Study Guide Medical Profesionalism

8/18/2019 Study Guide Medical Profesionalism

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Study Guide MedicalProfessionalism

~ CURRICULUM ~

Aims:

Comprehend the central position of professionalism in contemporary medicalpractice

Apply professionalism in the context of primary health care settings

Learning outcomes:

Awareness of professional, moral, ethical and legal implications of medical practice

Comprehension of the significance of the three dimensions of professionalism

underlying contemporary medical practice

Develop awareness and basic skill required to nurturing professional personalattributes: compassion, integrity, truthfulness, truth-worthiness, and lifelongcommitment or habit to maintaining professional competence and standards

Develop awareness and respect to the needs of a diverse patient population in terms

of gender, beliefreligion, education, ethnicity, and socio-cultural background

Differentiate between professional, moral and ethical issues

Able to understand and explain about bioethics, bioethical theories, research ethics,

clinical ethics, public health ethics, and biomedical ethics!

Able to differentiate between ethics, discipline, and law!

Able to apply philosophy of medicine and ""#$ in %ioethics! Apply the principles of biomedical ethics and ethical reasoning to formulate

questions while making ethical-decision!

Able to understand and explain about #&D'#( and #&D')*( in relation to

bioethical theories and health care!

Critically analy+e ethical issues commonly encountered in medical practice!

Able to resolve ethical issues faced during common clinical scenarios!

Curriculum contents:

Defining professional, moral and ethical issues

he three dimensions components of medical professionalism

Common educational strategies to nurture the development of affective behaviors

%asic principles and strategies of cross-cultural communication

$ational and global legal systems governing medical practice

he principles of moral and ethical reasoning, and ways to avoid pitfalls

*kills related to applying the basic principles of professionalism in virtual or real

patients

aculty of .edicine /dayana /niversity,D.' 1


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~ PLANNERS TEAM ~

NONAME

DEPARTMENT

0 dr! (!%! Alit, D.! *p! 12ead3 orensic .edicine

4 dr! ( 5! *ugiritama,.!#es 1*ecretary3 2istology

6 "rof! Dr! dr! $! .angku #armaya, .!)epro Anatomy

7 Drs! *upriyadi, .!*i "sychology

8 dr! Dudut )ustyadi, *p!, *2 orensic .edicine

9 dr! 2enky, *p!!, .,%'th!, AC.! orensic .edicine

; D)! dr! Dyah "aramitha D! .!#es "ublic 2ealth

< dr! A!A! *agung *awitri, ."2 "ublic 2ealth

= dr! $i $engah Dwi atmawati *p!.#, "hD .icrobiology

0> dr! #unthi ?ulianti *p! orensic .edicine

~ LECTURERS ~

NONAME DEPARTMENT PHONE

0 "rof! Dr! dr! $! .angku #armaya,.!)epro

Anatomy >


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~ ACILITATORS ~

Regular Class !Class A"

No Name #rou$ De$artment P%one&enue

!'n(

)loor"

0dr! ( "utu #urniyanta, *p!An

A0 Anasthesi >0

4dr! ( "utu %ayu .ayura, *!#ed

A4.icrobiology >4

6Dr! uh *eri Ani, *!#.,.!#es

A6"ublic 2ealth >6

7dr! "ratihiwi "rimadharsini,.!%iomol, *p!"D

A7(nterna >0=9 4nd floor:

)!4!>7

8dr! ( @ede "utu *upadmanaba,*!#ed

A8%iochemistry >0=8 4nd floor:

)!4!>9

;dr! $i .ade aksmi /tari,.!%iomed, *p!.

A;&pthalmology >;

<Dr!dr! ( @ A *ri .ahendra Dewi,*p!"A1#3

A< Anatomy"athology

>6

7dr! ( @ A Artini, .!*c

%7"harmacology >77

8dr! ( @st! anang $gurah Agung Artha 5iguna, *p!& 1#3

%8&rthopaedy >


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0>dr! ( .ade *udipta, *p!2- #

%0>'$ >> >=!08

>=!08 0>!6>0>!6> 04!>>04!>> 04!6>04!6> 07!>>07!>> 08!>>

>=!08 >=!6>>=!6> 0>!6>

04!>> 06!6>06!6> 08!>>00!6> 04!>>0>!6> 00!6>08!>> 09!>>

Intro(uction to t%e *loc3Lecture : Pro)essionalPersonal Attri4ute(nd! earning*@D%reak*tudent "roect"lennary

Class roomClass room

-Disc! room-Class roomClass room

Alit.angku #

-acilitator -

.angku #

'

5e(nes(a.

-6/01/'0-2

>> >=!>>>=!>> 0>!>>0>!>> 00!>>00!6> 04!>>04!>> 06!6>06!6> 08!>>

>=!>> 0>!>>0>!>> 00!>>00!>> 04!>>04!6> 06!>>06!>> 07!6>07!6> 09!>>

Lecture : *ioet%ics*@D"lennary%reak(nd! earning*tudent "roect

Class roomDisc! roomClass room/--

2enkyacilitator 2enky---

6

T%urs(a.

-1/01/'0-2

>> >=!>>

>=!>> 0>!>>0>!>> 00!>>00!6> 04!>>04!>> 06!6>06!6> 08!>>

>=!>> 0>!>>

0>!>> 00!>>00!>> 04!>>04!6> 06!>>06!>> 07!6>07!6> 09!>>

Lecture : *ioet%icalT%eories*@D"lennary%reak(nd! earning*tudent "roect

Class room

Disc! roomClass room/--

2enky

acilitator 2enky---

1

ri(a.

-7/01/'0-2

>> >=!>>

>=!>> 0>!>>0>!>> 00!>>00!6> 04!>>

04!>> 06!6>06!6> 08!>>

>=!>> 0>!>>

0>!>> 00!>>00!>> 04!>>04!6> 06!>>

06!>> 07!6>07!6> 09!>>

Lecture : In)orme(consent8 con)i(entialit.8Patient9s rig%t autonom. *@D"lennary%reak

(nd! earning*tudent "roect

Class room

Disc! roomClass room/

--

Alit

acilitator Alit-

--

7Mon(a.

-;/01/'0-2

>> >=!>>

>=!>> 0>!6>0>!6> 04!>>04!>> 04!6>04!6> 07!>>07!>> 08!>>

>=!>> 0>!>>

04!>> 06!6>06!6> 08!>>00!6> 04!>>0>!>> 00!6>08!>> 09!>>

Lecture : A/01/'0-2

>> >=!>>

>=!>> 0>!6>0>!6> 04!>>

04!>> 04!6>04!6> 07!>>07!>> 08!>>

>=!>> 0>!>>

04!>> 06!6>06!6> 08!>>

00!6> 04!>>0>!>> 00!6>08!>> 09!>>

Lecture : Researc%Et%ics(nd! earning*@D

%reak*tudent "roect"lennary

Class room

/Disc! room

/Disc! roomClass room

Dwi atmawati

-acilitator

--Dwi atmawati

?5e(nes(a.

'0/01/'0-2

>> >=!>>

>=!>> 0>!6>0>!6> 04!>>04!>> 04!6>04!6> 07!>>07!>> 08!>>

>=!>> 0>!>>

04!>> 06!6>06!6> 08!>>00!6> 04!>>0>!>> 00!6>08!>> 09!>>

Lecture : Pu4lic Healt%Et%ics(nd! earning*@D%reak*tudent "roect"lennary

Class room

/Disc! room/Disc! roomClass room

*awitri

-acilitator --*awitri

;T%urs(a.

'-/01/'0-2

>> >=!>>>=!>> 0>!>>0>!>> 00!>>

00!6> 04!>>04!>> 06!6>06!6> 08!>>

>=!>> 0>!>>0>!>> 00!>>00!>> 04!>>

04!6> 06!>>06!>> 07!6>07!6> 09!>>

Lecture : Clinical Et%ics*@D"lennary

%reak(nd! earning*tudent "roect

Class roomDisc! roomClass room

/--

2enkyacilitator 2enky

---



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>

ri(a.

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Lecture : Em$at%.(nd! earning*@D%reak*tudent "roect"lennary

Class room/Disc! room/Disc! roomClass room

*upriyadi-acilitator -

*upriyadi

-0Mon(a.

'7/01/'0-2

>> >=!>>

>=!>> 0>!>>0>!>> 00!>>00!6> 04!>>04!>> 06!6>06!6> 08!>>

>=!>> 0>!>>

0>!>> 00!>>00!>> 04!>>04!6> 06!>>06!>> 07!6>07!6> 09!>>

Lecture : Legal As$ect o)Me(ical Practice*@D"lennary%reak(nd! earning*tudent "roect

Class room


Dudut

acilitator Dudut---

--Tues(a.

'2/01/'0-2

>> >=!>>

>=!>> 0>!>>0>!>> 00!>>00!6> 04!>>04!>> 06!6>06!6> 08!>>

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Lecture : Me(icalMal$ractice*@D"lennary%reak(nd! earning*tudent "roect

Class room


Dudut

acilitator Dudut---

-'5e(nes(a.

'?/01/'0-2

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>=!>> 0>!>>0>!>> 00!>>00!6> 04!>>04!>> 06!6>06!6> 08!>>

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0>!>> 00!>>00!>> 04!>>04!6> 06!>>06!>> 07!6>07!6> 09!>>

Lecture : Legal As$ect o)

Me(ical Recor(8 Me(icalCerti)ication an( &isumet Re$ertum*@D"lennary%reak(nd! earning*tudent "roect

Class room


Alit

acilitator Alit---

-6T%urs(a.

