Martabat Pasien Psikiatri dalam Pelayanan Rumah Sakit: Studi Bioetika dan Etika Organisasi di Suatu Rumah Sakit Jiwa Daerah

Maria Devi Arianti, Prof. Dr. dr. Mubasysyr Hasanbasri, M.A; Dr. Dra. Retna Siwi Padmawati, M.A

2026 | Tesis | MAGISTER BIOETIKA

Pasien psikiatri merupakan kelompok rentan yang sering kali menghadapi ancaman terhadap hak-hak dasarnya selama menjalani perawatan di rumah sakit. Penelitian ini bertujuan untuk: (1) Mengidentifikasi pemaknaan konsep dan komponen martabat pasien psikiatri serta keluarganya oleh lintas profesi tenaga kesehatan dan manajemen; (2) Mengeksplorasi secara mendalam manifestasi lima bentuk perendahan martabat pasien dalam praktik pelayanan sehari-hari; dan (3) Membedah pengaruh kondisi etika organisasi terhadap risiko ancaman martabat pasien di RSKD Jiwa. Studi kualitatif dengan desain studi kasus ini melibatkan 16 informan kunci yang merepresentasikan unsur dokter spesialis jiwa, perawat terdepan, apoteker, manajer pelayanan pasien (case manager), kepala ruang, serta jajaran komite klinis (medik, mutu, etik) dan manajemen rumah sakit. Data dihimpun melalui wawancara mendalam serta diskusi berbasis 7 kasus vignette, kemudian dianalisis secara tematik menggunakan pendekatan induktif dan deduktif.Hasil penelitian mengungkap adanya disintegrasi pemaknaan konsep martabat; manajemen memandang martabat secara utilitarianadministratif, sedangkan petugas terdepan memaknainya secara relasional-praktis, sementara pemenuhan martabat keluarga pasien masih dikesampingkan. Lebih lanjut, perendahan martabat pasien terbukti termanifestasi nyata ke dalam lima bentuk tindakan operasional sehari-hari: kekerasan fisik dan verbal, fiksasi mekanis berkepanjangan akibat ketiadaan obat penenang, bias diagnostic overshadowing (pengabaian klinis fisik), kelangkaan obat psikotropika esensial secara kronis, serta pola komunikasi satu arah yang tidak transparan kepada keluarga. Kondisi etika organisasi yang patologis terbukti melanggengkan risiko ancaman ini melalui lumpuhnya implementasi SOP keselamatan, bertahannya budaya menyalahkan (blame culture) yang menghambat pembelajaran sistemik, tingginya distres moral petugas terdepan akibat keterbatasan logistik obat, serta peran case manager yang terdistorsi secara reaktif-korektif pasca-insiden, alih-alih bertindah preventif sejak fase admisi awal pasien.

 

Psychiatric patients represent a vulnerable group that frequently faces threats to their fundamental rights during hospital care. This study aims to: (1) Identify the conceptualization and components of dignity for psychiatric patients and their families as perceived by cross-professional healthcare workers and management; (2) Deeply explore the manifestations of five forms of patient dignity degradation in daily care practices; and (3) Dissect the influence of organizational ethics conditions on the risk of threats to patient dignity at RSKD Jiwa. This qualitative study employed a case study design involving 16 key informants, representing psychiatrists, frontline nurses, pharmacists, case managers, ward heads, clinical committees (medical, quality, ethics), and hospital management. Data were gathered through in-depth interviews and discussions based on 7 vignette cases, and subsequently analyzed thematically using inductive and deductive approaches. The results reveal a disintegration in the conceptualization of dignity; management views dignity through a utilitarian-administrative lens, whereas frontline staff perceive it relationally and practically, while the fulfillment of the patient's family's dignity remains marginalized. Furthermore, the degradation of patient dignity is visibly manifested in five forms of daily operational actions: physical and verbal abuse, prolonged mechanical restraint due to the absence of sedatives, diagnostic overshadowing bias (neglect of physical clinical care), chronic shortages of essential psychotropic medications, and a one-way, non-transparent communication pattern with families. Pathological organizational ethics conditions are proven to perpetuate these threat risks through the paralysis of safety SOP implementations, the persistence of a blame culture that hinders systemic learning, high moral distress among frontline staff due to logistical medication shortages, and the distorted role of case managers who act reactively-correctively postincident rather than preventively from the initial admission phase.

Kata Kunci : Martabat Pasien, Bioetika, Etika Organisasi, Rumah Sakit Jiwa, Diagnostic Overshadowing, Blaem Culture/ Patient Dignity, Bioethics, Organizational Ethics, Mental Hospital, Diagnostic Overshadowing, Blame Culture