Study Guide Medical Professionalism Tayang 6 Mei 2020

Study Guide Medical Professionalism
STUDY GUIDE
MEDICAL PROFESSIONALISM AND ETHICS
Editor
I Wayan Sugiritama
Publisher: Department of Medical Education Medicine Programme,

Faculty of Medicine, Udayana University
Faculty of Medicine UNUD,PSSKPD,2020

CONTENTS
Contents ......................................................................................................................... 1
Curriculum ................................................................................................ ...................... 2
Planners and lecturers.................................................................................................... 3
Facilitators ...................................................................................................................... 4
Learning Activity and Important Information ................................................................... 5
Student Projects .......................................................................................... ................... 6
Time Table ..................................................................................................................... 8
Learning Programs ......................................................................................... ................ 11
References ..................................................................................................................... 42
Curriculum Mapping ....................................................................................................... 43
Udayana University Faculty of Medicine, PSSKPD, 2020 1

GENERAL CURRICULUM OF MEDICAL PROFESSIONALISM AND ETHICS
Aims:
 Comprehend the central position of professionalism in contemporary medical
practice
 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 personal
attributes: compassion, integrity, truthfulness, truth-worthiness, and lifelong
commitment or habit to maintaining professional competence and standards
 Develop awareness and respect to the needs of a diverse patient population in terms
of gender, belief/religion, 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 PPKN in Bioethics.
 Apply the principles of biomedical ethics and ethical reasoning to formulate
questions while making ethical-decision.
 Able to understand and explain about KODEKI and KODERSI in relation to
bioethical theories and health care.
 Critically analyze 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
 The three dimensions/ components of medical professionalism
 Common educational strategies to nurture the development of affective behaviors
 Basic principles and strategies of cross-cultural communication
 National and global legal systems governing medical practice
 The principles of moral and ethical reasoning, and ways to avoid pitfalls
 Skills related to applying the basic principles of professionalism in virtual or real
patients

PLANNERS AND LECTURERS
NO
NAME DEPARTMENT PHONE
1 dr. I W. Sugiritama,M.Kes Histology 08164732743
2 dr. Ida Bagus Alit, Sp. F Forensic Medicine 081916613459
3 Prof. Dr. dr. N. Mangku Karmaya, Anatomy 0811387105
M.Repro
4 Dr. Ni Made Swasti Wulanyani,S.Psi, Psychology 082145010743
M.Erg., Psikolog
5 Dr. dr. A.A. Sagung Sawitri, MPH Public Health 0817340145
6 dr. Dudut Rustyadi, Sp.FM(K), SH Forensic Medicine 08123994234
7 Dr. dr. Dyah Pradnyaparamita Duarsa. Public Health 0818357777
M.Si
8 dr. Kunthi Yulianti Sp.F Forensic 081338472005
9 dr. Henky, Sp.F., M,BEth., FACLM. Forensic Medicine 08123988486
10 dr. Ni Nengah Dwi Fatmawati Sp.MK, Microbiology 087862200814
PhD
11 Dr. dr. I Nyoman Hariyasa Obstetric and 081936106315
Sanjaya,SpOG(K), MARS gynecology
12 Dr. dr. I Made Sudarmaja,M.Kes Parasitology 08123953945

FASILITATOR MEDICAL PROFESSIONALISM

Regular Class (Class A)
Venue
No Name Group Department Phone
(2rd floor)
Dr.dr.A.A.A Meidiary, Sp.S(K) 2rd floor
1 A1 Neurology 08123616763
2.09
dr.Dudut Rustyadi, Sp.F.,S.H 2rd floor
2 A2 Forensic 08123994234
2.10
Dr.dr. DAA Sri Laksemi, M.Sc 2rd floor
3 A3 Parasitology 081392017107
2.11
dr. Indira Vidiari Juhanna, M.Fis 2rd floor
4 A4 Physiology 087861704443
2.12
Clinical 08155735034 2rd floor
5 Dr.dr. A.A Ngurah Subawa.,M.Si A5
Pathology 2.13
6 dr. I G A Dewi Ratnayanti, A6 Histology 085104550344 2rd floor
M.Biomed 2.14
dr. Henky, Sp.F., M.Bioethics, 2rd floor
7 A7 Forensic 08123988486
SH 2.15
Dr.dr. Agung Wiwiek Indrayani, 2rd floor
8 A8 Pharmacology 08886855027
M.Kes 2.16
dr. Ida Ayu Sri Wijayanti, 2rd floor
9 A9 Neurology 081337667939 2.20
M.Biomed, Sp.S
Dr.dr.Ni Made Adi Tarini, 2rd floor
10 A10 Microbiology 081338675344
Sp.MK(K) 2.21
English Class (Class B)

Venue
No Name Group Department Phone
(2rd floor)
dr. Srie Laksminingsih, Sp.Rad 2rd floor
1 B1 Radiology 08164745561
(K) 2.09
dr. I Wayan Sugiritama, M.Kes 2rd floor
2 B2 Histology 08164732743
2.10
dr. Kunthi Yulianti, Sp.KF 2rd floor
3 B3 Forensic 081338472005
2.11
dr. I Made Winarsa Ruma, 2rd floor
4 B4 Biochemistry 081237786050
S.Ked. Ph.D 2.12
2rd floor
5 dr. Nila Wahyuni, M.Fis B5 Physiology 081805469684
2.13
Dr. dr. Made Lely Rahayu, Sp. 2rd floor
6 B6 ENT 08113809882
THT-KL (K), FICS 2.14
dr. Agus Roy Rusly Hariantana 08123511673 2rd floor
7 B7 Surgery
Hamid, Sp.BP-RE(K) 2.15
dr. Ida Bagus Putu Alit, 2rd floor
8 B8 Forensic 081916613459
Sp.FM(K), DFM 2.16
2rd floor
9 dr. I Wayan Surudarma ,M. Si B9 Biochemistry 081338486589
2.20
2rd floor
10 Prof.Dr.dr. I Made Jawi, M.Kes B10 Phamacology 08179787972
2.21

LEARNING ACTIVITY
There are several types of learning activity:
 Lecture
 Plenary session
 Independent learning based on the lecture’s topic
 Small group discussion to solve the learning task
 Practicing (BCS)
 Student project
 Self-assessment at the end of every topic
 E-Learning
IMPORTANT INFORMATION
Meeting of the students’ representative In the middle of the block schedule, a meeting is
designed among the student representatives of every small group discussions, facilitators,
and resource persons. The meeting will discuss the ongoing teaching -learning process,
quality of lecturers and facilitators as a feedback to improve the next process. The meeting
will be taken based on schedule from Department of Medical Education.

STUDENT PROJECT
Student have to write a paper with topics that has been given by lecturer. T he topic
will be chosen randomly on day 1, each small group discussion should work one paper.
Students make a paper as student project an will be presented in front of the class. The
paper and the presentation will be evaluated by respectively facilitator and lecturer.
Format of the paper :
1. Cover :
Tittle
Name
Student Registration Number
Faculty of Medicine, Udayana University 2019
2. Introduction
3. Content
4. Conclusion
5. References (minimal 5 refferences)
Student Project consist of 5-10 pages; 1,5 line spacing; Times new roman 12
Skill assessment will be carried out at the end of the semester using Objective
Structured Clinical examination (OSCE).
SGD will be reviewed every day by facilitator with a standard SGD assessment and
it contributes 10 % to final score. Student projects as a summative assessment account for
10 % of the final score.
NO Tittle Evaluator
1 Tantangan hubungan fiduciary dokter dr. Ida Bagus Alit, Sp. F

pasien dan dilema Etik informed
consent dalam menangani pasien
COVID 19
2 Peran dan tanggung jawab keluarga Prof. Dr. dr. N. Mangku Karmaya,
terhadap anggotanya yg terkonfirmasi M.Repro
covid positip
3 Program for building empathy in Dr. Ni Made Swasti Wulanyani,S.Psi,
physician. M.Erg., Psikolog
4 Tantangan tantangan etika komunitas DR. dr. A.A. Sagung Sawitri, MPH
dalam penerapan upaya pengendalian
epidemi Korona
5 Aspek medikolegal pelayanan medis dr. Dudut Rustyadi, SpFM(K), SH
telemedicine.
6 Pentingnya Dokter Memahami adanya Dr. dr. Dyah Pradnyaparamita Duarsa.

Keberagaman Latar Belakang Pasien M.Si

dalam Praktek Kedokteran
7 Rumah sakit berbinis di era pandemi dr. Kunthi Yulianti Sp.F
(tawaran pemeriksaan check up rapid
test covid-19) dari sudut pandang etika
kedokteran.
8 Bolehkah Dokter Tanpa APD Menolak dr. Henky, Sp.F., M,BEth., FACLM.
pasien di Masa Pandemi COVID-19 ?
9 Etika Penelitian dalam pengembangan dr. Ni Nengah Dwi Fatmawati Sp.MK,
vaksin dan terapi terkait penanganan PhD
Covid-19
10 Bagaimana membangun empati dan Dr. dr. I Nyoman Hariyasa
contoh-contohnya terhadap Sanjaya,SpOG(K), MARS
PDP,ODP,OTG, PMI dan tenaga medis
yg merawat pasien Covid 19 (yang
mengalami perlakuan diskriminatif di
masyarakat tempat tinggal mereka)?
11 Dilema Profesi Dokter dalam Dr. dr. I Made Sudarmaja,M.Kes
menjalankan kewajiban terhadap
pasien dengan kewajiban menjaga
kesehatan diri sendiri di era Pandemi
Covid 19

TIME TABLE
Class A and B
DAY/
DATE TIME ACTIVITY VENUE CONVEYER
08.00 – 08.50 Lecture 1 : Medical Class room Prof. Mangku

1 09.00 – 09.50 Professionalism
Lecture 2: Professional Class room Dr. Hariyasa S
Wednes 10.00 – 10.50 Personal Attribute
day 11.00 – 11.50 Independent learning Class room -
06-05-2020 12.00 – 12.50 Break -
13.00 – 13.50 Lecture 3 : Empathy Disc. room Dr. Wulanyani
Lecture 4: Awareness to Class room Dr. Dyah P.
diversity in medical practice Duarsa
14.00 – 14.50 - -
15.00 – 15.50 Independent learning Disc. room Facilitator
Student Project
08.00 – 08.50 Lecture 5 : Patient’s right & Class room dr. Alit
2 autonomy Class room
Friday 09.00 – 09.50 Independent learning
08-05-2020 10.00 – 10.50 SGD Disc. room Facilitator
11.00 – 11.50 SGD Disc. room Facilitator
12.00 – 12.50 Plenary session Class room Prof Mangku/
Dr. Hariyasa S
13.00 – 13.50 Plenary session Class room Dr. Wulanyani
/ Dr. Dyah P.
Duarsa/dr.
14.00 – 14.50 Break - Alit
15.00 – 15.50 Student Project Disc. room -
Facilitator
3 08.00 – 08.50 Lecture 6 :Informed consent & Class room dr. Alit
Monday Confidentiality
11-05-2019 09.00 – 09.50 Lecture 7 :Legal Aspect of Class room dr. Alit
Medical Record & Medical
10.00 – 10.50 Certification - -
11.00 – 11.50 Independent learning - -
12.00 – 12.50 Break Class room dr. Dudut
Lecture 8 : Legal Aspect of
13.00 – 13.50 Medical Practice Class room dr. Dudut
Lecture 9 : Criminal Law
14.00 – 14.50 Medical & Medical Malpractice - -
Student Project
08.00 – 08.50 Lecture 10 : Medical Class room dr.Alit
4 09.00 – 09.50 Certification - -
Tuesday 10.00 – 10.50 Independent learning Disc. room Facilitator
12.00 – 12.50 SGD Class room dr. Alit
13.00 – 13.50 Plenary session Class room dr. Dudut

