If you are asked to testify and disclose patient information in court, what would you do?

Professionalism 5. What are the foreseeable consequences of your decision? Can you justify this decision to accommodate: the patient or the patient’s family value; to your consultant; and to your peers? Vignette 3 Tony is 35 years old and is married. He has had unprotected sex with prostitutes on 2 occasions. Although he is asymptomatic, he becomes anxious about the possibility of having contracted a venereal disease and consults his physician. After conducting a thorough physical examination and providing appropriate counselling, Tony’s physician orders a number of tests. The only positive result is for the HIV blood test. The physician offers to meet with Tony and his wife to assist with the disclosure of this information, but Tony states that he does not want his wife to know about his condition. Assignments: 1. What is the ethical issue in this case? 2. What are the principles of biomedical ethics which can be implied in this case? 3. Should the doctor disclosed this information to his wife? Explain your arguments based on prima facie duties, the principle of confidentiality, ethical theory, KODEKI, and legal aspect 4. What are the foreseeable consequences of your decision? Can you justify this decision to accommodate: the patient or the patient’s family value; to your consultant; and to your peers? 5. Does it make any difference if the Tony’s diagnosis is not HIV? Explain Vignette 4 A 75-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 say anything about it. Assignments: 1. What is the ethical issue in this case? 2. What are the principles of biomedical ethics which can be implied in this case? 3. Should you report this case to the police? Explain your arguments based on prima facie duties, the principle of confidentiality, ethical theory, KODEKI, and legal aspect 4. What are the foreseeable consequences of your decision? Can you justify this decision to accommodate: the patient or the patient’s family value; to your consultant; and to your peers? 5. If you are asked to testify and disclose patient information in court, what would you do? Vignette 1 Jehovahs Witnesses have a belief that it is wrong to accept a blood transfusion. Therefore, in a life-threatening situation where a blood transfusion is required to save the life of the patient, the patient must be so informed. The consequences of Faculty of Medicine Udayana University,DME Day 5 Awareness to diversity in medical practices 23 Professionalism refusing a blood transfusion must be made clearly to the patient at risk of dying from blood loss. A desiring to benefit the patient, the physician may strongly want to provide a blood transfusion, believing it to be a clear medical benefit. When properly and compassionately informed, the particular patient is then free to choose whether 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. This communication process must be compassionate and respectful of the patient’s unique values, even if they differ from the standard goals of biomedicine. Assignment : Discuss the problem Vignette 2 This case comes from Emergency Medicine. When the patient is incapacitated by the grave nature of accident or illness, we presume that the reasonable person would want to be treated aggressively, and we rush to provide beneficent intervention by stemming the bleeding, mending the broken or suturing the wounded. Assignment : Please discuss what the physician can do Vignette 3 This case, in the treatment of suicidal patients who are a clear and present danger to themselves. Here, the duty of beneficence requires that the physician intervene on behalf of saving the patients life or placing the patient in a protective environment, in the belief that the patient is compromised and cannot act in his own best interest at the moment. As always, the facts of the case are extremely important in order to make a judgment that the autonomy of the patient is compromised. Assignment: Please discuss your opinion Learning tasks: 1. Explain and elaborate the journey of research ethics including Nuremberg Code, Declaration of Helsinski, Belmont Report, etc. 2. Explain about principles of Good Clinical Practice in human subject research 3. Explain and give examples of fabrication, falsification, plagiarism and false claim to authorship 4. Explain 4 different areas of research and give examples of each area Faculty of Medicine Udayana University,DME Day 6 Research Ethics 24 Professionalism Vignette 1 Ministry of Health of Indonesia have reported several 199 confirmed cases of and 167 death due to Avian Influenza since 2003 to 2015. This infection is fatal and become global public health concern. Several human cases reported in Indonesia was coming from Bali Province. Until now, chicken and duck, are considered as transmiter of and source of infection. Therefore, when there are suddent death of them, the procedure should be follow is elimination of all the chickenducks in certain related area. However, this outbreak control may not work well for some reason. In practice, there are many farmers who do not want to eliminate their chickens. Usually Bali Province fulfilled the need of chickens from outside Bali, particularly from East Java. Carefully read several related information provided in the link below 1. http:www.who.intinfluenzahuman_animal_interface2016_02_25_tableH5N1.pdf? ua=1 