We We havehave to to realizerealize that that majormajor advances advances of of science, technology and health care duringscience, technology and health care during the past 50 years have the past 50 years have ooutpaced the abilities utpaced the abilities of those in ethics of those in ethics andand law to solve problems law to solve problems created by these created by these aadvances.dvances.

We We havehave to to realizerealize that that majormajor advances advances of of science, technology and health care duringscience, technology and health care during the past 50 years have the past 50 years have ooutpaced the abilities utpaced the abilities of those in ethics of those in ethics andand law to solve problems law to solve problems created by these created by these aadvances.dvances.

BIOETHICS (1)BIOETHICS (1)

Bioethics is a composite term derived from Greek words Bioethics is a composite term derived from Greek words “bios”“bios” (life) and “ethike”(life) and “ethike” (ethics).(ethics).

O’Neill: “Bioethics is not a discipline”.O’Neill: “Bioethics is not a discipline”.

Aksoy: “Bioethics is a quasi-social science that offers Aksoy: “Bioethics is a quasi-social science that offers solutions to the moral conflicts that arise in medical and solutions to the moral conflicts that arise in medical and biological science practice”.biological science practice”.

Kugarise, Sheldon; 2000Kugarise, Sheldon; 2000::

The systematic study of the moral dimensions (including The systematic study of the moral dimensions (including moral vision, decisions, conduct and policies) of life moral vision, decisions, conduct and policies) of life sciences sciences and and health health care; care; employing employing a variety a variety of of ethical ethical methodologies in an interdisciplinary setting.methodologies in an interdisciplinary setting.

BIOETHICS (2)BIOETHICS (2)

The moral dimensions that are examined in The moral dimensions that are examined in bioethics are constantly evolving, but they tend bioethics are constantly evolving, but they tend to focus on several major questions:to focus on several major questions:

1.1. What is or what might be one’s or a society’s What is or what might be one’s or a society’s moral vision?moral vision?

2. What sort of person should one be, or what sort 2. What sort of person should one be, or what sort of society should we be?of society should we be?

3. What ought to be done in specific situations?3. What ought to be done in specific situations?

4. How are we to live harmoniously?4. How are we to live harmoniously?

BIOETHICS (3)BIOETHICS (3)

Many scholars and much of the public tend to Many scholars and much of the public tend to identifyidentify thethe scopescope ofof bioethicsbioethics inin somewhatsomewhat narrow narrow medical sense; in this approach bioethics wouldmedical sense; in this approach bioethics would bebe aa slightlyslightly expandedexpanded medicalmedical ethics,ethics, including the including the ethics of biomedical research.ethics of biomedical research.

The field of bioethics as going beyond biomedical The field of bioethics as going beyond biomedical ethics to embrace health-related and science-ethics to embrace health-related and science-related moral issues in the areas of publicrelated moral issues in the areas of public health,health, environmental health, population ethics, and environmental health, population ethics, and animal care.animal care.

SASARAN SASARAN BIO-ETHICS & BIO-LAW BIO-ETHICS & BIO-LAW

1. 1. Human:Human: a. a. Before life: Before life: - - ovum, spermatozoa, ovum, spermatozoa, and and embryo.embryo. - abortion, prenatal screening, bio-tech, ect.- abortion, prenatal screening, bio-tech, ect. b. b. During life:During life: - - the beginning and the end of life.the beginning and the end of life. - - terminal illnesses, futility, withholding treatment terminal illnesses, futility, withholding treatment andand withdrawing treatment, and euthanasia.withdrawing treatment, and euthanasia. - - infanticide, baby selling, etc. infanticide, baby selling, etc. - - prenatal screening and genetic counseling.prenatal screening and genetic counseling. - - infertility, tube baby, and surrogate mother.infertility, tube baby, and surrogate mother. - - transplantation, organ, and tissues donation.transplantation, organ, and tissues donation. - - human experimentation.human experimentation. - - biotechnology (genetic engineering, stem cells, etc).biotechnology (genetic engineering, stem cells, etc).

c. After deathc. After death::

- the sale of organs, etc.- the sale of organs, etc.

2. 2. Animal:Animal:

a. a. Using animals for experimentation.Using animals for experimentation. b. b. Using organ, tissues and cells for Using organ, tissues and cells for human human interests, ectinterests, ect..

GOALS OF BIOETHICS EDUCATION GOALS OF BIOETHICS EDUCATION

1. Develop Knowledge:1. Develop Knowledge:

DevelopingDeveloping trans-disciplinarytrans-disciplinary contentcontent knowledge. knowledge.

Understanding the advanced biological concepts.Understanding the advanced biological concepts.