14.00 – 14.50 Plenary session - -

15.00 – 15.50 Break Disc. room Facilitator
Student Project
5 08.00 – 08.50 Lecture 11 : Legal aspect of Class room dr. Alit

Wednes Visum et Repertum
day 09.00 – 09.50 Lecture 12 : Ethics & Bioethics Class room dr. Henky
13-05-2020 10.00 – 10.50 Independent learning - -
11.00 – 11.50 Break - -
12.00 – 12.50 Lecture 13 : Bioethical Class room Dr. Henky
13.00 – 13.50 Theories Class room Dr. Henky
Lecture 14 : Principles of
14.00 – 14.50 Biomedical Ethics - -
Student Project
08.00 – 08.50 Lecture 15 : Research Ethics Class room Dr.Dwi
6 Fatmawati
Thrusday 10.00 – 10.50 SGD Disc. room Facilitator
12.00 – 12.50 Plenary session Class room Dr. Henky
13.00 – 13.50 Plenary session Class room Dr. Dwi
Fatmawati/dr.
Alit
14.00 – 14.50 Break - -
15.00 – 15.50 Student Project Disc. room Facilitator
7 08.00 – 08.50 Lecture 16 : Clinical Ethics Class room Dr. Henky
Friday 09.00 – 09.50 Lecture 17 : Solidarity and Class room Dr. Henky
15-05-2020 Cooperation
11.00 – 11.50 Break - -
12.00 – 12.50 Lecture 18 : Public Health Class room Dr. Sawitri
13.00 – 13.50 Ethics Class room Dr.Sudarmaja
Lecturec 19 : Doctors as Part
14.00 – 14.50 of Society and Doctors as - -
15.00 – 15.50 Professionals Disc. room Facilitator
Independent learning
Student Project
8 08.00 – 08.50 Lecture 20 : Medical Re co rd & Disc. room Dr. Kunthi
Monday 09.00 – 09.50 ICD X - -
18-05-2020 10.00 – 10.50 Independent Learning Disc. room Facilitator
11.00 – 11.50 SGD Disc. room Facilitator
12.00 – 12.50 SGD Class room Dr. Henky/
Plenary session Kunthi
13.00 – 13.50 Class room Dr.
Plenary session Sudarmaja/Dr.
Sawitri
14.00 – 14.50 - -
15.00 – 15.50 Break Disc. room Facilitator
Student Project
9 08.00 – 08.50 Student Project Presentation Fasilitator &
Tuesday 09.00 – 09.50 Student Project Presentation Evaluator
19-05-2020 10.00 – 10.50 Break
11.00 – 11.50 Student Project Presentation Fasilitator &
12.00 – 12.50 Student Project Presentation Evaluator
13.00 – 13.50 Break

14.00 – 14.50 Student Project Presentation Fasilitator &
15.00 – 15.50 Student Project Presentation Evaluator
Saturday
30-05-2020 Pre Evaluation Brake
Monday
02-06-2020 EXAMINATION
Block Team
ASSESSMENT METHOD
Cognitive assessment will be carried out on Wednesday 02 June 2020. The test will
be consist of 100 questions with 100 minutes provide for working. The assessment will be
held at the same time for both Regular Class and English Class. SGD’s and student
project’s mark will be include in the final score as describe below. The overall passing score
requirement is ≥65. More detailed information or any changes that may be needed will be
acknowledged at least two days before the assessment.
 SGD : 10 %
 Final Exam : 80 %
 Student Project : 10 %

LEARNING PROGRAMS
LECTURE 1
INTRODUCTION TO MEDICAL PROFESSIONALISM
Prof. Dr. dr. N. Mangku Karmaya, M.Repro
Abstract
Profesionalisme adalah sebuah spirit, semangat dan konsep etika ketika seorang
professional melaksanakan tugasnya. Seorang disebut professional jika telah menguasai
pengetahuan dan keterampilan yang spesifik yang diperoleh sesudah melampui pendidikan
formal yang diakui yang dipraktekkan demi kesejahteraan masyarakat berdasarkan nilai -
nilai moral yang tinggi yang ditunjukkan dengan semangat tanggung jawab soaial,
kemanusiaan, professional dan Hukum.
Profesionalisme dalam bidang kedokteran mengacu pada prinsip -prinsip etika kedokteran
seperti Principle of nonmaleficence, Principle of beneficence, Principle of justice, Principle
of autonomy, Principle of veracity dan Principle of confidentiality
Dari prinsip etika kedokteran itu maka muncul beberapa komitment inti yang sebaiknya
dilakukan dokter baik dalam menghadapi pasien, masyarakat, maupun dalam menghadapi
berbagai tantangan dalam bidang profesi adalah Commitment to professional competence,
Commitment to honesty with patient, Commitment to patient confidentiality, Commitment to
maintaining appropriate relations with patient, Commitment to improving quality of care,
Commitment to improving access to car, Commitment to a just distribution of finite
resources, Commitment to scientific knowledge, Commitment to maintaining trust by
managing conflicts of interest, dan Commitment to professional responsibilities.
(Professionalism is a spirit, spirit and ethical concept when a professional performs his
duties. A person is called a professional if he has mastered the specific knowledge and
skills obtained after exceeding the recognized formal education that is practiced for the
welfare of the community based on high moral values that are demonstrated by the spirit of
social, humanitarian, professional and legal responsibility.
Professionalism in the field of medicine refers to the principles of medical ethics such as the
Principle of nonmaleficence, Principle of beneficence, Princip le of justice, Principle of
autonomy, Principle of veracity and Principle of confidentiality
From the medical ethics principle, a number of core commitments that should be performed
by doctors both in dealing with patients, the community, and in facing var ious challenges in

the professional field are Commitment to professional competence, Commitment to honesty

with patient, Commitment to patient confidentiality, Commitment to maintaining appropriate
relations with patient, Commitment to improving quality of care, Commitment to improving
access to car, Commitment to just distribution of finite resources, Commitment to scientific
knowledge, Commitment to maintaining trust by managing conflicts of interest, and
Commitment to professional responsibilities.)
Learning Task
1. Membedakan seorang pekerja biasa dengan seorang professional (Distinguish an
ordinary worker from a professional)
2. Menjelaskan unsur-usur sebagai persyaratan yang dimiliki seorang professional (.
Explain elements as requirements of a professional)
3. Menguraikan nilai-nilai yang mendasari profesionalisme (Describe the values that
underlie professionalism)
4. Dalam bidang kedokteran profesionalisme didasari oleh prinsip-prinsip etika medis.
Jelaskan (In the field of medicine professionalism is based on the principles of
medical ethics. Explain)
5. Menjelaskan 10 komitmen dalam praktek kedokteran (Explain 10 commitments in
medical practice)
Berikan tanggapan terhadap kasus di bawah ini berdasarkan prinsip-prinsip profesionalisme
1. Seorang dokter senior memeriksa pria paruh baya yang mengalami lutut kanan
bengkak dan sangat nyeri. Diagnosis kerja dokter adalah osteoarthritis. Namun tidak
kecil kemungkinan osteosarcoma. Lalu dokter mengkomunikasikan semua
kemungkinan diagnose penyakit tersebut. Dengan persetujuan pasien, dokter
merujuk ke dokter spesialis radiologi untuk x-ray.
2. Seorang pasien lansia diantar banyak keluarga untuk pemeriksaan penyakit kronis
yang dideritanya. Setelah melakukan pemeriksaan dokter menyampaikan bahwa
kemungkinan besar sang ayah menderita kanker paru-paru
3. Setelah jam praktek usai barulah dr. Toni menyadari bahwa dia telah membuat
kekeliruan menulis resep untuk pasien yang namanya bu Yeni. Dr Toni
menghubungi bu Yeni tapi tilpun tidak diangkat. Akhirnya dr. Toni memutuskan
untuk datang ke alamat bu Yeni. Ditemuinya bu Yeni dalam keadaan munta h-
muntah. Dr Toni minta maaf kepada keluarga karena adanya kekeliruan obat dan
segera menggantikannya dengan resep baru.
4. Sesudah melalui uji klinis dan di approved oleh FDA satu jenis antibiotika baru telah
dipasarkan oleh sebuah pabrik farmasi terkenal. Sekarang pabrik farmasi ini ingin
membandingkan efektivitasnya dengan antibiotika sejenis yang lazim digunakan di

RS tempat anda bekerja.Perusahaan menawarkan kepada anda dana 3 M untuk

melakukan penelitian singkat yang diterapkan pada pasien-pasien anda.
5. Ingin dibuktikan khaisat obat A untuk mengurangi serangan epilepsi. Sesudah anda
tetapkan kriteria inklusi anda memperoleh sampel penderita epilepsy dalam jumlah
yang cukup. Sampel dibagi dua kelompok kontrol dan kelompok perlakuan.
Kelompok kontrol diberikan placebo, kelompok perlakuan diberikan obat A sesuai
dosis. Sesudah pemberian selama satu tahun hasilnya menunjukkan perbedaan
sangat bermakna…..
6. Setiap hari ulang tahun Fakultas Kedokteran biasanya dilakukan pengabdian
masyarakat berupa kerja sosial kesehatan. Saat itu para dokter yang bertugas
mengajak mahasiswa kedokteran untuk ikut melakukan injeksi pasien….
7. Seorang dokter praktek umum yang sudah senior selalu dikunjungi banyak pasien.
Dokter yang baik hati ini enggan menolak pasien yang datang disaat -saat istirahat.
Bahkan hari liburpun dia buka buat mereka yang membutuhkan bantuan….
8. Keluarga pasien protes orang tuanya meninggal di bed UGD Rumah Sakit karena
dibiarkan oleh dokternya tanpa berbuat apa…
LECTURE 2
PROFESSIONAL PERSONAL ATTRIBUTE
Dr. dr. I Nyoman Hariyasa Sanjaya,SpOG(K), MARS
Abstract
People come to physician for help with their most pressing needs-relief from pain and
suffering and restoration of health and well being. They allow physicians to see, touch and
manipulate every part of their bodies, even the most intimate. They do this because they
trust their physicians to act in their best interests.
What constitutes a good doctor? Is technical proficiency sufficient to be a good
doctor? Clearly, a physician cannot lack necessary technical knowledge and skills and still
be a good doctor. Less clear is whether a technically proficient physician can lack
interpersonal skills necessary to relate well to patients and still be a good doctor. The
physician’s interpersonal skills are critical to establishing strong, trust-based physician-
patient relationships that offer multiple benefits. Most patients want a strong relationship
with a primary care physician.
The quality of a patient’s relationship with a physician can affect not only a patient ’s
emotional responses but also behavioral and medical outcomes such as compliance and
recovery. Consequently, physicians have been urged to improve their communication and
patient education techniques, develop their empathetic abilities, encourage participative
decision making, and convey respect and dignity.
Patients need good doctors. Good doctors make the care of their patients th eir
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.
Refferences :

1. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone.
Edinburgh. 2003 page : 51-57
2. CMA. Professionalism in Medicine.2001
3. Bendapudi,N.M. et al. Patient’s Perspectives on Ideal Phsician Behaviours.Mayo
Clin Proc.2006.81(3):338-344
Trigger Case 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.
Learning Task:
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 his/her empathy? Explain!
Trigger Case 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. T he
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, wh o goes
home without having spoken to the patient.
Learning Task:
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 his/her empathy? Explain!

