VALUE BASED ETHICSVALUE BASED ETHICS
Agus PurwadiantoAgus Purwadianto
-
KeputusanMedis
Keputusan etis
Pilar Keputusan Klinis/PH sehari2Biomedik
Info-medik
Indikasimedik
pilihan pasienkualitas hidup
fitur kontekstual
“Mindset non medis”Struktur Psiko-Sosio-budaya
BIOKULTURAL
VALUE
NEW MANAGEMENTNEW PARADIGM
NEW SYSTEM???
HIGHER EDUCATIONUNIVERSITY ?
PROCESSTO PRODUCESCIENCE OR
NEW INVENTION
EDUCATION/TYPHICAL LEARNING PROCESSTRUTH
SCIENTISTSCHOLAR
CIVILIZED & PROFESSIONALHUMAN RESOURCES
GLOBAL ECONOMY
HIGHER EDUCATION AS KNOWLEDGE AND CULTURE GENERATORS
Physician’s competence
Valid evidencePatient’s valuesPATIENT’S PREFERENCE
FROM STUDIES
JAMU DIPAKAI & BERMANFAAT(Riskesdas 2010)
INTI EVIDENCE BASED MEDICINE – modifikasi Sudigdo S
INTI RI’sJAMUOLOGY
“inter-subyektivitas”(bukan obyektivitas)
Saintifikasi Jamu
LEADING TOBIOCULTURAL MED
IDI KOLEGIUM nakestrad
BALITBANGKESKolegium peneliti
Akuntabilitas publik : papan nama + RM
EBMEBM THE CARE OF INDIVIDUAL PATIENTS SHOULD THE CARE OF INDIVIDUAL PATIENTS SHOULD
INVOLVE : the conscientious, explicit and judicious INVOLVE : the conscientious, explicit and judicious use of current best evidenceuse of current best evidence
Cochrane collaboration as Cochrane collaboration as ““officiallyofficially”” pooler of pooler of published SCIENTIFIC research published SCIENTIFIC research Improve cliniciansImprove clinicians”” knowledge & reading habit & computer knowledge & reading habit & computer
literacyliteracyProvides framework of teachingProvides framework of teachingDemocratization : juniors as best partners, >> Democratization : juniors as best partners, >>
communication Dr-Pat, >>> use of resourcescommunication Dr-Pat, >>> use of resources
HOW FAR VBM PENETRATE HOW FAR VBM PENETRATE HEALTH CARE SERVICES W/ HEALTH CARE SERVICES W/ EBM ?EBM ?
EBM : EMBEDDED PATIENTEBM : EMBEDDED PATIENT’’S VALUE S VALUE IDENTIFY : The best evaluated methods of health care > useless > harmful IDENTIFY : The best evaluated methods of health care > useless > harmful methods methods Enables Dr – Pat make better informed CHOICE & CONSENT decisionEnables Dr – Pat make better informed CHOICE & CONSENT decision
The objectives & trilogy of The objectives & trilogy of CLINICAL MANAGEMENTCLINICAL MANAGEMENT
1.1. To relieve his or her symptoms,To relieve his or her symptoms,2.2. To make him or her comfortable again.To make him or her comfortable again.3. To restore his or her sense of well-being.3. To restore his or her sense of well-being.a.a. ddiagnosisiagnosis ((to identify the cause of symptom and to identify the cause of symptom and
to decide on the natural of the illnessto decide on the natural of the illness);); b.b. ttreatmentreatment;; and and c.c. pprognosisrognosis (estimate (estimate of of how how longlong the the patient will patient will
be be ill ill duedue to to present present conditioncondition withwith or without or without treatmenttreatment).).
d.d. (Curran, W, J., 1982)(Curran, W, J., 1982)
WHAT ABOUT DRWHAT ABOUT DR’’S S SOUVEREIGNTY (TOTAL SOUVEREIGNTY (TOTAL INTEGRITY), AS THE INTEGRITY), AS THE PATIENTSPATIENTS’’ HERO? HERO?
Physician act as (only) AMPLIFIER (IN VITRO APPROACH) of Physician act as (only) AMPLIFIER (IN VITRO APPROACH) of THE THE ““CARTELCARTEL”” industry producing of EBM SCIENTISTS + industry producing of EBM SCIENTISTS + LEGALLY POSITIVISTIC MODERN REGULATORS ? LEGALLY POSITIVISTIC MODERN REGULATORS ?