Being to integrate the use of scientific knowledge,Being to integrate the use of scientific knowledge,

facts and ethical principles and argumentation in facts and ethical principles and argumentation in

discussing cases involving moral dilemmas. discussing cases involving moral dilemmas.

Understand the breadth of questionsUnderstand the breadth of questions that are pos-that are pos-

ed by advanced science and technology.ed by advanced science and technology.

(Darryl Macer, 2007)(Darryl Macer, 2007)

2. Develop Skills: 2. Develop Skills: Balancing benefits and risks of Science and Balancing benefits and risks of Science and Technology.Technology. BeingBeing ableable toto undertakeundertake aa riskrisk // benefitbenefit analysis. analysis. Developing critical thinking and decision ma- Developing critical thinking and decision ma- king skills and reflective processes.king skills and reflective processes. Developing creative thinking skills.Developing creative thinking skills. Developing foresight ability to evade possible Developing foresight ability to evade possible risks of science and technology.risks of science and technology. Developing skill for “informed choice”.Developing skill for “informed choice”. Developing required skills to detect bias in Developing required skills to detect bias in scientific method, interpretation and presentati-scientific method, interpretation and presentati- on of research result.on of research result. (Darryl Macer, 2007)(Darryl Macer, 2007)

3. Personal Moral Development:3. Personal Moral Development: Increasing respect for different people and Increasing respect for different people and culture, and their values. culture, and their values. Developing scientific attitudes, reflective pro-Developing scientific attitudes, reflective pro- cesses, and an ability for holistic appraisal, cesses, and an ability for holistic appraisal, while not ignoring the values for reductionist while not ignoring the values for reductionist analysis.analysis. Gaining knowledge about bias in the inter-Gaining knowledge about bias in the inter- pretation and presentation of research results, pretation and presentation of research results, benefits and risks of technology and bioethical benefits and risks of technology and bioethical issues, and how to detect bias. issues, and how to detect bias. Exploring moralsExploring morals // values (values clarification). values (values clarification). Promoting values analysis and value based Promoting values analysis and value based utilization our scarce natural resouces.utilization our scarce natural resouces. (Darryl Macer, 2007)(Darryl Macer, 2007)

TUJUAN

MEMPELAJARI BIO-LAW:

1.Develop knowledge

2.Develop skill

3.Develop attitude

TUJUAN

MEMPELAJARI BIO-LAW:

1.Develop knowledge

2.Develop skill

3.Develop attitude

tujuanmempelajari

bio-law???

tujuanmempelajari

bio-law???

PROGRESS INPROGRESS IN MEDICAL TECHNOLOGYMEDICAL TECHNOLOGY

It was triggered by the ability of understanding It was triggered by the ability of understanding genetics.genetics.

It uses a lot of advanced in imaging, computing and It uses a lot of advanced in imaging, computing and telecommunication.telecommunication.

Modern technology Modern technology ((machines, methods, and drugsmachines, methods, and drugs)) was founded for therapeutic and diagnostic needs. was founded for therapeutic and diagnostic needs.

But, some medical paradoxes then appears.But, some medical paradoxes then appears.

One of these is getting harder to differ between normal One of these is getting harder to differ between normal and abnormal or illnesses and non-illnessesand abnormal or illnesses and non-illnesses..

PARADOX OF MODERN MEDICINE PARADOX OF MODERN MEDICINE

PARADOX 1:PARADOX 1:

Modern medicine makes it possible !!! Modern medicine makes it possible !!! SometimesSometimes eveneven necessary,necessary, toto keepkeep deaddead peoplepeople alive.alive.

PARADOX 2:PARADOX 2:

Modern medicine tries to cure non-illnesses !!!Modern medicine tries to cure non-illnesses !!!

It It identifies identifies asymptomatic asymptomatic medical medical conditions conditions as as diseases. diseases.

Sometimes it even classifies risks as diseases.Sometimes it even classifies risks as diseases.

In In general, general, it it tends tends to to blur blur the the distinction distinction between between diseases and risks.diseases and risks.

(Prof. John Ladd)(Prof. John Ladd)

MEDICAL TECHNOLOGYMEDICAL TECHNOLOGY

Needs process that’s just understand well by Needs process that’s just understand well by the scientist.the scientist.

Public suspicious often comes about the truth of Public suspicious often comes about the truth of the information and independency of the scientist. the information and independency of the scientist.

The The suspicious suspicious appears because appears because of of the exact andthe exact and absolute answer can not been given by scientists.absolute answer can not been given by scientists.

The scientists themselves have some limitation or The scientists themselves have some limitation or even incapability to eliminate every risk element.even incapability to eliminate every risk element.

