MODUL OF

MEDICAL ETHICS AND

MEDICAL LAW

SCHOOL OF MEDICINE,
FACULTY OF MEDICINE AND HEALTH SCIENCE
MUHAMMADIYAH UNIVERSITY OF YOGYAKARTA
2011
 MODUL OF
MEDICAL ETHICS AND
MEDICAL LAW

Editor :
dr. Dirwan Suryo Soularto

Contributors :
Prof. Dr. dr. Soewito Atmosoewarno, Sp.THT-KL
dr. R. Soegandhi, SpF(K).
dr. Suryanto, Sp.PK
dr. Dirwan Suryo Soularto

Person in Charge :
dr. Dirwan Suryo Soularto
drh. Zulkah Noor, M.Kes.

Departments Involved :
Bioethics and Medical Humanities
(Ethics, Bioethics and Medical Anthropology)
Centre for Islamic Medical Studies (CIMS)
Public Health
Forensic Medicine

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 TABLE OF CONTENTS

Cover 2
Table of Contents 3

Overview Block 4
Topic Tree . 5

Teaching Learning Plan

A. Characteristic of Students . 6
B. Learning Outcome .. 6
B.1. Block Competencies 6
B.2. Standards of Medical Competencies 6
C. Topics 10
D. Pre-assessment ... 12
E. Teaching Strategy and Learning Experience.. 13
F. Facilities. 15
G. Evaluation.. 15
H. Learning Resources. 15

Supplement
Guidance of Tutorial . 19
Technical Guidelines of Tutorial.. 20
Checklist on Assessment Tutorial .. 23
Scenario 1.. 24
Scenario 2................................................................................................ 25
Scenario 3 ............................................................................................... 26
Scenario 4................................................................................................ 27
Scenario 5 ............................................................................................... 28
Guidance of Skill Activities....................................................................... 29
A. Topic 1. Identification of issue and principle of ethics in medical
practices.. 31
B. Topic 2. Identification of issue and ethical problem, law, and
discipline in medical practices . 37

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 OVERVIEW
BLOCK OF MEDICAL ETHICS AND MEDICAL LAW

The development of medical science and technology, the change of

structural value of social culture, acknowledgement of the existence of
pluralistic values, norms and beliefs and the change of economic health
pattern have caused various moral problems which cannot be solved by the
science of medicine itself. The teaching of ethics and medical laws for medical
students in pluralistic society like Indonesia is an urgent task. The teaching of
ethics and medical law can help students achieve matured personalities,
improve ethical awareness, possess reasoning capability in morality fields,
which in turn will produce professional and humanist physician in health
service.
Block of medical ethics and medical law is second block of 24 blocks of
medical curriculum in preclinical stage. In this module block of medical ethics
and medical law, the emphasis is given to moral dilemma in the practice of
daily health service. Five cases or scenario topics in this module will be
discussed by the students, i.e. elementary and clinical ethics, problem of
medical law and medical forensic and human rights issues. The discussion is
conducted when the students are doing tutorial activities. Besides discussion
and lectures, the students also do skills activities of which the objective is to
train the medical skills and as an introduction to some actual problems which
the students will face later.
The credit of Block Medical Ethics and Medical Law is 3.28 and the
time is 5.5 weeks. It is expected that after finishing this module the students
will be more critical which in turn will be able to integrate their new
experiences intellectually into their personalities.

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 TOPIC TREE
BLOCK OF MEDICAL ETHICS AND MEDICAL LAW

Human as Biopschycosocial Creature

Human
Right
Ethics Environmental
Physician- Ethics & Health Law
Medical
Colleagues
Research Legislations
Ethics Hospital Law
Physician
Basic
- Society
principles of
Regulations
medical
Works Health
Ethics ethics
Law
Physician- Medico-
Patients ethico-
MEDICAL
BIOETHICS legal HEALTH
MEDICAL LAW
conflict LAW
ETHICS
KUHAP,
Ethical code Medical KUHP,
KODEKI Forensic Administration

MEDICAL
SCIENCE
Profession standard,
Standard Operating
MEDICAL SCHOOL Procedures

Professional Physician

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 TEACHING LEARNING PLAN
BLOCK OF MEDICAL ETHICS AND MEDICAL LAW
A. Characteristic of Students
The student attending the Block of Medical Ethics and Medical Law are
those who have learned block of learning skill, it means that they are sitting in
first semester or first year. Block of Medical Ethics and Medical Law is the
second block of medical curriculum in pre clinical stage. They have learnt
learning skill at first block to equip basic knowledge and skills needed for
teaching-learning process in medical education. The students are expected to
develop critical thinking and ethical reasoning as well as maintaining their
independent and in-depth learning process, particularly when they deal with
problems of medical ethics and medical law.

B. Learning Outcome
B.1. Block Competencies
After completing a block, students are able to understand the principles
of moral, medical ethics, discipline, medical law and human right in health
fields as the preparation to implement the obligations, rights and
responsibilities as a professional physician

B.2. Standards of Medical Competencies

i) Areas Competency and Core Competency
Area 1. Effective communication
Able to explore and exchange information verbally and non-verbally with
patients of any age, family members, communities, colleagues and other
professionals.