VALUE …..VALUE ….. DECENCYDECENCY KINDNESSKINDNESS SYMPATHYSYMPATHY EMPATHYEMPATHY CARINGCARING DEVOTIONDEVOTION SERVICESERVICE GENEROSITYGENEROSITY
ALTRUISMALTRUISM SACRIFICESACRIFICE LOVELOVE
…….other GOODNESS.other GOODNESS
COMPONENT OF MEDICAL COMPONENT OF MEDICAL DECISION MAKINGDECISION MAKING
(ian Kerridge, 1998)(ian Kerridge, 1998)
SCIENTIFIC EVIDENCE (ebm)SCIENTIFIC EVIDENCE (ebm)PERSONAL EXPERIENCEPERSONAL EXPERIENCEPERSONAL BIASES & PERSONAL BIASES & VALUESVALUESECONOMIC & POLITICAL ECONOMIC & POLITICAL
CONSIDERATIONSCONSIDERATIONSPHILOSOPHICAL PRINCIPLES PHILOSOPHICAL PRINCIPLES
bioethical principlesbioethical principles
Healthy Community
& public’s prepathogene
sis
Patient’s individual/ Human suffering (bedside)
Diagnosis Treatment Prognosis
3. Public Health 2. Clinical Sciences
4. Medical Humanities
1. Biomedical Sciences
THE ROOT of MEDICAL SCIENCES UU DIKDOK no 20 th 2013
PHARMACEUTICALS/DEVICES as PRODUCTS HEGEMONY, “bench”
HOLISTIC MEDICINE # Science & arts # T&CM
Key characteristics of Key characteristics of good services delivery – good services delivery – WHO Health System WHO Health System StrengtheningStrengthening
COMPREHENSIVENESSCOMPREHENSIVENESS ACCESSIBILITYACCESSIBILITY COVERAGECOVERAGE CONTINUITYCONTINUITY QUALITYQUALITY
PERSON-PERSON-CENTEREDNESSCENTEREDNESS
CONTINUATIONCONTINUATIONACCOUNTABILITYACCOUNTABILITY
& EFFICIENCY& EFFICIENCY
Phenomenology Phenomenology of Medicineof Medicine
Patient’s perceptionPatient’s perception Finitude & dyingFinitude & dying ImaginationImagination Human personhoodHuman personhood HopeHope EmbodiementEmbodiement Illness Illness Emotive structure of Emotive structure of
abstract knowledgeabstract knowledge
Dr’s details of life-worldDr’s details of life-world Emphaty (of idiographic Emphaty (of idiographic
events) events) UniquenessUniqueness Interpretation Interpretation
hermeneuticshermeneutics Emotive structure of Emotive structure of
abstract knowledgeabstract knowledge Freely profess ability to Freely profess ability to
healheal
HEALTH & HUMAN RIGHTSHEALTH & HUMAN RIGHTS WHO Constitution: WHO Constitution: "the enjoyment of "the enjoyment of
the highest attainable standard of health the highest attainable standard of health is one of the fundamental rights of every is one of the fundamental rights of every human being..." human being..."
"The world needs a global health "The world needs a global health guardianguardian, a custodian of , a custodian of valuesvalues, a , a protector and defender of health, protector and defender of health, including the right to health." including the right to health." Dr Dr Margaret Chan, Director-General, WHO. Margaret Chan, Director-General, WHO. SETIAP ORANG BERHAK ATAS KESEHATAN – ps 4 UU Kes No. 36/2009
MEDICAL EDUCATIONMEDICAL EDUCATION
EBMEBM FORMAL CURRICULUMFORMAL CURRICULUM
SKILLSSKILLS TRAINING TRAINING
(TRANSMISSION OF (TRANSMISSION OF SPECIFIC SKILLS FOR SPECIFIC SKILLS FOR THE PREDICTABLE THE PREDICTABLE SOLUTION, ABILITY TO SOLUTION, ABILITY TO DOMINATE FACTS)DOMINATE FACTS)
MEDICINE AS SCIENCEMEDICINE AS SCIENCE
VBMVBM ESPECIALLY ESPECIALLY ““HIDDEN HIDDEN
CURRICULUMCURRICULUM”” ORIENTATIONORIENTATION EDUCATION (INQUIRY, EDUCATION (INQUIRY,
ADAPTABILITY, ADAPTABILITY, FLEXIBILITY, BE FLEXIBILITY, BE COMPASSIONATE & COMPASSIONATE & CARING DR)CARING DR)
MEDICINE AS ARTMEDICINE AS ART
VBM considerationVBM considerationTony Hope, J.Med.Ethics, 1995Tony Hope, J.Med.Ethics, 1995
Health care purchasingHealth care purchasingEBM as a tool to cut funding EBM as a tool to cut funding only highly relevant valid only highly relevant valid
evidence = reason to purchaseevidence = reason to purchase Critic to systematic bias into purchasingCritic to systematic bias into purchasing
Amount of effort of previous research Amount of effort of previous research Drug as Drug as ““OBJECTIVE WEAPONOBJECTIVE WEAPON”” after being FUNDED after being FUNDED
Ease quantification of desired outcomeEase quantification of desired outcomeAcute relieves : > dramatic than chronic disease Acute relieves : > dramatic than chronic disease
