Should you report this case to the police? Explain your arguments based on prima facie What are the foreseeable consequences of your decision? Can you justify this decision If you are asked to testify and disclose patient information in court, what would

Professionalism 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? Faculty of Medicine Udayana University, DME 19 Professionalism Vignette 1 Mr. A complained that when urinating he had pain. He 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. So far only USG had been performed. The doctor was threatening to such an extent that the patient sister started crying. The threat was made like this: “If a laser is not performed, you will have to read the holy verses, that is, he would die. This physician proceeded to perform intravenous pyelography. Then the patient was instructed to undergo a laser treatment that same evening by paying an advance of approximately Rp. 15.000.000,-. The patient was bewildered and contacted his brother who was engaged in the health field. He told him to delay it for one day until he would reach there. But the physician got angry and said, If this was not conducted, he would not care any more. It was not until realizing who his brother was that the physician was alerted. He asked what he should do to apologize for what he had done. Finally, the hospital director and one of his staff apologized to his brother. The patients decided to go to another private hospital where ultrasonography USG and other specific laboratory examinations showed that it was an inflammation. Assignments: 1. Identify the moral-ethical issue in this case 2. Identify the professional personal attribute in this doctor-patient relationship 3. What is your view about the doctor’s attitude in this case? 4. Has the doctor tried to demonstrate hisher empathy? Explain Vignette 2 Dr. P. an experienced and skilled surgeon, is about to finish night duty at medium-sized community hospital. A young woman is brought to the hospital by her mother, who leaves immediately after telling the intake nurse that she has to look after her other children. The patient is bleeding vaginally and is in great deal of pain. Dr. P examines her and decides that she has had either a miscarriage or self induced abortion. He does a quick dilatation and curettage and tells the nurse to ask the patient whether she can afford to stay in the hospital until it is safe for her to be discharged. Dr. Q comes in to replace Dr. P, who goes home without having spoken to the patient. Assignments: 1. Identify the moral-ethical issue in this case 2. Identify the professional personal attribute in this doctor-patient relationship 3. If you were doctor P, what would you do? 4. Has the doctor tried to demonstrate hisher empathy? Explain Faculty of Medicine Udayana University, DME 20 Day 3 Professional Personal Attribute Professionalism Learning Tasks 1. what is patient’s right? 2. what is the purpose of patient’s right 3. Describe the basic of patient’s right? 4. What is patient autonomy 5. Discuss about paternalism in doctor-patient relationship? 6. Discus about the balance of physician recommendation and patient autonomy Vignette 1 The family of the patient in terminal state need your help to close the treatment. Assignment What is your respond in this situation? Vignette 2 Patient with HIV AIDS has plan to get married. Assignment What will you do? Vignette 3 A patient come to the hospital and admitted to an intensive care unit with a chronic, progressive illness and has a small but real chance of leaving the hospital alive if he submits to invasive treatment. The patient feels that he has suffered enough, and he requests supportive care only. Assignment What is your decision? Vignette 4 A very rich patient pays you a lot of money and asks you to copy the prescription from another doctor. The drugs are very essential for his life. Assignment Faculty of Medicine Udayana University, DME 21 Day 4 Patient’s Right and Autonomy Professionalism What will you do? Vignette 5 The 64-year-old patient suffering from diabetes mellitus, and gangrene had developed on his leg causing sepsis with high fever, indicating it was a progressive gangrene. He was a former lawyer. The doctor advised the patient and his family that he have an amputation to prevent the spreading of infection and safe patient’s life. The family agreed, but the patient did not. The family followed the doctor reasoning: “I do not want the patient to die merely because of gangrene and diabetes”. Then the doctor told the family that if the patient fell into a coma, the doctor would have the right to undertake a professional intervention to save his life without having to obtain the patient’s approval. Once the patient went into coma, the doctor asked the family to sign the informed consent for the amputation. The amputation was finally done. Assignments: 1. Identify the ethical issues in this case 2. What is your view on the application of the principle of patient’s autonomy in this case? 3. Is there any violation to the patient’s right in this case? Give your reason 4. What do you think about the patient’s autonomy, if the patient comes in a state of unconsciousness? 5. What do you think about the patient’s autonomy, if the patient is a child? 6. What do you think about the patient’s autonomy, if the patient is mentally ill? 7. Has the doctor in this case applied the principle of informed consent? Explain 8. Under What circumstance informed consent given by the family is justified ? Vignette 6 Mrs. X is 35 and is in need of dialysis. She is refusing treatment because she is scared of the treatment which she believes is invasive. She has been counseled about the nature of the treatment-there are no alternatives that would be of practical benefit. She is competent to make treatment decisions. She understands that if she refuses dialysis she will die. She has a daughter of 15 years who lives at home. The clinicians feel very strongly that should receive dialysis but despite numerous attempts to persuade her refuses. Assignments: 1. Identify the ethical issues in this case 2. What is your view on the application of the principle of patient’s autonomy in this case? 3. If you were a doctor in this case what would you do? Faculty of Medicine Udayana University, DME 22 Professionalism 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? Faculty of Medicine Udayana University, DME 23 Day 5 Empathy Professionalism Task 1 Please try to interview one of your friends in SGD with the following questions: 1. What is herhis father or family leader name and job? 2. With whom are heshe staying at hisher house? 