Area 6. Self awareness and self development

a. Conduct medical practice within his/her ability and limitations
b. Manage emotional, personal, health, and welfare problems, which may
influence his/her professional capability
c. Undertake lifelong learning
d. Continually plan, apply, and evaluate his/her professional development

Area 7. Ethics, morals, medico-legal aspects and professionalism, and

patient safety
a. Behave professionally in medical practice, and support health policies
b. Demonstrate concern for moral and ethical aspects, and understanding of
ethical and medico-legal issues in medical practice
c. Apply patient safety procedures

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 ii) Components and Descriptions of Competency
Area 1.
At the end of this block, the students will be able to:
a. Communicate with the patient and members of his/her family.
a.1) Establish rapport with the patient and his/her family.
Always establish and maintain the patients dignity, confidentiality
and privacy
Treat the patient as an equal and ask for his/her agreement in
deciding on therapy and medical procedures
a.2) Understand the patients perspective.
Respect the patients belief in everything related to his/her illness.
Be sensitive to local biological, psychological, social, cultural
factors and norms in order to implement and maintain holistic
therapy, and to maintain a professional doctor-patient relationship.
Use polite and understandable language (including local
language) which is appropriate to the patients age and level of
education, in asking questions, summarizing information, and
explaining the diagnosis, the chosen management and the
prognosis.
a.3) Give explanations and information
Warn the patient when physical examination and clinical
procedures may cause pain or discomfort.
Give correct, clear, complete and honest explanations regarding
the aims, goals, benefits, and risks of diagnostic procedures and
medical procedures (therapy, surgery, prognosis, referral) before
they are undertaken.
Answer questions honestly, and provide consultation or referral for
difficult problems.
Reconfirm that the patient has understood all of the information
and choices about potential procedures.
Give enough time for the patient to reconsider and consult before
agreeing to a procedure.
Deliver bad news professionally in accordance with medical ethics
Confirm the availability of the health services that have been
chosen and agreed.
b. Communicate with medical colleagues
b.1) Give timely and accurate information to colleagues about the patients
condition, verbally, in writing or electronically to meet the needs of the
patient, health care and medical science.
b.2) Write a referral letter and / or report on the patients management
accurately to meet the needs of the patient, health care and medical
science.
c. Communicate with the community
c.1) Use language which the community can understand
c.2) Explore the health problems perceived by the community
d. Communicate with other professionals
d.1) Give timely and accurate information to insurance companies in
processing claims.

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 d.2) Give relevant information (whenever needed) to the legal system or
when acting as an expert witness in court.

Area 6.
At the end of this block, the students will be able to:
a. Achieve self-awareness
a.1) Be aware of his / her own capabilities and limitations in his/her
medical practice, and ask for professional assistance if needed.
a.2) Recognize and solve emotional, personal, and health-related
problems that may influence his/her professional capabilities.
a.3) Aware of the role of interpersonal relationships in the professional
and personal environment.
a.4) Recognize his / her own value and be appropriately self-confident in
his/her own medical practice.
b. Undertake lifelong learning
b.1) Keep up-to-date with recent knowledge
b.2) Participate actively in Continuing Medical Education and Training
Programs and other learning experiences
b.3) Show a critical attitude to evidence-based medical practice
b.4) Use information and evidence in making decisions about the
management of a patient and justify the chosen decisions
b.5) Read the medical literature critically, and consider its relevance to his
/ her patients
b.6) Be professional and identify his/her own learning needs

Area 7.
At the end of this block, the students will be able to:
a. Have a professional attitude
a.1) Behave appropriately, based on the Indonesian Code of Medical
Ethics.
a.2) Maintain patient confidentiality and trust.
a.3) How trustworthiness and respect in doctor patient relationships
a.4) Show empathy through a holistic approach.
a.5) Consider the financial problems and other obstacles to the provision
of health services, and their implications.
a.6) Behave ethically in patient management, based on professional
standards.
a.7) Recognize alternative options in facing a difficult ethical problem.
a.8) Analyse systematically and maintain a chosen ethical course of
action in patient management.
b. Behave professionally in cooperating with others
b.1) Respect everyone regardless of his/her social status.
b.2) Acknowledge that each person has a valued role and contribution
regardless of their social status.
b.3) Participate in activities which require collaboration with other health
professionals.
b.4) Recognize and try to mediate in conflict.
b.5) Respond constructively in receiving feedback from others.
b.6) Consider ethical and moral aspects in relation to other health
professionals, and act professionally.

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 b.7) Recognize and respond appropriately when a colleague has behaved
unprofessionally.
c. Play a role as a member of a professional health service team
c.1) Participate in patient management and apply professional values.
c.2) Respect the participation of other health professionals.
c.3) Realize that the medical profession has a role in the community, and
is able to contribute to change.
c.4) Deal appropriately with unprofessional behaviour by other health
professionals.
d. Conduct medical practice appropriately in the multicultural society of
Indonesia.
d.1) Respect patients and colleagues personal characteristics, life style,
and culture.
d.2) Understand the heterogeneity of perceptions due to differences in
age, gender, sexual orientation, ethnic group, disability, and socio-
economic status.
e. Comply with the medico-legal aspects of medical practice
Understand and accept legal responsibilities which relate to:
e.1) Human rights.
e.2) Medical prescriptions.
e.3) Physical and sexual abuse.
e.4) The Indonesian Code of Medical Ethics.
e.5) Issuing health, illness, and death certificates.
e.6) Legal processes in a court.
e.7) Understand Medical Practice Law No. 29, 2004.
e.8) Understand the role of the Indonesian Medical Council as an
institution that regulates medical practice.
e.9) Identify, state, and analyse the ethical aspects of health policies.
f. Prioritise patient safety in medical practice
Implement a standard for patient safety:
f.1) Patients rights.
f.2) Education of the patient and his/her family.