LECTURE 3
EMPATHY
Dr. Ni Made Swasti Wulanyani,S.Psi, M.Erg., Psikolog
Abstract
Effective doctor-patient communication increases patient and physician satisfaction,
decreases patient omplaints and malpractice claims and increases patients’ physical and
mental health related to their diseases. This happened because e ffective empathetic
communication enhances the therapeutic effectiveness of the doctor -patient relationship.
Appropriate use of empathy as a communication tool facilitates the clinical interview,
increases the efficiency of gathering information, improved health outcomes, better patient
compliance, reduction in medical-legal risk, and improved satisfaction of clinicians and
patients.
The origin of the word empathy dates back to the 1880s, when German psychologist
Theodore Lipps coined the term "einfuhlung" (literally, "in-feeling") to describe the emotional
appreciation of another's feelings. Empathy is ability to under standther person’s situation
(taking the role of the other). Mead saw empathy as a willingness or tendency to put one -
self in another person’s place and to modify one’s behavior as a result. Even more simply
stated, empathy is the ability to "put oneself in another's shoes."
Decety and Jackson pointed out three primary components of empathy: 1. Emotional
response to the other person, which includes emotion sharing; 2. Cognitive capacity of
taking others perspective, and 3. Emotion regulation which is regulation mechanisms that
enable distinguishing self from the other, and one’s own emotions from others. Studies
discuss several phenomena which are related to empathy but at the same time distinct from
it. Such phenomena are mimicry, emotional contagion, sympathy, compassion, empathic
concern, and empathic pain or personal distress. Neuroscience researches of empathy
began about 15 years ago and have shown that there is no universal neural empathy
model, but that empathy includes various parallel brain processes, since it is a complex
andmulti-level affective-cognitive-behavioral phenomenon.
Empathy was known as "bedside manner," a quality considered innate and
impossible to acquire. More recently, greater emphasis has been placed on empathy as a
communication tool of substantial importance in the medical interview, and many experts
now agree that empathy and empathetic communication are teachable, learnable skills.
Because empathy is such a powerful communication skill in medical practice, the clinicians
would scramble to learn about and use it at every available opportunity. Physicians fulfill a
dual role, for which empathy is indispensable. One of professors says, “We cure with
modern medicine, and we heal with our presence and compassion”.
Refferences :
1. Batmanabane, V. Empathy: A vital attribute for doctors. Indian Journal of Medical Ethics.
2008. 5(3) :128-129
2. Hardee, J.T. An Overview of Empathy. The Permanente Journal.2003.7 (4):51-54
3. Decety J, Jackson PL. The functional architecture of human empathy. Behav Cogn
Neurosci Rev. 2004;3:71-100.
4. Decety J, Jackson PL. A Social-Neuroscience Perspective on Empathy. Curr Dir
Psychol Sci. 2006;15:54-58
5. Josip Bošnjaković, Tanja Radionov. 2018. Empathy: Concepts, Theories and
Neuroscientific Basis. Alcoholism and Psychiatry Research 2018;54:123-150 . DOI:
10.20471/dec.2018.54.02.04

Learning Task:
1. Fill the self assessment about empathy. You can share the score to to your friends if
you want. Discuss the aspects that consist in that empathy scale.
2. Choose one of your best experiences when you get very bad illness.
 Try to remember, what did you want from people around you (family, friends,
teacher, doctor, nurse, etc) in that time.
 Explain what you feel, what you think, everything in detail.
 What happened then? Did you meet your expectation? Explain the reason.
3. Choose one of your memorable experiences when you failed to catch up other’s
emotional expression or when others failed to understand your expressions.
Describe the situation. Discuss with your group.
4. Case: A 74-year-old woman was prescribed 3 types of drugs without explanation.
The doctor thought that the pharmacist would be written on each packe t of medicine
(that the drug was taken 3 x 1). She was also in a hurry at that time because so
many patients were in line and suffered. Three days later the woman came back with
her teenage grandson, and said her illness had not better at all. After probin g, it
turns out that her perception of “ 3 x 1” is drug A taken in the morning, drug B taken
in the afternoon and C taken at night without interval time consideration. The doctor
then tried to explain the old woman how to take medicine because her grand son
seemed very busy with homework on his gadget. The doctor explained for so long
that a man in the queue could not stand the pain and became angry. T he patient's
wife cried sadly to see her husband cursing the doctor.
Discuss how empathy should take here.
5. Give examples how millennials medical student can show empathy to people
around!
LECTURE 4
AWARENESS TO DIVERSITY IN MEDICAL PRACTICES
Dr. dr. Dyah Pradnyaparamita Duarsa. M.Si
Abstract
Culture consists of patterns, explicit and implicit, of and for behaviour acquired and
transmitted by symbols, constituting the distinctive achievement of human groups. Culture is
a human creation, which includes codes of behaviour, language, ritual, and systems of
beliefs. The essential core of culture consists of traditional ideas and especially their
attached values. So culture is learned, shared, ideas about and patterns of behaviour.
Values of culture influenced gender perspective. Unequality of gender perspective is
different between countries. In higher-income countries women live longer than men. It is
different conditions especially in lower-income countries, by gender discrimination, resulting
in inequalities in education, income and employment, information and in access to health
services. Moreover, the problems for women are especially severe in relation to sexuality
and reproduction. However, although gender discrimination is more severe in low-and
middle-income countries.
A society is an organized group of individuals with specific boundaries, or criteria, of
membership. We will speak of both societies and cultures in terms of levels of inclusiveness
(about gender as the cultural construction, values, norms, and belief). Factors inherent
within a given culture are also likely to influence deeply the percept ion and definition of

illness, and any consequent actions. Although this subject highlights the different influences
on health and many of this factors are inter-related.
References:
1. Campbell AV. Bioethics The Basic. Oxon: Routledge; 2013.
2. Principles of Bioethics, Thomas R. McCormick, D.Min., Senior Lecturer
Emeritus,Dept. Bioethics and Humanities, School of Medicine, University of
Washington
3. Ross J.Taylor. et al. Health and Illness in the community. Oxford University Press.
2003
Trigger Case 1
Jehovah's 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 refusing a bl ood
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 compa ssionately 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.
Learning Task:
Discuss the problem!
Trigger Case 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.
Learning task:
Please discuss what the physician can do!
Trigger Case 3
This case, in the treatment of suicidal patients who are a clear a nd present danger to
themselves. Here, the duty of beneficence requires that the physician intervene on behalf of
saving the patient's 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.
Learning task:

Please discuss your opinion!
LECTURE 5
PATIENT RIGHT’S AND AUTONOM Y
dr. Ida Bagus Alit, Sp. F
Abstract
Dalam pelayanan kesehatan pemenuhan hak pasien adalah suatu hal yang paling
mendasar.Pelayanan kesehatan kalau dianalogikan sebagai sebuah rumah, hak pasien
menjadi dasar rumah tersebut sedangkan etik dan hukum menjadi atap. Pelayanan
kesehatan analog dengan ruang yang ada dirumah tersebut, sehingga isu etik dan hukum
serta landasan pemenuhan hak pasien selalu melekat dengan tindak medis.
Diantara hak-hak pasien, hak yang paling mendasar adalah hak mendapat
pelayanan kesehatan (righ to health care) dan hak menentukan keputusan sendiri (right to
self-determination). Kedua hak pasien ini dikembangkan menjadi berbagai hak-hak pasien
lainnya.
Sekarang hak-hak pasien sudah diatur dalam perundang-undangan seperti undang -

undang No. 29 tahun 2004 tentang Praktek Kedokteran dan undang -undang No. 44 tahun
2009 tentang Rumah Sakit. Dilihat dari segi hukum, pemenuhan hak pasien merupakan
kewajiban dokter yang sudah diundangkan (Tort basis duties). Tidak terpenuhinya hak
pasien oleh dokter menjadi pengabaian kewajiban hukum dokter (legal duty).
Salah satu hak pasien adalah dirahasiakannya segala hal yang terjadi berkenaan
dengan penyakit yang dideritanya. Hal ini merupakan rahasia kedokteran (Confidentiality).
Tersimpannya rahasia pasien akan membentukrasa percaya (Confident) pasien terhadap
profesi dokter sehingga terjadi hubungan dokter pasien yang bersifat fiduciary.
Rahasia kedokteran merupakan tanggu jawab moral, etik dan hukum bagi seorang
dokter. Pembukaan rahasia kedokteran hanya boleh dilakukan atas ijin atau permintaan
dari pasien sendiri, dan bila diminta oleh Negara untuk kepentingan hukum dan peradilan.
Pembukaan rahasia kedokteran oleh Negara berdasarkan konsep “Balancing public
interact concept”
References :
 Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone.
Edinburgh. 2003 page 61-80
 Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th ed. New York:
Oxford University Press, 2008.
 Kode Etik Kedokteran Indonesia (KODEKI).
 Undang-Undang Republik Indonesia Nomor 29 Tahun 2004TentangPraktik
Kedokteran
 Peraturan Menteri Kesehatan Republik Indonesia Nomor 290/MENKES/PER/III/2008
tentang Persetujuan Tindakan Kedokteran
 Shepherd, R. The Ethics of Medical Practice in Simpson,s Forensic Medicine.
Twelfth Edition.2003.page 8-14
 Shepherd, R. The Ethics of Medical Practice in Simpson,s Forensic Medicine.
Twelfth Edition.2003.page 8-14
 CMA. Professionalism in Medicine.2001
 Bendapudi,N.M. et al. Patient’s Perspectives on Ideal Phsician Behaviours.Mayo

Clin Proc.2006.81(3):338-344
Triger case 1
A 25 years old man, who works as a travel driver was admitted to “A” Hospital with a
diagnosis of Epilepticus Status. He had recurrent seizures. After the seizures are handled
the patient asks for an explanation of his illness to the doctor. At about the same time, the
company asked for information about the patient's condition for reimbursement of medical
expenses
Learning task
1. Compare the rights of the patient in the Medical Practice Law ( UU Praktek Kedokteran )
with the patient's right in the Hospital Law (UU Rumah Sakit)
2. A doctor other than having an obligation, also has rights. Explain the doctor's right set
out in both laws above (UU Praktek Kedokteran and UU Rumah Sakit).
3. Describe the relationship Between patient rights, medical ethics and law
Explain the concept of Medical Convidentiality from aspects of ethics and law
LECTURE 6
INFORMED CONSENT & CONFIDENTIALITY
Informed Consent
Patients are entitled to make decisions about their medical care and to be given
relevant information on which to base such decisions. The physician's obligation to obtain
the patient's consent to treatment is grounded in the bioethical principles of patient
autonomy and respect for persons and is affirmed by Indonesian law and professional
policy. A large body of research supports the view that the process of obtaining consent can
improve patient satisfaction and compliance and, ultimately, health outcomes.
Physician must disclose relevant and detail information, so the patient can
understand it clearly. Both elements are necessary for valid consent. Physician should
inform the patient adequately about the treatment and its expected effects, relevant
alternative options and their benefits and risks, and the consequences of declining or
delaying treatment. The physician’s goal is to disclose information that a reasonable person
in the patient's position would need in order to make an informed decision. Therefore,
physician may need to consider how the proposed treatment (and other options) might
affect the patient's employment, finances, family life and other personal concerns. Physician
may also need to be sensitive to cultural and religious beliefs that can affect disclosure.
The situation in which an adult lacks the capacity, for whatever reason, to make an
informed decision is somewhat confused. Where a patient is suffering from a mental
condition, he may be given treatment for his mental condition without consent. In
emergency, such as an accident where the victim is unconscious or shocked, no permission
is necessary and doctors must do as they think best for the patient in those urgent
circumstance. Exceptions to the principle of informed consent also occur with regard to
persons with impaired, such as children who are usually represented by a third party, such
as parents or other close relatives, vis-à-vis the physician. Substitute decision-making poses
two main questions: Who should make the decision for the incapable person, and, how
should the decision be made? To answer these questions, physician should become
familiar with the legal requirements.
Refferences :
 Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone.
CASE
A woman enters the emergency room with stomach pain. She undergoes a CT scan and is
diagnosed with an abdominal aortic aneurysm (a weakening in the wall of the aorta which
causes it to stretch and bulge). The physicians inform her that the only way to fix the
problem is surgically, and that the chances of survival are about 50/50. They also inform her
that time is of the essence, and that should the aneurysm burst, she would be dead in a few
short minutes. The woman is a photo model and actress; she worries that the surgery will
leave a scar that will negatively affect her work; therefore, she refuses any surgical
treatment. Even after much pressuring from the physicians, she ada mantly refuses surgery.
Feeling that the woman is not in her correct state of mind and knowing that time is of the
essence; the surgeons decide to perform the procedure without consent. They anesthetize
her and surgically repair the aneurysm. She survives, and sues the hospital for millions of
dollars.
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. What is your view on the application of the principle of informed consent in this case?
4. Try to find the reason, why the doctor decides as he did?
5. If you were doctor in this case, what would you do? (Explain your arguments based on
prima facie duties, the principle of informed consent, ethical theory, KODEKI, and legal
aspect)
Confidentiality
Physicians are obliged to keep information about their patients secret. The
understanding that the physician will not disclose private information about the patient
provides a foundation for trust in the therapeutic relationship. Respect for confidentiality is
firmly established in codes of ethics and in law. It is sometimes necessary, however, for
physicians to breach confidentiality. Physicians should familiarize themselves with
legislation governing the disclosure of certain kinds of in formation without the patient’s
authorization. Even when no specific legislation applies, the duty to warn sometimes
overrides the duty to respect confidentiality. The physician should disclose only that
information necessary to prevent harm, and should reveal this information only to those who
need to know it in order to avert harm. Whenever possible any breach of confidentiality
should be discussed with the patient beforehand.
Refference :
 Tony Hope et al. Medical ethics and Law the core curriculum. Chur chill Livingstone.
 Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th ed. New York:
Oxford University Press, 2008.
 Kode Etik Kedokteran Indonesia (KODEKI).
 Undang-Undang Republik Indonesia Nomor 29 Tahun 2004 Tentang Praktik
Kedokteran