';/01/'0-2

>> >=!>>>=!>> 0>!>>0>!>> 00!>>00!6> 04!>>04!>> 07!>>

>=!>> 0>!>>0>!>> 00!>>00!>> 04!>>04!6> 06!>>07!>> 09!>>

Lecture : Me(ical Recor(*@D"lennary%reakStu(ent Pro@ectPresentation !I8II"

Class roomDisc! roomClass room/Class room-

#unthiacilitator #unthi-ecturer -

*ASIC CLINICAL SILL

-1

ri(a.

'>/01/'0-2

>> >=!>>0>!>> 06!>>

06!>> 08!>>

>=!>> 0>!>>06!>> 09!>>

0>!>> 06!>>

#uest LectureStu(ent Pro@ectPresentation !III8I&8&"In(B Learning

Class room

Class room-

(D(

ecturer-

-7Mon(a.

0'/07/'0-2

>> >=!>>

0>!>> 06!>>06!>> 08!>>

>=!>> 0>!>>

06!>> 09!>>0>!>> 06!>>

Lecture : Me(icalCerti)ication an( &isumet Re$ertum 5riting S3illTrainingIn(B Learning

Class room-

orensic eam

orensic eam

Tues(a.

06/07/'0-2 Pre$aration )or Eam5e(nes(a.

01/07/'0-2 EAMINATION %lock eam

&enue:ecture and "lenary session : ecture )oom 7!>4, 7th floor @roup discussion : Discussion room of west wing 4nd floor, room with partitionsno! 4!>0-4!>< and rooms no! 4!40!4!44



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~ MEETIN# O STUDENT REPRESENTATI&ES AND ACILITATORS~

.eeting of student representatives and facilitators will be held on riday 44n( A$ril '0-2Bhis meeting will be organi+ed by the planners and attended by lecturers, student group

representatives and all facilitators! .eeting with student representatives will take place at-'B00 until -'B17 $m and meeting with the facilitators at -'B17 until -6B60 $mB he purposeof the meeting is to evaluate the teaching learning process of the %lock! eedbacks andsuggestion are welcome for improvement of the %lock educational programs!

~ STUDENT PROECT ~*tudent have to write a paper with topics that has been given by lecturer! he topic will bechosen randomly on day 0, each small group discussion should work one paper! *tudentsmake a paper as student proect an will be presented in front of the class! he paper andthe presentation will be evaluated by respectively facilitator and lecturer!

ormat of the paper :0 Cover :

ittle$ame

*tudent )egistration $umber aculty of .edicine, /dayana /niversity 4>09

4 (ntroduction6 Content7 Conclusion8 )eferences 1minimal 6 refferences3

$ote : 8-0> pagesE 0,8 line spacingE imes new roman 04

~ ASSESSMENT METHOD ~

Cognitive assessment will be carried out on 5ednesday 1t% Ma. '0-2! he test will beconsist of 0>> questions with 0>> minutes provide for working! he assessment will be heldat the same time for both )egular Class and 'nglish Class! *@DFs and student proectFsmark will be include in the final score as describe below! he overall passing scorerequirement is G;>! .ore detailed information or any changes that may be needed will beacknowledged at least two days before the assessment!

*kill assessment will be carried out at the end of the semester using &bective*tructured Clinical examination 1&*C'3!

*@D will be reviewed every day by facilitator with a standard *@D assessment andit contributes 8H to final score! *tudent proects as a summative assessment account for 08H of the final score!



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~ LEARNIN# PRO#RAMS ~

A4stracts o) Lectures

"eople come to physician for help with their most pressing needs-relief from pain andsuffering and restoration of health and well being! hey allow physicians to see, touch andmanipulate every part of their bodies, even the most intimate! hey do this because theytrust their physicians to act in their best interests!

5hat constitutes a good doctorI (s technical proficiency sufficient to be a gooddoctorI Clearly, a physician cannot lack necessary technical knowledge and skills and stillbe a good doctor! ess clear is whether a technically proficient physician can lack

interpersonal skills necessary to relate well to patients and still be a good doctor! hephysicianFs interpersonal skills are critical to establishing strong, trust-based physician-patient relationships that offer multiple benefits! .ost patients want a strong relationshipwith a primary care physician!

he quality of a patientFs relationship with a physician can affect not only a patientFsemotional responses but also behavioral and medical outcomes such as compliance andrecovery! Consequently, physicians have been urged to improve their communication andpatient education techniques, develop their empathetic abilities, encourage participativedecision making, and convey respect and dignity!

"atients need good doctors! Good doctors make the care of their patients their first concern; they are competence, keep their knowledge and skills up to date,establish and maintain good relationships with patients and colleagues, are honest

and trustworthy, and act with integrity.

)efferences :0! ony 2ope et al! .edical ethics and aw the core curriculum! Churchill ivingstone!

'dinburgh! 4>>6 page : 80-8;

4! C.A! "rofessionalism in .edicine!4>>0

6! %endapudi,$!.! et al! "atientFs "erspectives on (deal "hsician %ehaviours! MayoClin Proc !4>>9!


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Bioethics is the ethics of biological science and medicine Bioethics concerns theethical !uestions that arise in the relationshi"s bet#een biology$ ecology$medicine$ cybernetics$ "olitics$ la#$ "hiloso"hy$ theology$ and social science %thas a broad meaning$ ho#e&er in this lecture$ the sco"e #ill be restricted to theareas of human life in #hich medicine andthe biomedical sciences can a'ect human #ell(being ) for good or for ill

Bioethics has a &ery long history *thical codes$ such as the +i""ocratic ,athand the -hara.a Samhita ,ath$ has been a""lied in medical "ractice as a codeof conduct since ancient times %n the nineteenth and early t#entieth centuriesthe ra"id e/"ansion of biological sciences began to raise ne# !uestions aboutthe "ossibilities for human "rogress and the "otential con0icts bet#een science

and religion e&ertheless$ the birth and ra"id de&elo"ment of modern bioethicscame as a result of the atrocities of the Second orld ar$ #hich brought us theethics of medical research

n e&en more "otent in0uence came from the dramatic e/"ansion of medicinesca"acity to sa&e li&es and either cure or "re&ent disease$ through the "roductionof a &ast range of "harmaceuticals and &accines$ the renement of life(sa&ingmedical technologies such as dialysis and heart(lung machines$ and maorim"ro&ements in surgical techni!ues et$ of course$ e&ery ne# ad&ance broughtfresh ethical "roblems ith the ad&ent of organ trans"lantation$ it becamenecessary to nd a ne# denition of death ) 8brain death ) so that the organs tobe trans"lanted #ould remain &iable9 and the ability to .ee" "eo"le ali&e onmachines did not necessarily mean that the !uality of a "atients life #asim"ro&ed or e&en maintained Moreo&er$ the massi&e commercial "o#er of thetransnational "harmaceutical and medical technology industries could also "osea maor threat to health$ through the medicali:ation of all human e/"eriencefrom birth to death ;hese "henomenon ga&e birth to clinical ethics

Globally$ ;he +, has focused on ustice in health care resources$ as #ell as arecognition of the social determinants of ill(health ) "o&erty$ unem"loyment$lac. of education and absence of ade!uate food$ clean #ater and sanitation ;heissues of breast feeding$ tobacco use$ +%S$ global "andemics$ global#arming and its detrimental e'ects on human health ha&e entered into

bioethical discussion as "ublic health ethics

?astly$ the e/"onential de&elo"ment of human genetics follo#ing the ma""ing of the human genome has raised some .ey !uestions about the determinants of human beha&ior$ the "otential for "redicting disease and disability and the"rotection of human "ri&acy ;his has led to a broadening out of bioethics from afocus on health care and the clinical relationshi" to 8biomedical ethics$ the studyof the ethical im"lications of ndings in the biosciences$ "articularly in genetics

Re)erences:0! Campbell AB! %ioethics he %asic! &xon: )outledgeE 4>06!

aculty of .edicine /dayana /niversity,D.'

Lecture: *ioet%icsdr! 2enky, *p!!, .,%'th!, AC.!

@


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;heory is an account of the #orld that goes beyond #hat #e can see andmeasure %t embraces a set of interrelated denitions and relationshi"s thatorgani:e conce"ts in a systematic #ay ;he conce"t itself is dened as theterminological means by #hich bioethicists see. to analyse moral "henomenon$to classify the obects of the obser&ed #orld$ im"art meaning throughe/"lanation to selected "henomena and formulate higher(order "ro"ositions of #hat #e ought to do in gi&en situations$ #hat #e ta.e to be Agood or Abad$

Aright or A#rong

;heory is im"ortant because C1D %t allo#s us to "roduce a Astory about ho# themoral #orld o"erates or should o"erate %t brings Aorder to the Achaos throughgenerali:ations and classications of the moral$ social and "olitical uni&erse$ C2D%t gi&es meaning and focus to moral in!uiry or in&estigation ;heories o'er acoherent strategy for thin.ing about moral "henomena$ #hat #e are doing or#hat #e ought to do across time$ s"ace$ and situations$ C3D %t sets the "u::lesCAethical dilemmasD and standards for their solution ,nce something has beenidentied as a bioethical dilemma or issue$ theory sha"es action that is ta.en toresol&e the "roblem9 C4D Bioethical theory see.s not only to ma.e thingsintelligible$ but to ma.e them Abetter by setting standards for beha&iour*thical discourse is a codied body to abstract .no#ledge held by e/"erts aboutthe 8good and #ays to reali:e it$ C5D ;heory is a Abo/ of tools that suggest #aysof loo.ing at the #orld that can ma.e the strange familiar9 re&eal ta.en(for(granted &alues$ hidden moral "remises$ norms$ intentions$ that informarguments and diagnosis

Generally$ bioethics focuses on normati&e and a""lied theories %n this lecture$some of "o"ular a""roaches on normati&e and a""lied ethics #ill be disscused$including &irtue theory$ conse!uentialism$ .antianism$ communitarianism$libertarianism$ and "rinci"lism

Re)erences:0! (rvine )! Critical Concepts in %ioethics 1ecture $otes3! *ydney: he /niversity of

*ydneyE 4>06!4! Campbell AB! %ioethics he %asic! &xon: )outledgeE 4>06!6! %eauchamp , Childress ! "rinciples of %iomedical 'thics! ;th ed! $ew ?ork: &xford

/niversity "ressE 4>06!7! 2ope , *avulescu , 2endrick ! .edical ethics and law: the core curriculum! 4nd ed!