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 C. Topics
Strategy
Competence Core Competency Learning: Topics
Area (SKD) Lecture,
Clinical
Skills,
Tutorial
Able to explore and Medical Anthropology; An
exchange information introduction
verbally and non-verbally Societys Opinion on Physicians:
with patients of any age, Its Implication to Medical
family members, Profession.
communities, colleagues Medical Confidentiality, Medical
and other professionals. Lecture
Record and Informed Consent
AREA 1
Family Medicine Concept
Knowing Human as a
Biopschycosocial Creatures
The Function of Family to Fulfill
The Patients Right
Scenario about Dilemma of
Tutorial
Medical Ethics.
AREA 6 a. Conduct medical Clinical and Professional
practice within Decision Based on EBM, Ethics,
his/her ability and Law and Humanity
limitations Islamic Medicine: Its Meaning
b. Manage emotional, and the Principles
personal, health,
and welfare
problems, which
may influence
Lecture
his/her professional
capability
c. Undertake lifelong
learning
d. Continually plan,
apply, and evaluate
his/her professional
development

a. Behave professionally Basic Concepts of Ethics and

in medical practice, Philosophy of Ethical Profession
and support health Professionalism of Physician
policies Medical History and The
b. Demonstrate concern Development of Text of
for moral and ethical Indonesian Hippocratic Oath
aspects, and Ethics of Moslem Physician
AREA 7 Lecture
understanding of Hippocratic Oats in Islamic
ethical and medico- Perspective.
legal issues in Ethical Aspects of Physician-
medical practice Patients Relationship
c. Apply patient safety Ethical Aspects of Physician-
procedures Societys Relationship

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 Strategy
Competence Core Competency Learning: Topics
Area (SKD) Lecture,
Clinical
Skills,
Tutorial
(continued..) Ethical Aspects of Physician-
Colleague, Paramedics and
a. Behave Medical Service Providers
professionally in Relationship
medical practice, Bioethical Aspects of the
and support health Development of Medical Science
policies and Technology and Research
b. Demonstrate The Law System and Medical
concern for moral Law in Indonesia; An
and ethical aspects, Introduction
and understanding Law of the Republic Indonesia
of ethical and no. 23/1992 Regarding Health
medico-legal issues and no. 29/2004 Regarding
in medical practice Medical Practice: A Medico
c. Apply patient safety legal Perspective
procedures Medical Liability
Malpractice, Profession
Standard, Medical Service
(continued..) Standard
Lecture Medical Discipline and
Enforcement in Medical
(continued.. Practice
AREA 7) Law of Consumers Protection
and The Legal Relations of
Health Professions, Medical
Service Provider and Patient
Aspects of Ethics and Legal in
Environmental Health and
Contagious Diseases in Global
Era and Legal Aspect of Work
Health
Introduction to Medical Forensic:
The Medical Roles in Forensic
Legislation of Medical Forensic
Principles of Medical Forensic
Examination
Basic Concept of Human Right
and Health
Scenario about Principle of
Medical Ethics
Scenario about Medical
Tutorial
Discipline
Scenario about Medical
Malpractice

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 Strategy
Competence Core Competency Learning: Topics
Area (SKD) Lecture,
Clinical
Skills,
Tutorial
Scenario about The Right to
Tutorial
Health (In English)
(continued..) Issues and Principle of Ethics
(continued..
Identification
AREA 7)
Skill activity Identification of ethical, law and
discipline problems in medical
practices

D. Pre-assessment
Block of Medical Ethics and Medical Law is the second block in MUY
curriculum which give the students the basic principle and concept medical
ethics, medical law and right to health in the medical practice. These basic
knowledge and skills will be applied in the later block and in the medical
practice field. Therefore the students must follow block of Medical Ethics and
Medical Law before continue to the next block.
All students must attend the whole learning activities as it is the
requirement to take final examination. Minimal attendance of the learning
activity :
1. Lecture : 75%
2. Tutorial : 75%
3. Clinical Skill : 100%

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 E. Teaching strategy and learning experience

Week 1:
Topics Strategy Department Duration
Basic Concepts of Ethics and
2
Philosophy of Ethical Profession
Professionalism in Medical Education 2
Medical History and The Development Bioethics and
1
of Text of Indonesian Hippocratic Oath Human
Ethics of Moslem Physician Lecture Science 1
Medical Anthropology; An introduction 1
Societys Opinion on Physicians: Its
1
Implication to Medical Profession.
Hippocratic Oats in Islamic
CIMS 1
Perspective.
Scenario about Principle of Medical Bioethics and
Ethics Tutorial Human 2x2
Science
Identification of issue and principle of
Skill activity Medical Skill 2
ethics in medical practices

Week 2:
Topics Strategy Department Duration
Ethical Aspects of Physician-Patients
2
Relationship
Ethical Aspects of Physician-Societys
1
Relationship
Ethical Aspects of Physician-
Colleague, Paramedics and Medical Bioethics and 1
Service Providers Relationship Lecture Human
Bioethical Aspects of the Development Science
of Medical Science and Technology 2
and Research
Clinical and Professional Decision
Based on EBM, Ethics, Law and 2
Humanity
Scenario about Dilemma of Medical Bioethics and
Ethics. Tutorial Human 2x2
Science
Identification of issue and ethical
Forensic
problem, law, and discipline in medical
Skill activity Medicine and 2
practices
Medicolegal

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Week 3:
Topics Strategy Department Duration
The Law System and Medical Law in
1
Indonesia; An Introduction
Law of the Republic Indonesia no.
23/1992 Regarding Health and no.
1
29/2004 Regarding Medical Practice:
A Medico legal Perspective
Medical Liability 1
Bioethics and
Medical Confidentiality, Medical
Lecture Human 1
Record and Informed Consent
Sciences
Malpractice, Profession Standard,
2
Medical Service Standard
Medical Discipline and Enforcement in
1
Medical Practice
Law of Consumers Protection and The
Legal Relations of Health Professions, 1
Medical Service Provider and Patient
Scenario about Medical Discipline Forensic
Tutorial Medicine and 2x2
Medicolegal

