as, for instance, appendixes.

Abortion - PersonhoodThe position taken by the defender of abortion while fetuses are genetically human, they are not human in the same (ethically significant) sense that you and I are human is certainly quite persuasive.

Abortion - Potential PersonhoodPersons are ethically valuable (lets agree, in other words, that properties like autonomy and higher mental functioning are ethically essential).Potentially a person also has ethical value.If this second claim is accepted, then the abortion becomes morally wrong because fetuses, even if they are not persons now, surely will become persons if they are not aborted.

Abortion - Potential PersonhoodTheir potential personhood, in other words, puts them on a par ethically with actual persons.This idea is meant to be that if fetuses are potential persons, and if persons must not be killed, then fetuses must not be killed either. But the conclusion does not follow.

Some highlights of fetal developmentAt 20 weeks the baby is viableAt 6 weeks we can measure brain wavesAt 6 weeks he begins to move his arms and legsAt 3 weeks his heart begins to beatScientifically, biologically, and medically, life begins at conception

STANDART KOMPETENSI DOKTERSTANDAR KOMPETENSI DOKTERBy. : Prof. Budhianto Suhadi Sp.PK

Area KompetensiKomunikasi efektifKetrampilan klinisLandasan ilmiah Ilmu KedokteranPengelolaan masalah kesehatanPengelolaan informasiMawas diri dan pengembangan diriEtika, moral, medikolegal dan profesionalisme serta keselamatan pasien

Perbedaan etik dengan hukum adalah :Etik berlaku untuk lingkungan profesi, hukum berlaku untuk umum.Etik disusun berdasarkan kesepakatan anggota profesi. Hukum dibuat oleh suatu kekuasaan atau adat.Etik tidak seluruhnya tertulis. Hukum tercantum secara terinci dalam kitab undang-undang/lembaran negara.Sanksi terhadap pelanggaran etik umumnya berupa tuntunan. Sanksi terhadap pelanggaran hukum berupa tuntutan.Pelanggaran etik diselesaikan oleh Majelis Kehormatan Etik Kedokteran (MKEK) yang dibentuk oleh Ikatan Dokter Indonesia (IDI) dan Panitia Pertimbangan dan Pembinaan Etika Kedokteran (P3EK).Penyelesaian pelanggaran etik tidak selalu disertai bukti fisik. Penyelesaian pelanggaran hukum memerlukan bukti fisik.

Yang termasuk pelanggaran etik murni antara lain :Menarik imbalan jasa yang tidak wajar dari klien/pasien atau menarik imbalan jasa dari sejawat dokter dan dokter gigi beserta keluarga kandungnya.Mengambil alih pasien tanpa persetujuan sejawatnya.Memuji diri sendiri di depan pasien, keluarga atau masyarakat.Pelayanan kedokteran yang diskriminatif.Kolusi dengan perusahaan farmasi atau apotik.Tidak pernah mengikuti pendidikan kedokteran berkesinambungan.Dokter mengabaikan kesehatannya sendiri.