Public health perspective >< individual PatientPublic health perspective >< individual Patient’’s choices choice““best buybest buy”” logic > most effective treatment logic > most effective treatment
VBM > EBMVBM > EBM EBM : > DrEBM : > Dr’’s centered biass centered bias
Hierarchical evidence : RCT, DB, MA Hierarchical evidence : RCT, DB, MA ConsumerConsumer’’s section of Cochrane Collabs section of Cochrane Collab
Objectivity & rationality behind the medical data …..Objectivity & rationality behind the medical data …..Who determined the research question Who determined the research question ? ?
Fact : Value driven question behind the research Fact : Value driven question behind the research question !!! question !!! ““Why some hospital units had a high infection rate ?Why some hospital units had a high infection rate ?”” > than : > than :
““Do all women who undergo SC should be given an antibiotic Do all women who undergo SC should be given an antibiotic prophylaxis ?prophylaxis ?””
PatientsPatients’’ Involvements InvolvementsClinical Practice Guidelines (CPG) as the Clinical Practice Guidelines (CPG) as the
DrDr’’s monopoly ?s monopoly ?No !!! No !!! Patient & Public Involvement Patient & Public Involvement
Program Program Patients, consumers & public Patients, consumers & public Involvement : communication, consultation, Involvement : communication, consultation,
participationparticipation>>> in Scandinavian countries>>> in Scandinavian countries
VBM on patientVBM on patient’’s side : s side : BALLANCING the benefit – harmBALLANCING the benefit – harmPatientPatient’’s decision aids presenting optionss decision aids presenting options Individualised risk assesmentIndividualised risk assesmentProbabilities of benefits & downsides Probabilities of benefits & downsides
supporting choices of supporting choices of ““preference preference sensitive decisionssensitive decisions”” (of mass screening) (of mass screening)
PatientPatient’’s rationalitys rationality3 MU3 MU’’s : mujarab, mudah, murahs : mujarab, mudah, murahAccountability : Effective & QualityAccountability : Effective & QualityAccessibleAccessibleAffordable Affordable
HUMAN VALUESHUMAN VALUES
WHICH VALUES INFLUENCING HEALTH PROFESSION : WHICH VALUES INFLUENCING HEALTH PROFESSION : EXISTENCY, CLINICAL SETTING, RELIGION, CULTURE, EXISTENCY, CLINICAL SETTING, RELIGION, CULTURE, HUMAN DIGNITYHUMAN DIGNITY
Existency of Values : Existency of Values : 7 7 THREATS TO ETHICSTHREATS TO ETHICS
The Death of GodThe Death of GodRelativismRelativismEgoismEgoismEvolutionary TheoryEvolutionary TheoryDeterminism & FutilityDeterminism & FutilityUnreasonable demandsUnreasonable demandsFalse consciousnessFalse consciousness
Simon Blackburn, 2001
Clinical Setting AdvantagesClinical Setting Advantages More humaneMore humane
Full of phenomenology – Merleau PontyFull of phenomenology – Merleau Ponty Responsibility precedes the freedom - Levinas Responsibility precedes the freedom - Levinas Emancipating power – Juergen Habermas Emancipating power – Juergen Habermas
Plenty of contextualities – point of hermeneuticsPlenty of contextualities – point of hermeneutics Elective vs emergency, social vs individual, East vs Elective vs emergency, social vs individual, East vs
West, EBM vs VBM, biosafety vs biosecurityWest, EBM vs VBM, biosafety vs biosecurity Melting pot of theories/perspectives/paradigm Melting pot of theories/perspectives/paradigm
Biomedic vs infomedic – Foss & RothenbergBiomedic vs infomedic – Foss & Rothenberg Ethicolegal system - APEthicolegal system - AP
Agent of change & iatrogenicity ‘par excellence’ Agent of change & iatrogenicity ‘par excellence’
Agus Purwadianto, 2009
3 3 IhsanIhsan’’s componentss components Ikhlasun niyat Ikhlasun niyat : : melakukan pekerjaan dmelakukan pekerjaan dgg motif motif yygg
bersibersihh, murni k, murni krn rn AllahAllah = profesi luhur = tak ada = profesi luhur = tak ada sengaja misconduct/WCC sengaja misconduct/WCC . .