2. http:balipost.comreadbali2016032147304puluhan-ribu-unggas-mati- mendadak-diduga-terjangkit-flu-burung.html 3. http:bali.tribunnews.com20160324bali-resah-dengan-merebaknya-wabah-flu- burung 4. http:balipost.comreadkesehatan2016032247399warga-banyuwangi- musnahkan-unggas-terjangkit-flu-burung.html Assignments: 1. What is the ethical issue in this case? 2. What are the principles of PH ethics which can be implied in this case? 3. If you were doctor who work at the Public Health Office, how you explain the rationale in term of PH ethics of this situation to the community? Vignette 2 Based on the report of Ministry of Health of Indonesia, Bali rank the fourth in term of HIV prevalence in Indonesia. Currently the HIV epidemic was mainly driven sexual transmission, which is believed to be related with female sex workers FSW. In order to control the spread of HIV, at other provinces, many Governors have closed localisation where FSWs usually do the transaction with their clients. The followings are information related to the above case: 1. http:lipsus.kompas.comtopikpilihanlist30641gang.dolly.ditutup 2. https:m.tempo.coreadnews20140620058586646psk-dolly-dilaporkan-pindah- ke-papua 3. http:www.bbc.comindonesiaberita_indonesia201602160228_indonesia_kalijodo Faculty of Medicine Udayana University,DME Day 7 Public Health Ethics 25 Professionalism 4. http:www.bbc.comindonesiaberita_indonesia201602160225_indonesia_kalijodo _ditutup Assignments: 1. What is the ethical issue in this case? 2. What are the principles of PH ethics which can be implied in this case? 3. If you are doctor who open the general doctor private practice in the area, where you also have many patients from the localisation; how you will response to the closing of localisation? Explain your answer using the PH ethic concepts. Vignette 3 Japanese Encephalitis JE has been reported in Bali, where Bali is the province with the highest cases in Indonesia. Compare to other endemic country such as China, the Incidence of JE in Bali is still far lower. However, JE can cause severe neurologic complication in to death. Therefore, there is a need to do more intensive and effective prevention control through vaccination program. Recently, JE vaccine is available in certain private clinic and only accessed by foreign tourist and some Indonesian. Decision on vaccination program is on the Ministry of Health, and currently is not allowed yet. Vaccine price is expensive 1.5 million in a private clinic. One study in Bali has noted that mothers are willing to pay at least IDR 50.000,00 for this vaccine. The followings are information related to the above case: 1. http:www.kalbemed.comPortals609_193Japanese20Encephalitis.pdf 2. http:www.klinikvaksinasi.commengenali-japanese-encephalitis-lebih-dekat 3. http:kalteng.litbang.pertanian.go.idindpdfall- pdfpeternakanfulltekswartazoawazo153-1.pdf 4. http:saripediatri.idai.or.idpdfile10-5-5.pdf 5. http:www.klinikraisha.comdaftar-harga-vaksin Assignments: 1. What is the ethical issue in this case? 2. What are the principles of PH ethics which can be implied in this case? 3. If you are living in Bali, what will be your opinion in term of vaccination program being conducted in Bali? Learning Tasks Please watch the Movie in class. Assignments: 1. Please identify at least 3 ethical issues in the movie 2. Do you agree about how the ethical problems resolved in the movie? Faculty of Medicine Udayana University,DME Day 8 Clinical Ethics 26 Professionalism 3. Could you please explain your reasoning based on ethical theories? Write an experience, when did you feel empathy and when you feel sympathy. Your feelings descriptions should be clear that includes: how it came, when it came, why it came, and what youre doing when it came. Example of feeling description : “ Waktu saya bertemu dengan pemulung tua ibu Ketut Sunie, hati saya tergetar, kok tega- teganya petugas malam itu mengusir dia dari halaman kantor. Dia berjalan sendirian, padahal dia sudah sangat tua dan renta....wah teganya. Hati saya semakin kasihan saat melihat dia menyeret kantong plastiknya dan jika kelelahan dia tidur di emperan toko dengan hanya beralaskan koran. Hati saya semakin trenyuh saat dia menceritakan pengalaman hidupnya yang penuh dengan derita, ingin rasanya saya setiap hari menyediakan makanan dan tempat beristirahat untuk dia,....E aaalah kok yha tega-teganya anggota satpam itu” Once your feelings descriptionsis is clear, then describe whether these feelings can affect your attitude toward the events on your everyday life. Give your opinion if these feeling are useful for yourself and your profesion as a doctor and if useful how you maintain these feelings. Write your observation report with a brief on A4 paper with a font 12, 1.5 spaces line as much as 4 pages. The report will be discussed at the Small Group Discussion, and also will be discussed at the Plenary Session. Assigments : 1. What is the difference between empathy and sympathy and give an examples 2. Explain with your own word the definition of empathy 3. Why empathy is important in medical practice 4. Is empathy can be developed or learned? If the answer is yes, how? Vignette 1 A mother, 68 years old, who currently staying with her married child, have been experiencing series of minor cerebral hemorrhage for the past 11 years and for the past two years she has been