The suspicious increased because in reality, theThe suspicious increased because in reality, the technology technology is is under-controlled under-controlled by by multinational multinational company.company.

11

22

33

44

55

OTHER SIDE OFOTHER SIDE OF MEDICAL TECHNOLOGY MEDICAL TECHNOLOGY

1. 1. GiveGive chanceschances toto createcreate technologicaltechnological com- com- pulsion, that is, “if we can do it, let’s do it”.pulsion, that is, “if we can do it, let’s do it”.

2.2. Then, ethical and law problems appear.Then, ethical and law problems appear.

3. 3. “The slippery slope argument” may come to“The slippery slope argument” may come to trytry toto solvesolve ethicalethical andand lawlaw problems.problems.

4. 4. So, needed ethics and law discussion to So, needed ethics and law discussion to something something that that technically technically not not a a problem.problem.

PRENATAL SCREENIGPRENATAL SCREENIG

There is evidence from variety of studies There is evidence from variety of studies to suggest that being a carrier of a genetic to suggest that being a carrier of a genetic disease can be associated with :disease can be associated with :

Stigmatisation.Stigmatisation.

Discrimination. Discrimination.

Anxiety about future health.Anxiety about future health.

Loss of self esteem.Loss of self esteem.

A CASEA CASE

A pregnant woman with three children, all A pregnant woman with three children, all of them are daughters, visited an anti aborti-of them are daughters, visited an anti aborti-on clinic and said:on clinic and said:““Doctor, you have to perform abortion Doctor, you have to perform abortion unless you assure me that my baby is a unless you assure me that my baby is a malemale””..

What your opinion about this case ???What your opinion about this case ???What will you do as a doctor ???What will you do as a doctor ???Perform Perform sex screening sex screening while while hoping hoping thatthat the the result will be suitable with her will ---- or ---- result will be suitable with her will ---- or ---- do nothing ??? do nothing ???

AccordingAccording to abortion of fetus with genetic to abortion of fetus with genetic defect, a judge from Sweden, Hadding, 1982, defect, a judge from Sweden, Hadding, 1982, said:said:

““I am no friend of abortion and I am I am no friend of abortion and I am definitely no friend of infanticide, but I am definitely no friend of infanticide, but I am an enemy of senseless sufferingan enemy of senseless suffering andand II dodo react react when it is considered immoral to speak ofwhen it is considered immoral to speak ofabortionabortion asas consequentialconsequential measuremeasure toto undesir-undesir-ability of giving birth to disabled children ability of giving birth to disabled children wherewhere painpain sufferingsuffering areare prevailingprevailing condition”condition”..

APPLICATION of APPLICATION of MEDICAL TE MEDICAL TECCHNOLOGYHNOLOGY

1. Respect to life and living.1. Respect to life and living. 2. 2. Respect to human dignity and rights.Respect to human dignity and rights.

3. 3. Equality between risk and advantage.Equality between risk and advantage.

44. Awareness that ethics . Awareness that ethics and law and law were were

not as simple as the nature.not as simple as the nature.

oleh

Sofwan Dahlan

ABORSIABORSIDILIHAT DARI ASPEKDILIHAT DARI ASPEK

MEDIKAL, ETIK DAN HUKUMMEDIKAL, ETIK DAN HUKUM

ABORSIABORSIDILIHAT DARI ASPEKDILIHAT DARI ASPEK

MEDIKAL, ETIK DAN HUKUMMEDIKAL, ETIK DAN HUKUM

MOTHER THERESA:MOTHER THERESA:

““The greatest The greatest destroyer of destroyer of

peace peace is is the the

crying crying of innocent of innocent unborn babies”.unborn babies”.

Karena korban aborsi jauh lebih banyak dari korban perang dimanapun !!! Korban perang di Kamboja 1 juta orang. Korban bom atom di Jepang 175.000 orang.

Karena korban aborsi jauh lebih banyak dari korban perang dimanapun !!! Korban perang di Kamboja 1 juta orang. Korban bom atom di Jepang 175.000 orang.

Don’t make us cry, .….doctor!!!

Don’t make us cry, .….doctor!!!

JUMLAH ABORSIJUMLAH ABORSI

• 46 juta kasus aborsi 46 juta kasus aborsi di seluruh dunia per di seluruh dunia per tahun.tahun.• 26 juta diantaranya 26 juta diantaranya legal.legal.• 20 juta sisanya dila-20 juta sisanya dila- kukan secara illegal.kukan secara illegal.• Semakin liberal suatu negara, semakin Semakin liberal suatu negara, semakin

rendah tingkatrendah tingkat aborsi. aborsi. (Durwald, 1971)(Durwald, 1971)

ALASAN ABORSI Penelitian di 27 negara th 1998,

menunjukkan bahwa alasan aborsi adalah: 1. Keinginan untuk menunda memiliki

anak. 2. Masalah pekerjaan / pendidikan. 3. Masalah keuangan. 4. Perceraian. 5. Kelainan kongenital pada janin.

