MEDICAL LOGIC

MEDICAL ETHICS
by
Rusdi Ismail

Instructional Lecture
Department of Child Health
School of Medicine, Sriwijaya University

MISSION
Medical Sciences
Applied Sciences
Medical Profession
Medical Problems Solving

SOFTWARE FOR THE PROCESS

Problems
Identification
P
R
O
C
E
S
S
Problems
Solving

KNOWLEDGE
SKILLS
LOGIC
SYSTEMATICS

ETHICS

AIMS

Highlights the relevancy

position of:
* Medical logic
* Medical ethics
In
Medical problems solving

MEDICAL LOGIC

MEDICAL PARADIGM

Natural history of the disease

NATURAL HISTORY OF THE DISEASES

Pathogenesis vs
defense mechanisms

Etiology
Pat.Anatomy

assumptions

Pat.Physiol
Clin.Mnifes

Every disease has the etiology

Etiology may elicits the structural damages
Etiology may elicits functional disturbances
Structural and functional abnormalities elicit clinical manifestation
Body mobilized defense mechanism
Interaction: pathogenesis and defense mechanism lead to outcome
completely cured
with sequel
death
chronic

Outcome

LINE OF THOUGHT IN PROBLEMS SOLVING

Diagnostic process
Pathogenesis vs
defense mechanisms

Etiology
Pat.Anatomy
Pat.physiol.

Clin.Mnifes
ELABORATE CLINICAL MANIFESTATIONS
== Clinical examinations
ABALYSE THE PATHO PHYSIOLOGY
= Functional diagnosis
ANALYSE THE PATHO-ANATOMY
= Anatomical diagnosis
ANALYSE THE ETIOLOGY
= Causal diagnosis
ESTIMATE THE THE DEFENSE MECHANISM
= Functional diagnosis

Outcome

Sequelae

LINE OF THOUGHT IN PROBLEMS SOLVING

Therapeutic Process - Intervention

Pathogenesis vs
defense mechanisms

Etiology
Pat.anatomy
Pat.physiol.

Clin.Mnifes

Outcome
= Clinical manifestation
IDENTIFY SYMPTOMATIC THERAPY
= Functional diagnosis
= Anatomical diagnosis
IDENTIFY PALIIATIVE AND SUPPORTIVE THERAPY
= Causal diagnosis
IDENTIFY CAUSAL THERAPY
= Defence mechanism
IDENTIFY SUPPORTIVE THERAPY TO ENHANCE DEF.MECH

LINE OF THOUGHT IN PROBLEMS SOLVING

Prognostic Process
Pathogenesis vs
defense mechanisms

Etiology
Pat.Anatomy
Pat,physiol.

Clin.Mnifes

Outcome
Estimate the role of etiology
Estimate the structural and functional damages
Sequelae
Identify the relevant intervention
Estimate the feasibility of intervention
Analyze the prognosis, for :
The pertinency of etiology probability of chronicity and recurrence
The recovery of damages qua ad sanationum
The probability of death qua ad vitam

FRAMEWORK OF ANALYSIS
Clinical questions

Clinical decisions
DIAGNOSTIC

THERAPEUTIC

PROGNOSTIC
OTHERS

FRAMEWORK OF CLINICAL DECISION MAKING

CLINICAL EXAM
RESULT
(Minor Premise )

RELEVANT
KNOWLEDGE
(Major Premise)

Deduction

CLINICAL DECISIONS

FRAMEWORK OF CLINICAL DECISION MAKING

CLINICAL EXAM
RESULT

RELEVANT
EXPERIENCES
Analogy

Induction

CLINICAL DECISIONS

FRAMEWORK OF CLINICAL DECISION MAKING

continous analysis
AVAILABLE DATA

Induction-deduction
ONGOING CLINICAL DECISIONS
SELECTED NEW DATA
MORE FOCUSED DECISIONS

CONTINOUS ANALYSIS
Systematics
Etiology
Pathology
Physiology
Clin.Mnifes

Genetics
Congenital
Infections
Allergy
Auto-immune
Degenerative
Neoplasm
Trauma
etc.

Outcome

Systems
Organs
Pathogenesis vs
defense mechanisms

CONTINOUS ANALYSIS

Supported by

ALGORYTHM
STANDARD

STANDARD
Problems
Identification
P
R
O
C
E
S
S
Problems
Solving

S
T
A
N
D
A
R
D

KNOWLEDGE
SKILLS

LOGIC
SYSTEMATICS

ETHICS

WORKING STANDARD
Standard

Medical
Guidelines

Technical
Guidelines

Set up
Guidelines

Profession

++++

Procedure

++

++++

++

Care

++++

EXTENTION OF STANDARD
STANDARD
EXTENTION
SECOND THOUGHT
SECOND OPINION
CONSULTATION
REFERAL
EVALUATION

CLINICAL APPLICATIONS
Data collection

Clinical examination

Data analysis

Ongoing analysis, Resume

Alternative of problems

Differential diagnosis

Problems identification

Working diagnosis

Problem solving planning Therapy

Additional examination
Actuation of Prob. solving Actuation of therapy
Prediction of outcome

Prognosis

Follow up

Follow up

Evaluation

Evaluation

THE ROLE OF MEDICAL LOGIC

KNOWLEDGE
SKILLS
DIRECTIONS
FOCUS
SYSTEMATICS
EFFICIENCY
Problems
Identification

Process

Problems
Solving

MEDICAL PROBLEMS SOLVING

MORAL IMPLICATIONS

ETHICAL JUDGEMENTS

Medeical Problems
Solvong
moral implications
Analysis

Impacts:
Patients
Community

Community
Morality

References

Professional
responsibility

Decisions

Harmony
In
Morality

Medical
Ethics

Ethical Judegement
Ethical Decisions
Process:
Deduction or Inductioan
Guidelines
Clinical Ethics, Johnsen et al

Ethical Judegement
Clinical Ethics,
Johnsen et al
Mayor Premise: Bioethics Principles
Minor Premise: Moral facts based on medical
problem solving process
Technics in analyzing the premises
4 steps of anlysis process

Seorang nona manis, usia 21 tahun, mahasiswi berprestasi dioperasi

dengan diagnosa appendisitis akut. Opersai dilakukan sesuai
standard melalui sayatan pada di titik Mc. Burney.
Ternyata kelainan yang ditemukan adalah kehamilan ektopik
dengan torsi.
Dokter berfikir:
Apakah akan dilakukan juga appendektomi pada appendik sehat?
Selesai operasi dokter juga ragu, sampai dimana kenyataan ini akan
diungkapkan.
Tolong bantu menganalisanya dari sudut pandang etik.
Indication?
Patient preferences?
Quality of life?
Contextual features?

Prinsip Etik
Fasal-fasal KODEKI?

End Remarks
Knowledge and skill are the
basic resources for the
medical professionals in
solving the medical
problems.
Medical logics and
systematic improving the
efficiency of the process.
Medical ethics improving the