unable to talk and showing signs of diminishing hearing abilities. This has resulted in lack of communication between her and her family. The family later requested a doctor to do euthanasia to her. Faculty of Medicine Udayana University,DME Day 10 Legal Aspect of Medical Practice Day 9 Empathy 27 Professionalism Assignments: 1. In your opinion, what the doctor should do? 2. In your opinion, is the doctor guilty if at all heshe grants the family’s request of euthanasia towards her mother? Explain 3. What is your point of view regarding the ethical aspect in euthanasia? Vignette 1 A female, aged 14 years old, went with her mother to a hospital with possible pregnancy after forced to do an intercourse with her neighbor. The test results reveals positive pregnancy test aged 6 weeks of gestation. The girl then consulted to psychiatry department, diagnosed with mild post psychic traumatic depression. The mother then requested the medical doctor to do an abortion procedure with an excuse that her daughter not yet ready mentally and physically to conceive the pregnancy and so that she can be back to school again. Assignments: 1. In your opinion, what the doctor should do regarding the mothers request? 2. When the doctor agrees’s for an abortion, can the doctor be said to have done a criminal act? Explain Vignette 2 A young man, aged 21 years old, had a traffic accident. He is diagnosed with right epidural hematoma by a surgeon in the hospital where he receiving treatment. The surgeon suggested a trepanation procedure to be done to evacuate the bleeding occurred. In the operation room, the surgeon has done the trepanation procedure in the left lobe instead of doing in right lobe. After a while, the surgeon realized that he has mistakenly interpreted the CT scan results. The surgeon then has done the trepanation procedure in the right lobe to evacuate the bleeding. After operation done and the patient treated in the same hospital for few days, the patient discharged in improved condition. Assignments: 1. In your opinion, does the mistake done by the surgeon considered a malpractice? How do you prove it? 2. After arriving home, the patient then realize that there has been a mistake in the operation done trepanation and he decided to sue the surgeon to compensate the damage done to him. In your opinion, how the surgeon should do or explain his decisions to defend himself from a possible malpractice charge? Vignette 3 A 45-year-old man was suffering from intestinal cancer stage IV. The surgeon who handled him post medically decided the patient to be operated though the possibility of success was Faculty of Medicine Udayana University,DME Day 11 Criminal Law and Medical Malpractice 28 Professionalism very little. However, it was preferable as compared with no operation. In consideration of the patient’s weak condition and the anticipated influence of anesthetic, the surgeon undertook the operation in a hurry in the hope that the patient’s condition would not become worse due to the surgery. After the operation and during treatment, the patient complained of a chronic stomachache despite long administration of analgesic. To find out the cause of pain, an X- ray of the abdomen was made and the image showed that a metal instrument was lying inside the patient’s abdomen. Assignments : 1. Does the doctrine res ipsa loqiutur apply on the above case? 2. Explain the term and condition of res ipsa loquitur 3. What are the conditions that can serve as a defense on the above case? Vignette 1 A husband punched his wife till made her fell and hit a table. This violence caused by his suspicion on their 2 years old child not from their married. His wife was brought to hospital and examined by doctor A. Doctor A recorded all findings from examination and treatment given on medical record. On examination found bruises on right forehead and open wound on left temple that required treatment. His wife brought by police to hospital and asked for wound VeR. The victim want to have Sick Leave Certificate for getting off from duty cause she works in a private company. A few days later, her company asked for Medical Certificate needed to reimburst to health insurance company. On the other hand, her husband insist for patternity test to their child by DNA examination to ensure the real father. Based on the test result, he want Certificate of Patternity to the corresponding child. Assignments: 1. Medical certificate has vary form according to patient need but in general it has the same components. Discuss about this components 2. Medical certificate required by the law must follow medicolegal procedures. Discuss about this medicolegal procedure and how it is connected with profession responsibility in law 3. Discuss about medical confidentiality aspect on medical certificate making process 4. If the requirement for medical certificate delayed after examination. Discuss about the solution regarding to this certificate making process Vignette 2 A policewoman escorted a 20-year-old girl who was a victim of sexual harassment. A doctor at the emergency department examined her after obtaining the consent from her. Faculty of Medicine Udayana University,DME Day 12 Legal Aspect of Medical Record, Medical Certification and Visum et Repertum Medico-legal report 29 Professionalism Assignment: 1. What the doctor should do to document the result of the examination?