DEFINISI Ada banyak kebingungan menyangkut definisi aborsi.

Aborsi spontan (miscarriage) didefinisikan sebagai hilangnya kehamilan sebelum janin viabel (25 - 26 mgg kehamilan).

Hilangnya kehamilan sesudah itu disebut “preterm delivery”, atau dalam hal janin su-dah benar-benar mati disebut “stillbirths”.

Dalam hubungannya dengan terminologi “induced abortion”, umur (fase) kehamilan tidak dipersoalkan samasekali !!!

PERSPEKTIF ABORSI

Induced abortion dapat dilihat dari berbagai perspektif, antara lain:

1. Medical Perspectives.2. Ethical Perspectives.3. Legal Perspectives.4. Religious Traditions:

a. Jewish Perspectives.b. Roman Catholic Perspectives.c. Protestant Perspectives.d. Islamic Perspectives.

MEDICAL PERSPEKTIF

Perspektif medis dari aborsi tidak dapat dipisah- kan samasekali dari nilai moralitas.Oleh sebab itu bagi masyarakat yang peduli terha-dap etika akan mempertanyakan:

1. Apakah medical knowledge memperjelas status moral fetus sebagai human being?2. Apakah medical information memperkuat penda- pat bahwa aborsi merupakan tindakan yang aman bagi wanita?3. Apa kaitan antara early dan late abortion?4. Apa kaitan antara aborsi dengan public health ser- ta international perspectives?

MEDICAL KNOWLEDGE

Meski medical knowledge sudah mampu menjelas-kan tentang kehamilan, fetus dan perkembangannya, namun ia belum mampu menjelaskan kapan dimulai kehidupan, meliputi kapan roh manusia ditiupkan.

Akibatnya hingga kini para dokter masih berbeda pendapat tentang status moral dari fetus, antara lain tentang: 1. Apakah fetus merupakan human being? 2. Apakah fetus sudah mempunyai hak-hak tertentu yang harus dilindungi?

SAFETY AND HARM

1. Possible physical harm:Ada kaitan erat antara keselamatan

dengan status etik dari aborsi.

2. Abortion procedures:Prosedur aborsi juga berkaitan dengan

etika dikarenakan tingkat keselamat- annya pada masing-masing prosedur.

3. Availability of abortion providers:Persoalan etik yang serius menyangkut

masalah tanggung-jawab profesi untuk menyediakan layanan aborsi yang dapat diakses semua yang memerlukan.

4. Possibly harmful effects on subsequence pregnancy:

Pertanyaan yang muncul adalah tentang kemungkinan munculnya long-term harmful effects, utamanya bagi yang telah menjalani multiple abortions.

5. Psychological effects:

Kekhawatiran timbulnya psychological consequences dari induced abortion, meski hal ini tidak dapat digeneralisasi.

CONTROVERSESEARLY & LATE ABORTION

Para dokter menghadapi kesulitan dalam membandingkan late abortion dengan early abortion disebabkan:

1. Prosedur pada late abortion lebih sulit.

2. Perkembangan fetus pada late abortion yg

semakin sempurna.

Para dokter menghadapi kesulitan dalam membandingkan late abortion dengan early abortion disebabkan:

1. Prosedur pada late abortion lebih sulit.

2. Perkembangan fetus pada late abortion yg

semakin sempurna.

PUBLIC HEALTH &

INTERNATIONAL PERSPECTIVES

1. Layanan aborsi tersedia secara luas di negara-negara maju dengan tingkatan pembatasan yang berbeda-beda.

2. Dalam tahun-tahun belakangan ada kecenderu-3. ngan liberalisasi & legalisasi aborsi.3. Aborsi illegal banyak dilakukan di negara-negara

yang melarang aborsi sehingga angka kematian ibu menjadi sangat tinggi.

4. Konsekuensinya, public health menuntut perlu-nya bioetika memberikan respon sehingga ada

persamaan hak akses bagi semua orang.

1. Layanan aborsi tersedia secara luas di negara-negara maju dengan tingkatan pembatasan yang berbeda-beda.

2. Dalam tahun-tahun belakangan ada kecenderu-3. ngan liberalisasi & legalisasi aborsi.3. Aborsi illegal banyak dilakukan di negara-negara

yang melarang aborsi sehingga angka kematian ibu menjadi sangat tinggi.

