.png)
1.jpg)
Ethical and Legal Aspects in the Implementation of the Triage System in Extraordinary Events and Outbreaks after Covid-19 in Indonesia
Antonius Kuncup Wisnu Baroto Sutrisno Putro, Slamet Suhartono, Yovita Arie Mangesti, Erny Herlin Setyorini
| Abstract views: 0
| 
views: 0
Abstract
The Intensive Care Unit triage system is an option in disaster management efforts amidst limited human health resources. This study aims to analyze the ethical and legal aspects of implementing the triage system in a disease outbreak disaster. The method in this study is normative juridical. The study’s results indicate that although triage aims to save as many lives as possible, its practice often causes ethical problems, especially when choosing the most important patients. The technical guidelines for triage have been legally regulated, but legal protection for health workers is still limited, and the objective criteria for the triage process are unclear. This study found that strengthening ethical elements and legal protection in the triage system is very important so that its implementation does not cause injustice or violation of patient rights. Therefore, current regulations should be supplemented with more in-depth ethical guidelines and clear mechanisms for determining who is responsible for carrying out triage. The study recommends ethical training, regulatory alignment with bioethics standards, and integration of ethical reviews to enhance future triage system resilience.
Abstrak
Sistem triase Intensive Care Unit menjadi pilihan dalam upaya penanggulangan bencana di tengah keterbatasan sumber daya manusia kesehatan. Tujuan penelitian ini untuk menganalisis aspek etis dan legal penerapan sistem triase pada kondisi bencana wabah penyakit. Metode dalam penelitian ini adalah yuridis normatif. Hasil penelitian menunjukkan bahwa meskipun triase bertujuan untuk menyelamatkan sebanyak mungkin nyawa, praktiknya sering kali menyebabkan masalah etis, terutama ketika memilih pasien mana yang paling penting. Pedoman teknis triase telah diatur secara hukum, tetapi pelindungan hukum tenaga kesehatan masih terbatas dan kriteria objektif proses triase belum jelas. Studi ini menemukan bahwa penguatan elemen etis dan pelindungan hukum dalam sistem triase sangat penting agar pelaksanaannya tidak menyebabkan ketidakadilan atau pelanggaran hak pasien. Oleh karena itu, peraturan saat ini harus dilengkapi dengan pedoman etis yang lebih mendalam dan mekanisme yang jelas untuk menentukan siapa yang bertanggung jawab atas pelaksanaan triase. Studi ini merekomendasikan pelatihan etika, penyelarasan peraturan dengan standar bioetika, dan integrasi tinjauan etika untuk meningkatkan ketahanan sistem triase di masa mendatang.
Keywords
Full Text:
PDFReferences
Abma, Inger L., Gert J. Olthuis, Irma T. H. M. Maassen, Marjan L. Knippenberg, Miriam Moviat, Annie J. Hasker, A. G. Buenen, Bernard G. Fikkers, and Anke J. M. Oerlemans. “Putting ICU Triage Guidelines into Practice: A Simulation Study Using Observations and Interviews.” PLOS ONE 18, No. 8 (August 2023): 1–20. https://doi.org/10.1371/journal.pone.0286978
Abraham Haileamlak. “Pandemics Wil be More Frequent.” Ethiopian Journal of Health Sciences 32, No. 2 (March 2022): 228. https://doi.org/10.4314/ejhs.v32i2.1
Apeldorn, Van. Pengantar Ilmu Hukum, Terjemahan dari Inleiding Tot De Studie Het Nederlandse Recht oleh Oetarid Sadino. Jakarta: Pradya Pramita, 1990.
Arie, Yovita and Slamet Suhartono Mengesti. Ilmu Hukum Kontemporer: Menembus Batas Kekakuan Hukum Normatif. Malang: Setara Press, 2020.
Bardosh, Kevin Louis, Daniel H. de Vries, Sharon Abramowitz, Adama Thorlie, Lianne Cremers, John Kinsman, and Darryl Stellmach. “Integrating the Social Sciences in Epidemic Preparedness and Response: A Strategic Framework to Strengthen Capacities and Improve Global Health Security.” Globalization and Health 16, No. 1 (December 2020): 1–18. https://doi.org/10.1186/s12992-020-00652-6
Bazyar, Jafar, Mehrdad Farrokhi, Amir Salari, and Hamid Reza Khankeh. “The Principles of Triage in Emergencies and Disasters: A Systematic Review.” Prehospital and Disaster Medicine 35, No. 3 (June 2020): 305–313. https://doi.org/10.1017/S1049023X20000291
Bentham, Jeremy. Deontology ; Together with a Table of Springs of Action; and the Article on Utilitarianism. England: Oxford University Press, 1983.