Itqanul amalItqanul amal : : rapi dalam bekerja rapi dalam bekerja patut, teliti, patut, teliti, hati2, sesuai indikasi medik & standar, spy mujarabhati2, sesuai indikasi medik & standar, spy mujarab
Jaudatul ada’Jaudatul ada’ : : melakukan dan menyelesaikan melakukan dan menyelesaikan pekerjaan hingga tuntaspekerjaan hingga tuntas : komprehensif : D/ Th/ s/d : komprehensif : D/ Th/ s/d Prognosis, mujarab, murah, mudah. Prognosis, mujarab, murah, mudah.
VALUEVALUE’’s origin : s origin : SECULAR vs Islamic EthicsSECULAR vs Islamic Ethics
Western Western bioethicsbioethics = rights-based, = rights-based, with a with a strong emphasis on individual rights, strong emphasis on individual rights,
Islamic Islamic bioethicsbioethics is based on duties and is based on duties and obligations (e.g., to preserve life,obligations (e.g., to preserve life, seek seek treatment), although rights (of God, the treatment), although rights (of God, the community andcommunity and the individual) do feature in the individual) do feature in bioethicsbioethics, as does a call to virtue, as does a call to virtue (Ihsan).(Ihsan).
Abdallah S. Daar and A. Khitamy CMAJ • January 9, 2001; 164 (1)
ValueValue’’s source : s source : Human dignityHuman dignity Intrinsic value of every human being, equal Intrinsic value of every human being, equal
for all humansfor all humansBecause of the sole fact that he/she is human Because of the sole fact that he/she is human
Ricoer 1988, De Koninck, 1995Ricoer 1988, De Koninck, 1995
Respect for the inherent value of every Respect for the inherent value of every human being and of humanityhuman being and of humanity
““respect for autonomy” + spiritual respect for autonomy” + spiritual dimension of human existencedimension of human existence
Lenoir & Mathieu 1998Lenoir & Mathieu 1998Human : > biological & genetic levelHuman : > biological & genetic level
2 aspect of human dignity2 aspect of human dignity IndividualIndividual
Foundation of all rights & freedom Foundation of all rights & freedom Promoting self-determination & protect Promoting self-determination & protect
against any inhuman/degrading treatmentagainst any inhuman/degrading treatmentCollective Collective wholistic incl future wholistic incl future
generationsgenerationsSociety have a solidarity rights : society have Society have a solidarity rights : society have
an intrinsic value as well (in a derivative way an intrinsic value as well (in a derivative way from individual perspective)from individual perspective)
Value - NormValue - NormValueValue Not concrete (no empirical-observational facts) Not concrete (no empirical-observational facts) subjective subjective
(basic/motivation of will, idea, hope and internal (basic/motivation of will, idea, hope and internal judgment/mind of human behavior/action explicitly or judgment/mind of human behavior/action explicitly or tacitly tacitly
NormsNorms ConcreteConcrete Value objectivation Value objectivation
Values Values Pre-moralPre-moral
Not refered to specific concrete norm of Not refered to specific concrete norm of human actionhuman action
MoralMoral Imperative of human to conduct or to refer Imperative of human to conduct or to refer
specific action of concrete norm; specific action of concrete norm;
Value Value Triad : Choosing, Prizing, ActingTriad : Choosing, Prizing, Acting
CanCan’’t be taught, but can be experienced t be taught, but can be experienced As basic cause of conflictAs basic cause of conflict
Category :Category :Value in itself (intrinsic value)Value in itself (intrinsic value)
PleasurePleasureHappinessHappiness
Instrumental value (extrinsic value)Instrumental value (extrinsic value)Good/right if the goal have been achievedGood/right if the goal have been achieved
NORMS (:modernity)NORMS (:modernity) Ethics (narrow interpretation) Ethics (narrow interpretation)
Goals of the goodness of personal life or clearness/purity of Goals of the goodness of personal life or clearness/purity of conscience (intra-personal principles). conscience (intra-personal principles).