Week 4:
Topics Strategy Department Duration
The Function of Family to Fulfill The Bioethics and
Patients Right Human 1
Sciences
Family Medicine Concept 1
Knowing Human as a Biopschycosocial
1
Creatures
Aspects of Ethics and Legal in Public Health
Environmental Health and Contagious Lecture
1
Diseases in Global Era and Legal
Aspect of Work Health
Introduction to Medical Forensic: The
1
Medical Roles in Forensic
Forensic
Legislation of Medical Forensic 1
Medicine and
Principles of Medical Forensic
Medicolegal 1
Examination
Scenario about Medical Malpractice Tutorial 2x2

Week 5:
Topics Strategy Department Duration
Islamic Medicine: Its Meaning and the
CIMS 1
Principles
Lecture
Basic Concept of Human Right and
Bioethics and 2
Health
Scenario about The Right to Health (In Human
English) Tutorial Sciences 1x2
Plenary Discussion 2
Preparing Block Examination
Block Examination: OSCE and MCQ

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 F. Facilities
Medical faculty of MUY has some facilities to support teaching learning
activities. The facilities consists of :
a. 3 Amphitheatre for lecturing completed with computer/notebook & LCD
projector, audio recorder, internet
b. 15 tutorial room for small group discussion with capacity 12-15
students/room completed with TV, DVD media player, CCTV, internet
c. 2 clinical skills laboratory rooms
d. 6 laboratoties for practical work
e. 1 Facultys Library
f. 1 Laboratory of Information Technology
g. hot-spot area

G. Evaluation
Assessment is conducted using formative and summative assessment.
Formative assessment by assessing daily activities using check list, written
report, quiz, etc. Summative assessment using written examination (MCQ)
and OSCE.
The final score of block will be determined by:
a. 50% of MCQ
b. 30 % of Tutorial
c. 20 % of OSCE

The students pass Block of Medical Ethics and Medial Law if fulfill all of
these criteria below:
a. The minimum score of MCQ is 60
b. Te minimum score of OSCE is 60
c. The minimum of the final score is 60

H. Learning Resources
a. Text Book
1. _____, 2002, Undang-undang no. 23 tahun 1992 tentang Kesehatan, CV
Eko Jaya, Jakarta.
2. _____, 2004, Undang-undang no. 29 tahun 2004 tentang Praktik
Kedokteran, CV Eko Jaya, Jakarta.
3. _______, 2005, Medical Ethics Manual, WMA.
4. _______, 2006, Seri Pembinaan dan MKDKI Konsil Kedokteran
Indonesia.
5. Addlakha, R., and Seeberg, J., 2005, Ethical Issues in Clinical Practice:
A-qualitative Interview Study in Six Asian Countries, in: Health Ethics in
South-East Asia, Volume-3, World Health Organization Regional Office
for South-East Asia, New Delhi.
6. Beauchamp TL., Childress JF., 2001, Principles of Biomedical Ethics, 5nd
ed., Oxford University Press.
7. Dep. Kes. RI., 1993,. Petunjuk Teknis Penyelenggaraan Rekam Medis /
Medical Record Rumah sakit. Dep. Kes. RI. Dir. Jen. Pelayanan Medik,
Jakarta.
8. Edge RS, Groves JR., 1999, Ethics of Health Care : A Guid for Clinical
Practice. Second Edition, Delmar Publishers, Singapore.

15
9. James, SH., Nordby, JJ., 2005, Forensic Science, An Introduction to
Scientific and Investigate Technique, 2nd ed., CRC Press, Florida
10. Jonsen, AR., Siegler, M., Winslade, WJ., 2002, Clinical Ethics: A
Practical Approach to Ethical Decisions in Clinical Medicine, 5nd ed.,
McGraw-Hill.
11. Kasturiaratchi, N., Lie, R., and Seeberg, J., 2005, Health Ethics in Six
SEAR Conutriues, in: Health Ethics in South-East Asia, Volume-1, World
Health Organization Regional Office for South-East Asia, New Delhi.
12. Kasule, O.H., 2008, Kuliah Kedokteran Islam, Forum Kedokteran Islam
Indonesia, Yogyakarta.
13. Kasule, Sr., Omar Hasan, 2000, Lecturer Ion Islamic Medicine, IIUM,
Malaysia.
14. Kerridge, I., Lowe, M., McPhee, J., 1998, Ethics and Law for The Health
Profession, Social Science Press, Katoomba, NSW, Australia
15. Knight, Bernard, 1996, Forensic Pathology, 2nd ed., Oxford University
Press, Inc., New York.
16. Lie, R., 2005, Ethical dilemmas and resource allocation: Two
questionnaire studies With annotated bibliography of literature on health
ethics and health policy in the SEA Region, in: in: Health Ethics in South-
East Asia, Volume-2, World Health Organization Regional Office for
South-East Asia, New Delhi.
17. Majelis Kehormatan Etik Kedokteran Indonesia, 2002, Kode Etik
Kedokteran Indonesia dan Pedoman Pelaksanaan Kode Etik Kedokteran
Indonesia, Ikatan Dokter Indonesia, Jakarta.
18. Mappes, Thomas; DeGrazia, David, 2002, Biomedical Ethics,5nd,
McGraw-Hill Higher Education, New York, USA.
19. Samil, R.S., 2001, Etika Kedokteran Indonesia, Yayasan Bina Pustaka
Sarwono Prawirohardjo, Jakarta.
20. Seeberg, J., 2005, Teaching Health Ethics Resource Materials from the
WHO SEA Region, in: Health Ethics in South-East Asia, Volume-4,
World Health Organization Regional Office for South-East Asia, New
Delhi.
21. Soepardi S.. 2001, Kode Etik Kedokteran Islam. Edisi Pertama,
Akademika pressindo, Jakarta, 2001.