'dinburgh: Churchill ivingstone, 4>>

"ress aylor J rancis @roupE 4>09!

;! #ode 'tik #edokteran (ndonesia 1#&D'#(3E 4>04!


Lecture: *ioet%ical T%eoriesdr! 2enky, *p!!, .,%'th!, AC.!

E


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%ase on "rinciples of %ioethics, Autonomy is one of principles that must be concern by thedoctor! Autonomy is the rights to self determination and the patient not only the obect of treatment but also has role in making decision! he doctor must respect to this rights

because this rights is 2uman )ights for all person!

"atients are entitled to make decisions about their medical care and to be given relevantinformation on which to base such decisions! he physicianKs obligation to obtain thepatientKs consent to treatment is grounded in the bioethical principles of patient autonomyand respect for persons and is affirmed by (ndonesian law and professional policy! A largebody of research supports the view that the process of obtaining consent can improvepatient satisfaction and compliance and, ultimately, health outcomes!

"hysician must disclose relevant and detail information, so the patient can understand itclearly! %oth elements are necessary for valid consent! "hysician should inform the patientadequately about the treatment and its expected effects, relevant alternative options and

their benefits and risks, and the consequences of declining or delaying treatment! hephysicianFs goal is to disclose information that a reasonable person in the patientKs positionwould need in order to make an informed decision! herefore, physician may need toconsider how the proposed treatment 1and other options3 might affect the patientKsemployment, finances, family life and other personal concerns! "hysician may also need tobe sensitive to cultural and religious beliefs that can affect disclosure!

he situation in which an adult lacks the capacity, for whatever reason, to make an informeddecision is somewhat confused! 5here a patient is suffering from a mental condition, hemay be given treatment for his mental condition without consent! (n emergency, such as anaccident where the victim is unconscious or shocked, no permission is necessary anddoctors must do as they think best for the patient in those urgent circumstance! 'xceptionsto the principle of informed consent also occur with regard to persons with impaired, such aschildren who are usually represented by a third party, such as parents or other closerelatives, vis-L-vis the physician! *ubstitute decision-making poses two main questions:5ho should make the decision for the incapable person, and, how should the decision bemadeI o answer these questions, physician should become familiar with the legalrequirements!

"hysicians are obliged to keep information about their patients secret! he understandingthat the physician will not disclose private information about the patient provides afoundation for trust in the therapeutic relationship! )espect for confidentiality is firmly

established in codes of ethics and in law! (t is sometimes necessary, however, for physiciansto breach confidentiality! "hysicians should familiari+e themselves with legislation governingthe disclosure of certain kinds of information without the patientFs authori+ation! 'ven when


In)orme( consent8 con)i(entialit.8Patient9s rig%t autonom.

Dr! (!%! Alit, D.! *p

1F


11/39


no specific legislation applies, the duty to warn sometimes overrides the duty to respectconfidentiality! he physician should disclose only that information necessary to preventharm, and should reveal this information only to those who need to know it in order to avertharm! 5henever possible any breach of confidentiality should be discussed with the patientbeforehand!

Concept of Autonomy, take place the patient in doctor - patient relationship in theproportional position! he doctor and patient have )ights and (nterest that must berespected! he doctor has two kinds of duties : irst the duties that caused by patient-doctor relationship 1contractual bases3 and second the duties that regulated by the regulations andaw 1ort %ases3! "atient rights have recently become the centre of national attention in thepractice of medicine! "atient rights encompass legal and ethical issues in the provider-patient relationship, including a personKs right to privacy, the right to quality medical carewithout preudice, the right to make informed decisions about care and treatment options,and the right to refuse treatment!

he purpose of delineating patient rights is to ensure the ethical treatment of persons

receiving medical or other professional health care services! 5ithout any exception, allpersons in all settings are entitled to receive ethical treatment! A patientKs rights occur at many different levels, and in all specialties! he American .edical Association 1A.A3 outlines fundamental elements of the doctor-patient relationship in their Code of .edical 'thics! hese rights include the following:

0! he right to receive information from physicians and to discuss the benefits, risks,and costs of appropriate treatment alternatives

4! he right to make decisions regarding the health care that is recommended by thephysician

6! he right to courtesy, respect, dignity, responsiveness, and timely attention to healthneeds

7! he right to confidentiality

8! he right to continuity of health care

9! he basic right to have adequate health care

Re)erences :

• ony 2ope et al! .edical ethics and aw the core curriculum! Churchill ivingstone!

'dinburgh! 4>>6 page 90-

• ony 2ope et al! .edical ethics and aw the core curriculum! Churchill ivingstone!

'dinburgh! 4>>6 page >

• #ode 'tik #edokteran (ndonesia 1#&D'#(3!

• /ndang-/ndang )epublik (ndonesia $omor 4= ahun 4>>7 entang "raktik #edokteran


http://www.emedicinehealth.com/script/main/art.asp?articlekey=7132http://www.emedicinehealth.com/script/main/art.asp?articlekey=7132http://www.emedicinehealth.com/script/main/art.asp?articlekey=7132http://www.emedicinehealth.com/script/main/art.asp?articlekey=7132


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• "eraturan .enteri #esehatan )epublik (ndonesia $omor 4=>.'$#'*"')(((4>><

tentang "ersetuuan indakan #edokteran

• *hepherd, )! he 'thics of .edical "ractice in *impson,s orensic .edicine! welfth

'dition!4>>6! page >0

• %endapudi,$!.! et al! "atientFs "erspectives on (deal "hsician %ehaviours! Mayo Clin

Proc !4>>9!>6


A


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he origin of the word empathy dates back to the 0

(n doing research, the researcher should understand that they should maintain their integrity by providing reliable research data, and avoiding in doing fabrication, falsification,plagiarism, and false claims to authorship! /nderstanding research ethics and maintainingresearch integrity are keywords for researcher for their dignity in scientific field!


Em$at%.Drs! *upriyadi, .!*i!

Researc% Et%icsdr! $i $engah Dwi atmawati *p!.#, "hD

13


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Re)erences:0! Campbell AB! %ioethics he %asic! &xon: )outledgeE 4>06!

Achieving health for all is not easy! @overnment through the .inistry of 2ealth1.&23 have been conducting many health programs to increase the health status of community! 2ealth "rogram comprises several health activities that systematicallydeveloped, being massively conducted, and usually compulsory! 2ealth "rogramuses the concepts of preventive medicine and health promotion! "reventivemedicine deals on how to prevent of control disease, while health promotion ingeneral is encouraging healthier life styles by persuasion, education and legislation!

'ven though the goal of health program is good, to some limits there alwaspossibilities for a rising of ethical problems! his is because there is dilemma in termof keeping the balance between the goods of society with the freedom of theindividual! ailure in balancing social ustice or to fairly distributed the burdens andbenefits in society will lead to ethical issues in "2!

or example, screening program rise ethical issue due to uncertainty for thetest accuracy and whether these program should be done compulsory or optional!Baccination also lead to ethical issue due to some Nfree ridersO and decision on it tobe compulsory or optional! 'pidemic or pandemic control may reduce autonomy of persons and make any harm to a lot of community members! Another example is theimplementation of None child policyO in China, had also made serious problem not

limited to health and ethics! Despite the success of health program in making whatwe think is better for human, we face another problem! &ne example is calledparadox of health care, a phenomena of a continuing demand following thesuccesfull of one health programactivities and that outweighing the supply!

o maintain the ethical aspect in "2 program, we need to distribute theresources fairly in the macro, meso, and micro level! At the micro level, there is aproblem to prioritise fairly on who is to receive a given treatment when there are notresources to treat everyone! Puestions always rise on whether the rich person havebetter access than the poorI 5ho should come first to access the health serviceI&r 5ho shall liveI *ince health is not a luxury goods, ethical issue may rise whenwe prioritise health program without un-clear concept! here are six principles toallocate resources including equal share, according to individual choice, potential for future life years, what they deserve, social usefulness, and their needs!

Another "2 ethical issue is related to global inequity in health and the gobalsurvival! he first term refer to the higher burden of morbidity and mortality in lowand middle income countries compare to the high income countries! 5hile the globalsurvival questioning about the resources use by recent generation and what will beleft for the future generation!

Re)erences:

0! Campbell AB! %ioethics he %asic! &xon: )outledgeE 4>06!


