Dilema Bioetis Dalam Tatatalaksana Nyeri Kronis Yang Dihadapi Oleh Dokter Spesialis Neurologi Di Bondowoso, Situbondo, Jember Dan Malang
ARSYZILMA HAKIIM, Dr. Sri Setiyarini, S.Kp.,M.Kes ; Dr. CB. Kusmatyanto, SCJ
2023 | Tesis | MAGISTER BIOETIKA
Pendahuluan : Kasus nyeri kronis merupakan masalah kesehatan global dan dapat menimbulkan kecacatan, biaya pengobatan yang tinggi dan berpengaruh pada kualitas hidup. Pasien nyeri kronis dipengaruhi multiple factor sehingga membutuhkan tatalaksana nyeri kronis dengan multidisiplin dan long treatment. Sebagian besar kasus nyeri kronis di Indonesia ditangani oleh dokter spesialis neurologi/saraf. Penanganan multidisiplin dan long treatment seringkali menimbulkan dilema bioetis (beneficence, non maleficence, autonomy, justice) pada dokter spesialis neurologi/saraf.
Tujuan penelitian : Mengeksplorasi dan memahami dilema bioetis (beneficence, non maleficence, autonomy, justice) dalam tatalaksana nyeri kronis yang dihadapi oleh dokter spesialis neurologi di Bondowoso, Situbondo, Jember Dan Malang.
Metode : Penelitian menggunakan rancangan kualitatif dengan pendekatan fenomenologi. Pengumpulan data dilakukan dengan wawancara semi terstuktur yang dilakukan kepada 8 informan dokter spesialis neurologi dengan menggali dilema bioetika dalam tatalaksana nyeri kronis meliputi farmakologi, rehabilitasi medis, minimal invasive, open surgery, dan CBT (Cognitive Behavior Terapy). Analisis data dilakukan dengan menggunakan analisi metode Colaizzi.
Hasil : didapatkan tiga tema yaitu 1) dilema dalam prinsip beneficence dan non- maleficence meliputi kewajiban dokter (membantu), terapi (efek samping sulit dihindari), perbedaan ekspektasi, prognosis sulit, dan ketidakpastian manfaat intervensi. Kemudian 2) dilema dalam prinsip justice : sarana rumah sakit terbatas, akses layanan kesehatan, pelatihan, dan batasan asuransi. Dan 3) dilema dalam prinsip autonomy pasien : kepribadian pasien, vulnerability pasien, informed consent, dan ketakutan pasien.
Kesimpulan : Ditemukan dilema bioetika (beneficence, non maleficence, autonomy, justice) dalam tatalaksana nyeri kronis yang dihadapi dokter spesialis neurologi. Diharapkan adanya seminar atau pendidikan berkelanjutan terkait dilema bioetika dalam praktek kedokteran khususnya terkait tatalaksana nyeri kronis di Rumah Sakit, pemerataan layanan kesehatan terkait tatalaksana nyeri kronis, terutama dari segi fasilitas rumah sakit, sumber daya manusia, ketersedian jenis obat, dan keterjangkauan biaya kesehatan.
Kata Kunci : Dilema Bioetika, Tatalaksana Nyeri, Nyeri Kronis, Dokter Spesialis Neurologi, Beneficence
Introduction: Chronic pain is a global health problem and can cause disability, high medical costs and affect the quality of life. Chronic pain patients are influenced by multiple factors and require multidisciplinary and long treatment for chronic pain. Most cases of chronic pain in Indonesia are handled by neurologist. Multidisciplinary treatment and long treatment often give rise to bioethical dilemmas (beneficence, non-maleficence, autonomy, justice) for neurologists.
Aim : Explore and acquaint the bioethical dilemma (beneficence, non-maleficence, autonomy, justice) in the management of chronic pain handled by neurologists in Bondowoso, Situbondo, Jember and Malang.
Methods : The research uses a qualitative design with a phenomenological approach. Data collected by carried out using semi-structured interviews with 8 informants who were neurologist by exploring bioethical dilemmas in chronic pain management including pharmacology, medical rehabilitation, minimally invasive, open surgery, and CBT (Cognitive Behavior Therapy). Data analysis use Colaizzi method of analysis.
Results: three themes were obtained, 1) dilemmas in the principles of beneficence and non-maleficence including the doctor's obligations (to help), therapy (side effects are difficult to avoid), differences in expectations, difficult prognosis, and uncertainty about the benefits of intervention. 2) dilemma in the principle of justice: limited hospital facilities, access to health services, training, and insurance limits. 3) dilemmas in the principle of patient autonomy : patient personality, patient vulnerability, informed consent, and patient fears
Conclusion : Bioethical dilemmas (beneficence, non-maleficence, autonomy, justice) were found in the management of chronic pain handled by neurologists. It is hoped that there will be seminars or continuing education related to bioethical dilemmas in medical practice, especially regarding the management of chronic pain in hospitals, equitable distribution of health services related to chronic pain management, especially in terms of hospital facilities, human resources, availability of types of drugs, and affordability of health costs.
Keywords : Bioethical Dilemma, Pain Management, Chronic Pain, Neurologist, Beneficence
Kata Kunci : Dilema Bioetika, Tatalaksana Nyeri, Nyeri Kronis, Dokter Spesialis Neurologi, Beneficence