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Autonomy & Individual Responsibility

dr. Amalia Muhaimin, M.Sc.Department of Bioethics, Faculty of Medicine

Universitas Jenderal Soedirman

Learning Objectives Mampu menjelaskan konsep-konsep otonomi (autonomy) dan tanggungjawabindividu (individual responsibility)

Mampu menentukan kemampuan atau kapasitas (competency or capacity)seseorang/individu dalam membuat keputusan pribadi dengan penuhtanggungjawab (autonomous and responsible decision)

Mampu menjelaskan konsep consent, informed consent, dan kaitannya denganprinsip autonomy

Mampu menjelaskan konsep privacy dan confidentiality, serta kaitannya denganprinsip autonomy

Mampu menjelaskan pentingya konsep-konsep tersebut dalam kehidupan sehari-hari dan dalam pelayanan kesehatan

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AutonomyBerasal dari bahasa Yunani Autos: self Nomos: rule, governance, law Digunakan untuk self governance of independent Hellenic city states(Individual) Autonomy:

Meliputi 2 kondisi: Kebebasan/kemerdekaan Kemampuan/kapasitas

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Autonomy Kemerdekaan dari pengaruh

Bertindak dengan tujuan Dengan pemahaman Terbebas dari pengaruh

Kebebasan dari pengaruh & perintahdari pihak luar

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Kapasitas individu untuk menentukan nasib sendiri, pilihan independen,bertindak dan mengevaluasi

Kemampuan untuk menentukan aturan pribadi Kemampuan untuk mengikuti pilihan Kemampuan untuk merefleksikan prinsip-prinsip dan aturan dalam membentukpribadi diri

Kemampuan untuk bertindak berdasarkan prinsip-prinsip rasional dan aturanyang dapat diterima sesuai dengan pemahaman mengenai nilai baik, kehormatandan kebahagiaan

Autonomy merupakan hasil pemikiran dan pertimbangan berdasarkanpengetahuan, wawasan dan pengalaman

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Are you an autonomousperson?

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Responsibility Adalah pemahaman terhadap kewajiban untuk membuat keputusandan bertindak sesuai komitmen tertentu

Status Perjanjian Penghormatan kepada orang lain Prinsip dan aturan yang diterima dll

Aspek responsibility Komitmen yang diperoleh secara spontan Komitmen yang diperoleh secara sadar Tanggung jawab legal

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Autonomy and Responsibility

Tidak ada autonomy tanpa responsibility

Setiap orang mempunyai hak yang sama,yang harus dihormati dan dilindungi!

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Contoh aplikasi : Tell the truth Menghargai privasi Menjaga kerahasiaan Persetujuan untuk setiap tindakan Membantu dalam melakukan pilihan yang penting dan sulit

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Consent and Informed Consent What is consent?

What is informed consent?

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Medical Concept of Decision Making Capacity All adult patients unless there is evidence obtained by history, behavior, or physicalexaminationThe determination of decision making capacity requires that:1. The patient appreciates he/she has the power to make decisions on his/her behalf2. The patient understands- the medical situation & prognosis,- the nature of the recommended evaluation or care,- the alternatives,- the risks & benefits of each, and- the likely consequences

3. The patient's decision is stable over time, and is consistent with his or her life values orgoals.

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The degree/level of decision-making capacity varies with the degree & probabilityof risk, benefit, & patient's decision to consent/refuse

The greater the risk the more exacting the standard of capacity A patient might need a low level of capacity to consent to a procedure withsubstantial benefits and minimal risks, but a high level of capacity to refuse thesame treatment.

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The Concept of Legal Competence? Each state may have slightly different criteria for the determinationof competence

How about Indonesia??

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Privacy and Confidentiality

Can you give any example related toprivacy in everyday life?

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PRIVACY:The right to be left aloneThe right of an individual or a group to be free from intrusion from othersThe right to determine which information about them should be disclosed toothersThe capacity to be physically alone (solitude), to be free from: physical interference threat or unwanted touching (assault, battery) to avoid being seen or overheard in particular contexts

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What is confidentiality?

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How is privacyrelated to confidentiality?

CONFIDENTIALITY: An attribute of personal information requiring that it not bedisclosed to others without sufficient reason

Confidentiality is closely related to privacy, but not identical.

One observes rules of confidentiality out of respect for, and toprotect and preserve, the privacy of others

It refers to the obligations of individuals and institutions to useinformation under their control appropriately once it has beendisclosed to them.

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2. Reasons for respecting privacy and confidentiality

a. Individuals own their information: it is essential to theirpersonal integrity.

b. For many people privacy is an essential aspect of theirdignity; invading their privacy is a violation of their dignity.

c. Respect for others requires protecting their privacy and theconfidentiality of information about them.

d. Doctors need patients trust!

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The new hidden cameras will allow us o see if anyone isviolating our privacy policy by reading someone elses email

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Reference Macer DRJ. 2006. A Cross Cultural Introduction to Bioethics. Eubios EthicsInstitute

Unesco. 2008. Bioethics Core Curriculum. Unesco Beauchamp TL, Childress JF. 1994. Principles of Biomedical Ethics. OxfordUniversity Press

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