e-health

DIVISION OF BIOETHICS HUMANIORA

MEDICOLEGAL AND PROFESSIONALISM
MEDICAL EDUCATION UNIT
SCHOOL OF MEDICINE
UNIVERISTY OF SUMATERA UTARA

things to know
definition

things to know
10 es in e-health

things to know
examples of
e-relationship

things to know
implications
for e-health

things to know
the field
of e-health

things to know
bioethical principles/
principles of biomedical ethics

things to know
case study

definition
world health organization:
combined use of electronic
communication and
information technology
In the ehalth sector

10 es
Efficiency
Enhancing quality
Evidence-based
Empowerment
Encouragement
Education
Enabling
Extending
Ethics
Equity

10 es
addition
easy to-use
entertaining
exciting

examples
of e-relationship
b2b
(business to business)
www.pfizer.com/business

examples
of e-relationship
b2p
(business to provider)
www.medscape.com

examples
of e-relationship
b2c
(business to consumer/ patient)
www.rx.com

examples
of e-relationship

implications
legal

implications
safety

the field
electronic health records

the field
electronic health records
quality of medical care
optimal information management

the field
electronic health records
(EHR)
bioethical issues:
privacy
confidentiality
security

the field
clinical alerts and
decision support

the field
clinical alerts and
decision support
EHRs
provide automatic alerts

the field

the field

the field
clinical alerts and
decision support
properly designed
adhere to the underlying goals of medicine

the field
internet-based
consumer health information

the field
internet-based
consumer health information
primacy of the patients best interest

the field
internet-based
consumer health information
certification programs

the field
evidence-based medicine
outcome measures
practice guidelines

the field
evidence-based medicine
scientific evidence

the field
outcome measures
proper use of their results

the field
practice guidelines
expert/ consensus panels to
produce prescriptive recommendations

bioethical principles
beneficence

bioethical principles
nonmaleficence

bioethical principles
justice

bioethical principles
autonomy

case study

Sarah White, 24, a U.S.-based psychology

graduate, has established a "naked
therapy practice." Karen Flores, who
wrote the ABS-CBNNews.com article,
noted that naked therapy is "a new kind
of 'treatment' that is slowly gaining
popularityparticularly among malesin
New York."

case study

Flores explained how White "treats" her

patients: "In hour-long sessions via the
Internet, White converses with her clients
and tries to solve their problems while
slowly taking off her clothes. Toward the
end of the session, she is completely
naked.

case study

She told the New York Daily News: 'For men

especially, who are less likely than women to go to
therapy, it is more interesting, more enticing, more
exciting. It's a more inspiring approach to therapy.
'I felt early on that something was missing from
classical therapy, it seemed to encourage repression
as opposed to encouraging people to open up.'
The 24-year-old begins the session with her clothes
on, as the hour-long appointment progresses, she
takes off every item of clothing until there is
nothing left.

case study

The initial sessions, which cost $150, are conducted via

a one-way web cam and text chat.
Once she builds a rapport with a client she moves to
two-way Skype video appointments and then, in some
cases, in-person consultations.
Online: The 24-year-old advertises herself on her
website, which also contains a host of modelling shots
So far, she has around 30 clients which are an eclectic
mix of college students with sexual issues, middle-aged
men with relationship problems and even some women
who enjoy a chat with a nude peer.

case study

She said of her approach: 'Naked therapy has been

very eye opening and worldly for my clients.
'The goal is to show patients I have nothing to hide,
and encourage them to be more honest.
'For men in particular, seeing a naked woman can
really help them focus, look deeply into themselves
and speak their minds openly.
'Freud used free association. I use nakedness.'
Clients schedule appointments through her website,
sarahwhitelive.com.

case study

case study

case study

enough of that!!!

case study
http://indokesehatan.blogspot.com/

share your opinion

with the cards

APPENDIX
BENEFICENCE
Kriteria
1. Mengutamakan altruism (menolong tanpa pamrih, rela berkorban untuk
kepentingan orang lain)
2. Menjamin nilai pokok harkat dan martabat manusia
3. Memandang pasien/keluarga sebagai sesuatu yang tak hanya
menguntungkan dokter
4. Mengusahakan agar kebaikan lebih banyak dibandingkan keburukannya
5. Paternalisme bertanggungjawab/berkasih sayang
6. Menjamin kehidupan baik minimal manusia
7. Pembatasan goal based (sesuai tujuan/kebutuhan pasien)
8. Maksimalisasi pemuasan kebahagiaan/preferensi pasien
9. Minimalisasi akibat buruk
10. Kewajiban menolong pasien gawat darurat
11. Menghargai hak-hak pasien secara keseluruhan
12. Tidak menarik honorarium di luar kewajaran
13. Maksimalisasi kepuasan tertinggi secara keseluruhan
14. Mengembangkan profesi secara terus menerus
15. Memberikan obat berkhasiat namun murah
16. Menerapkan golden rule principle