Pu4lic Healt% Et%icsDr! A!A! *agung *awitri, ."2

14


15/39


*thical issues are imbedded in e&ery clinical encounter bet#een "atients andcaregi&ers because the care of "atients al#ays in&ol&es both technical andmoral considerations ;he central feature of this clinical encounter is thethera"eutic relationshi" bet#een a "hysician and a "atient$ a relationshi" that is"ermeated #ith ethical res"onsibilities Physicians must aim$ in the #ords of +i""ocrates$ Ito hel" and do no harmI Modern "hysicians a""roach the doctor)"atient relationshi" #ith a "rofessional identity that includes the obligations to"ro&ide com"etent care to the "atient$ to "reser&e condentiality$ and tocommunicate honestly and com"assionately

-linical ethics is a structured a""roach to ethical !uestions in clinical medicine-linical ethics de"ends on the larger disci"line of bioethics$ #hich in turn dra#su"on disci"lines such as moral "hiloso"hy$ health la#$ communication s.ills$ andclinical medicine ;he scholars called IbioethicistsI must master this eld+o#e&er$ clinicians in the daily "ractice of medicine can manage #ith a basicunderstanding of certain .ey ethical issues such as informed consent and end(of(life care -entral to the "ractical a""lication of clinical ethics is the ability toidentify and analy:e an ethical !uestion and to reach a reasonable conclusionand recommendation for action

Bioethics identies four ethical "rinci"les that are "articularly rele&ant to clinical

medicineH the "rinci"les of benecence$ non(malecence$ res"ect for autonomy$and ustice ;o these$ some bioethicists add em"athy$ com"assion$ delity$integrity$ and other &irtues ;he bioethical literature discusses these "rinci"lesand &irtues at length %n this lecture$ a method to identify the ethical dimensionsof "atient care and to analy:e and resol&e ethical "roblems #ill be introduced

;his method is useful for structuring the !uestions faced by any clinician #hocares for "atients ;he method is called the four to"ics #hich constitute theessential structure of a case in clinical medicine$ namely$ medical indications$"atient "references$ !uality of life$ and conte/tual features

Medical indications refer to the diagnostic and thera"eutic inter&entions that arebeing used to e&aluate and treat the medical "roblem in the case Patient

"references state the e/"ress choices of the "atient about their treatment$ orthe decisions of those #ho are authori:ed to s"ea. for the "atient #hen the"atient is inca"able of doing so Juality of life describes features of the "atientKslife "rior to and follo#ing treatment$ insofar as these features are "ertinent tomedical decisions -onte/tual features identify the familial$ social$ institutional$nancial$ and legal settings #ithin #hich the "articular case ta.es "lace$ insofaras they in0uence medical decisions

Re)erences:0! onsen A, *iegler ., 5inslade 5! Clinical ethics: A practical approach to ethical

decisions in clinical medicine! ;th ed! $ew ?ork: .c@raw-2illE 4>0>!

4! Campbell AB! %ioethics he %asic! &xon: )outledgeE 4>06!


Lecture: Clinical Et%icsdr! 2enky, *p!!, .,%'th!, AC.B

15


16/39


6! %eauchamp , Childress ! "rinciples of %iomedical 'thics! ;th ed! $ew ?ork: &xford/niversity "ressE 4>06!

7! 2ope , *avulescu , 2endrick ! .edical ethics and law: the core curriculum! 4nd ed!'dinburgh: Churchill ivingstone, 4>>

8! #erridge (2, owe ., *tewart C! 'thics and aw for the 2ealth "rofessions! 7th ed!

*ydney: he ederation "ressE 4>06!

According to the Assembly of (ndonesian aw of 2ealth, aw of 2ealth includes allregulation that is directly related to maintenanceservices of health care and itsF application,which includes Civil Code, Criminal Code and aw of Administration! aw of 2ealth isdivided into two, direct and indirect!

Direct La< o) Healt% is a law regulation that is directly related to maintenance of health, such as:

• Act $umber! 4= ?ear 4>>7 concerns of .edical "ractice

• Act $umber 69 ?ear 4>>= concerns of 2ealth

In(irect La< o) Healt% includes all application of law regulation that is related to lawspeciali+ation, such as: Civil Code, Criminal Code and aw of Administration which can beimplied in maintenanceservices of health care!

he purpose of aw of 2ealth is to provide legal protection and assurance to both givingand receiving parties in health care services! hus, aw of 2ealth consists of:

• .edicalDentistry aw• Clinical "harmacy aw

• 2ospital aw• Community 2ealth aw• 'tc!.edical aw is a aw of 2ealth in a constricted meaning, which is also the core of aw

of 2ealth which regulates the medical services! he meaning of .edical aw is divided intoa broad and constricted meaning!

Me(ical La< in t%e 4roa( meaning is all the regulations in medical services, such asmedical services provided by doctors, dentists, nurses, and laboratories!

Me(ical La< in t%e constricte( meaning is all the regulations that only cover thedoctorFs professions, such as:

• Doctor-patient relationship• .edical )ecord and medical Confidentiality

• (nformed Consent• .edical malpractice• 'uthanasia• 'tc!

)efferences :

0! *hepherd, )! he 'thics of .edical "ractice in *impson,s orensic .edicine!welfth 'dition! 4>>6!page 0-<

4! ony 2ope et al! .edical ethics and aw the core curriculum! Churchill ivingstone!'dinburgh! 4>>6 page : 6=-7=

6! *anbar, *!*! et al! egal .edicine and 2ealth aw 'ducation in : egal .edicine!*anbar, *!*! 1'd3! 0==


17/39


7! "iorkowski, !D!.edical testimony and the expert witness in : egal .edicine!*anbar, *!*! et al 1'd!3! 0==

A patient or hisher familyFs dissatisfaction towards a medical care received from adoctor or a hospital can evoke a legal action! he legal action occurred perhaps notbecause of the mistake done by a doctor or the hospital, but because of the breach inmedical ethics, medical disciplines, or even the criminal act and the medical malpracticeitself! &ccurrence of medical malpractice is solely because of the doctorFs negligence whichcauses loss for the patient and hisher family! o prove a malpractice has occurred, thereare two proving procedures or mechanism, the first is direct proving method using 7DcriteriaE Duty, Dereliction of duty, Damage and Direct causation! he second provingprocedure is via indirect method using doctrine Res Ipsa Loquitor (the thing speaks for itself).

)efferences :

0! ony 2ope et al! .edical ethics and aw the core curriculum! Churchill ivingstone!

'dinburgh! 4>>6 page : 08-40

4! lamm, .!%! .edical .alpractice and the physician defendant in : egal .edicine*anbar, *!*! et al! 1'd!3 0==


Criminal La< an( Me(ical Mal$racticedr! Dudut )ustyadi, *p!, *2

Legal As$ect o) Me(ical Recor(8 Me(ical Certi)ication an(Visum et epertum !Me(ico/legal re$ort"

Dr! (!%! Alit, D.! *p

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%asic principal of medical certificate on medicolegal aspect mainly consist of factand medical opinion! acts based on medical examination meanwhile medical opinion madeaccording to medical procedure! herefore, medical certificates are tightly attached tomedical confidentiality!

Doctor profession has many responsibilities, one of them is legal duty! his

responsibility is an obligation mainly assisting law and trial process! or instance, Bisum etrepertum is medical certificate made for law enforcement! he division of visum et repertumdepends on substance needed by the state! @enerally, it is differentiated in to "sychiatricBisum et )epertum and "hysical Bisum et )epertum! "hysical Bisum et repertum can bedivided in to death victim Bisum et repertum and live victim Bisum et repertum! .eanwhilelive victim visum et repertum can be made for physical violence and toxin Be) and sexualharassment Be)!

.edical record in other hand is a note for all medical information collected frompatient examination and analysis including medical procedure performed! .edical record iscompulsory to all practicing doctor which has function for administration, legal, financial,research data and education! (ts legal function needed as a source for medical certificateand Be) aside used as written evidence on medical dispute!

)efferences :0! 2irsh, 2!! .edical )ecord in : egal .edicine! *anbar, *!*! et al 1'd!3!0==

ecord is used to describe the systematic documentation of "atients medicalhistory and care across time #ithin one "articular health care "ro&iders urisdiction Medical ecord is &ery im"ortant as it contains &arious ty"es of notes entered o&er time by health care "rofessionals$ diagnosis$ test results andalso recording obser&ation and orders for drugs administration and thera"ies

;he "ur"ose of medical re"ort is to ensure documentation of com"liance #ithinstitutional$ "rofessional or go&ernmental regulation ;he information containedin the medical record also allo# the health care "ro&iders to determine the"atients medical history and "ro&ide informed care Medical ecord also ser&esa "ur"ose as the mean of communication among "atient$ health care "ro&iderand other "rofessionals contributing to "atients care "art from being a

medical re"ort itself$ Medical ecord are legal document #hich can be used as abasis for hos"ital de&elo"ment$ building statistic also for educational and


Me(ical Recor(dr! #unthi ?ulianti *p!

1@


19/39


uridical "ur"ose %n the ser&ice of clinical forensic medicine$ Medical ecord areused es"ecially in the la# enforcement

?egal basis of medical record in %ndonesia are regulation number 2E=2FF4 onMedical Practice and Ministry of +ealth regulation CPermen.esD number

26E=M*L*S=P*=%%%=2FF@ on Medical ecord %n medical record$ the diagnosisrefer to %-> %nformation relating to Medical ecord is condential #hich shouldbe .e"t only by doctors$ students$ certain health #or.ers$ medical records oNcerand chairman of health care facilities -ontents of Medical ecord can be o"enedthrough the regulation a""licable in %ndonesia

Re)erences:

0! /ndang-undang )epublik (ndonesia nomer 4= tahun 4>>7 tentang "raktek #edokteran4! "eraturan .enteri #esehatan )( nomer 26E=M*L*S=P*=%%%=2FF@6! +, Medical record manual H guide for de&elo"ing country 5orld 2ealth

&rgani+ation H estern Pacic region9 2FF67! +ealth information systems .no#ledge hub >o.umentating medical record H

handboo. for doctors Oni&ersity of Jueensland9 2F138! 52&! (CD Q : (nternational statistical classification of disease and related health

problem! 4>0> ed! 5orld 2ealth &rgani+ationE 4>00!

LEARNIN# TASS

&ignette -

.r! A complained that when urinating he had pain! 2e went to a hospital and was managed

by an urologist who said that laser treatment should be performed because it might be due

to prostate! *o far only /*@ had been performed! he doctor was threatening to such an

extent that the patient sister started crying! he threat was made like this: N(f a laser is not

performed, you will have to read the holy verses,M that is, he would die! his physicianproceeded to perform intravenous pyelography! hen the patient was instructed to undergo

a laser treatment that same evening by paying an advance of approximately )p!