 Peraturan Menteri Kesehatan Republik Indonesia Nomor 290/MENKES/PER/III/2008

tentang Persetujuan Tindakan Kedokteran
CASE
Joice and Doni have been married for 12 years and have a 6 -year-old son. Doni’s father
and grandfather died from cancer when they were in their early forties. Because of the
strong family 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
hereditary non-polyposis colorectal cancer. Now, Doni is feeling tired and unwell, and has a
colonoscopy. The test reveals that he has inoperable bowel cancer. Joice is concerned that
their son might also be at risk of colon cancer when he is older. She asked you to d o a
genetic test for his son to see if he is at risk.
Assignment:
3. Should parents be allowed to have their children tested for adult -onset genetic
conditions? Why?
4. What would you do? (Explain your arguments based on prima facie duties, the principle
of informed consent, ethical theory, KODEKI, and legal aspect)
5. What are the foreseeable consequences of your decision? Can you justify this d ecision
to accommodate: the patient or the patient’s family value; to your consultant; and to your
peers?
CASE 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:
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
peers?
5. Does it make any difference if the Tony’s diagnosis is not HIV? Explain!
CASE 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:
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
peers?
5. If you are asked to testify and disclose patient information in court, what would you do?
LECTURE 7
LEGAL ASPECT OF MEDICAL RECORD AND MEDICAL CERTIFICATION
Abstracts
Doctor who main profesion for health sevices also has responsibility to make
medical documents in form of certificate needed by patient, third party and state in the name
of law. These medical documents consist of Health Certificate, Sick Leave Certificate,
Certificate of non-infected from any contagious disease and etc. There are trends of upward
need to medical certificate for many different purposes according to development of medical
technology and science. Nowadays, Certificate of Patternity, Certificate of Gender,
Certificate of Virginity and etc are frequently needed.
Basic principal of medical certificate on medicolegal aspect mainly consist of fact
and medical opinion. Facts based on medical examination meanwhile medical opinion made
according to medical procedure. Therefore, medical certificates are tightly attached to
medical confidentiality.
Doctor profession has many responsibilities, one of them is legal duty. This
responsibility is an obligation mainly assisting law and trial process. For instance, Visum et
repertum is medical certificate made for law enforcement. The division of visum et repertum
depends on substance needed by the state. Generally, it is differentiated in to Psychiatric
Visum et Repertum andPhysical Visum et Repertum. Physical Visum et repertumcan be
divided in to death victim Visum et repertum and live victim Visum et repertum. Meanwhile
live victim visum et repertum can be made for physical violence and toxin VeR and sexual
harassment VeR.
Medical record in other hand is a note for all medical information collected from
patient examination and analysis including medical procedure performe d. Medical record is
compulsory to all practicing doctor which has function for administration, legal, financial,
research data and education. Its legal function needed as a source for medical certificate
and VeR aside used as written evidence on medical dispute.
Refferences :
1. Hirsh, H.L. Medical Record in : Legal Medicine. Sanbar, S.S. et al (Ed.).1998. Page
280-296
2. Plueckhahn, V.D. and Cordner, S.M. Ethics, Legal Medicine and Forensic Pathology,
Second Edition. 1991. Page 111-122
Trigger Case 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.
Learning Task:
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!
Trigger Case 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.
Learning Task:
1. What the doctor should do to document the result of the examination?
2. The policewoman requested the doctor to make medico-legal report (visum et
repertum). Explain the role of and procedures to make visum et repertum!
3. According to the legal procedures, the attorney requests the doctor to give expert
witness at a trial. Explain the differences between witness and expert witness. What the
doctor should do if requested to stand in trial?
LECTURE 8
LEGAL ASPECT OF MEDICAL PRACTICE
dr. Dudut Rustyadi, SpFM(K), SH
Abstracts
According to the Assembly of Indonesian Law of Health, Law of Health includes all
regulation that is directly related to maintenance/services of health care and its’ application,
which includes Civil Code, Criminal Code and Law of Administration.Law of Health is
divided into two, direct and indirect.
Direct Law of Health is alaw regulation that is directly related to maintenance of
health, such as:
 Act Number. 29 Year 2004 concerns of Medical Practice
 Act Number 36 Year 2009 concerns of Health
Indirect Law of Health includes all application of law regulation that is related to law
specialization, such as: Civil Code, Criminal Code and Law of Administration which can be
implied in maintenance/services of health care.
The purpose of Law of Health is to provide legal protection and assurance to both
giving and receiving parties in health care services. Thus, Law of Health consists of:
• Medical/Dentistry Law
• Clinical Pharmacy Law
• Hospital Law
• Community Health Law
• Etc.
Medical Law is a Law of Health in a constricted meaning, which is also the core of
Law of Health which regulates the medical services.The meaning of Medical Law is divided
into a broad and constricted meaning.
Medical Law in the broad meaning is all the regulations in medical services, such
as medical services provided by doctors, dentists, nurses, and laboratories.
Medical Law in the constricted meaning is all the regulations that only cover the
doctor’s professions, such as:
• Doctor-patient relationship
• Medical Record and medical Confidentiality
• Informed Consent
• Medical malpractice
• Euthanasia
• Etc.
Refferences :
1. Shepherd, R. The Ethics of Medical Practice in Simpson,s Fore nsic Medicine.
Twelfth Edition. 2003.page 1-8
3. Sanbar, S.S. et al. Legal Medicine and Health Law Education in : Legal Medicine.
Sanbar, S.S. (Ed). 1998.Page 3-10
4. Piorkowski, J.D.Medical testimony and the expert witness in : Legal Medicine.
Sanbar, S.S. et al (Ed.). 1998. Page 132-144
5. Wiradharma, D. Penuntun Kuliah Hukum Kedokteran. Page 25-35
6. Ohoiwutum, T. Bunga Rampai Hukum Kedokteran.page 1-13
Trigger Case
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 hea ring abilities. T his
has resulted in lack of communication between her and her family. The family later
requested a doctor to do euthanasia to her.
Learning task:
1. In your opinion, what the doctor should do?
2. In your opinion, is the doctor guilty if at all he/she grants the family’s request of
euthanasia towards her (mother)? Explain!
3. What is your point of view regarding the ethical aspect in euthanasia?
LECTURE 9
CRIMINAL LAW AND MEDICAL MALPRACTICE
dr. Dudut Rustyadi, SpFM(K), SH
Abstracts
In general, the understanding of criminal law is the law which legislate and control a
human’s forbidden act and when this is disobeyed, the respected person will be charged
according to law. A doctor is said to have done a criminal act when he/she breaks the rules
stated in Indonesian Criminal Law (KUHP), and other laws, for an example, Law of
Health.
A patient or his/her family’s dissatisfaction towards a medical care received from a
doctor or a hospital can evoke a legal action. The legal action occurred perhaps no t
because of the mistake done by a doctor or the hospital, but because of the breach in
medical ethics, medical disciplines, or even the criminal act and the medical malpractice
itself. Occurrence of medical malpracticeis solely because of the doctor’s neg ligence which
causes loss for the patient and his/her family. To prove a malpractice has occurred, there
are two proving procedures or mechanism, the first is direct proving method using 4D
criteria; Duty, Dereliction of duty, Damage and Direct causation. The second proving
procedure is via indirect method using doctrine Res Ipsa Loquitor (the thing speaks for
itself).

Refferences :
2. Flamm, M.B. Medical Malpractice and the physician defendant in : Legal Medicine
Sanbar, S.S. et al. (Ed.) 1998. Page 123-129
Trigger Case 2
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.
Learning task:
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!
Trigger Case 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 receivin g 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.
Learning task:
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?
Trigger Case 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
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.
Learning task:
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?

LECTURE 10
MEDICAL CERTIFICATION
Abstract
Medical Certification is all of the written explanation related to Medical matter. Medical
certification requested by patient, third part and the Law. The development of medical
certification was follow the development of medical science and medical technology.
In making Medical Certification, confidentiality is the important issue. Informed consent is
absolute as a conditions if the Medical certification is requested by third part. In the other
hand, consent is not need if the Medical Certification to Law supremacy. The concept of
Law is balancing public interest.
There are two components of Medical Certification: Medical fact and Medical opinions.
Medical fact is collected from medical examination physically or laboratories, while Medical
opinion is interpretation of medical fact base on the competences.
Ethical issue related to medical Certification is article 7 Indonesian Medical Ethical Code.
The doctor only can give the information which can be verified. This article refer the doctor
in making Medical Certification base on medical examination and explain only the objective,
relevans and qualified medical fact. If the doctor in not impartial position that caused by
Doctor and Patient relationship, the doctor must refer the patien to other impartial doctor.
The Medical Certification must objective and impartial.
The Medical Certification is need in wide conditions and make the Medical Certification had
variation depend on the condition. This situation is State of The Art in Medical Certification.
Learning Task
VIGNETTE
A man 45 years of old, the defendant of corruption case. He complain suffered by epigastric
pain and severe headache. He can not to go to Trial because his condition. The Jugde
request the doctor to make examination and give Medical Certificate.
1. Explain the component of Medical Certification and the application on Certificate of
Death, Certification of paternity, Certification of communicable disease, ect
2. How the role of critical thinking in making Medical Certification
3. Expalin the Ethical issue in the above case
4. How do you do in making medical certification in above case
References
Budiyanto A, Widiatmaka W, Sudiono S, Winardi T, Abdul Mun'im, Sidhi, dkk. Ilmu
Kedokteran Forensik. Jakarta: Bagian Kedokteran Forensik Fakultas Kedokteran
Universitas Indonesia; 1997. 979-8687-00-6.
Knight B. Forensic Pathology. Wales Institute of Forensic Medicine; 1996. 0 -304-58897-7
McLay WDS. Clinical Forensic Medicine; 1996. 1-900151-200
Gee J.D., Watson A. A. Lecture Notes on Forensic Medicine; 1989. 0 -632-02595-6
Shepherd R. Simpson’s Forensic Medicine; 2003. 0-340-76422