NONMALEFICENCE
Kriteria
1. Menolong pasien emergensi :
Dengan gambaran sbb :
- pasien dalam keadaan sangat berbahaya (darurat) /
berisiko
kehilangan sesuatu yang penting (gawat)
- dokter sanggup mencegah bahaya/kehilangan tersebut
- tindakan kedokteran tadi terbukti efektif
- manfaat bagi pasien > kerugian dokter
2. Mengobati pasien yang luka
3. Tidak membunuh pasien ( euthanasia )
4. Tidak menghina/mencaci maki/ memanfaatkan pasien
5. Tidak memandang pasien hanya sebagai objek
6. Mengobati secara proporsional
7. Mencegah pasien dari bahaya
8. Menghindari misrepresentasi dari pasien
9. Tidak membahayakan pasien karena kelalaian
10. Memberikan semangat hidup
11. Melindungi pasien dari serangan
12. Tidak melakukan white collar crime dalam bidang kesehatan

AUTONOMY
Kriteria
1. Menghargai hak menentukan nasib sendiri, menghargai
martabat pasien
2. Tidak mengintervensi pasien dalam membuat keputusan
(kondisi elektif)
3. Berterus terang
4. Menghargai privasi
5. Menjaga rahasia pasien
6. Menghargai rasionalitas pasien
7. Melaksanakan informed consent
8. Membiarkan pasien dewasa dan kompeten mengambil
keputusan sendiri
9. Tidak mengintervensi atau menghalangi otonomi pasien
10. Mencegah pihak lain mengintervensi pasien dalam mengambil
keputusan termasuk keluarga pasien sendiri
11. Sabar menunggu keputusan yang akan diambil pasien pada
kasus non emergensi
12. Tidak berbohong ke pasien meskipun demi kebaikan pasien
13. Menjaga hubungan (kontrak)

JUSTICE
Kriteria
1. Memberlakukan sesuatu secara universal
2. Mengambil porsi terakhir dari proses membagi yang telah ia
lakukan
3. Memberi kesempatan yang sama terhadap pribadi dalam
posisi yang sama
4. Menghargai hak sehat pasien
5. Menghargai hak hukum pasien
6. Menghargai hak orang lain
7. Menjaga kelompok yang rentan
8. Tidak melakukan penyalahgunaan
9. Bijak dalam makro alokasi
10. Memberikan kontribusi yang relative sama dengan kebutuhan
pasien
11. Meminta partisipasi pasien sesuai kemampuannya
12. Kewajiban mendistribusikan keuntungan dan kerugian (biaya,
beban, sanksi) secara adil
13. Mengembalikan hak kepada pemiliknya pada saat yang tepat
dan kompeten
14. Tidak member beban berat secara tidak merata tanpa alas an
tepat/sah
15. Menghormati hak populasi yang sama-sama rentan
penyakit/gangguan kesehatan

thank you

one more thing

always remember

beneficence

nonmaleficence

justice

autonomy

references
1.
2.
3.

4.
5.

6.

World health organization. E-health definition. Available at:

http://e-healthexpert.org/defehealth
Eysenbach G. What is e-health? J Med Internet Res 2001;3(2):e20
Winkelstein PS. Ethical and social challenges of electronic health
information. In: Chen H, Fuller SS, Friedman C, Hersh W, eds.
Medical informatics: knowledge management and data mining.
New York: Springer, 2005. pp. 139-58.
Broderick M, Smaltz DH. E-health defined. Available
at:http://www.himss.org/content/files/ehealth_whitepaper.pdf
Purwadianto A. Kaidah dasar moral dan teori etika dalam
membingkai tanggungjawab profesi kedokteran. In: bahan ajar
tutor/ pengajar etika kedokteran FK UI. Jakarta: Balai Penerbit
FK UI, 2003.
Humaryanto. Kaidah dasar bioetika. Bahan kuliah bioetika.
Jambi: FK UNJA, 2010

thank you