Day 1

Pro)essional Personal Attri4ute

1E


20/39


08!>>>!>>>,-! he patient was bewildered and contacted his brother who was engaged in

the health field! 2e told him to delay it for one day until he would reach there! %ut the

physician got angry and said, (f this was not conducted, he would not care any more! (t was

not until reali+ing who his brother was that the physician was alerted! 2e asked what he

should do to apologi+e for what he had done! inally, the hospital director and one of his

staff apologi+ed to his brother! he patients decided to go to another private hospital whereultrasonography 1/*@3 and other specific laboratory examinations showed that it was an

inflammation!

Assignments:

0! (dentify the moral-ethical issue in this case4! (dentify the professional personal attribute in this doctor-patient relationship6! 5hat is your view about the doctorFs attitude in this caseI1B 2as the doctor tried to demonstrate hisher empathyI 'xplainR

&ignette 'Dr! "! an experienced and skilled surgeon, is about to finish night duty at medium-si+edcommunity hospital! A young woman is brought to the hospital by her mother, who leavesimmediately after telling the intake nurse that she has to look after her other children! hepatient is bleeding vaginally and is in great deal of pain! Dr! " examines her and decidesthat she has had either a miscarriage or self induced abortion! 2e does a quick dilatationand curettage and tells the nurse to ask the patient whether she can afford to stay in thehospital until it is safe for her to be discharged! Dr! P comes in to replace !r. ", who goeshome without ha#ing spoken to the patient.

Assignments:

0! (dentify the moral-ethical issue in this caseR4! (dentify the professional personal attribute in this doctor-patient relationship6! (f you were doctor ", what would you doI1B 2as the doctor tried to demonstrate hisher empathyI 'xplainR

Learning Tas3sPlease ans0>! Does it matter if our current use of natural resources is likely to totally destroy theenvironment in a few years from nowI


Day 2*ioet%ics

2F


21/39


&ignette -& is a 4;-year-old woman who has struggled with anorexia nervosa since she was 00 yearsold! *he is extremely intelligent, and having gained a first class degree in history at &xford/niversity, she is now halfway through her "hD! (t is at times when her life is most stressfulthat she struggles with her anorexia! he first time she was admitted to hospital was whenshe was 06! *he was being badly bullied at school and had stopped eating in order tobecome thin to prevent being teased about being overweight! %eing able to lose so muchweight gave her the sense that she had some control over at least one aspect of her life!& has spent the past 07 years in and out of hospital! &n two occasions she had to beadmitted to intensive care as she had lost consciousness! During these admissions she was

fed by a nasogastric tube! *he also has a history of obsessive-compulsive disorder and hasbeen receiving cognitive behavioral therapy! A year ago she had managed to stabili+e her weight at 8> kg she is 0!; m tall! 5ith the stress of her "hD and the breakdown of her relationship with her boyfriend, when you initially see & she weighs less than 68 kg! Although you want to feed her by nasogastric tube to prevent her needing a third admissionto intensive care, she adamantly refuses to have this! *he tells you that she does not wantto die, but neither does she want to be force fed! *he is extremely frail and needs constantsupervision by a healthcare assistant! Due to a shortage of beds on the psychiatric ward, &is currently being nursed on a general ward! he older women in her bay are complainingabout the amount of personal attention she is receiving, as when they need assistance tochange position or to go to the bathroom there is often a long wait due to staff shortages!

Assignments:0! 5hat is principlismI4! 2ow can the four principles be applied to this case scenario to offer guidance to the

doctor about whether & should be force fedI

&Ignette '?ou are a doctor called to the ward to see an elderly, confused man! 2e is wanderingaround and crying out! he nurses have tried persuading him to stay by his bed or at least inhis bay, but he is refusing to listen to them! &ne female patient has become upset becausehe keeps going to stand at the end of her bed and stares at her! he nurses are worried thatas well as upsetting other patients, he is very unsteady on his feet and they fear he may fallover and inure himself! ?ou read his notes to try to find a cause for his confusion! ?ou learnthat ., ;9 years old, was an elective admission yesterday for a laparoscopiccholecystectomy! wo weeks earlier he had been admitted to Accident and 'mergency withshortness of breath and pleuritic chest pain! 2e was kept in for 6 days and treated withintravenous antibiotics! here are at least two possible causes for his confusion: arecurrence of his pneumonia 1or other sepsis3 or a reaction to the general anesthetic! ?oudecide to speak to . and try to take some blood! . refuses to cooperate and activelypushes you away from him, shouting and swearing! 2e then tries to leave the ward,claiming he is well enough to go home and it is illegal for you to keep him a prisoner! henurses suggest he should be physically restrained so that you can take blood and assesshim, and that it may be a good idea to give him a sedative so that he does not continue toupset the other patients!

Assignments:0! *hould you use restraint in this caseI


Day 3*ioet%ical T%eories

21


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4! Could you please explain your reasoning based on ethical theoriesI

&Ignette 6"lease read the #&D'#( 1#ode 'tik #edokteran (ndonesia3 and then analy+e each article

based on any ethical theories that you knowR

&ignette - A woman enters the emergency room with stomach pain! *he undergoes a C scan and isdiagnosed with an abdominal aortic aneurysm 1a weakening in the wall of the aorta whichcauses it to stretch and bulge3! he physicians inform her that the only way to fix theproblem is surgically, and that the chances of survival are about 8>8>! hey also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a fewshort minutes! he woman is a photo model and actressE she worries that the surgery willleave a scar that will negatively affect her workE therefore, she refuses any surgicaltreatment! 'ven after much pressuring from the physicians, she adamantly refuses surgery!eeling that the woman is not in her correct state of mind and knowing that time is of theessenceE the surgeons decide to perform the procedure without consent! hey anestheti+eher and surgically repair the aneurysm! *he survives, and sues the hospital for millions of dollars!

Assignments:0! 5hat is the ethical issue in this caseI4! 5hat are the principles of biomedical ethics which can be implied in this caseI

6! 5hat is your view on the application of the principle of informed consent in this caseI

7! ry to find the reason, why the doctor decides as he didI8! (f you were doctor in this case, what would you doI 1'xplain your arguments based on

prima facie duties, the principle of informed consent, ethical theory, #&D'#(, and legalaspect3

&ignette '

oice and Doni have been married for 04 years and have a 9-year-old son! DoniFs father andgrandfather died from cancer when they were in their early forties! %ecause of the strongfamily history of cancer, Doni wanted to have a genetic test to find out his level of risk! Although no clear diagnosis was possible, tests indicated that he was at risk of hereditarynon-polyposis colorectal cancer! $ow, Doni is feeling tired and unwell, and has acolonoscopy! he test reveals that he has inoperable bowel cancer! oice is concerned thattheir son might also be at risk of colon cancer when he is older! *he asked you to do agenetic test for his son to see if he is at risk!

Assignment:0! 5hat is the ethical issue in this caseI4! 5hat are the principles of biomedical ethics which can be implied in this caseI6! *hould parents be allowed to have their children tested for adult-onset genetic

conditionsI 5hyI


DAY 4In)orme( Consent 8 Con)i(entialit.8

Patient9s rig%t an( Autonom.

22


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7! 5hat would you doI 1'xplain your arguments based on prima facie duties, the principleof informed consent, ethical theory, #&D'#(, and legal aspect3

5. 5hat are the foreseeable consequences of your decisionI Can you ustify this decisionto accommodate: the patient or the patientFs family valueE to your consultantE and to your peersI

&ignette 6ony is 68 years old and is married! 2e has had unprotected sex with prostitutes on 4occasions! Although he is asymptomatic, he becomes anxious about the possibility of having contracted a venereal disease and consults his physician! After conducting athorough physical examination and providing appropriate counselling, onyFs physicianorders a number of tests! he only positive result is for the 2(B blood test! he physicianoffers to meet with ony and his wife to assist with the disclosure of this information, butony states that he does not want his wife to know about his condition!

Assignments:0! 5hat is the ethical issue in this caseI

4! 5hat are the principles of biomedical ethics which can be implied in this caseI6! *hould the doctor disclosed this information to his wifeI 1'xplain your arguments based

on prima facie duties, the principle of confidentiality, ethical theory, #&D'#(, and legalaspect3

4. 5hat are the foreseeable consequences of your decisionI Can you ustify this decisionto accommodate: the patient or the patientFs family valueE to your consultantE and to your peersI

8! Does it make any difference if the onyFs diagnosis is not 2(BI 'xplainR

&ignette 1 A ;8-year-old woman shows signs of abuse that appears to be inflicted by her husband! As

he is her primary caregiver, she feels dependent on him and pleads with you not to sayanything about it!

Assignments:

0! 5hat is the ethical issue in this caseI4! 5hat are the principles of biomedical ethics which can be implied in this caseI

6! *hould you report this case to the policeI 1'xplain your arguments based on prima facieduties, the principle of confidentiality, ethical theory, #&D'#(, and legal aspect3

1B 5hat are the foreseeable consequences of your decisionI Can you ustify this decisionto accommodate: the patient or the patientFs family valueE to your consultantE and to your peersI

7B (f you are asked to testify and disclose patient information in court, what would you doI


Day 5A


24/39


&ignette -

ehovahKs 5itnesses have a belief that it is wrong to accept a blood transfusion!herefore, in a life-threatening situation where a blood transfusion is required tosave the life of the patient, the patient must be so informed! he consequences of refusing a blood transfusion must be made clearly to the patient at risk of dying from

blood loss! A desiring to MbenefitM the patient, the physician may strongly want toprovide a blood transfusion, believing it to be a clear Mmedical benefit!M 5henproperly and compassionately informed, the particular patient is then free to choosewhether to accept the blood transfusion in keeping with a strong desire to live, or whether to refuse the blood transfusion in giving a greater priority to his or her religious convictions about the wrongness of blood transfusions, even to the point of accepting death as a predictable outcome! his communication process must becompassionate and respectful of the patientFs unique values, even if they differ fromthe standard goals of biomedicine!