Law Law Goals of peaceful social life (inter-personal principles) after Goals of peaceful social life (inter-personal principles) after
socializing & enforcing determined-normssocializing & enforcing determined-norms Etiquette Etiquette
Goals of harmony of social life, esp. physical aspect (inter-personal Goals of harmony of social life, esp. physical aspect (inter-personal principles)principles)
Religion/beliefsReligion/beliefs Goals of Goals of ““akhlakakhlak””/good behavior purification & celestial (world + /good behavior purification & celestial (world +
heaven) (intra-personal principles)heaven) (intra-personal principles)
Ethical justificationEthical justification
Claims of rights (goal oriented)Claims of rights (goal oriented)Claims of conscience (process oriented)Claims of conscience (process oriented)Distinguishing morality & ethicsDistinguishing morality & ethics
RightsRights= justified claims that a person can = justified claims that a person can
make on others or on societymake on others or on societyoften controversy : individual vs often controversy : individual vs
society, individual vs individual; society, individual vs individual; society vs societysociety vs society
ConscienceConscience= self-reflection + judgment about = self-reflection + judgment about
whether an action is right or wrongwhether an action is right or wrong= build a sense of wholeness or = build a sense of wholeness or
integrity & responsibility, not to feel integrity & responsibility, not to feel ashamed & guilty ashamed & guilty
Meaningful Life - theoryMeaningful Life - theoryLove incorporated to God (Plato, sufi-ism Love incorporated to God (Plato, sufi-ism
Islam, Kejawen)Islam, Kejawen)Pleasure-based (eudamonia)Pleasure-based (eudamonia)Virtue Ethics (Aristotle)Virtue Ethics (Aristotle)Pain-hindrancePain-hindrance’’s feeling (Epikurus)s feeling (Epikurus) Individual voluntariness incorporating with Individual voluntariness incorporating with
Natural Law as GodNatural Law as God’’s Law/sunatullah s Law/sunatullah (Stoa) (Stoa)
Meaningful Life – theory (2)Meaningful Life – theory (2) Love of God (Agustinus)Love of God (Agustinus) Follow the natural law (Love to God + virtue)Follow the natural law (Love to God + virtue) Not having, but being (Erich Fromm)Not having, but being (Erich Fromm) Freedom/autonomy of subject as moral Freedom/autonomy of subject as moral
resources (Kant)resources (Kant) World view/lebenswelt (Habermas)World view/lebenswelt (Habermas) etcetc
NILAI dlm Kode NILAI dlm Kode Etik Dokter RIEtik Dokter RI
Kemurnian niat = sikap moral tanpa Kemurnian niat = sikap moral tanpa pamrih, rela berkorban/menolong pamrih, rela berkorban/menolong
Kesungguhan kerja = Kesungguhan kerja = ketuntasan ketuntasan tindakan baik & adil, teliti hati2 tindakan baik & adil, teliti hati2
Kerendahan hati = santunKerendahan hati = santun Integritas ilmiah & sosialIntegritas ilmiah & sosial
kesesuaian kata-perbuatan/pikiran-kesesuaian kata-perbuatan/pikiran-sikap-tindak-perilaku = martabat sikap-tindak-perilaku = martabat profesi luhur (hormat diri sendiri & profesi luhur (hormat diri sendiri & adil) adil)
VBE VBE FRAMING THE AGENT FRAMING THE AGENT’’S S ETHICAL THEORY ETHICAL THEORY
AGENTAGENT : : VIRTUEVIRTUE
ACTSACTS : DEONTOLOGI: DEONTOLOGI
ENDSENDS : TELEOLOGICAL: TELEOLOGICAL
CONSEQUENCESCONSEQUENCES : CONSEQUENTIALIST: CONSEQUENTIALIST (UTILITARIAN)(UTILITARIAN)
MEANINGFUL LIFE FIDUCIARY RELATION
Golden ruleKantianPlural
Goal-based
RELEVANCY OF VBM – RELEVANCY OF VBM – CATCHING DRCATCHING DR’’S IDENTITY & CHARACTERS IDENTITY & CHARACTER
COGNITIVE ETHICSCOGNITIVE ETHICS GOOD DOCTORSGOOD DOCTORS ETHICAL DRETHICAL DR
““ISOLATEDISOLATED”” ETHICS ETHICS (INDEPENDENT OF ITS (INDEPENDENT OF ITS PRACTITIONERS & PRACTITIONERS & EXTERNAL TO THE EXTERNAL TO THE PROBLEM AT HAND)PROBLEM AT HAND)
CULTURAL ETHICSCULTURAL ETHICS DRDR’’S WHO S WHO ““DO GOODDO GOOD”” DRDR’’S WHO ACT S WHO ACT