4. Konsekuensinya, public health menuntut perlu-nya bioetika memberikan respon sehingga ada

persamaan hak akses bagi semua orang.

ETHICAL PERSPECTIVES

1. Personhood & the abortion debate.

2. Right & the abortion controversy.

3. Consequentialist arguments:

a. Consequences of medical method of abortion.

b. Consequences of nonsurgical abortion methods.

4. Abortion & the issue of justice.

5. Is abortion an insoluble moral problem.

1. Personhood & the abortion debate.

2. Right & the abortion controversy.

3. Consequentialist arguments:

a. Consequences of medical method of abortion.

b. Consequences of nonsurgical abortion methods.

4. Abortion & the issue of justice.

5. Is abortion an insoluble moral problem.

ASPEK ETIKAAda dua masalah utama, yaitu:

Hak Janin v. Hak Ibu.Konsep mengenai awal kehidupan.

Pro Choice beranggapan bahwa:Wanita berhak mengatur tubuhnya, termasuk kehamilannya.Fetus dianggap belum sebagai person yang memiliki hak penuh sebagai manusia.

Pro Life beranggapan bahwa:Embrio dianggap manusia sejak awal konsepsi serta punya hak dilahirkan hidup.Aborsi dianggap pembunuhan, kecuali ada indi-kasi medis.

CIRI PERSON

1. Consciousness, and in particular the capacity to feel pain.

2. Reasoning (the developed capacity to solve new and relatively complex problems).

3. Self-motivated activity (activity that is relatively independent of either genetic or direct external control).

4. The capacity to communicate.

5. The presence of selfconcepts & selfawareness,

individual or racial or both.

(Warren, 1978)

1. Consciousness, and in particular the capacity to feel pain.

2. Reasoning (the developed capacity to solve new and relatively complex problems).

3. Self-motivated activity (activity that is relatively independent of either genetic or direct external control).

4. The capacity to communicate.

5. The presence of selfconcepts & selfawareness,

individual or racial or both.

(Warren, 1978)

LEGAL & REGULATION

1. Model of prohibition:Mis: di negara-negara Islam dan Afrika.

2. Model of permission:Dibolehkan tetapi setelah disetujui olehkomite tertentu, board atau pengadilan.

3. Model of prescription:Pemerintah mendorong aborsi yang dike-hendaki pemerintah (misalnya Cina).

4. Model of privacy:Dibolehkan semua aborsi sepanjang olehtenaga medis di sarana yang memadai.

1. Model of prohibition:Mis: di negara-negara Islam dan Afrika.

2. Model of permission:Dibolehkan tetapi setelah disetujui olehkomite tertentu, board atau pengadilan.

3. Model of prescription:Pemerintah mendorong aborsi yang dike-hendaki pemerintah (misalnya Cina).

4. Model of privacy:Dibolehkan semua aborsi sepanjang olehtenaga medis di sarana yang memadai.

UU KESEHATAN

Aborsi medicinalis dapat diakukan bila:

1. Wanita dalam bahaya maut, hamil karena perkosaan, atau janin menderita kecacatan yang akan menyulitkan kehidupannya.

2. Setelah meminta pertimbangan tim ahli medik, agama, hukum dan psikolog.

3. Ada informed consent dari wanita ybs.

4. Dilakukan oleh dokter SpOG.

5. Tempat aborsi memadai dan ditunjuk oleh pemerintah.

SANKSI PIDANA

KUHP, Psl 346: Dipidana 4 th.

KUHP Psl 347:1. Tanpa consent dipidana

12 th.2. Bila wanita meninggal

dipidana 15 th.KUHP Psl 348:

1. Dengan consent dipidana 5 th 6 bl.

2. Bila wanita meninggal dipidana 7 th.

KUHP Psl 349:

Bila dilakukan tenaga medis, hukuman ditambah sepertiganya.

KUHP Psl 299:

1. Mengobati, menganjurkan diobati untuk pengguguran kandungan dipidana 4 th atau denda ……….. rupiah.

2. Jika untuk tujuan memperoleh keuntu-ngan atau profesi medis dapat ditambah sepertiganya.

3. Bisa dicabut ijin rakteknya.

KESIMPULANKESIMPULAN

1. Masalah etika & moral atas aborsi pada dasarnya tergantung dari sisi mana kita memandangnya.

Kelompok Pro Choice membenarkan abor-si atas dasar:

a. Aborsi illegal mengancam kes. masy.

b. Social justice menuntut hak yang sama.

c. Woman’s right to control her own body.

Kelompok Pro Life tidak membenarkan aborsi atas dasar:

a. The right to be born alive.

b. The right to be born normal.