Assignment :

Discuss the problem R

&ignette '

his case comes from 'mergency .edicine! 5hen the patient is incapacitated by the gravenature of accident or illness, we presume that the reasonable person would want to betreated aggressively, and we rush to provide beneficent intervention by stemming thebleeding, mending the broken or suturing the wounded!

Assignment :"lease discuss what the physician can doR

&ignette 6his case, in the treatment of suicidal patients who are a clear and present danger tothemselves! 2ere, the duty of beneficence requires that the physician intervene on behalf of saving the patientKs life or placing the patient in a protective environment, in the belief thatthe patient is compromised and cannot act in his own best interest at the moment! Asalways, the facts of the case are extremely important in order to make a udgment that theautonomy of the patient is compromised!Assignment:"lease discuss your opinionR

Learning tas3s:

0! 'xplain and elaborate the ourney of research ethics 1including $urembergCode, Declaration of 2elsinski, %elmont )eport, etc!3R

4! 'xplain about principles of @ood Clinical "ractice in human subect researchR


Day 6Researc% Et%ics

24


25/39


6! 'xplain and give examples of fabrication, falsification, plagiarism and falseclaim to authorshipR

7! 'xplain 7 different areas of research and give examples of each areaR

&ignette -.inistry of 2ealth of (ndonesia have reported several 0== confirmed cases of and09; death due to Avian (nfluen+a since 4>>6 to 4>08! his infection is fatal and

become global public health concern! *everal human cases reported in (ndonesiawas coming from %ali "rovince! /ntil now, chicken and duck, are considered astransmiter of and source of infection! herefore, when there are suddent death ofthem, the procedure should be follow is elimination of all the chickenducks incertain related area! 2owever, this outbreak control may not work well for somereason! (n practice, there are many farmers who do not want to eliminate theirchickens! /sually %ali "rovince fulfilled the need of chickens from outside %ali,particularly from 'ast ava!Carefully read several related information provided in the link below

0 http:www!who!intinfluen+ahumanSanimalSinterface4>09S>4S48Stable28$0!pdfI

uaT0

4 http:balipost!comreadbali4>09>6407;6>7puluhan-ribu-unggas-mati-mendadak-diduga-terangkit-flu-burung!html

6 http:bali!tribunnews!com4>09>647bali-resah-dengan-merebaknya-wabah-flu-

burung7 http:balipost!comreadkesehatan4>09>6447;6==warga-banyuwangi-

musnahkan-unggas-terangkit-flu-burung!html

Assignments:

0 5hat is the ethical issue in this caseI4 5hat are the principles of "2 ethics which can be implied in this caseI6 (f you were doctor who work at the "ublic 2ealth &ffice, how you explain the

rationale in term of "2 ethics of this situation to the communityI

&ignette '%ased on the report of .inistry of 2ealth of (ndonesia, %ali rank the fourth in term of2(B prevalence in (ndonesia! Currently the 2(B epidemic was mainly driven sexualtransmission, which is believed to be related with female sex workers 1*53! (norder to control the spread of 2(B, at other provinces, many @overnors have closedlocalisation where *5s usually do the transaction with their clients!he followings are information related to the above case:


Day 7Pu4lic Healt% Et%ics

25

http://www.who.int/influenza/human_animal_interface/2016_02_25_tableH5N1.pdf?ua=1http://www.who.int/influenza/human_animal_interface/2016_02_25_tableH5N1.pdf?ua=1http://balipost.com/read/bali/2016/03/21/47304/puluhan-ribu-unggas-mati-mendadak-diduga-terjangkit-flu-burung.htmlhttp://balipost.com/read/bali/2016/03/21/47304/puluhan-ribu-unggas-mati-mendadak-diduga-terjangkit-flu-burung.htmlhttp://bali.tribunnews.com/2016/03/24/bali-resah-dengan-merebaknya-wabah-flu-burunghttp://bali.tribunnews.com/2016/03/24/bali-resah-dengan-merebaknya-wabah-flu-burunghttp://balipost.com/read/kesehatan/2016/03/22/47399/warga-banyuwangi-musnahkan-unggas-terjangkit-flu-burung.htmlhttp://balipost.com/read/kesehatan/2016/03/22/47399/warga-banyuwangi-musnahkan-unggas-terjangkit-flu-burung.htmlhttp://www.who.int/influenza/human_animal_interface/2016_02_25_tableH5N1.pdf?ua=1http://www.who.int/influenza/human_animal_interface/2016_02_25_tableH5N1.pdf?ua=1http://balipost.com/read/bali/2016/03/21/47304/puluhan-ribu-unggas-mati-mendadak-diduga-terjangkit-flu-burung.htmlhttp://balipost.com/read/bali/2016/03/21/47304/puluhan-ribu-unggas-mati-mendadak-diduga-terjangkit-flu-burung.htmlhttp://bali.tribunnews.com/2016/03/24/bali-resah-dengan-merebaknya-wabah-flu-burunghttp://bali.tribunnews.com/2016/03/24/bali-resah-dengan-merebaknya-wabah-flu-burunghttp://balipost.com/read/kesehatan/2016/03/22/47399/warga-banyuwangi-musnahkan-unggas-terjangkit-flu-burung.htmlhttp://balipost.com/read/kesehatan/2016/03/22/47399/warga-banyuwangi-musnahkan-unggas-terjangkit-flu-burung.html


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0 http:lipsus!kompas!comtopikpilihanlist6>970gang!dolly!ditutup4 https:m!tempo!coreadnews4>07>94>>8409>4409>409>448SindonesiaSkaliodo

Sditutup

Assignments:0 5hat is the ethical issue in this caseI4 5hat are the principles of "2 ethics which can be implied in this caseI3 (f you are doctor who open the general doctor private practice in the area,

where you also have many patients from the localisationE how you willresponse to the closing of localisationI 'xplain your answer using the "2ethic concepts!

&ignette 6

apanese 'ncephalitis 1'3 has been reported in %ali, where %ali is the provincewith the highest cases in (ndonesia! Compare to other endemic country such asChina, the (ncidence of ' in %ali is still far lower! 2owever, ' can cause severeneurologic complication in to death! herefore, there is a need to do more intensiveand effective prevention control through vaccination program! )ecently, ' vaccineis available in certain private clinic and only accessed by foreign tourist and some(ndonesian! Decision on vaccination program is on the .inistry of 2ealth, andcurrently is not allowed yet! Baccine price is expensive 10!8 million in a privateclinic3! &ne study in %ali has noted that mothers are willing to pay at least (D)8>!>>>,>> for this vaccine!he followings are information related to the above case:

1 htt"H==###.albemedcom=Portals=6=FE1E3Qa"aneseR2F*nce"halitis"df 2 htt"H==###.lini.&a.sinasicom=mengenali(a"anese(ence"halitis(lebih(

de.at=3 htt"H==.altenglitbang"ertaniangoid=ind="df=all(

"df="eterna.an=fullte.s=#arta:oa=#a:o153(1"df 4 htt"H==sari"ediatriidaiorid="dle=1F(5(5"df 5 htt"H==###.lini.raishacom=daftar(harga(&a.sin=

Assignments:0 5hat is the ethical issue in this caseI4 5hat are the principles of "2 ethics which can be implied in this caseI6 (f you are living in %ali, what will be your opinion in term of vaccination

program being conducted in %aliI

Learning Tas3s"lease watch the .ovie in class!


Day 8Clinical Et%ics

26

https://m.tempo.co/read/news/2014/06/20/058586646/psk-dolly-dilaporkan-pindah-ke-papuahttps://m.tempo.co/read/news/2014/06/20/058586646/psk-dolly-dilaporkan-pindah-ke-papuahttp://www.bbc.com/indonesia/berita_indonesia/2016/02/160228_indonesia_kalijodohttp://www.bbc.com/indonesia/berita_indonesia/2016/02/160225_indonesia_kalijodo_ditutuphttp://www.bbc.com/indonesia/berita_indonesia/2016/02/160225_indonesia_kalijodo_ditutuphttp://www.kalbemed.com/Portals/6/09_193Japanese%20Encephalitis.pdfhttp://www.klinikvaksinasi.com/mengenali-japanese-encephalitis-lebih-dekat/http://www.klinikvaksinasi.com/mengenali-japanese-encephalitis-lebih-dekat/http://kalteng.litbang.pertanian.go.id/ind/pdf/all-pdf/peternakan/fullteks/wartazoa/wazo153-1.pdfhttp://kalteng.litbang.pertanian.go.id/ind/pdf/all-pdf/peternakan/fullteks/wartazoa/wazo153-1.pdfhttp://saripediatri.idai.or.id/pdfile/10-5-5.pdfhttp://www.klinikraisha.com/daftar-harga-vaksin/https://m.tempo.co/read/news/2014/06/20/058586646/psk-dolly-dilaporkan-pindah-ke-papuahttps://m.tempo.co/read/news/2014/06/20/058586646/psk-dolly-dilaporkan-pindah-ke-papuahttp://www.bbc.com/indonesia/berita_indonesia/2016/02/160228_indonesia_kalijodohttp://www.bbc.com/indonesia/berita_indonesia/2016/02/160225_indonesia_kalijodo_ditutuphttp://www.bbc.com/indonesia/berita_indonesia/2016/02/160225_indonesia_kalijodo_ditutuphttp://www.kalbemed.com/Portals/6/09_193Japanese%20Encephalitis.pdfhttp://www.klinikvaksinasi.com/mengenali-japanese-encephalitis-lebih-dekat/http://www.klinikvaksinasi.com/mengenali-japanese-encephalitis-lebih-dekat/http://kalteng.litbang.pertanian.go.id/ind/pdf/all-pdf/peternakan/fullteks/wartazoa/wazo153-1.pdfhttp://kalteng.litbang.pertanian.go.id/ind/pdf/all-pdf/peternakan/fullteks/wartazoa/wazo153-1.pdfhttp://saripediatri.idai.or.id/pdfile/10-5-5.pdfhttp://www.klinikraisha.com/daftar-harga-vaksin/


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Assignments:0! "lease identify at least 6 ethical issues in the movieR4! Do you agree about how the ethical problems resolved in the movieI6! Could you please explain your reasoning based on ethical theoriesI

5rite an experience, when did you feel empathy and when you feel sympathy! ?our feelingsdescriptions should be clear that includes: how it came, when it came, why it came, andwhat youKre doing when it came!