Bufacchi, Vittorio. “Justice as Non-Maleficence.” Theoria 67, No. 162 (March 2020): 1–27. https://doi.org/10.3167/th.2020.6716201
Close, Eliana, Simon Young, Tina Cockburn, Lindy Willmott, and Ben P White. “Legal Challenges to ICU Triage Decisions in the COVID-19 Pandemic: How Effectively Does the Law Regulate Bedside Rationing Decisions in Australia?” University of New South Wales Law Journal 44, No. 1 (April 2021): 9–59. https://doi.org/10.53637/FSJG1698
Croce, Yoann Della. “Epistemic Injustice and Nonmaleficence.” Journal of Bioethical Inquiry 20, No. 3 (September 2023): 447–456. https://doi.org/10.1007/s11673-023-10273-4
Darmawati, Noviani and Iman Rozani. “Pengaruh Alokasi Bantuan Pengendalian Penyakit Avian Influenza (Flu Burung) Selama Kurun Waktu 2013-2016.” Jurnal Ekonomi Pertanian dan Agribisnis 5, No. 1 (January 2021): 156–167. https://doi.org/10.21776/ub.jepa.2021.005.01.15
Eleni (Elena) Douvika, “Comparative Approach of Triage’s Legal Regulation,” Bioethica 8, no. 2 (November 2022): 65–84. https://doi.org/10.12681/bioeth.31781
Emanuel, Ezekiel J., Govind Persad, Ross Upshur, Beatriz Thome, Michael Parker, Aaron Glickman, Cathy Zhang, Connor Boyle, Maxwell Smith, and James P. Phillips. “Fair Allocation of Scarce Medical Resources in the Time of Covid-19.” New England Journal of Medicine 382, No. 21 (May 2020): 2049–2055. https://doi.org/10.1056/NEJMsb2005114
Fitriah, Sephin and Rio Christiawan. “Jaminan Pemerintah untuk Tenaga Kesehatan yang Terlibat dalam Penanganan Covid-19.” Jurnal Hukum Staatrechts 6, No. 1 (August 2, 2023): 80–96. https://doi.org/10.52447/sr.v6i1.7042
George, Aaron Samuel; Ganesan, Priya; Christopher, Jeyalinda; Paul, Sheeba, “A review of triage practices and evolution of christian medical college, Vellore triage system (CMCTS) during the COVID-19 pandemic,” Current Medical Issues 19, no. 4 (October 2021): 292–299, https://doi.org/http://dx.doi.org/10.4103/cmi.cmi_77_21
J. A., Sofia. “Kajian Penerapan Etika Dokter pada Pemberian Pelayanan Kesehatan di Era Pandemi Covid-19.” Jurnal Hukum dan Pembangunan Ekonomi 9, No. 1 (July 2021): 16–25. https://doi.org/10.20961/hpe.v9i1.52592
Jaziri, R., and S. Alnahdi. “Choosing Which COVID-19 Patient to Save? The Ethical Triage and Rationing Dilemma.” Ethics, Medicine and Public Health 15 (October 2020): 1–12. https://doi.org/10.1016/j.jemep.2020.100570
Joynt, G M, D P Gopalan, A A Argent, S Chetty, R Wise, V K W Lai, E Hodgson, et al. “The Critical Care Society of Southern Africa Consensus Statement on ICU Triage and Rationing (ConICTri).” South African Medical Journal 109, No. 8b (August 2019): 36–52. https://pmc.ncbi.nlm.nih.gov/articles/PMC10503494/
Knochel, Kathrin, Eva‐Maria Schmolke, Lukas Meier, and Alena Buyx. “Translating Theories of Justice into a Practice Model for Triage of Scarce Intensive Care Resources during a Pandemic.” Bioethics 38, No. 3 (March 2024): 223–332. https://doi.org/10.1111/bioe.13198
Maves, Ryan C., James Downar, Jeffrey R. Dichter, John L. Hick, Asha Devereaux, James A. Geiling, Niranjan Kissoon, et al. “Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation.” Chest 158, No. 1 (July 2020): 212–225. https://doi.org/10.1016/j.chest.2020.03.063