ETHICALLYETHICALLY ““INTEGRATEDINTEGRATED”” ETHICS ETHICS
(FUNCTION AS (FUNCTION AS INTEGRAL PART OF DRINTEGRAL PART OF DR’’s IDENTITY)s IDENTITY)
“GOOD “APPLICANT DR“GOOD” = SENSITIVE/CARING DR“BAD” = INSENSITIVE DR
SOCIALIZATIONSOCIALIZATIONMERTON, READER, KENDALL, 1957MERTON, READER, KENDALL, 1957
PROCESS BY WHICH PEOPLE ACQUIRE PROCESS BY WHICH PEOPLE ACQUIRE THE VALUES & ATTITUDES, THE THE VALUES & ATTITUDES, THE INTERESTS, SKILLS & KNOWLEDGE INTERESTS, SKILLS & KNOWLEDGE = THE CULTURE, IN THE GROUPS OF WHICH = THE CULTURE, IN THE GROUPS OF WHICH
THEY ARE, OR SEEK TO BECOME, A MEMBERTHEY ARE, OR SEEK TO BECOME, A MEMBER VBM = AS AN VALUE APPLICATION to the VBM = AS AN VALUE APPLICATION to the
STUDENT during SOCIALIZATION STUDENT during SOCIALIZATION About rightness/wrongness within overall culture About rightness/wrongness within overall culture
of medicineof medicine
Self reflectionSelf reflectionAre you a virtuous student ? Are you a virtuous student ? Do you understand the Do you understand the ““ambiguityambiguity”” of of
medicinemedicine’’s culture ? s culture ? Are you preparing to Are you preparing to ““act rightlyact rightly”” while while
maintaining maintaining ““your natural good characteryour natural good character”” ? ?
Self-reflectionSelf-reflection’’s vigilances vigilance
Are you preparing to Are you preparing to ““act rightlyact rightly”” while maintaining while maintaining ““your natural good characteryour natural good character”” ? ?
after internalize the after internalize the ““hidden valuehidden value”” which you got at which you got at the place between the : the place between the : blackboard – pen (not at the formal curriculum) ? blackboard – pen (not at the formal curriculum) ? ward A – ward B (at ward A – ward B (at ““corridorscorridors”” of the clinical ward, not of the clinical ward, not
““bedsidebedside””)?)?Lab C– lab D (at locker Lab C– lab D (at locker ‘‘s room, not s room, not ““benchbench””))Health centre A – posyandu B (at market, not health Health centre A – posyandu B (at market, not health
care facilities)care facilities)
Good doctorsGood doctors““combine combine
individualindividual clinical clinical expertise expertise andand best best available external available external evidence; evidence; theythey areare thoughtful, thoughtful, evidence based evidence based practitionerspractitioners
Good doctorsGood doctorsuseuse "intangible "intangible personal personal
resources" resources" in the care of in the care of their patients;their patients; …. …. attaches attaches toto vocationalism in vocationalism in medicine medicine and to theand to the personalpersonal qualities qualities required of its practitioners, required of its practitioners, includingincluding truthfulness truthfulness
Good Good doctorsdoctorsreflective turn of mind reflective turn of mind
open to audit open to audit and to and to learning fromlearning from
mistakesmistakes .... .... personal qualities more personal qualities more
prominently than prominently than proficiency in proficiency in knowledge and knowledge and technical skillstechnical skills..””
CONCLUSION CONCLUSION Value based ethics (VBE) is a tool to balance & to Value based ethics (VBE) is a tool to balance & to
criticized EBM by raising the criticized EBM by raising the ““whatwhat’’s behinds behind”” questionquestion
DrDr’’s VALUE as the s VALUE as the ““subjectivesubjective”” core of meaningful core of meaningful life basis should be balance with Patientlife basis should be balance with Patient’’s & Public s & Public Involvements forming the virtuous Involvements forming the virtuous association/institution association/institution
VBE as a source of norms, are incorporated & VBE as a source of norms, are incorporated & embedded in every article Code of Medical Ethics & embedded in every article Code of Medical Ethics & Other health professionalsOther health professionals
Agus Purwadianto