'xample of feeling description :N Waktu saya bertemu engan pemulung tua ibu !etut "unie# hati saya tergetar# kok tega$teganya petugas malam itu mengusir ia ari halaman kantor. %ia ber&alan senirian# paahal ia suah sangat tua an renta....'ah teganya. ati saya semakin kasihan saat melihat ia menyeret kantong plastiknya an &ika kelelahan ia tiur i emperan tokoengan hanya beralaskan koran. ati saya semakin trenyuh saat ia menceritakan pengalaman hiupnya yang penuh engan erita# ingin rasanya saya setiap hari menyeiakan makanan an tempat beristirahat untuk ia#.... aaalah kok yha tega$teganyaanggota satpam ituO

&nce your feelings descriptionsis is clear, then describe whether these feelings canaffect your attitude toward the events on your everyday life! @ive your opinion if thesefeeling are useful for yourself and your profesion as a doctor and if useful how you maintain

these feelings!5rite your observation report with a brief on A7 paper with a font 04, 0!8 spaces line

as much as 7 pages! he report will be discussed at the *mall @roup Discussion, and alsowill be discussed at the "lenary *ession!

Assigments :

0! 5hat is the difference between empathy and sympathy and give an examples R

4! 'xplain with your own word the definition of empathyR6! 5hy empathy is important in medical practice7! (s empathy can be developed or learnedI (f the answer is yes, howI

&ignette -

A mother, 9< years old, who currently staying with her married child, have beenexperiencing series of minor cerebral hemorrhage for the past 00 years and for the past two


Day 9Em$at%.

Day 10Legal As$ect o) Me(ical Practice

27


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years she has been unable to talk and showing signs of diminishing hearing abilities! hishas resulted in lack of communication between her and her family! he family later requested a doctor to do euthanasia to her!

Assignments:

0! (n your opinion, what the doctor should doI4! (n your opinion, is the doctor guilty if at all heshe grants the familyFs request of

euthanasia towards her 1mother3I 'xplainR6! 5hat is your point of view regarding the ethical aspect in euthanasiaI

&ignette - A female, aged 07 years old, went with her mother to a hospital with possible pregnancyafter forced to do an intercourse with her neighbor! he test results reveals positivepregnancy test aged 9 weeks of gestation! he girl then consulted to psychiatry department,diagnosed with mild post psychic traumatic depression! he mother then requested themedical doctor to do an abortion procedure with an excuse that her daughter not yet readymentally and physically to conceive the pregnancy and so that she can be back to schoolagain!Assignments:

0! (n your opinion, what the doctor should do regarding the mothers requestI4! 5hen the doctor agreesFs for an abortion, can the doctor be said to have done a

criminal actI 'xplainR

&ignette ' A young man, aged 40 years old, had a traffic accident! 2e is diagnosed with right epiduralhematoma by a surgeon in the hospital where he receiving treatment! he surgeonsuggested a trepanation procedure to be done to evacuate the bleeding occurred! (n theoperation room, the surgeon has done the trepanation procedure in the left lobe instead of

doing in right lobe! After a while, the surgeon reali+ed that he has mistakenly interpreted theC scan results! he surgeon then has done the trepanation procedure in the right lobe toevacuate the bleeding! After operation done and the patient treated in the same hospital for few days, the patient discharged in improved condition!

Assignments:

0! (n your opinion, does the mistake done by the surgeon considered a malpracticeI2ow do you prove itI

4! After arriving home, the patient then reali+e that there has been a mistake in theoperation done 1trepanation3 and he decided to sue the surgeon to compensate thedamage done to him! (n your opinion, how the surgeon should do or explain his

decisions to defend himself from a possible malpractice chargeI


Day 11Criminal La< an( Me(ical Mal$ractice

2@


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&ignette 6 A 78-year-old man was suffering from intestinal cancer stage (B! he surgeon who handledhim post medically decided the patient to be operated though the possibility of success wasvery little! 2owever, it was preferable as compared with no operation! (n consideration of thepatientFs weak condition and the anticipated influence of anesthetic, the surgeon undertook

the operation in a hurry in the hope that the patientFs condition would not become worse dueto the surgery! After the operation and during treatment, the patient complained of a chronicstomachache despite long administration of analgesic! o find out the cause of pain, an Q-ray of the abdomen was made and the image showed that a metal instrument was lyinginside the patientFs abdomen!

Assignments :

0! Does the doctrine res ipsa loqiutur apply on the above caseI4! 'xplain the term and condition of res ipsa loquitur* 6! 5hat are the conditions that can serve as a defense on the above caseI

&ignette - A husband punched his wife till made her fell and hit a table! his violence caused by his

suspicion on their 4 years old child not from their married! 2is wife was brought to hospitaland examined by doctor A! Doctor A recorded all findings from examination and treatmentgiven on medical record! &n examination found bruises on right forehead and open woundon left temple that required treatment!

2is wife brought by police to hospital and asked for wound Be)! he victim want tohave *ick eave Certificate for getting off from duty cause she works in a private company! A few days later, her company asked for .edical Certificate needed to reimburst to healthinsurance company!

&n the other hand, her husband insist for patternity test to their child by D$Aexamination to ensure the real father! %ased on the test result, he want Certificate of "atternity to the corresponding child!

Assignments:

0! .edical certificate has vary form according to patient need but in general it has thesame components! Discuss about this componentsR

4! .edical certificate required by the law must follow medicolegal procedures! Discussabout this medicolegal procedure and how it is connected with profession responsibilityin lawR

6! Discuss about medical confidentiality aspect on medical certificate making processR4. (f the requirement for medical certificate delayed after examination! Discuss about the

solution regarding to this certificate making processR

&ignette ' A policewoman escorted a 4>-year-old girl who was a victim of sexual harassment! A doctor at the emergency department examined her after obtaining the consent from her!


Day 12Legal As$ect o) Me(ical Recor(8 Me(ical

Certi)ication an( Visum et epertum !Me(ico/legalre$ort"

2E


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Assignment:

-B 5hat the doctor should do to document the result of the examinationI

'B he policewoman requested the doctor to make medico-legal report 1visum

et repertum3! 'xplain the role of and procedures to make visum et repertumR

6B According to the legal procedures, the attorney requests the doctor to giveexpert witness at a trial! 'xplain the differences between witness and expert witness!5hat the doctor should do if requested to stand in trialI

&ignette -

A 7=-year-old male was brought to the emergency department with convulsions!

Assignments:0! 5hat data is needed during registration that will be used in patient recordsI4! (s it necessary to ask the socioeconomic status of patients during registrationI 'xplain

whyR

&ignette '

A 7=-year-old male was brought to the emergency department with an infected wound of theright foot! %ecause of repeated convulsions, he was admitted to the hospital! he examiningdoctor made a diagnosis of tetanus! 2is wife reported that working in the fields two weekspreviously, he stepped on a nail! hen the doctors manage the tetanus based on standardprocedure!

Assignments:0! 5hat are the information required to be created by physician in the patientKs medical

recordI4! 5hen the doctor incorrectly write the data in the medical record, explain how to correct

the writingR

&ignette 6

A 7=-year-old male was brought to the emergency department with an infected wound of theright foot! %ecause of repeated convulsions, he was admitted to the hospital! he examiningdoctor made a diagnosis of tetanus! 2is wife reported that he was working in the fields twoweeks ago while he stepped on a nail! 2e treated the wound by himself! he patient diedbecause of asphyxia during convulsions one day after admission!

Assignments:


Day 13Medical Record

3F


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0! Complete the death certificate and make a diagnosis of the cause of death based on (CDQR

*ASIC CLINICAL SILL

Date and "lace :


Da. -7.'D(CA C')((CA(&$ A$D B(*/. ')'"')/. 5)(($@ *#( )A($($@

31


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• 5ednesday, >7th .arch 4>08

• Class )oom and ab! %ersama

acilitator : orensic team

LATAR *ELAAN#"rofesi dokter memiliki berbagai tanggung awab meliputi tanggung awab terhadap

pasien, tanggung awab moral 1moral duty3, tanggung awab hukum 1legal duty3 dantanggung awab terhadap sesama dokter! anggung awab moral berhubungan denganetika kedokteran sedangkan tanggung awab hukum merupakan tanggung awab profesiterhadap negara! Dalam tanggung awab hukum, profesi medis harus menerapkan1aplikasi3 ilmu dan teknologi kedokteran untuk membantu proses hukum dan peradilan!

anggung awab hukum bersifat obligasi 1keharusan3 tidak bisa ditolak oleh seorangdokter,karena akan dikenakan sanksi hukuman! Disamping itu,tanggung awab hukumsecara universal di seluruh dunia berdasarkan konsep N balancing public interestO yang

menekankan dalam memenuhi tanggung awab hukum dapat mengabaikan tanggung awablainnya!*alah satu tanggung awab hukum bagi profesi dokter adalah pembuatan sertifikasi

medis baik untuk kepentingan masyarakat maupun kepentingan hukum! *ertifikasi medisuntuk masyarakat seperti penerbitan *urat #eterangan .edis dan *urat #eterangan#ematian! *edangkan untuk kepentingan hukum, sertifikasi medis berupa aporan .ediko-legal 1medico legal report3! aporan .edikolegal di (ndonesia secara khusus diberikannama B(*/. ' )'"')/.!

umlah dan enis sertifikasi medis berkembang sesuai dengan N*tate of the artO dariperkembangan ("'#D, sehingga sekarang banyak ragam sertifikasi medis, seperti*urat keterangan keayahan, surat keterangan tidak berpenyakit menular, surat keterangankegadisan dan lain sebagainya!