b. Journal
1. http://ajobonline.com
2. http://jme.bmj.com
3. http://www.aslme.org
4. http://www.biomedcentral.com
5. http://www.bmjjournals.com
6. www.nejm.org

c. Web site
1. http://www.unesco.org/shs/ethics
2. http://www.unescobkk.org/index.php?id=2508
3. www.bioethics.gov
4. www.bioethics.net

16
 5. www.ethics-network.org.uk
6. www.hsph.harvard.edu/bioethics
7. www.who.int/ethics
8. www.wma.net/e/ethicsunit/education/html

d. Expert
1. Prof. Dr. dr. Soewito Atmosoemarno, Sp. THT-KL.
2. dr. R. Soegandhi, SpF (K).
3. dr. Tri Joko Hadianto, DTM&H., M.Kes.
4. Susi Hadijah, SH.
5. Fitri Murniati, SH., M.Hum.
6. M. Endrio Susilo, SH., MCL.
7. dr. Wiwik Kusumawati, M.Kes.
8. dr. Titik Hidayati, M.Kes.
9. dr. Kusbaryanto, M.Kes.
10. Tri Pitara Mahanggoro, S.Si., M.Kes.
11. drg. Iwan Dewanto
12. dr. Deni Anggoro P.
13. dr. Dirwan Suryo Soularto

17
 SUPPLEMENTS OF
BLOCK OF MEDICAL ETHICS AND
MEDICAL LAW

18
 GUIDANCE OF TUTORIAL
BLOCK OF MEDICAL ETHICS AND
MEDICAL LAW

19
 TECHNICAL GUIDELINES OF TUTORIAL
SEVEN JUMPS
Tutorial process in problem based learning (PBL) will use seven jumps as
guidance for tutor and students to discus problem from scenario. There are
seven steps in Seven jumps i.e. :

1. Clarifying unfamiliar terms

2. Problem definitions
3. Brainstorm
4. Analyzing the problem
5. Formulating learning issues
6. Self study
7. Reporting

1. Clarifying unfamiliar terms

Unclear terms and concepts in a problem description are clarified, so that
every group member understands the information that is given

2. Problem definitions
The problem is defined in the form of one or more questions. The group has to
agree upon the phenomena that need to be explained

3. Brainstorm
The preexisting knowledge of group members is activated and determined.
This process entails the generation of as many explanations and hypotheses
as possible. The ideas of all the group members are collected, without critical
analysis
4. Analyzing the problem
Explanations and hypotheses of the group members are discussed in depth
and are systematically analyzed. Ideas from the brainstorm are ordered and
related to each other

5. Formulating learning issues

Based on obscurities and contradictions from the problem analysis, questions
are formulated that form the foundation for the study activities of the group
members. In short, it is determined what knowledge the group lacks and
learning issues are formulated on these topics

6. Self study
Group members search relevant literature that can answer the questions in
their learning issues. After studying this literature the group members prepare
themselves for reporting that they have found to the tutorial group

7. Reporting
After reporting what sources group members have used in their self study
activities, a discussion of the learning issues takes place based on the studied
literature. Group members try to synthesize what they have found in different
sources

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 Step 1 to 5 will be conduct in the first meeting, after that the students will
conduct self study to search the explanation to answer the learning issues.
The 7 step will be conduct in the second meeting.

Overview of student skills in PBL

Preliminary discussion

Step Description Chair Scribe

1. Clarifying unfamiliar Invites group members to read the Divides the
terms problem blackboard into
Checks if everyone has read the three parts
Unfamiliar terms in the problem Notes down the
problem text are clarified Checks if there are unfamiliar terms in unfamiliar terms
the problem
Concludes and proceeds to the next
phase
2. Problem definition Ask the group for possible problem Notes down the
definitions problem
The tutorial group Paraphrases contributions of group definitions
defines the problem in a members
set of questions Checks if everyone is satisfied with the
problem definitions
Concludes and proceeds to the next
phase
3. Brainstorm Allows all group members to Makes brief and
contribute one by one clear summaries
Preexisting knowledge is Summarizes contributions of group of contributions
activated and members Distinguishes
determined, hypotheses Stimulates all group members to between main
are generated contribute points and side
Summarizes at the end of the issues
brainstorm
Makes sure that a critical analysis of
all contributions is postponed until step
four
4. Analyzing the problem Makes sure that all points from the Makes brief and
brainstorm are discussed clear summaries
Explanation and Summarizes contributions of group of contributions
hypotheses are members Indicates
discussed in depth and Asks questions, promotes depth in the relations
are systematically discussion between topics,
analyzed and related to Makes sure the group does not stray makes
each other from the subject schemata
Stimulates group members to find
relations between topics
Stimulates all group members to
contribute

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Step Description
5. Formulating learning
issues
It is determined what
knowledge the group
lacks, and learning
issues are formulated on
these topics
Chair Scribe
Asks for possible learning issues Notes down the
Paraphrases contributions of group learning issues
members
Checks if everyone is satisfied with
the learning issues
Checks if all obscurities and
contradictions from the problem
analysis have been converted into
learning issues

Reporting phase

Step Description Chair Scribe

7. Reporting Prepares the structure of the Makes brief
reporting phase and clear
Findings from the Makes an inventory of what sources summaries of
literature are reported have been used contributions
and answers to the Repeats every learning issue and Indicates
learning issues are asks what has been found relations
discussed Summarizes contributions of group between topics,
members makes
Asks questions, promotes depth in schemata
the discussion Distinguishes
Stimulates group members to find between main
relations between topics points and side
Stimulates all group members to issues
contribute
Concludes the discussion of each
learning issue with a summary