LECTURE 11
LEGAL ASPECT OF VISUM ET REPERTUM
Visum et Repertum is written expert witness that made by the doctor to the Law (pro justitia)
about medical examination on the human or human part, life person or dead person by
formal investigator request, base on competence and firming by oath.
There are many types of Visum et Repertum. Visum et Repertum phsyciatricum for mental
status in competences to responbility, this Visum commonly for the suspect. Visum et
Repertum Ragawi (physical Visum et Repertum) to the Visctims. Physical Visum et
Repertum is devided to Visum et Repertum dead victim and life victim. To life victims, there
are Visum et Repertum physical assault (torture) and Visum et Repertum sexual assault.
The component of Visum et Repertum is professional witness and expert witness.
Professional witness is physical evidence that collected by medical examination base on
implicit reasoning. Medical science, medical theory and specific medical purpose are the
implicit reasoning for physical evidence. While Expert witness is interpretation of physical
evidence base on competence and critical thinking. The judge refer the Expert witness to
make Legal judgement, so that Expert Witness call a Legal proof.
Medico legal procedures in making Visum et Repertum is base on formal request from the
investigator (police). Visum et Repertum is one of Legal duty for Medical Doctor. Many
article in Indonesian Positive Law that regulated Visum et Repertum, especially article 133
Indonesian Legal Procedures.
Visum et Repertum devide in to 5 parts include: Pro Justitia, opening paragraph,
Pemberitaan (professional witness/ physical evidence), Conclusion (expert witness) and
closing statement. Pro Justitia reflected Visum et Repertum is formal for Justice. In opening
paragraph was writted identity of police, the doctor, the victim, time and place of
examination. All of medical examination result were writted in Pemberitaan. Conclusion is
opinion base competence to explain medico legal causality. Closing statement is statement
that give firmming that Visum et Repertum is made base on oath.
The role of Visum et Repertum in the Law are: to be expert witness, document evidence and
hint.
Learning Task
Vignette
A man 25 years of old, was found hanged in his house. On examination was encountered
indentation mark around the neck and sign of asphyxia. On autopsy were found swelling of
braind and Lungs. Cervical fractures were found on first and second part of cervical bones.
Base on the examination result, died of the victim is hanging.
1. Explain the Medico Legal procedures in making Visum et Repertum

2. Explain parts of Visum et Repertum
3. Explain physical evidence and interpretation (expert witness) in above case
4. Explain about Medico Legal Causality in above case
References
Budiyanto A, Widiatmaka W, Sudiono S, Winardi T, Abdul Mun'im, Sidhi, dkk. Ilmu
Kedokteran Forensik. Jakarta: Bagian Kedokteran Forensik Fakultas Kedokteran
Universitas Indonesia; 1997. 979-8687-00-6.
Knight B. Forensic Pathology. Wales Institute of Forensic Medicine; 1996. 0 -304-58897-7
McLay WDS. Clinical Forensic Medicine; 1996. 1-900151-200
Gee J.D., Watson A. A. Lecture Notes on Forensic Medicine; 1989. 0 -632-02595-6
Shepherd R. Simpson’s Forensic Medicine; 2003. 0-340-76422

LECTURE 12
ETHICS & BIOETHICS
dr. Henky, Sp.F., M,BEth., FACLM.
Ethics :
Morality is a unique feature of the life of human beings. It is deeply influenced by several
cultural factors, such as history, traditions, education, religious beliefs, etc. The intellectual
analysis of this human dimension in all of its complexity is the goal of the discipline called
Ethics. Ethics does not create morality or moral behaviour. The goal of ethics is much more
modest: to explore the nature of moral experience, its universality and its diversity. Ethics
and morality are generally taken as synonyms, because they originally had the same
meaning: the study of the disposition, character, or attitude of a specific person, group of
people or culture, and ways of promoting or perfecting it.
Ethics is both a theoretical and a practical discipline. The language of ethics refers to duties
and values. One goal of ethics is to determine right decisions, and in order to do that, it is
necessary to go step by step, analyzing, first, the facts of the case, second, the values at
stake, and third, the duties.
Trigger Case
A 17 year old young woman is brought to the emergency room with a septic abortion. She is
living separately from her parents, from whom she is estranged and who live in a distant
town. Local law requires parental consent if there is an abortion in a minor. The patient is
septic, blood pressure is stable, and antibiotics are started. The patient does not want her
parents informed, but the practitioner is concerned about legal consequences if the patient
is treated without parental consent.
Learning Task:
1. Please identify ethical, legal, cultural, and religious issues in this case! Explain!
2. What is your decision in this case? Explain!
References:
1. Bioethics Core Curriculum. UNESCO; 2008.
Bioethics :
Bioethics is a relatively new word coined by a biochemist, Van Rensselaer Potter, in
1970 in an endeavor to draw attention to the fact that the rapid advances in science had
proceeded without due attention being paid to values. For some time the word referred to
the attempt to link scientific facts and values in the area of environmental concerns.
Nowadays it has taken on a more general meaning which includes medical, or more
generally, health care ethics. Though there are examples of reflection on ethics in medicine
through the ages the subject of bioethics has mushroomed into sub -discipline of ethics in
the past decades. This growth was stimulated both by abuses of human beings in the
course of medical research, especially during the Second World War, and by the
emergence of medical technologies which have challenged various widely held public
values.
One profession dealing with life during centuries and millennia, especially with hum an life,
has been medicine. But today there are many sciences and professions working in this field.
Therefore, bioethics should not be confused with medical ethics, which is only one of its
branches. The field of bioethics is as wide as the facts of life, and its study is divided in

many branches, each one with its specificity: Ecological or environmental bioethics, Medical
bioethics, Clinical bioethics, etc including Global bioethics.
The UNESCO UDBHR identifies fifteen bioethical principles:

i. Human dignity and human rights
ii. Benefit and harm
iii. Autonomy and individual responsibility
iv. Consent
v. Persons without the capacity to consent
vi. Respect for human vulnerability and personal integrity
vii. Privacy and confidentiality
viii. Equality, justice and equity
ix. Non-discrimination and non-stigmatization
x. Respect for cultural diversity and pluralism
xi. Solidarity and cooperation
xii. Social responsibility and health
xiii. Sharing of benefits
xiv. Protecting future generations
xv. Protection of the environment, the biosphere and biodiversity
Trigger Case
A fifty year old psychiatrist hires a patient to clean her apartment. At the same time she is
treating the patient for phobias with hypnosis after returning home in the evenings. The
arrangement for her cleaning work was intended to provide a kind of ‘paymen t’ for the
treatment she could not afford otherwise.
Learning Task:
1. Please identify medical ethics and bioethical issues in this case! Explain!
2. What is your decision in this case? Please explain using the principles of bioethics!
References:
LECTURE 13
BIOETHICAL THEORIES
Abstracts
Theory is an account of the world that goes beyond what we can see and measure.
It embraces a set of interrelated definitions and relationships that organize concepts in a
systematic way. The concept itself is defined as the terminological means by which
bioethicists seek to analyse moral phenomenon, to classify the objects of the observed
world, impart meaning through explanation to selected phenomen a and formulate higher-
order propositions of what we ought to do in given situations, what we take to be “good” or
“bad”, “right” or “wrong”.
Theory is important because (1) It allows us to produce a “story” about how the
moral world operates or should operate. It brings “order” to the “chaos” through
generalizations and classifications of the moral, social and political universe, (2) It gives
meaning and focus to moral inquiry or investigation. Theories offer a coherent strategy for
thinking about moral phenomena, what we are doing or what we ought to do across time,
space, and situations, (3) It sets the puzzles (“ethical dilemmas”) and standards for their
solution. Once something has been identified as a bioethical dilemma or issue, theory

shapes action that is taken to resolve the problem; (4) Bioethical theory seeks not only to
make things intelligible, but to make them “better” by setting standards for behaviour. Ethical
discourse is a codified body to abstract knowledge held by experts about the ‘good ’ and
ways to realize it, (5) Theory is a “box of tools” that suggest ways of looking at the world that
can make the strange familiar; reveal taken-for-granted values, hidden moral premises,
norms, intentions, that inform arguments and diagnosis.
Generally, bioethics focuses on normative and applied theories. In this lecture, some
of popular approaches on normative and applied ethics will be disscused, including virtue
theory, consequentialism, and kantianism.
Trigger Case
B is a prisoner serving a 20-year sentence handed down in 1996. In August 2006, B was
referred for medical treatment after being diagnosed with testicular cancer. B was
handcuffed on the way to and from the hospital for treatments. B had an operation to
remove one of his testicles. He was handcuffed when he went into surgery, and still
handcuffed when he awoke from the anaesthetic. He was also handcuffed on his way back
to prison. Moreover, B has allegedly been required to supply samples, including semen
samples, while in the presence of prison officers. On other occasions, he allegedly had to
provide semen samples with one hand handcuffed. B claims that during his various medical
consultations and treatments, he felt humiliated and demeaned and suffered from pain and
discomfort. His privacy was invaded at a time he was feeling vulnerable.
Learning Task:
1. Please identify bioethical issues in this case? Explain!
2. What is the bioethical theory related in this case? Explain!
References:
1. Irvine R. Critical Concepts in Bioethics (Lecture Notes). Sydney: The University of
Sydney; 2013.
3. Hope T, Savulescu J, Hendrick J. Medical ethics and law: the core curriculum. 2nd ed.
Edinburgh: Churchill Livingstone, 2008.
4. Kerridge IH, Lowe M, Stewart CL. Ethics and Law for the Health Professions. 4th ed.
Sydney: The Federation Press; 2013.
LECTURE 14
PRINCIPLES OF BIOMEDICAL ETHICS
Abstracts
The principles of biomedical ethics were first introduced in late 1977 by Be auchamp
and Childress, the well-known bioethicists from The Kennedy Institute of Bioethics located
at Georgetown University. It was a moral framework consisted of four basic principles:
respect for autonomy, non-maleficence, beneficence, and justice. There were also several
derivative substantive rules, such as veracity, fidelity, privacy, and confidentiality.
Admittedly, this approach has become one of the most famous works in medical field. T he
principle has been used as groundwork for educating many medical students as well as for
training countless health care professionals all over the world because of its vast coverage
of various concepts and topics in biomedical ethics. Moreover, it can be universally applied
to explain and justify substantive moral issue in numerous ethical quandaries arising from
medical context.
In 1990, the term ‘Principlism’ and ‘Georgetown Mantra’ were first coined by Clouser
and Gert, who criticized the four principles approach. According to them, principlism refers
to the practice of replacing moral theories and rules with four principles while dealing with
ethical issues in medical practice. They claim that these principles have misled medical
practitioners to believe that they have systematically applied the well-established principles.
In fact, they have haphazardly applied numerous unrelated moral considerations in each
principle without any capacity to guide their action since the principles are derived from
various types of conventional moral philosophies, which are not systematically related to
each other. In other words, principlism has problems with the absence of direct normative
guidance and the lack of deep moral substance.
However, the main concept of principlism does not simply depend on the prima facie
four principles frameworks, but strongly embedded in the concept of common morality which
is defined as: “the set of universal norms shared by all persons committed to morality”. T he
four principles are merely a part of thin universal moral norms which should be dif ferentiated
with particular moral norms that is the specific morality found in various cultural and religious
traditions in concrete communities. When applied in factual cases, hence, it is important to
note these diversities by specifying the moral norms in relation to the four principles. As a
consequence, usually, there are conflicts within and between principles which should be
balanced with additional methods. Ultimately, the final coherent judgment should be
grounded on the balancing of a “considered opinion” that is one prima facie duty is weightier
than another in specific circumstances.
Learning Tasks
Please read the KODEKI (Kode Etik Kedokteran Indonesia) and then analyze each article
based on principles of biomedical ethics!
References:
1. Beauchamp TL, Childress JF. Principles of Biomedical Ethics 7th ed. New York: Oxford
University Press; 2013.
2. Kode Etik Kedokteran Indonesia (KODEKI); 2012.
LECTURE 15
RESEARCH ETHICS
dr. Ni Nengah Dwi Fatmawati Sp.MK, PhD
Abstracts
Research ethics issues have been started since World War II in the Nuremberg City,
Germany in 1945-1946, which introduced 10 principles that known as Nuremberg Code.
The journey of research ethics were then continued by establishment of regulatory guidance
documents, including the World Medical Association Declaration of Helsinki (World Medical
Association); the Belmont Report share a common purpose: to protect the autonomy, safety,
privacy, and welfare of human research subjects. The three primary ethical principles cited
in Belmont are: autonomy, beneficence, and justice. All of the regulations agree with the
same principles of research ethics protection of the research participant as paramount;
independent ethical review; scientific validity of the research; fully informed and vo luntary
consent; and an acceptable balance of risks and benefits. In order to perform clinical
research, responsibility for the interpretation and application of these ethical principles and
regulations are the duties of committees comprised of scientist a nd non-scientists, called
Institutional Review Boards for the Protection of Human Subjects (IRBs).
In 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. Understanding research ethics and maintaining
research integrity are keywords for researcher for their dignity in scientific field.

