MEMBANGUN MODEL INFORMED CONSENT BERDASAR BUDAYA HUKUM INDONESIA (Studi Interaksi Pasien dan Dokter di Rumah Sakit

Abstract

Informed consent di bidang kedokteran merupakan proses komunikasi. yaitu dokter menginformasikan kepada pasien tentang diagnosis, tata cara, keuntungan, den risiko tindakan medik serta tindakan altematif. Kasus-kasus yang muncul di dalam negeri maupun di Mar negeri, berpangkal dad masalah komunikasi dan interaksi pasien, keluarga pasien, dan dokter, serta informed consent yang tidak dimengerti pasien ataupun kurang lengkap. Pertanyaan penelitian dafam studi ini adalah 1). Apakah praktik informed consent sesuai dengan budaya hukum Indonesia?; 2).Bagaimana budaya hukum pasien dan dokter dalam praktik informed consent ?; 3). Bagairnana model informed consent yang sesuai dengan budaya trukum Indonesia? Studi ini bertujuan membangun model informed consent berdasar budaya hukum Indonesia. Studi ini menggunakan metode kualitatif-naturafistik dan paradigma konstruktivisme, untuk menggali makna informed consent, balk °fah pasien maupun dokter, den tidak bermaksud membuat generalisasi. Studi ini diharapkan dapat memberikan sumbangan bagi perkembangan hukum kedokteran, dan membangun model informed consent sebagai acuan para dokter dan pasien. Menurut Lawrence M. Friedman, buciaya hukum pasien dan dokter merupakan nilai-nilai, keyakinan, si-kap mereka lerhadap informed consent. Studi dilakukan di tiga rumah sakit di Semarang, yaitu rumah sakit pemerintah, rumah sakit keagarnaan dan rumah sakit swasta mumi. Data primer diperoleh dari informan .kunci dan dikembangkan dengan metode snowball. Data sekunder diperoleh dari survei rekam medik, laporan tahunan rumah sakit, dokumen peneliti terdahulu, jurisprudensi !Liar negeri dan jumal. Data dikumpulkan dengan observasi, wawancara, studi dokumen, focus group discussion dan member checking. Analisis hasil penefitian menunjukkan bahwa pasien dan dokter belum sepenuhnya mematiarni hakekat informed consent. Konsep informed consent yang berasal- dari Barat menekankan otonomi pasien secara individual berbeda dengan struktur masyarakat Indonesia yang lebih bersifat komunal. Hal ini senada dengan teori William J. Chambliss dan Robert B. Seidman tentang efektifitas bekerjanya hukum dalam masyarakat. Akhimya diusuikan suatu model informed consent di mana dalam banal( seorang dokter sudah harus tertanam nilai-nilai Pancasila sebagai grundnorm, kaidah dasar moral (autonomy, beneficence, non maleficence den justice) serta prinsip etilca idinik (medical indications, patient preferences, quality of fife, dan contextual features), sehingga dalam menyuson program perigobatan pasien selaiu berpegang pada patient's best interests serta prinsip cure and care. Mengingat masyarakat Indonesia cenderung bersifat komunal, make keluarga dengan permintaan dan persetujuan pasien (dalam hal pasien sedan den kompeten), dapat dlikutsertakan dafam interaksi pasien dan dokter dalam praktik informed consent. Kate kunci: informed consent, interaksi pasien dokter, budaya hukum ABSTRACT Informed consent in medicine is the communication process whereby the physician informs the patient about the diagnosis, treatment, the benefits and the risks of the procedure, also the alternatives. The cases appearing in the country and abroad focus on communication and interaction among patient, patient's family. The questions of this resarch are:1).Does the informed consent practice match the Indonesian's legal culture? 2). What are the doctor's and patient's legal culture in the informed consent practice? 3).What is the informed consent model that match the Indonesian's legal culture?This research is directed to built informed consent model based on the Indonesian's legal culture. This research uses the naturalistic qualitative method with constructivism paradigm to dig out the meaning of informed consent either by the patient or the doctor, and not to make generalization. This research is expected to give contribution to the growth of medical law, and to build the informed consent model as a reference for patients and doctors. According to Lawrence M. Friedman theory, the patient and doctor legal culture mean values, opinions, and attitudes about informed consent.This research was done in Three hospital in Semarang, that is the government hospital, religious private hospital, and pure private hospital. The primary data was acquired from key informant and developed with snow ball method, The secondary data was from medical record survey, hospital annual report, former research document, jurisprudence from abroad and journals. The data are collected by observation, interview, document's study, and focus group discussion also member checking. The result of the research show that patients and doctors do not fully understand the informed consent. The concept of informed consent coming from Western country and emphasizing the patient individual autonomy is different from the Indonesian culture having more communal character. This is fits William J. Chambliss and Robert B. Seidman theory about legal effectivity in the community. Finally it is proposed informed consent model, where Pancasila as grundnorm, moral based values (autonomy, beneficence, non maleficence den justice) and ethical clinics (medical indications, patient preferences, quality of life, contextual features), should have been implanted in the doctor's mind, so that in planning the patient treatment program he always bases on the patient's best interests and the priciple of cure and care. Regarding to the communal character of the Indonesian society, so that the family with the agreement and request from patient (conscious and competent) could participated in the patient and doctor interaction in informed consent practice. Key words: informed consent, patient doctor interaction, legal culture, model