2. Profesi medis dihimbau melihat segala sesuatu berdasarkan temuan klinis yang bersifat empirik.

3. Diharapkan mereka tidak menceburkan diri kedalam polemik politik berkepanja-ngan tentang kontroversi seputar aborsi.

4. Dengan segenap kemampuan dan obyektivitasnya harus berusaha melihat aborsi dari sudut pandang indikasi yang sesuai dengan apa yang telah ditentukan oleh UU Kesehatan dan KUHP.

5. Dalam RUU Kesehatan yang sedang digo-dog di DPR, ada rencana melegalisasi aborsi berdasarkan kecacatan janin serta melegalisasi aborsi kehamilan pada kasus perkosaan.

Jika ada hak bayi untuk dilahirkan normal makamestinya ada kewajiban bagi wanita hamil untuk menjaga kesehatannya agar bayinya lahir normal.

Jika ada hak bayi untuk dilahirkan normal makamestinya ada kewajiban bagi wanita hamil untuk menjaga kesehatannya agar bayinya lahir normal.

TRANSPLANTASITRANSPLANTASI

Dalam masalah transplantasi, aspek filosofis Dalam masalah transplantasi, aspek filosofis menjadimenjadi pentingpenting gunaguna melihatmelihat kebenaran darikebenaran dari aspek yang paling dalam (hakiki).aspek yang paling dalam (hakiki). Contoh:Contoh: Jika Dr melakukan transplantasi, mengganti Jika Dr melakukan transplantasi, mengganti otak otak seorang seorang ustad ustad karena karena kanker kanker dgn dgn otak otak preman yang mati tertembak jantungnya, ma- preman yang mati tertembak jantungnya, ma- ka siapa sebenarnya yg telah diselamatkan?? ka siapa sebenarnya yg telah diselamatkan??

Sang Ustad dgn memberikan otak baru atau-Sang Ustad dgn memberikan otak baru atau- kah si preman dgn memberikan tubuh baru??kah si preman dgn memberikan tubuh baru??

ASPEK PSIKOLOGIS TRANSPLANTASIASPEK PSIKOLOGIS TRANSPLANTASI

Rochelle:Rochelle: - - 33,33 % 33,33 % pasien cangkok jpasien cangkok jantung ---- depresi nyata.antung ---- depresi nyata. - - beberapa diantaranya ---- mengalami depresi berat.beberapa diantaranya ---- mengalami depresi berat.

Penn dkk:Penn dkk: DDari 292 ari 292 pasien cangkokpasien cangkok ginjal menunjukan: ginjal menunjukan: - - semuanya ( semuanya (100 %100 %)) ----- ----- mengalami mengalami reaksi depresi.reaksi depresi. - - 52 pasien ----- 52 pasien ----- menderita menderita depresi berat.depresi berat. - - 7 pasien ----- mencoba bunuh diri7 pasien ----- mencoba bunuh diri,, dan 2 berhasil. dan 2 berhasil.

Kraft:Kraft: - - Seorang pasiennya bertanya, apakah denganSeorang pasiennya bertanya, apakah dengan mene- mene- rima jantung wanita akan merubah jati diririma jantung wanita akan merubah jati diri saya saya?? - - Seorang laki-laki yg menerima jantung peSeorang laki-laki yg menerima jantung perempuanrempuan berkata: “berkata: “nnow I am a woman”.ow I am a woman”.

THE IDEATHE IDEA:: ApaApa yangyang ditransplantasikanditransplantasikan bukanlahbukanlah organorgan jantung, jantung, si si pembawa pembawa kehidupan, kehidupan, melainkan melainkan sebuah pompa yang sangat sederhana.sebuah pompa yang sangat sederhana.

Dr Michel De Bakey:Dr Michel De Bakey: ““JantungJantung merupakanmerupakan pompapompa yangyang hebat,hebat, tetapi tetapi iantung tak lebih dari sebuah pompa belakaiantung tak lebih dari sebuah pompa belaka”.”.

Dr Denton Cooley:Dr Denton Cooley: ““JantungJantung hanyalahhanyalah sebuahsebuah pompa,pompa, yangyang harus harus harus harus diganti diganti dengan dengan model model baru baru manakalamanakala yang lama sudah terlalu tua untuk melakukanyang lama sudah terlalu tua untuk melakukan pekerjaannyapekerjaannya..

KORNEAKORNEA

MerupakanMerupakan jaringanjaringan avascularavascular yangyang mempe- mempe- roleh roleh pasokan pasokan nutrisi nutrisi secara secara langsung langsung dari dari aqueous humor.aqueous humor.