Learning tasks:
Case 1
A researcher has investigated about embryonic stem cells for genetic diseases therapy. The
result of his study is publishing in 2 different scientific articles with similar content and in the
similar way.
What is (are) research ethics issue(s) of this case and explain the reason
Case 2
A researcher is performing research using animal models (rat) to prove that Helicobacter
pylori infection influences atherosclerotic plaque in rat. Researcher needs to sacrifice the rat
to get its aorta. Unfortunately, he collected the rat’s aorta without anesthesia.
Case 3
A medical student is performing research for his final exam. The research theme is
investigating inhibition effect of ethanol extract of mangosteen peel against Staphylococcus
aureus. Unfortunately, the result of it is not significant, encouraging the student to change
the result data.
References:
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!
LECTURE 16
CLINICAL ETHICS
Abstracts
Ethical issues are imbedded in every clinical encounter between patients and
caregivers because the care of patients always involves both technical and moral
considerations. The central feature of this clinical encounter is the therapeutic relationship
between a physician and a patient, a relationship that is permeated with ethical
responsibilities. Physicians must aim, in the words of Hippocrates, "to help and do no harm."

Modern physicians approach the doctor–patient relationship with a professional identity that
includes the obligations to provide competent care to the patient, to preserve confidentiality,
and to communicate honestly and compassionately.
Clinical ethics is a structured approach to ethical questions in clinical medicine.

Clinical ethics depends on the larger discipline of bioethics, which in turn draws upon
disciplines such as moral philosophy, health law, communication skills, and clinical
medicine. The scholars called "bioethicists" must master this field. However, clinicians in the
daily practice of medicine can manage with a basic understanding of certain key ethical
issues such as informed consent and end-of-life care. Central to the practical application of
clinical ethics is the ability to identify and analyze an ethical question and to reach a
reasonable conclusion and recommendation for action.
Bioethics identifies four ethical principles that are particularly relevant to clinical
medicine: the principles of beneficence, non-maleficence, respect for autonomy, and justice.
To these, some bioethicists add empathy, compassion, fidelity, integrity, and other virtues.
The bioethical literature discusses these principles and virtues at length. In this lecture, a
method to identify the ethical dimensions of patient care and to analyze and resolve ethical
problems will be introduced. This method is useful for structuring the questions faced by any
clinician who cares for patients. The method is called the four topics which constitute the
essential structure of a case in clinical medicine, namely, medical indications, patient
preferences, quality of life, and contextual features.
Medical indications refer to the diagnostic and therapeutic interventions that are
being used to evaluate and treat the medical problem in the case. Patient preferences state
the express choices of the patient about their treatment, or the decisions of those who are
authorized to speak for the patient when the patient is incapable of doing so. Quality of life
describes features of the patient's life prior to and following treatment, insofar a s these
features are pertinent to medical decisions. Contextual features identify the familial, social,
institutional, financial, and legal settings within which the particular case takes place, insofar
as they influence medical decisions
Trigger Case
S is a 17-year-old boy with a condition known as bilateral gynaecomastia, or enlarged
breast tissue. To avoid great embarrassment and the suffering caused by ridicule from his
peers, S never swam, never went to the beach, and never engaged in any activities that
might expose his chest to view. Gym days at school were particularly difficult for S. Although
he eventually lost a significant amount of weight and went down eight clothing sizes, S’s
gynaecomastia was not dispelled. S thus continued to avoid situations where his condition
would be apparent to others. Moreover, although he was accepted for admission to an out -
of-state university, he decided not to attend as he did not want to live in a dormitory where
he anticipated being subjected to ridicule. Dr. G, S’s paediatrician, recommended surgery to
eliminate S’s “deformity” and its consequent emotional pain. According to Dr. G, the
procedure was medically necessary.
Learning Task:
1. Please identify ethical issues in this case! Explain!
2. Do you agree to perform the surgery on S? Explain using the four topics approach!
References:
1. Jonsen A, Siegler M, Winslade W. Clinical ethics: A practical approach to ethical
decisions in clinical medicine. 8th ed. New York: McGraw-Hill; 2015.

LECTURE 17
SOLIDARITY AND COOPERATION
Abstracts
Solidarity is often considered to be opposed to individualistic behavior and
contrasted with self-centered individualism, as a personal and social concern for vulnerable
groups in modern societies, in particular the chronically ill, the handicapped, political
refugees, immigrants and the homeless.
From an ethical perspective, solidarity is first and foremost a moral value focused on
providing support to those who need it. Among members of a community mutual obligations
exist. This also implies that a fundamental difference should be made between two forms of
solidarity: solidarity as instrumental value and solidarity as moral value. In present -day
societies there is a tension between solidarity, personal autonomy and responsibility.
Solidarity goes beyond justice. Justice is a matter of obligation from one free
individual to another; it is based on the shared interest of preserving the requisite amou nt of
freedom for all citizens. Solidarity is not necessarily a legal obligation. Solidarity does not
necessarily restrict autonomy. In relation to health insurance as a means, everyone is
obliged to make a fair financial contribution to a collectively organised insurance system that
guarantees equal access to health and social care for all members of society.
Organ donation programs are an example of solidarity among citizens of a nation,

with organs from a deceased person allowing another citizen to live . In many countries this
is achieved by people voluntarily joining a register. Some countries however have adopted
an “opting out” policy for organ donation - in that all citizens are presumed to be willing
organ donors unless they apply to “opt-out”.
Trigger Case
Mr. X is a middle aged man who has suffered a large stroke and is declared brain dead
whilst on mechanical ventilation. His family request a further 24 hours to wait for a miracle
which is granted by the doctors. There is no change in his condit ion and his organs are
becoming less viable by the day, with some already unusable because of the delay. His
family request a further 24 hours to wait for some sign of improvement; his mother is
particularly distressed. The hospital authorities say that this will make his organs unusable
and he is taken to surgery for organ harvesting whilst the family are distraught. The country
has an opting out policy and the authorities say they are respecting Mr. X’s choice to not opt
out by harvesting his organs whilst still viable. This “opting out” policy has dramatically
increased organ transplants in this country and has saved many lives.
Learning Task:
1. Does the benefit of a life-saving organ transplant outweigh the distress caused to Mr. X’s
family? Explain!
2. Which one would you choose: “opting out” or “opting in” policy? Explain!
References:
2. Have HAMJ, Gordijn B (Editors). Handbook of Global Bioethics. New York: Springer;
2014.

LECTURE 18
PUBLIC HEALTH ETHICS
Dr. dr. A.A. Sagung Sawitri, MPH
Abstracts
The World Health Organization stated that all people should be able to realize their
right to the highest possible level of health. Therefore “Health for all” has become a vision
to support countries in moving towards Universal Health Coverage (UHC). However,
achieving health for all is not easy. In Indonesia, the Ministry of Health (MOH) conducts
health community programs to increase the health status. Health Program comprises
several health activities that systematically developed, being massively conducted, and
usually compulsory. Health Program uses the concepts of preventive medicine and health
promotion. Preventive medicine deals on how to prevent of control disease, while health
promotion in general is encouraging healthier life styles by persuasion, education and
legislation.
Even though the goal of health program is good, to some limits there alwas
possibilities for a rising of ethical problems. This is because there is dilemma in term of
keeping the balance between the goods of society with the freedom of the individual. Failure
in balancing social justice or to fairly distributed the burdens and benefits in society will lead
to ethical issues in PH.
The screening program, as an example, rise ethical issue due to uncertainty for the
test accuracy and whether these program should be done compulsory or optional.
Vaccination also lead to ethical issue due to some “free riders” and decision on it to be
compulsory or optional. Epidemic or pandemic control may reduce a utonomy of persons
and make any harm to a lot of community members. Another example is the implementation
of “one child policy” in China, had also made serious problem not limited to health and
ethics. Despite the success of health program in making what we think is better for human,
we face another problem. One example is called paradox of health care, a phenomena of a
continuing demand following the succesfull of one health program/activities and that
outweighing the supply.
To maintain the ethical aspect in PH program, we need to distribute the resources
fairly in the macro, meso, and micro level. At the micro level, there is a problem to prioritise
fairly on who is to receive a given treatment when there are not resources to treat everyone.
Questions always rise on whether the rich person have better access than the poor? Who
should come first to access the health service? Or Who shall live? Since health is not a
luxury goods, ethical issue may rise when we prioritise health program without un -clear
concept. There are six principles to allocate resources including equal share, according to
individual choice, potential for future life years, what they deserve, social usefulness, and
their needs.
Another PH ethical issue is related to global inequity in health and the gobal survival.
The first term refer to the higher burden of morbidity and mortality in low and middle income
countries compare to the high income countries. While the global survival questioning about
the resources use by recent generation and what will be left for the future generation.
References:
Trigger Case 1
Fake News and Missinformation has become a 9th global health issue. Carefully
read an information provided in the following link; and discuss the below questions:
https://www.intrahealth.org/vital/10-global-health-issues-watch-2018

Two decades have passed since a notorious paper published in The Lancet claimed a link
between childhood vaccines and autism. It took years for scientists to discover the study
results were fraudulent, and over a decade for The Lancet to retract the article. By then, the
damage was done. This one piece of fake news helped inspire public doubt in one of the
most powerful weapons we have against human disease, and it persists to this day. In the
past few years alone, myths and misinformation have resulted in outbreaks of measles and
mumps in the US and in the stubborn persistence of polio in Pakistan, Afghanistan, and
Nigeria. In West Africa, they contributed to the deaths of over 11,300 people due to Ebola.
False facts have the power to maim children, kill health workers, and stoke public health
disasters. Misinformation will likely affect global health in many ways in 2018, ranging from
Internet-powered self-misdiagnoses to misguided policies around family planning and
women’s health. We should all be watching very closely.
Source: https://www.intrahealth.org/vital/10-global-health-issues-watch-2018
Learning Task:
1. What is the impact of fake news and missinformation 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 where you are conducting
immunization program, how you explain if there are fake news related the vaccination
program to the community?
Trigger Case 2
In April 2018, there were Japanese Encephalitis Immunization Campaign in Bali
Province. As a campaign, it is expected that all children aged 9 months to less than 15
years old children will be immunized. The target of coverage for immunization is 95% and
the immunization campaign was done through the school, the health post and the health
services.
In some schools in Denpasar, many parents stated that they did not want to have
immunization for their children for many reasons. On the other hand, many parents also
protest due to those rejection.
Learning Task:
1. What is the PH ethics issues rise from that situation?
2. If you were doctor who work at the Public Health Office where you are conducting
immunization program, how you overcome this situation?
Trigger Case 3
Not all health problem or diseases, particularly chronic disease can be handled by
the government through the health program such population health screening. T hat’s why,
for some reasons, there are also encouragement for having health checks. Carefull y read
the article related the “health check” and answer the questions:
https://bmcmedethics.biomedcentral.com/track/pdf/10.1186/s12910-017-0213-x
“Health checks identify (risk factors for) disease in people without symptoms. They may be
offered by the government through population screenings and by other providers to
individual users as ‘personal health checks’. Health check providers’ perspective of ‘good’
health checks may further the debate on the ethical evaluation and possible regulation of
these personal health checks.”
Learning Task:
1. What is the different between health check and population screening?
2. What are the principles of PH ethics which can be implied in this case?