Morrow, B M, P D Gopalan, I Joubert, F Paruk, and A Pope. “Critical Care Triage during the COVID-19 Pandemic in South Africa: A Constitutional Imperative!” South African Medical Journal 110, No. 12 (November 2020): 1176–1179. https://scielo.org.za/pdf/samj/v110n12/16.pdf
Ningsih, Winda. “Kesiapan Rumah Sakit dalam Pencegahan Penularan Covid-19 pada Tenaga Kesehatan di Rumah Sakit X Purwodadi.” JKM (Jurnal Kesehatan Masyarakat) Cendekia Utama 10, No. 1 (August 2022): 110–127. https://doi.org/10.31596/jkm.v10i1.1033
Peta, Dawn, Alison Day, Walter Sergio Lugari, Vanessa Gorman, Nurul’Ain Ahayalimudin, and Vientiane Melchizedek T. Pajo. “Triage: A Global Perspective.” Journal of Emergency Nursing 49, No. 6 (November 2023): 814–825. https://doi.org/10.1016/j.jen.2023.08.004
Pratiwi, Santy Widi. “Analisis Kelembagaan Bencana: Studi Kasus Penanggulangan Bencana Non Alam Covid-19 di Kota Salatiga.” JIIP: Jurnal Ilmiah Ilmu Pemerintahan 6, No. 2 (September 2021): 234–251. https://doi.org/10.14710/jiip.v6i2.11193
Purwacaraka, Manggar, Rio Ady Erwansyah, Shulhan Arief Hidayat, and Farida Farida. “Hubungan Ketepatan Triase dengan Keberhasilan Penatalaksanaan Tindakan Keperawatan Kegawatdaruratan Ruang IGD di Rumah Sakit Daerah Tulungagung.” Professional Health Journal 5, No. 2 (January 2024): 597–605. https://doi.org/10.54832/phj.v5i2.681
Rubio, Rubén Darío Camargo. “Los Aspectos Morales Bioéticos y Científicos Guían Las Decisiones En El Contexto de Recursos Escasos Durante La Pandemia Por COVID-19.” Acta Colombiana de Cuidado Intensivo 21, No. 3 (July 2021): 212–220. https://doi.org/10.1016/j.acci.2020.10.005
Savulescu, Julian, Ingmar Persson, and Dominic Wilkinson. “Utilitarianism and the Pandemic.” Bioethics 34, No. 6 (July 2020): 620–632. https://doi.org/10.1111/bioe.12771
Savulescu, Julian, James Cameron, and Dominic Wilkinson. “Equality or Utility? Ethics and Law of Rationing Ventilators.” British Journal of Anaesthesia 125, No. 1 (July 2020): 10–15. https://doi.org/10.1016/j.bja.2020.04.011
Sjamsuhidajat, R, Putri Dianita Ika Meilia, and Itsna Arifatuz Zulfiyah. “Etika Kedokteran dalam Kegiatan Tanggap Darurat Bencana.” Jurnal Etika Kedokteran Indonesia 4, No. 1 (February 2020): 1–8. https://www.academia.edu/107588471/Etika_Kedokteran_dalam_Kegiatan_Tanggap_Darurat_Bencana
Smith, George P. “Crisis Standards of Care and Triage: Medico-Legal Conundrums.” SSRN Electronic Journal, (June 2024): 751–777. https://doi.org/10.2139/ssrn.4849110
Susilo, Astrid Pratidina; Dewi, Ervin Dyah Ayu Masita. “Dilema Etik di Rumah Sakit saat Keterbatasan Sumber Daya dalam Pandemi Covid-19,” KELUWIH : Jurnal Sosial dan Humaniora 2, No.2 (October 2021): 96–100. https://doi.org/10.24123/soshum.v2i2.4647
Tutić, Andreas, Ivar Krumpal, and Friederike Haiser. “Triage in Times of COVID-19: A Moral Dilemma.” Journal of Health and Social Behavior 63, No. 4 (December 2022): 560–576. https://doi.org/10.1177/00221465221080958
Varkey, Basil. “Principles of Clinical Ethics and Their Application to Practice.” Medical Principles and Practice 30, No. 1 (June 2020): 17–28. https://doi.org/10.1159/000509119
Xiya Ma and Dominique Vervoort, “Critical Care Capacity during the COVID-19 Pandemic: Global Availability of Intensive Care Beds,” Journal Critical Care 58 (August 2020): 96–97. https://doi.org/10.1016/j.jcrc.2020.04.012
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Refbacks
- There are currently no refbacks.