Termasuk non regenerative tissue sehingga Termasuk non regenerative tissue sehingga berdasarkanberdasarkan etikaetika && hukumhukum tidaktidak dibenarkan dibenarkan diambil dari donor hidup.diambil dari donor hidup.

Resipien perlu mendapatkan informasi yang Resipien perlu mendapatkan informasi yang jelasjelas && lengkaplengkap,, termasuktermasuk risikonya,risikonya, sebelum sebelum memberikan informed consent.memberikan informed consent.

PROBLEMPROBLEM

1. Problem utama transplantasi kornea 1. Problem utama transplantasi kornea adalah keterbatasan supply.adalah keterbatasan supply.2. Digunakannya kebijakan opting in system.2. Digunakannya kebijakan opting in system.

(Green, B; 2005)(Green, B; 2005)

CARA MEMPEROLEH KORNEACARA MEMPEROLEH KORNEA

Ada dua cara, yaitu:Ada dua cara, yaitu:a. Opting in system a. Opting in system (contracting in system);(contracting in system);b. Opting out system b. Opting out system (contracting out system).(contracting out system).

SOLUSI PROBLEMSOLUSI PROBLEM UntukUntuk meningkatkan supply,meningkatkan supply, adaada 33 metodametoda

yang dapat ditempuh, yaitu:yang dapat ditempuh, yaitu:a. allow the sale of organs; a. allow the sale of organs; b. a system of opting out; andb. a system of opting out; andc. a system of required request.c. a system of required request.

(Green, B; 2005)(Green, B; 2005)

PENJUALAN ORGANPENJUALAN ORGAN

Menyebabkan:Menyebabkan:1. Ekploitasi kemiskinan;1. Ekploitasi kemiskinan;2. Membenturkan donor hidup dengan risiko 2. Membenturkan donor hidup dengan risiko dan rasa sakit dalam operasi;dan rasa sakit dalam operasi;3. Memperlakukan tubuh sebagai komoditas;3. Memperlakukan tubuh sebagai komoditas;4. Hakekatnya, tak ada orang yg secara suka-4. Hakekatnya, tak ada orang yg secara suka- rela mau menjalani prosedur yg riskan;rela mau menjalani prosedur yg riskan;5. Rusaknya5. Rusaknya sistemsistem pendonoran altruistik ygpendonoran altruistik yg selama ini dianut. selama ini dianut. (Green, B; 2005)(Green, B; 2005)

THE BODYTHE BODY

The body has become big business.The body has become big business.The body and its parts have become of in-The body and its parts have become of in-creasing interest to the health care industry.creasing interest to the health care industry.

Pertanyaan filosofis, apakah tubuh manusia Pertanyaan filosofis, apakah tubuh manusia (whole or parts) merupakan: (whole or parts) merupakan: 1. kekayaan (property)?1. kekayaan (property)? 2. barang dagangan (commodity)?2. barang dagangan (commodity)? 3. sesuatu yang dapat dihadiahkan (gift)?3. sesuatu yang dapat dihadiahkan (gift)?

(Campbell, A: 2010)(Campbell, A: 2010)

PROPERTYPROPERTY

Sekelompok hak yang menyertai, antara lain:Sekelompok hak yang menyertai, antara lain: - the right to posess;- the right to posess; - the right to use;- the right to use; - the right to manage;- the right to manage; - the right to income;- the right to income; - the right to capitol;- the right to capitol; - the right to security;- the right to security;Juga transmissibility, absence of term, duty toJuga transmissibility, absence of term, duty toprevent harm, liability to execution dan residuarity.prevent harm, liability to execution dan residuarity.Oleh sebab itu perlu pendekatan social constructi-Oleh sebab itu perlu pendekatan social constructi-vist approach, bukan natural rights approach.vist approach, bukan natural rights approach.

(Campbell, A: 2010)(Campbell, A: 2010)

KKONTROVERSIONTROVERSI ETIETIK & HUKUMK & HUKUM

Penentuan kematian pada Penentuan kematian pada cadaver organ donors.cadaver organ donors.Cara memperoleh Cara memperoleh donor organs.donor organs.Keterbatasan persediaan Keterbatasan persediaan organ.organ.Penggunaan binatang untuk Penggunaan binatang untuk human recipients.human recipients.Hak untuk menjadi Hak untuk menjadi organ donors.organ donors.Tanggungjawab Tanggungjawab organ donor.organ donor.Tanggungjawab Tanggungjawab organ recipient.organ recipient.LivLivinging donordonor, such as:, such as:

- non-malfeasance.- non-malfeasance. - regenerative and non-regenerative - regenerative and non-regenerative tissuestissues..