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 CHECKLIST ON ASSESMENT TUTORIAL
Tutorial contributes 30% to the final score of the block, consisting of 15%
average score of mini quiz and another 15 % of activities score of each tutorial
meeting. The components to score in each tutorial are as follow:

Students name :
Students number :
BLOCK :
Score (meeting )
No Criteria Unsatisfactory Satisfactory Good No judgment
DEALING WITH
WORK
1 Preparation of task
2 Completeness in
performing task
3 Brainstorming task
4 Active participation
in a group
5 Report back
DEALING WITH
OTHERS
6 Working in a team
7 Listening to others
8 Performance as a
chair of a group
9 Summarizing
discussion
DEALING WITH
ONE SELF
10 Dealing with
feedback
11 Giving feedback
12 The ability to reflect
13 Dealing with
appointment
14 Being in time

Unsatisfactory : below the expected average level of the tutorial group. Item for
improvement are clear and easy to mention. (score: <60).
Satisfactory : on the expected level of the tutorial group. Some issues for
improvement rest. (score: 60-69,9).
Good : students perform better than expected average of the group
(score: 70-80).
No Judgment : because student was absent to frequently (score: 0).

23
SCENARIO 1

A patient, a member of health insurance, visited a familys physician

recommended by the health insurance company. To get insurance company
reimburse, the physician must write the result of the examination, diagnosis
and treatment to be submitted to the insurance company.
The physician objects for doing such a thing because he will break
Hippocratic oath as the physicians legal act, confidentiality, and fidelity or
other various of ethical principles as the morality norm of medical practices.
On the other hand, if he does not fulfill the requirements, he will get no
reimburse from the insurance company.

Discuss this scenario using seven jumps !

24
SCENARIO 2

In a traffic accident case, a patient is loosing a lot of blood and has to

get blood transfusion immediately. The patient is in comma. Based on the
information from one of his family and the accompanying familys physician,
the patient belongs to a religious sect that consider blood transfusion as an
illegal act and they have any objections on the blood transfusion, although,
the risk has been explained completely by the familys physician and the
emergency unit physician.
The emergency unit physician is now in a dilemma because if he does
not do the blood transfusion, it can be stated the patient will not survive and
indeed, the physician does maleficence. On the other hand, if the physician
does transfusion, the patients family might charge against him for doing a
medical treatment without any permission and breaking patients autonomy.

Discuss this scenario using seven jumps !

25
SCENARIO 3

A patient visited a familys physician with an inconsistent stomachache

for more than three times. The patient argues to have a right to be referred to
a specialist such as surgeon or internist for consultation. The familys
physician refused to do so because based on his examination and evidence
based on medicine, the patient did not have any serious diseases and the
stomachache were actually caused by psychosomatic causes and asked him
to calm down. The familys physician declares that he is able to take care of
the patient as primary healthcare and has an obligation to give any treatments
according to the profession standard and general practitioner discipline.

Discuss this scenario using seven jumps !

26
SCENARIO 4

A General practitioner temporarily replaced a surgeon in a hospital. A

male patient visited him and said that he had a sprained leg after falling off in
the field. Besides writing a prescription, the physician recommended him to
have a physiotherapy treatment (massage). A few days later, the patient came
back without any significant improvement. The physician recommended him to
have an x-ray. The x-ray showed that his leg is fractured.
The patient has got upset and charged the hospital. Patient has
suspected that the physician has done medical misconduct namely
malpractice, medical negligence, ethical and discipline misconduct. The
patient argues that the physician has not conducted medical treatments as it
should be or based on medical procedures. Subsequently, the patients
condition has been getting worse.

Please discuss the scenario with seven jump steps!

27
SCENARIO 5

Mr. S is married and the father of two school children. He is treated in

your clinic for a rare form of pneumonia that often associated with AIDS. His
blood test results show that he is indeed HIV-positive. Mr. S says that wants
to decide himself if and when he will tell his wife about the infection. You
indicate that it could be live-saving for his wife to protect herself from infection.
Beside, it would be important for her to have an HIV test herself. In case of a
positive test result she would then have opportunity to take drugs to slow
down the outbreak of the disease and thereby prolong her life.
Six week later, Mr. S comes into your clinic for a control investigation.
Answering your question he says that he hasnt informed his wife yet. He
doesnt want her to know about his homosexual contact because he fears that
she would end their relationship and the family would shatter. But to protect
her he has had only safer sex with her. As the treating physician, you
wonder whether you should inform Mrs. S of the HIV status of her husband
against his will so that she would have the opportunity to start treatment if
needed.

Discuss this scenario using modification of seven jumps! (Use English,

only one meeting).

28
GUIDANCE OF SKILL ACTIVITIES
BLOCK OF MEDICAL ETHICS AND
MEDICAL LAW

29
 SKILL ACTIVITIES
ETHICS BLOCK AND MEDICAL LAW

Topic:
1. Identification of issue and principle of ethics in medical practices
2. Identification of issue and ethical problem, law, and discipline in medical
practices

Instructional Objectives:
1. Be able to identify existing ethical issue at clinical case in medical
practices.
2. Be able to specify the main principle of ethic at clinical case in medical
practices.
3. Be able to identify ethical issue, law, and discipline involved in medical
practices.
4. Be able to specify ethical norm, law, and discipline that related to case of
medical practices.

30
TOPIC 1.
IDENTIFICATION OF ISSUE AND PRINCIPLE OF ETHICS IN
MEDICAL PRACTICES.

TASK:
Identification of ethical issue existing at following case / according to enlist
criteria of Principles of Biomedical Ethics according to Childress and
Beauchamp and determine the dominant ethical principle on the
issue/problem.