LECTURE 19
Doctors as Part of Society and Doctors as Professionals
Dr. dr I Made Sudarmaja,M.Kes
Abstracts
The doctor's oath which was first introduced by Hippocrates has brought the medical world
into a profession that prioritizes patient health. In the course of his medical profession when
the Nazis were easily making patients as experimental animal and many deaths occurred
because doctors at that time tried a number of new treatment methods and techniques for
their patients. The Geneva Declaration of 1948 was actually born to protect patients and
stated that patient health would be a major consideration for the medical profession.
As part of the community (general public), doctors certainly have almost the same
rights and obligations as other communities, both rights and obligations to the state, to the
community and to the family. For the state and government doctors also have the same
rights as the right to obtain legal protection, the right to get jobs and decent livelihoods, get
the same position in the of law and government, have the freedom to embrace and live the
religion / belief adopted, the right to get education and teaching, and the right to freedom of
association, gathering and issuing opinions both orally and in writing.
As part of the profession, doctors have specific rights and obligations which are
regulated through the Medical Practice Law, Medical Ethics Code and Minister of Health
Regulation. The right of the doctor in pursuing his profession can be in the form of: obtaining
legal protection as long as carrying out duties according to professional standards and
standard operating procedures, has the right to obtain honest and complete information
from patients and their families and has the right to receive service benefits. Doctors also
have the right to provide medical services according to professional sta ndards and
operational procedures. The doctor's obligation to pursue medical practice is: having a
practice permit (having a certificate of competence and STR), installing a practice sign,
following a standard medical service, having to make a medical reco rd, having to seek
patient approval for medical action, must keep medical secrets, must hold quality control
and cost control. Besides that doctors have the obligation to refer patients to other doctors
who have better skills and abilities. Doctors are also obliged to carry out emergency help on
the basis of humanity and must always increase their knowledge.
Learning Task:
1. Case: A doctor on duty in a health center and living in a remote puskesmas official's
house one night was beaten by the patient and his family to ask for help. The doctor
at that time was having a fever and needed a rest to recover quickly and didn't want
to wake up and told his wife to tell the patient that the doctor was not well. The
patient's family did not accept and was angry with the damage to the flower pots on
the yard of the doctor's official residence.
Discuss the case, is there something wrong with the doctor's behavior?
2. Case: A doctor was reported to the police because he was leaked the secret of the
disease so that the patient was fired by the company manager where the patient
worked. Initially the company manager where the patient worked, asked the
company doctor to thoroughly check all of his employees. One patient was
suspected of having a mild mental disorder and the company doctor was sent to a
psychiatrist. Psychiatrists through back referrals affirm that the patient is indeed
suffering from a mental disorder that can recur at any time. The company doctor
then reported this to the company manager and the company manager dismissed
the patient from his job as a tourism guide for fear of causing problems.
As a company doctor, what is the mistake of the doctor and reported to the police?
Are there violations of rights and obligations as a doctor?
3. The development of the medical world in the practice of medicine has given rise to
several technical innovations and also new drugs for the medical world. T o be able
to get innovations and drugs, of course, requires the involvement of patients as the
source of research.
As a doctor, what procedures should be taken to be able to use patients as trial
people from a treatment technique or the discovery of new drugs?
4. Case: A doctor who is taking a schoolboy by car suddenly sees an accident on the
road. As a doctor he was moved to help the victim but his son did not want to be late
for school because there was a test.
Discuss this case by looking at the rights and obligations of the doctor as a
community and perhaps as a profession.
LECTURE 20
MEDICAL RECORD & ICD X
dr. Kunthi Yulianti Sp.F
Medical Record :
Rekam medis adalah berkas yang berisikan catatan dan dokumen tentang identitas
pasien, hasil pemeriksaan dan pengobatan yang diberikan kepada pasien. 1 Rekam medis
wajib dibuat oleh dokter yang menjalankan praktek kedokteran.2
Dengan perkembangan kompleksitas layanan kesehatan, Rekam Medis tidak saja
berisi catatan dokter tentang pasiennya tetapi juga berisi catatan dari profesi lain yang ikut
terlibat dalam perawatan pasien tersebut. Catatan ini sangat penting karena dapat
bermanfaat sebagai pengingat bagi dokter yang merawat, konsultasi pada spesialisasi lain,
instruksi yang harus dikerjakan perawat, catatan perkembangan keperawatan, instruksi bagi
petugas laboratorium dan sebagainya. Agar dapat dimengerti oleh tenaga kesehatan lain
yang membaca rekam medis, maka penulisannya memilik standar tertentu. 3,4 Namun
demikian informasi yang terkait Rekam Medis merupakan rahasia kedokteran yang harus
dijaga oleh dokter, tenaga kesehatan tertentu, petugas pengelola dan pimpinan sarana
pelayanan kesehatan. 2
Bagi rumah sakit Rekam Medis merupakan dokumen yang menunjukkan
kesinambungan dari perawatan dan pengobatan pasien yang menjalani rawat inap hingga
rawat jalan, dan sebagai alat komunikasi antara dokter penanggung jawab pasien dengan
dengan dokter konsultan atau dengan tenaga kesehatan lainnya. Bahkan Rekam Medis
dapat berperan sebagai dokumen otorisasi atau pemberian kewenangan pasien kepada
tenaga kesehatan untuk melakukan tindakan medis. 3 Selain berperan besar dalam
pelayanan kesehatan, Rekam Medis dapat digunakan sebagai dasar perencanaan
pengembangan Rumah sakit, anggaran, statistik, pendidikan serta untuk kepentingan
yuridis. Namun perlu diingat bahwa pembukaan informasi Rekam Medis dapat dilakukan
dengan mematuhi aturan perudangan-undangan yang berlaku di Indonesia

References:
2. Peraturan Menteri Kesehatan RI nomer 269/MENKES/PER/III/2008
3. Undang-undang Republik Indonesia nomer 29 tahun 2004 tentang Praktek Kedokteran
4. WHO. Medical record manual : A guide for developing country. World Health
Organization: Western Pacific region; 2006.
5. Health information systems knowledge hub. Dokumentating medical record : A handbook
for doctors. University of Queensland; 2013.
6. WHO. ICD 10 Volume 2 : International statistical classification of disease and related
health problem. 2010 ed. World Health Organization; 2011
7. Rusli A, Rasad A, Enizar, Irdjiati I, Subekti I, Suprapta IP. Manual rekam medis. Konsil
Kedokteran Indonesia, 2006.
Vignette 1
Tuan A, laki-laki 50 tahun, datang diantar oleh istrinya ke IGD Rumah Sakit dalam keadaan
kesadaran menurun. Dari anamnesis didapatkan informasi bahwa pasien mengalami kejang
pada seluruh tubuh berulang sejak pagi. Tidak ada riwayat kejang sebelumnya. Istrinya
mengatakan bahwa kira-kira 5 hari sebelum masuk Rumah sakit, suaminya yang seorang
petani tertusuk paku saat bekerja di kebun. Setelah kejadian pasien mengobati lukanya
sendiri. Dari pemeriksaan dokter menyimpulkan pasien mengalami tetanus, dan kemudian
melakukan tatalaksana tetanus pada pasien
Learning task:
1. Sebutkan data-data apakah yang diperlukan dari seorang pasien saat melakukan
registrasi masuk ke Rumah Sakit?
2. Jelaskan kepentingan menanyakan status sosial ekonomi pada pasien!
3. Informasi apakah yang penting dibuat oleh seorang dokter dalam Rekam Medis!
4. Mengapa diagnosis penyakit pada Rekam Medis perlu ditulis dengan menggunakan
Huruf Kapital ?
5. Jelaskan peran Rekam Medis penting dalam pelayanan kesehatan?
ICD 10
International Statistical Classification of Diseases and Related Health Problems, Tenth

Revision disebut ICD 10 adalah sistem klasifikasi penyakit yang disusun oleh World Health
Organization (WHO), yang bertujuan sebagai acuan dalam pembuatan diagnosis penyakit
terutama pada sertifikasi penyebab kematian. Diagnosis terstandar ini dapat dib andingkan
untuk menilai keadaan antar rumah sakit, antar wilayah ataupun negara dalam kurun waktu
yang sama ataupun berbeda. ICD 10 memiliki 3 elemen dalam strukturnya yaitu terdiri dari
3 volume; berisi 21 bab pengelompokan penyakit; dan kode alfanumerik tiap penyakit. T iga
Volume dalam ICD 10 terdiri dari Volume 1 adalah tabular list yang berisi penyakit dan
kelompok penyakit; Volume 2 adalah instruksi cara penggunaan Volume 1 dan 3; Volume 3
berisi indeks alfabetik dari penyakit. Kode alfanumerik menggun akan 3 karakter kategori
yaitu satu huruf diikuti oleh 2 angka dan 4 karakter subkategori.

ICD dikembangkan sejak tahun 1900 dengan beberapa kali dilakukan revisi. Pada
tahun 1992 WHO menetapkan disebut ICD 10 untuk pengkodean morbiditas dan mortalitas.
Pengkodean ini memungkinkan dilakukan pengolahan dan analisis secara statistik sehingga
hasilnya dapat digunakan untuk perencanaan kesehatan masyarakat, penelitian, studi
epidemiologi, perbaikan mutu pelayangan rumah sakit dan pembiayaan.
Di Indonesia, ICD sudah digunakan sejak tahun 1979, yaitu ICD 9. Pada tahun 1992
WHO menetapkan ICD 10, Indonesia secara resmi menggunakannya mulai tahun 1998
dengan diterbitkan SK Menteri Kesehatan RI nomer 50/MENKES/KES/SK/I/1998 tentang
Pemberlakuan Klasifikasi Statistik International mengenai Penyakit Revisi ke-10
menggantikan ICD 9. Kemudian di tahun 2006 diterbitkan kembali SK Menteri Kesehatan RI
nomer 844/MENKES/SK/X/2006 tentang penetapan standar kode data bidang kesehatan
dimana dinyatakan bahwa untuk kode penyakit mengacu pada ICD 10.
Dokter bertanggung jawab membuat dan melengkapi rekam medis dengan
menentukan diagnosis akhir penyakit atau sebab kematian dalam sertifikat medis kematian.
Standar penulisan diagnosis yaitu harus dibuat dengan huruf kapital, tidak menggunakan
singkatan dan mengacu pada istilah medis yang ada di ICD 10. Kualitas statistik morbiditas
dan mortalitas selain tergantung pada dokter juga tergantung pada Coder Klinik, karena
dipengaruhi oleh seberapa baik perawatan yang telah diberikan tela h didokumentasikan
dalam rekam medis, kelengkapan catatan pemulangan dan sertifikat kematian yang diisi
dengan tulisan yang baik dan terbaca.
Referensi :
8. WHO. ICD 10 : International statistical classification of disease and related health
problem. Volume 1,2,3. 2010 ed. World Health Organization; 2011
9. Health information systems knowledge hub. Introducing the International Statistical
Classification of Diseases in countries: Guidelines for implementing cause -of-death
certification, morbidity and mortality coding. University of Queensland; 2013.
10. SK Menteri Kesehatan RI nomer 50/MENKES/KES/SK/I/1998 tentang
Pemberlakuan Klasifikasi Statistik International mengenai Penyakit Revisi ke -10.
11. SK Menteri Kesehatan RI nomer 844/MENKES/SK/X/2006 tentang penetapan
standar kode data bidang kesehatan
Vignette 1
Seorang laki-laki, umur 62 tahun, datang ke IGD dengan keluhan demam sejak 4 hari
sebelum masuk rumah sakit. Keluhan lain adalah batuk kering disertai sesak nafas dengan
sedikit terasa nyeri saat menelan. Pasien memiliki riwayat kencing manis sejak 10 tahun
yang lalu namun tidak minum obat dan control secara teratur. Pasien juga mengaku baru
datang dari kota yang diketahui sebagai tempat endemis Covid-19 an. Pada pemeriksaan
ditemukan temperatu 38 o C, pemeriksaan auskultasi thorax terdengar ronchi. Pada
pemeriksaan thorax ditemukan gambaran perselubungan pada kedua paru. Hasil
pemeriksaan swab nasofarinx menunjukan hasil positif Covid-19. Pasien dirawat selama 7
hari namun kondisinya memburuk dan dinyatakan meninggal akibat cardiac arrest.

