THE BASIC CONSEPT of BIOEHTICS

in Health Education, Services, and Research

Soenarto Sastrowijoto
Center for Bioethics, School of Medicine,
Gadjah Mada University, 2008
E-mail : Bioetika_2007@yahoo .com
Phone : +62 274 547489

I. Introduction

The International Standards in Medical

Education (WFME, 2003) for Basic, Postgrad, and

CPD1
Promotes:
1. The highest scientific and ethical standards
2. New instructional tools and new learning methods
3. Innovative management

Competence Based Curriculum (CBC)

1.
2.
3.

1,2

Knowledge (cognitive) comp - writing Scientific

manuscripts
Skills (psychomotor) comp.
Behavior and Ethical comp.

Nuremberg Code (1947) 3

WMA, Medical Practice Code. (1948, 1968) 3

1. Declaration of Geneva (1948), Sydney (1968)

2. International Code of Medical ethics (1949)
3. Kode Etik Kedokteran; Lafal Sumpah Dokter
2

 ETHICS : can be described as a subbranch of applied

philosophy that
seek what are the right and
the
wrong, the good and the bad set of
behaviors in a given circumstance
BIOETHICS : on the other hand, is a quasi
social science that offers solutions to
the moral conflicts that arise in medical
and biological
science practice
(Sohin Aksoy, 2002) 4
3

The basic moral/ethical principles5

1. Respect for persons (others)
autonomy, self determination/ choice,
privacy, dignity, confidentiality, etc
2. Beneficence and Non-maleficence
maximized benefits, minimized risk
do no harm (non-maleficence)

3. Justice
Treat morally right and proper
Equitable distribution

1. The Ethics of Health

Research3,6
1) The quality and ethical standards of
health research
2) Ethical and Regulatory aspect of
health research e.g. informed
consent.
3) The ethics of scientific manuscript
writing
4) Ethics in health service (treatment)
and research patients or research
participants.
5

2.

The Ethics of Health Services7,8

(Clinical Ethics)
1) The fundamental principle
A clinical intervention is justified if and
only if the expected benefits out weigh
the expected burdens from the
perspective of the patients

2) Shared Decision Making

Paternalism
Complete patients autonomy
Shared decision making
6

3) Two rules
A competent patient
An incompetent patient

Medico legal perspective

Competent /incompetent adults

Surrogate decision maker
Informed consent

4) Clinical decision making Should be

based on :

a) Scientific basis EBM

b) Ethical basis the basic moral /ethical
principles
c) Legal basis Act /law and regulations
d) Humane basis patients expectation.
7

3. Ethics in Medical / Health Education 8

Implementation Basic moral/ethics Principles.
The professionalism as a medical teacher /
student
The minimal standards of teaching and
learning process qualified process to
produce qualified outcome (standards)
Case-studies / discussions
in teaching learning bioethics for medical
students (undergrad, post grad, CPD)

The Ethical Principles of

Teaching
1.
2.
3.
4.
5.
6.
7.
8.
9.

Content competence
Pedagogical competent
Dealing with sensitive topic
Student development
Dual relationship with students
Confidentiality
Respect for colleagues
Valid assessment of student
Respect for institution
9

III.

9,10
To Be A Professional 9,10

Lecturer/teacher, researcher, and practitioner; manager

students, etc (to be trained in professionalism)

A. THE COMPONENTS OF PROFESSIONALISM

1. Altruism - the essence of professionalism
- the best interest of others
(students/client/patient/research participant,
colleagues, non acad. Staff), rather than self interest is
the RULE
2. Accountability
- professionals (medical, lecturer, etc)
accountable to others and Community / public
- advancement of science
- honored ethical principles
3. Excellence
- Commitment to life-long learning and goals
the professionals to community
- should begin on the first day of higher
Education
(Med. School) as a student.
10

4. Duty
- Commitment to service, teaching, and
research for the welfare of the community
- regardless of ability to pay.
5. Honor and Integrity:- highest standards of behavior
- No violate personal & professional code
- trustful, commitments
- no self interest
6. Respect for Others: the essence of humanities
- to patient /student/ research participant/
colleagues, and community
7. PERSONAL Commitment
- life long learning
- highest quality of services, rapid progress
of science
& technology and tools.
- accepted from the beginning must be
honored
throughout ones life as an experts / scientist /
professional.

11

B. Challenge :
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)

Abuse of power
Discrimination
Breach of confidentiality
Arrogancy
Greedy
Misrepresentation
Impairment
Reluctance
Lack of conscientiousness
Conflict of interest
12

Teaching Ethics & Attitude for Medical

11
Students11
A good doctor and ethical practitioner
How ethics can be taught in a way this is enjoyable
and effective for life-long leaner in medicine.
At the very least, they are keen to avoid
complaints by their patients and colleagues, or
being sued for malpractice.
In the decade, medical ethics has taken its rightful
place at the centre of the curriculum. (Basic, post grad,
CPD)
Ethics : as moral principle or codes
Ethical : as conforming to a recognized standard
13

 Teaching ethics and law

Small
group

1. Use cases and vignettes

2. Create a safe
environment
3. Use students name
4. Set out ground rules
5. Encourage discussion
6. Allow experiences to be
shared
7. Aim to develop :
to lerance
the ability to cope
with ambiguity
the ability to
appreciate different
view

Large
group

1. Keep the session

interactive
2. Use video clips and
other media
3. Set up an ethics
debate
4. Divide the students
into buzz groups
5. Team teach with
other
6. Vary the style and
pace
14

Topic covered (Undergrad)

1. The patients value
2. The patients
narrative
3. Going into hospital
4. Professional
obligation
5. The individual and
society
6. Justice and
healthcare

Year -1 Afternoon Sessions

- plenary presentation
small group tutorial.
Year -3 - ethics s symposium
- ethical dilemmas
- clinical attachment,
obyn
Year -5 further ethics teaching

pre registration
15

 Professionalism and Personal

development (Post grad)
Communication skills
Professional duties and responsibilities
Avoidance of plagiarism & cheating
Personal presentation
Punctuality and good time keeping
Reflective practice
Team work & leadership
Postgraduate deanery !
- Core and ethics modules.
Opportunity for clinicians to discuss ethical,
legal,
and professional issues;
uncertainly and dilemmas.

- Post graduate workshop

16

 GMC Duties doctors

1. Make the care of patient their first
concern
2. Treat every patient politely and
considerately
3. Respect patients dignity and
privacy
4. Listen to patient and respect their
views
17