- professional paternalism.- professional paternalism.- use of minors as organ donors.- use of minors as organ donors.- paid donors.- paid donors.

Informed consent (donor and recipien).Informed consent (donor and recipien).Organ Organ dari terpidana mati (dari terpidana mati (executed criminalsexecuted criminals)). .

XENOTRANSPLANTATIONXENOTRANSPLANTATION

1. Ada kekhawatiran mengenai penyebaran 1. Ada kekhawatiran mengenai penyebaran penyakit dari binatang ke manusia;penyakit dari binatang ke manusia; 2. Ada problem etika yang berkaitan dengan 2. Ada problem etika yang berkaitan dengan pemanfaatan binatang (animal welfare).pemanfaatan binatang (animal welfare).

LIABILITY FOR DEFECTIVE ORGANSLIABILITY FOR DEFECTIVE ORGANS 1. Claim in negligence;1. Claim in negligence; 2. Possible claim under Consumer Protecti-2. Possible claim under Consumer Protecti- on, but certain hurdles.on, but certain hurdles.

(Green, B: (Green, B:

2005)2005)

ETHICSETHICS & LAW & LAW

Both ethicsBoth ethics and law and law actually come from the same actually come from the same base, which is moral.base, which is moral.

Generally, good and bad in the view of ethics will Generally, good and bad in the view of ethics will be the same in the view of law.be the same in the view of law.

However the law does not cover small and simple However the law does not cover small and simple thing, so that why it doesthing, so that why it doesn’tn’t need to be intervened. need to be intervened.

Small violation of ethics is not considered a threat Small violation of ethics is not considered a threat to public and does not need to be regulated and to to public and does not need to be regulated and to be punished by law because the society can be punished by law because the society can control it themselves without making any chaos.control it themselves without making any chaos.

RONALD DWORKIN:RONALD DWORKIN: ““Moral principles is the foundation ofMoral principles is the foundation of law”.law”. COLERIDGE:COLERIDGE:

““It would not be correct to say that every It would not be correct to say that every moral obligation involves a legal duty,moral obligation involves a legal duty, butbut every legal duty is founded on moral every legal duty is founded on moral obligobligation”.ation”. Area etika yang Area etika yang overlaps overlaps dgn dgn area area hukum hukum disebut area disebut area “etiko-legal”, “etiko-legal”, dan pelanggaran dan pelanggaran pada area ini disebut pada area ini disebut “gross immorality”. “gross immorality”.

KEBIJAKAN UKEBIJAKAN UU KESEHATAU KESEHATANN

1. Diizink1. Diizinkkan kan atas dasar atas dasar kemanusiaan.kemanusiaan.2. Tidak dibenarkan ada ko2. Tidak dibenarkan ada komersialisasimersialisasi..3. Organ3. Organ // jaringan tidak boleh dijual-belikan.jaringan tidak boleh dijual-belikan.4. T4. Tenaga kesehatan yangenaga kesehatan yang melakukan harus melakukan harus memiliki syarat memiliki syarat keahlian keahlian dandan kewenangan. kewenangan.5. Hanya di RS yang5. Hanya di RS yang ditetapkanditetapkan oleholeh Menteri.Menteri.6. Ada6. Ada persetujuanpersetujuan donordonor dan/ataudan/atau ahliahli waris.waris.7. Pengambilan organ atau jaringan harus 7. Pengambilan organ atau jaringan harus memmemperhatikan kesehatan donor.perhatikan kesehatan donor.

PP No. 18 Th. 1981PP No. 18 Th. 1981

1. Boleh dilakukan di RS yang ditunjuk Menteri;1. Boleh dilakukan di RS yang ditunjuk Menteri;2.2. Tidak boleh dilakukan oleh Dr yang mengobati Tidak boleh dilakukan oleh Dr yang mengobati donor;donor;3. Penentuan saat kematian bukan oleh 2 Dr yang 3. Penentuan saat kematian bukan oleh 2 Dr yang melakukan transplantasi;melakukan transplantasi;4. Persetujuan tertulis disertai meterai dan disaksi-4. Persetujuan tertulis disertai meterai dan disaksi- kan 2 orang saksi;kan 2 orang saksi;5.5. Pada korban kecelakaan lalu-lintas persetujuan Pada korban kecelakaan lalu-lintas persetujuan tertulis oleh keluarga terdekat;tertulis oleh keluarga terdekat;6.6. Donor/keluarga tdk boleh menerima kompensasi.Donor/keluarga tdk boleh menerima kompensasi.7.7. Dilarang mempernjual-belikan organ/jaringan.Dilarang mempernjual-belikan organ/jaringan.