ACTIVITY STEP:
1. Participants are divided into groups consist of 10-15 students
2. Every participant gets criteria of Principles of Biomedical Ethics according
to Childress & Beauchamp.
3. Each group get one or more cases which handed out randomly to be
discussed with instructor guidance.
4. Identify the existing criteria/principles of Principles of Biomedical Ethics in
every case and determine the dominant ethical principle on the
issue/problem.

CASE-1:

Don't be operated, doc!

A parkingman come to general practitioner with complain of veruca plana

on his plantar pedis. The physician checks the veruca plana by depressing it
using pinset so the parkingman feel pain, the he write down prescription of
nub with cream for 2 week. The parkingman than run all physician advice,
nevertheless that wart does not disappear. When the parkingman come for
further consultation, the physician states that the parkingman have not apply
the medication truly yet and the physician suggests operation of wart lifting.
The parkingman refuses that suggestion and exit from the practices room with
disgruntled romance.
(Case Hipotetik created by dr. Kulsum, FK Abulyatama. On Non-degre Program of Bioethics,
Medical Law, and Human Rights, Jakarta, 2005)

CASE-2:
Physician who doesnt want to conduct anamnesis

A physician accepts a male patient around 40 years old, show cachexia,

walk uneasily and suffer from continues cough in front of the physician. The
patient is accompanied by his thin daughter. The physician is referred shy at
conduct anamnesis and directly check the patient. When the children asking
the physician about her father complain, the physician only suggests the man
to take medicine regularly and give prescription. At the end, the children
enquire again about the way to take the medicine, but the physicain only
suggests then to ask to the officer of drug store where they buy the medicine.

31
Being underestimated, the child and her father step out from practices room
without saying good bye. Their face shows dissatisfaction.
(Case Hipotetik created by dr. Kulsum, FK Abulyatama. On Non-degre Program of Bioethics,
Medical Law, and Human Rights, Jakarta, 2005)

CASE-3:

Old Woman that do not willing to be cut open

A female patient comes to a physician with chief complain of dysplasia

vulva that generate doubt of ferocity existence. The physician conducts biopsy
and finds a carcinoma. Then, the physician explains to the patient that she
must be surgery. The patient refuses to any surgery. She says,No, I do not
willing to surgery. She said again,I have been old, 70 year and destitute of
symptom, this only grow small, then why I must be surgery? The physician
has explained that this surgery is not of detrimental nevertheless, the patient
strongly refused. At this moment, the physician together with the husband and
her daughter try to continue assure the woman that she must be surgery. At
the same time, the physician do not willing to tell that she has cancer. If she
disagrees to be operated for, then later, its disease increased worse and in a
moment later become invasive till will get larger ones problem and radical
surgery. This time the right not to be conducted simple vulvectomy, not
unlikely later she is asked for radical vulvectomy.

(Case Hipotetik created by dr. Kulsum, FK Abulyatama. On Non-degre Program of Bioethics,

Medical Law, and Human Rights, Jakarta, 2005)

CASE-4:

Beautiful Woman complains doctor

Mrs. P is a 30 years old midwife, who is still young and beautiful. She
comes alone to obstetrician and gynaecologist specialist, the only one
obstetrician in the city, for consultancy about her pregnancy. After finishing the
USG inspection, non-intentionally hand of the obstetrician gropes patient
stomach. At that time, the patient was so angry and expressed her feeling to
the obstetrician. She then reports the case at local police force.
(Case Hipotetik created by dr. Kulsum, FK Abulyatama. On Non-degre Program of Bioethics,
Medical Law, and Human Rights, Jakarta, 2005)

32
TOPIC-1 ENCLOSURE.
PRINCIPLES OF BIOMEDICAL ETHICS
ACCORDING TO CHILDRESS & BEAUCHAMP

A. Principle of Beneficence (Altruism in medical practice)

Criteria Yes No
1. Major altruism (help reward less, willing to scarify for the sake
of others).
2. Guarantying values of human reputation and prestige.

3. Regarding patient/family wellness beyond doctor profit.

4. Establishing effort in order to reach more benefits rather than
badness.
5. Responsible paternalism or taking care.

6. Guarantying human minimal wellness.

7. Goal-Based demarcation.

8. Optimizing patient satisfaction and preference.

9. Minimizing bad consequence.

10. Obligation of helping emergency patient.

11. Respecting patients rights.

12. Gaining brisk honorarium.

13. Optimizing overall satisfaction.

14. Developing profession continuously.

15. Giving efficacious cheap medicine.

16. Applying Golden Rule Principle.

33
B. Principle of nonmalficence (Do no harm in situation emergency and
clinical practices)

Criteria Yes No
1. Help emergency patient.
Illustration of this condition:
a. Patient in a state of very dangerous/emergency/risky of loosing
something important (emergency).
b. Physician ready to prevent danger or loss.
c. Medical action mentioned effectively proven
d. Patients benefit > physician loss (only experiencing of minimum
risk)

2. Cure wounded patient.

3. No kill patient (no euthanasia)

4. No affront/scorn/exploit patient.

5. Not regarding patient as an object

6. Cure disproportionally

7. Not preventing patient from danger

8. Avoiding misrepresentation of the patient

9. Non-threatening patient life due to negligence

10. Giving no life motivation/expectation

11. Not protecting patient from attack

12. Avoiding white collar attitude in the field of health/hospital that is

harmful for the patient/its relatives.