3. If one of the family members falls sick, who will label the illness? 4. Which health provider will heshe be taken to? 5. Who make the decicion for it question no. 4? According to task above, please discuss within your SGD. 1. Why should we ask name and job of the family leader? 2. What image of the family could we get by asking name and job of the family leader? 3. What is the family type? 4. What can we imagine from the answer? 5. Why are they labeling the illness like that ? 6. What is their seeking behavior? 7. How is the decision making process in that family? Please make a summary and we will choose a group randomly to present in front of the classroom Task 2 Please try to interview an elderly person with the following questions: 1. What is hisher name full name? 2. Where is heshe come from? 3. What is hisher ethnicity? 4. What is hisher occupation? 5. What is hisher last education? 6. What does heshe think about geriatric? 7. Is heshe enjoy hisher life? Observation Guide 1. Observe hisher clothing. 2. Listen and observe hisher language and body language. 3. Hisher behaviour. 4. Hisher personal hygiene. 5. Hisher topic in their conversation. 6. Hisher expression in enjoying their life. Please make a summary and we will choose a group randomly to present in front of the classroom Faculty of Medicine Udayana University, DME 24 Day 6 Awareness to diversity in medical practices Professionalism According to task above, please discuss within your SGD 1. By knowing hisher name, could you know what is hisher ethnic, stratificationespecialy ascribe stratification? 2. Could you know the gender difference by the name? 3. Why do we need to know about their education and occupation? Please explain your answer. Vignette Paul Farmer is a physician and anthropologist who for the last two decades has split his time between Harvard and a medical clinic in rural Haiti. He has watched HIVAIDS since its earliest days in Haiti, and his writings put the pandemic into its historical and international context. In the early 1980s, Haiti had become the symbol of AIDS for North Americans, but this was merely the latest definition of Haiti for Americans. For 200 years Haiti had been a dark, sinister place. From the time of Columbus, the island was exploited by the Spanish and then the French. As the Indian population died off, enslaved Africans were brought in to work the plantations. Serious slave uprisings began in 1971, and by 1804 the Republic of Haiti had become only the second country to free itself from European colonial rule. But the first such country, the United States, still maintained slavery, and the example of Haiti’s violent slave revolt terrified the planters of the American South. From the mid-19 th century the United States regularly sent warships to protect American interests in Haiti, and from 1915 to 1937 the U.S. Marines occupied Haiti. Voodoo, with its dark, ecstatic rituals, added to the sinister image of this troublesome land. In the early years of HIVAIDS, when it was little understood, and when many poor refugees from Haiti were found to be HIV positive, it was easy for North Americans to blame Haitians for the disease. From the Haitian standpoint, however, AIDS was just the latest indignity foisted on the country from the United States. But a more proximate reason for the illness was explained by Haitian folk beliefs in witchcraft-someone has sent misfortune to another. In his earlier worke.g., 1992 Paul Farmer emphasized the atmosphere of accusation and counteraccusation that characterized the early days of HIVAIDS, as well as the historical and cultural contexts from which these accusations were made. In his later work 1999 he concentrates on the effects of poverty. HIVAIDS cannot be curred, but it can be controlled by massive and very expensive medication that is simply out of reach of most Haitian peasents : One can be impressed by the power of modern medicine and yet dejected by our failure to deliver it equitably . . . Moving along the fault lines of society, HIV continues to entrench itself among the world’s poor and marginalized. Farmer, 1999:264-265 And so this medical anthropologist, after years of facing the biological, cultural, and historical aspects of HIVAIDS, winds up with the realization that it is the inequalities built into the transnational social system that will sustain and spread HIVAIDS among the poor. And once more we see the utility of thinking in terms of a biocultural model, for neither part can be understood alone.Heider, 2004 in Seeing Anthropology 3 rd ed. p 414-415. Learning Task 1.What is Haitian think about HIVAIDS? Discuss with your group 2. What is your perception of health? 3. What do we mean by illness? What the different with disease? 4. What do we mean by seeking behavior? 5. Why culture has important role to human health and illness? 6. Why physician have to understand about diversity and multiculturalism in the Faculty of Medicine Udayana University, DME 25 Professionalism societies? 7. Discuss, how are you develop the strategies of cross-cultural perspective in the case above. 8. What are another determinant factor of the disease above that Paul Farmer thought? 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. 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 doctor in private practice in the peripheral area, visited by patients with the condition of withdrawal syndrome due to the habit of using narcotics. Assignments: 1. What action you as a physician who practices in peripheral regions? 2. What follow-up of patients is related to the habit of using drugs? 3. Mention things that can be done by a doctor in drug delivery to the patient? 4. Narcotics which class should not be used for treatment?