Learning task:
1. Jelaskan aplikasi ICD 10 dalam praktek kedokteran!
2. Menurut anda, apakah diagnosis penyebab kematian yang dibuat oleh dokter
tersebut sudah tepat? Jelaskan alasan anda!
3. Apa resikonya bila diagnosis dokter tidak sesuai dengan diagnosis yang tertera
dalam ICD 10?
4. Apakah kode ICD 10 yang tepat untuk diagnosis dalam kasus ini?
References:
1. WHO. ICD 10 Volume 1,2,3 : International statistical classification of disease and related
health problem. 2010 ed. World Health Organization; 2011
2. Health information systems knowledge hub. Introducing the International Statistical
Classification of Diseases in countries: Guidelines for implementing cause -of-death
certification, morbidity and mortality coding. University of Queensland; 2013.
3. Health information systems knowledge hub. Dokumentating medical record : A handbook
for doctors. University of Queensland; 2013.
4. SK Menteri Kesehatan RI nomer 50/MENKES/KES/SK/I/1998 tentang Pemberlakuan
Klasifikasi Statistik International mengenai Penyakit Revisi ke-10.
5. SK Menteri Kesehatan RI nomer 844/MENKES/SK/X/2006 tentang penetapan standar
kode data bidang kesehatan

REFERENCES
1. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingsto ne.
2. Beauchamp T.L. and Childress J.F. principles of Biomedical Ethics. 4 th ed. Oxford
University Press. NY. 1994
3. CMA. Professionalism in Medicine.2001
4. Bendapudi,N.M. et al. Patient’s Perspectives on Ideal Phsician Behaviours. Mayo Clin
Proc.2006.81(3):338-344
5. Batmanabane, V.Empathy: A vital attribute for doctors. Indian Journal of Medical Ethics.
2008. 5(3) :128-129
6. Hardee, J.T. An Overview of Empathy. The Permanente Journal.2003.7 (4):51-54
7. Ross J.Taylor. et al. Health and Illness in the community. Oxford University Press. 2003
8. Shepherd, R. The Ethics of Medical Practice in Simpson,s Forensic Medicine. Twelfth
Edition.2003. page 8-14
9. Sanbar, S.S. et al. Legal Medicine and Health Law Education in : Legal Medicine.
Sanbar, S.S. (Ed). 1998.Page 3-10
10. Piorkowski, J.D.Medical testimony and the expert witness in : Legal Medicine. Sanbar,
S.S. et al (Ed.). 1998. Page 132-144
11. Wiradharma, D. Penuntun Kuliah Hukum Kedokteran. Page 25-35
12. Ohoiwutum, T. Bunga Rampai Hukum Kedokteran.page 1-13
13. Flamm, M.B. Medical Malpractice and the physician defendant in : Legal Medicine
Sanbar, S.S. et al. (Ed.) 1998. Page 123-129
14. Hirsh, H.L. Medical Record in : Legal Medicine. Sanbar, S.S. et al (Ed.).1998. Page 280-
296
15. Plueckhahn, V.D. and Cordner, S.M. Ethics, Legal Medicine and Forensic Pathology,
Second Edition. 1991. Page 111-122
16. Kushe H. and Singer P. Bioethics An Anthology. Blackwell Pub. Ltd. Oxford. 1999

CURRICULUM
Program or curriculum blocks

10 Senior Clerkship
9 Senior Clerkship
8 Senior Clerkship
Health System- Community-based Evidence-based Special topics : Elective Study IV Compre 18
7 based Practice practice Medical Practice Health Ergonomy & (evaluation) Clinic
(3 weeks) Health Environment Orientation
(4 weeks) (2 weeks) (2 weeks) (Clerkship)
BCS (1 weeks) (2 weeks) + medical
ethic
(4 weeks)
The Medical The Urinary The Reproductive Elective Study III 19
6 Cardiovascular Emergency System and System and Disorders
System and (3 weeks) Disorders (3 weeks) (3 weeks)
Disorders (3 weeks)
(3 weeks) BCS (1 weeks) BCS (1 weeks) BCS (1 weeks)
BCS (1 weeks)
Neuroscience and The Respiratory The skin & Special Topic : Forensic Medicine Elective 18
5 neurological System and hearing system - Palliative med and Medicolegal Study II
disorders Disorders & disorders - Complemnt & (2 weeks) (2 weeks)
(3 weeks) (3 weeks) (3 weeks) Alternative Med.
BCS (1 weeks) BCS (1 weeks) BCS (1 weeks) (2 weeks)

Musculoskeletal Alimentary The Endocrine Clinical Nutrition and The Visual 18
4 system & & hepatobiliary System, Disorders system &
connective tissue systems & Metabolism and (2 weeks) disorders
disorders disorders Disorders (2 weeks)
(3 weeks) (3 Weeks) (3 weeks)
BCS (1 weeks) BCS (1 weeks) BCS (1 weeks) BCS (1 weeks) BCS (1weeks)
Behavior Change Basic Infection Immune system Hematologic Special Topic 19
3 and disorders & infectious & system & disorder & - Andro & aging
(3 weeks) diseases disorders clinical oncology - - Geriatri
(3 weeks) (2 weeks) (3 weeks) -Travel medicine
BCS (1 weeks) BCS (1 weeks) BCS (1 weeks) BCS (1 weeks) - (4 weeks)
BIOMEDIK III Growth Medical Medical Basic Elective Study 17
2 (4 weeks) & communication Professionalism Pharmaceutical I
development (2 weeks) (2 weeks) medicine & drug (2 weeks)
(2 weeks) etics
BCS: (1 weeks) BCS (1 weeks) BCS (1 weeks) (2 weeks)
Studium BIOMEDIK I The cell BIOMEDIK II 19
1 Generale and (8 weeks) as biochemical (6 weeks)
Humaniora machinery
(2 weeks) (2 weeks)
BCS(1 weeks)
Pendidikan Pancasila & Kewarganegaraan ( 3 weeks )

Study Guide Medical Professionalism Tayang 6 Mei 2020

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Study Guide Medical Professionalism Tayang 6 Mei 2020

Uploaded by

Copyright:

Available Formats

Study Guide Medical Professionalism

Publisher: Department of Medical Education Medicine Programme,

Faculty of Medicine UNUD,PSSKPD,2020

Udayana University Faculty of Medicine, PSSKPD, 2020 1

GENERAL CURRICULUM OF MEDICAL PROFESSIONALISM AND ETHICS

Udayana University Faculty of Medicine, PSSKPD, 2020 2

PLANNERS AND LECTURERS

Udayana University Faculty of Medicine, PSSKPD, 2020 3

FASILITATOR MEDICAL PROFESSIONALISM

English Class (Class B)

Udayana University Faculty of Medicine, PSSKPD, 2020 4

Udayana University Faculty of Medicine, PSSKPD, 2020 5

1 Tantangan hubungan fiduciary dokter dr. Ida Bagus Alit, Sp. F

Udayana University Faculty of Medicine, PSSKPD, 2020 6

Keberagaman Latar Belakang Pasien M.Si

Udayana University Faculty of Medicine, PSSKPD, 2020 7

08.00 – 08.50 Lecture 1 : Medical Class room Prof. Mangku

Udayana University Faculty of Medicine, PSSKPD, 2020 8

14.00 – 14.50 Plenary session - -

5 08.00 – 08.50 Lecture 11 : Legal aspect of Class room dr. Alit

13.00 – 13.50 Break

Udayana University Faculty of Medicine, PSSKPD, 2020 10

Udayana University Faculty of Medicine, PSSKPD, 2020 11

the professional field are Commitment to professional competence, Commitment to honesty

Udayana University Faculty of Medicine, PSSKPD, 2020 12

RS tempat anda bekerja.Perusahaan menawarkan kepada anda dana 3 M untuk

Udayana University Faculty of Medicine, PSSKPD, 2020 13

1. Identify the moral-ethical issue in this case

1. Identify the moral-ethical issue in this case!

Udayana University Faculty of Medicine, PSSKPD, 2020 14

Udayana University Faculty of Medicine, PSSKPD, 2020 15

Udayana University Faculty of Medicine, PSSKPD, 2020 16

Discuss the problem!

Udayana University Faculty of Medicine, PSSKPD, 2020 17

Please discuss your opinion!

Sekarang hak-hak pasien sudah diatur dalam perundang-undangan seperti undang -

 Bendapudi,N.M. et al. Patient’s Perspectives on Ideal Phsician Behaviours.Mayo

Udayana University Faculty of Medicine, PSSKPD, 2020 20

 Peraturan Menteri Kesehatan Republik Indonesia Nomor 290/MENKES/PER/III/2008

Udayana University Faculty of Medicine, PSSKPD, 2020 21

Udayana University Faculty of Medicine, PSSKPD, 2020 24

Udayana University Faculty of Medicine, PSSKPD, 2020 25

dr. Ida Bagus Alit, Sp. F

Udayana University Faculty of Medicine, PSSKPD, 2020 26

1. Explain the Medico Legal procedures in making Visum et Repertum

Udayana University Faculty of Medicine, PSSKPD, 2020 27

Udayana University Faculty of Medicine, PSSKPD, 2020 28

The UNESCO UDBHR identifies fifteen bioethical principles:

Udayana University Faculty of Medicine, PSSKPD, 2020 29

Udayana University Faculty of Medicine, PSSKPD, 2020 31

1. Explain and elaborate the journey of research ethics (including Nuremberg

2. Explain about principles of Good Clinical Practice in human subject research!

3. Explain and give examples of fabrication, falsification, plagiarism and false

4. Explain 4 different areas of research and give examples of each area!

Udayana University Faculty of Medicine, PSSKPD, 2020 32

Clinical ethics is a structured approach to ethical questions in clinical medicine.

Udayana University Faculty of Medicine, PSSKPD, 2020 33

Organ donation programs are an example of solidarity among citizens of a nation,

Udayana University Faculty of Medicine, PSSKPD, 2020 34

Udayana University Faculty of Medicine, PSSKPD, 2020 35

1. What is the impact of fake news and missinformation in this case?

Udayana University Faculty of Medicine, PSSKPD, 2020 36