34
C. Principle of autonomy (Patient Autonomy in so many situation)

Criteria Yes No

1. Esteeming self determination rights, esteeming patient prestige.

2. No patient intervention in (at elective condition)

3. Telling the truth.

4. Esteeming patient privacy.

5. Keeping patient private secret.

6. Esteeming patient rationality.

7. Applying informed consent

8. Allowing adult and competent patient taking decision by himself.

9. No intervention on patient autonomy.

10. Preventing patient from any intervention, including from the

family.
11. Being patient awaiting patient decision that being taken at non
emergency case

12. No lie to patient even though for the patients good.

13. Maintaining interpersonal rapport.

35
D. Principle of Justice (Justice Principle in the context of patient-physician
relationship)

Criteria Yes No

1. Applying everything universally

2. Taking last portion on any dividing process that he/she already

conducts.

3. Giving the same opportunity to person in the same position.

4. Esteem healthy rights patient (affordability, equality,

accessibility, availability, quality)

5. Esteeming law rights of patient.

6. Esteeming others rights.

7. Protecting high risk group (the riskiest to harm)

8. Not to practicing any abuse.

9. Being wise in macro allocation.

10. Giving contribution that relatively equal to patient need.

11. Requiring patient participation comparably to his/her capacity.

12. Obligation in distributing advantage and disadvantage

(expense, sanction) in justice.

13. Giving back rights to its owner on proper time and competent.

14. Not to giving flatten burden without valid reason.

15. Respecting population rights whose tendency to suffer from

disease/ health trouble.
16. No discrimination on patient service on basis of SARA
(racialism, fanatics, social status etc).

36
TOPIC 2.
IDENTIFICATION OF ISSUE AND ETHICS NORM, LAW, AND
DISCIPLINE IN MEDICAL PRACTICES

TASK:
Identify the type of the issue or the problem (could be ethics / law and or medical
discipline) existing at the following case and specify any norm/regulation those
established in Indonesia which related to the issue or the problem.

ACTIVITY STEP:
1. Participant is divided into groups consist of 10-15 students.
2. Every participant gets various NORM cards containing ethics rule, law and
medical discipline randomly.
3. Instructor begin the discussion by taking one CASE card randomly and read
by one of participant.
4. Every participant suit the case that read off with card NORM and then being
discussed.
5. Identify ethics issue, law and or medical discipline existing in every case and
determine the written regulation than can be used as guidance in handling
referred issue / problem.

CONTEXT NORMA &

CASES REGULATION
E L D
INVOLVED
1. A physicain prescribe herbal preparation /
Indonesian traditional preparation to its
patient
2. Patients child complain to hospital for his
parent death after taken home by request of
his relatives
3. A physician that have no STR and SIP yet
conduct practices
4. A physician that practices but stake no
practices name board
5. Incompetent substitutive physician, compare
to the substituted physician
6. A physician conducts abortion to woman of
rape victim
7. A 24 hour clinic employs just passes
physician and still have no SIP and or STR.
8. A physician blames other physician that
prescribe certain medicine to patient and
complain that his medicine more efficacious

37
 CONTEXT NORMA &
CASES REGULATION
E L D
INVOLVED
9. Physician on duty of an emergency unit
works 48 hour, seen fatigue till can fall
asleep when serve his patient.
10. Physician conducts suturing without
anaesthesia to arsonist who experiences
mass violence.
11. A physician writes down an information letter
of sickness for his friend that who
undergoing investigation process by police.
12. A physician complained by female patient
with stadium IV carcinoma mama after
radiotherapy because of hair moults
13. Miss Artistik, a beautiful and interesting
physician, become an advertisement star of
a tooth paste product and food supplement
14. A physician checks vagina without gloves
and accompanied by a female nurse
15. A doctor always conducts hypodermic
roborantia to every patient
16. A sheet of lint is left in postpartum patient
vagina, with haemorrhage causing
inflammation of vagina.
17. At a board of a physician practices, besides
name and practices time existed following
article: general practitioner serves child
patient and adult.
18. A physician of a prison is assigned for
accompanying executor team executes
capital punishment.
19. A physician comes to its practices place after
patient long queue up.
20. A physician using billboard lamp on his
practices board.
21. When Caesar surgery a obstetrician and
gynaecologist also conduct appendectomy.
22. Medical team conduct mass circumcision
with equipments that used in rotation
mosque terrace.
23. Medical team that led by a physician
conducts mass service to society in natural
disaster area without practices permission
24. A physician in hospital give no prescription
or medicine to an ambulatory patient after
staying for few days on hospital
25. A physician gives medicine directly to his
patient without pharmacy.

38
TOPIC-2 MATERIALS
A. Medical Ethics
1. Hippocratic Oat
2. Code of Indonesia Medical Ethic

B. Medical Discipline
1. Decision of Indonesia Medical Council no. 17/KKI/KEP/VIII/2006 about
Guidance of Discipline Enforcement Medical Profession.
2. Decision of Indonesia Medical Council no. 18/KKI/KEP/IX/2006 about
Good Governance Medical Practice in Indonesia.

C. Law
1. Law of the Republic Indonesia no. 36/2009 of Health.
2. Law of the Republic Indonesia no. 29/2004 of Medical Practices.
3. Law of the Republic Indonesia no. 8/1999 of Consumer Protection.
4. Law of The Republic Indonesia n. 8/1946 of Criminal Law and Law of
Criminal Procedure.
5. Law of The Republic Indonesia of Civil Law
6. Ministerial Decree no. 512/Menkes/Per/IV/2007 of Practical Licence and
Medical Practice.
7. Ministerial Decree no. 585/Menkes/Per/IX/1989 of Informed Consent.
8. Ministerial Decree no. 749a/Menkes/Per/XII/1989 about Medical Record.
9. Government Decree no. 10/1966 of Medical Confidentiality

D. Religion
1. Al Quran
2. AL Hadist

39