#onsep dasar sertifikasi medis adalah A#A dan "'$DA"A yang disampaikansecara tertulis oleh dokter tentang apa yang diperiksanya! akta merupakan bukti fisik danpendapat merupakan opini berdasarkan keilmuan kedokteran!

*ehubungan dengan Bisum et )epertum, penerbitannya diatur oleh hukum positif di(ndonesia khususnya pasal 066 #/2A"! *ebagai #eterangan Ahli tertulis, Bisum et)epertum diatur dalam pasal 0;= #/2A" dan pasal 0 #/2A"!

(stilah Bisum et )epertum hanya ada di (ndonesia dan tidak pernah ditemukan dinegara lainnya di dunia! .eskipun istilah Bisum et )epertum hanya ada di (ndonesia tetapikonsepnya sama dengan konsep aporan .ediko-legal di negara-negara lainnya! *ecarainternasional, hukum memerlukan dua bukti yaitu bukti fisik 1physical evidence3 dan buktipendapat 1 opinion evidence3! %ukti fisik diperoleh dari pengamatan fisik secara implisityang pengertiannya sama dengan NvisumO sedangkan bukti opini merupakan interpretasi

dari bukti fisik secara ekplisit dan pengertiannya sama dengan NrepertumO!#ompetensi dokter sangat diperlukan profesionalitasnya dalam pendekatan implisit

dan eksplisit dari bukti yang tertuang dalam Bisum et )epertum! "endekatan implisit1implisit reasoning3 diperlukan dalam pengumpulan bukti fisik! %ukti fisik diperoleh daripemeriksaan dan observasi yang didasari komitmen teori, ilmu kedokteran dan tuuanmedis tertentu! %ukti pendapat 1opinion evidence3 merupakan interpretasi terhadap faktamedis berdasarkan pemikiran kritis 1critical thinking3! "emikiran kritis ini adalah unsur eksplisit dalam pembuatan visum et repertum! "emikiran kritis profesi dokter berdasarkandua pendekatan yaitu pendekatan medis 1medical reasoning3 dan pendekatan hukum 1legalreasoning3!

Disamping itu, kompetansi dokter diperlukan dalam memberikan bukti yang sah dandapat diterima 1admissible3 di pengadilan berdasarkan relevansi, tidak tersanggahkan,otentik, reliable dan tidak diperoleh dengan alan yang melanggar hukum!



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%erdasarkan uraian diatas, maka dapat disimpulkan pentingnya kemampuan klinispembuatan sertifikasi medis dan Bisum et )epertum diberikan kepada mahasiswakedokteran dengan alasan sebagai berikut :

0! "rofesi dokter memiliki berbagai tanggung awab, diantaranya adalah tanggung

awab hukum 1legal duty3! anggung awab hukum bersifat obligasi dan didasari

konsep Nbalancing public interestO yang tidak bisa ditolak dan dapat mengabaikantanggung awab lainnya!

4! "embuatan sertifikasi medis, khususnya Bisum et )epertum adalah salah satu

tanggung awab hukum profesi dokter 6! "rofesionalisme pembuatan sertifikasi medis dan Bisum et )epertum harus terus

dikembangkan karena sertifikasi medis berkembang sesuai dengan state of the art

1*&A3 dari perkembangan ("'#D!7! #ompetensi dokter diperlukan untuk memberikan A#A dan "'$DA"A medis

secara tertulis baik untuk masyarakat maupun untuk hukum8! #ompetensi dokter diperlukan dalam melakukan pendekatan secara implisit dalam

mengumpulkan bukti fisik dan pendekatan eksplisit dalam memberikan opini medis

TUUAN

Tu@uan Umum Agar mahasiswa mempunyai kompetensi mengerti tentang konsep pembuatan

sertifikasi medis dan Bisum et )epertum serta mampu membuatnya secara mandiri untukmemenuhi kewaiban hukum profesi dokter

Tu@uan %usus0! .ahasiswa mengerti tentang prosedur .ediko-legal penerbitan *ertifikasi medis dan

Bisum et )epertum4! .ahasiswa memahami anatomi umum dari sertifikasi medis dan Bisum et )epertum6! .ahasiswa mampu mengidentifikasi bukti fakta dari sertifikasi medis dan Bisum et

)epertum7! .ahasiswa mampu menuliskan secara naratif berdasarkan interpretasi medikolegal

bukti fakta dalam sertifikasi medis dan Bisum et )epertum8! .ahasiswa mampu memberikan opini terhadap bukti fakta berdasarkan pendekatan

medis 1medical reasoning3 dan pendekatan hukum 1legal reasoning39! .ahasiswa mampu mengaplikasikan ilmu dan teknologi kedokteran terbaru dalam

pembuatan sertifikasi medis dan Bisum et )epertum

METODOLO#I PEM*ELAARAN

"embelaaran dilakukan dengan metoda :0! #uliah interaktif 1introduction lecture34! *mall group discussion6! "emberian tugas belaar 7! #emampuan klinis : dengan mengerakan langsung pembuatan sertifikasi medis

dan konsep Bisum et )epertum



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SEL ASSESSMENT

*ioet%ic :0! 5hat is ethicsI

4! ist and explain the principles of biomedical ethicsR6! ist and explain any ethical theories that you knowR7! "lease read the #&D'#( 1#ode 'tik #edokteran (ndonesia3 and then analy+e each

article based on the principles of biomedical ethicsR

In)orme( Consent0! Describe the principles of informed consentR

4! 'xplain under what circumstances a physician should or should not respect the patientKs

right to informed consentR



35/39


6! 2ow to provide informed consent to the patientI

7! Describe the patientKs right to informed consent in emergency circumstancesR

8! (s a familiesF informed consent ustifiedI /nder what circumstancesI

9! (s there any relationship between informed consent and lawI 'xplainR

;! (s there any relationship between informed consent and autonomyI 'xplainR

Con)i(entialit.0! Describe the principles of confidentialityR

4! 5hen does disclosure not constitute a breach of the confidentialityI

6! 5hat are the consequences if the physician breaches confidentialityI

Pro)essional Personal Attri4ute0! 5hat are the principles underlying the doctor-patient relationshipI

4! 5hat personal attribute constitutes a good doctorI

6! 5hy doctor should be competentI

7! 5hat is honesty, and its role in doctor-patients relationshipI

8! 5hat is compassion, and its role in doctor-patients relationshipI

9! 5hat is truthfulness, and its role in doctor-patients relationshipI

;! 5hat is empathyI

=! 5hat is the role of empathy on doctor-patients relationshipI

0>! 2ow the doctor should apply empathyI

Patient9s rig%t an( Autonom.0! Describe the principles of patientFs autonomy

4! (s there any relationship between patientFs right and autonomyI 'xplainR

6! 'xplain under what circumstances a physician should or should not respect the patientKsright to autonomy

7! Describe the possible conflict that may arise between patient autonomy and the

interests of the family



36/39


8! 'xplain under what circumstances the patient lost hisher autonomyR

Em$at%.0! 5hat is empathyI

4! 5hat are differences between empathy and sympathy and antipathyI

6! 5hat is the role of empathy on doctor-patients relationshipI

7! 2ow the doctor should apply empathyI

A


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e! *ocial and distributive ustice4! Due to in adequate vaccination program in the above island, a private pharmacy

take advantage by providing immuni+ation for under-five children living in that island!

he cost of vaccines are varied, but still considered as expensive for most people

living in the island! his situation reflected the existence of imbalance of:

a! *ocial usticeb! Distributive usticec! 'qual usticed! 'quality usticee! *ocial and distributive ustice

6! Due to in adequate vaccination program at the above island, the under-five children

are mostly susceptible to certain diseases! inally an outbreak of N?O disease occurs,

that made @overnment had to compulsory isolate many children and their family at

their houses! his situation may results an issue of:a! *ocial usticeb! Distributive ustice

c! 'qual usticed! 'quality usticee! *ocial and distributive ustice

7! he head office at District NAO introduces screening of cervical cancer using NQO

method to mothers living in the district! 'venthough the test is highly accurate, the

cost of package for screening test is very expensive and the government is not be

able to pay all the cost of the test! %ecause the head wants to test all mothers, the

cost of test is shared with the mothers 5hat ethical issue may rise for this situationIa! *ocial ustice

b! Distributive ustice

c! est accuracyd! 'qual usticee! 'quality ustice

8! ife expectancy of people in %ali province is higher than in $usa enggara %arat

province! herefore there are a lot of ageing persons living in %ali! A national health

survey showed that expenditure for maintain health for elderly in %ali is far higher

than in $%! (n addition, numbers of chronic diseases such as hypertension and

diabetes in %ali also higher in %ali than in $%! his phenomen is called:

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