General Cases (Bioethics)

Lampiran Case A.1 Skenario (3 kasus) CONFLICT AND CONFLICT-SOLVING (Verification on item Help Aspect and KDM) 1. THE INFANT WHO WAS NOT REFERRED FOR PROPER TREATMENT
Physician: One of the neonatal cases came from a district hospital in the suburb of the city. The obstetrician and the paediatrician there did not have a good relationship. The baby was a forceps delivery, and it had birth injury resulting in haematoma of the head, which is a precipitating factor for neonatal jaundice. We should look for jaundice from day 1. There was a history of exchange transfusion in a previous child. The history of exchange transfusion was not taken. It was blood group "O". Thus, the birth injury, haematoma of the head, blood group "O" and history of exchange transfusion in the sibling, all suggested monitoring neonatal jaundice in the newborn baby. In spite of that, the obstetrician did not consult the paediatrician in the same hospital. She looked after the baby by herself. At last, the baby had intense yellow coloration (of the skin). In spite of that, she did not refer the baby to us. She sent the mother to consult a paediatrician who was practicing privately in that district. When the baby finally arrived here on day 5, he had impending kernicterus. However, in spite of our efforts to save the child with exchange transfusion, the condition deteriorated and the baby died after two hours of exchange transfusion. Summarize the important factors in this case and list ethical issues involved. Q Given the circumstances, do you find that this physician has an ethical obligation to take action to address the fatal lack of collaboration between the obstetrician and the paediatrician? Why/why not? What would you do in a similar situation? 2. THE CASE OF 'DOCTOR-SHOPPING' THAT RESULTED IN DISCOVERY OF A MALIGNANT TUMOUR Physician: Sometimes, patients who are being seen by another consultant, would like to come over and seek your opinion as well. I want to discourage 'doctor-shopping' by all means. But if the patient is in trouble, or in case they really push me hard, then I have to give in, but this is against the ethics. I am not very sure whether it is good or bad for the patient. Like yesterday, there was a 36-year-old lady who was seen by another doctor in the last eight months. But the patient was not feeling better. She had pain in her back and the doctor had tried all kinds of pain killers. She came over to me and said she really wanted to see me because she was not getting any better. Initially, I said no, but she insisted, and I relented. I told the other physician that I was going to see her. It turned out that her X-ray showed a secondary deposit in the L-3 vertebra, which was a cancer, just perhaps missed being detected. The diagnosis has still to be confirmed. Looking at the chances of having a secondary, if it has arrived in the bone, we also have to look for a primary. And in case from a primary site there is a secondary deposit in the bone, then the prognosis is not very good. Q Describe the ethical dilemma in this case. Discuss how you think physicians should deal with the phenomenon of 'doctor-shopping' in the context of a

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General Cases (Bioethics)

busy hospital department.

3. CORRECTING PATIENT

COLLEAGUE'S

EXCESSIVE

MEDICATION

OF

Physician: Sometimes you see patients who have been seen by other doctors. And they come with the prescriptions. Sometimes a prescription which has been given to the patient contains many drugs, which may not be needed. A mother came with her child who had been prescribed a lot of unnecessary drugs. Now, the question arises: Should I tell the mother that "Don't give the medicines, it will harm your child", because if you tell that, then your personal relationship with your colleague might be strained. But you know that so many drugs are not good for the child and therefore should not be used. It is a difficult situation. I told the mother that "probably these medicines were prescribed when your physician saw the child for the first time. But I don't think these medicines should be taken any more. So you can stop all these medicines and give only these drugs." Q Discuss the problem of excessive, unnecessary and potentially harmful overprescription of drugs. Identify factors that may contribute to this problem. List all the ethical issues involved and discuss how the individual physician should deal with the problem. Q Is the physician correct in protecting his colleague in this way? Discuss the conflict of professional ethics versus the obligation to serve the patient's interests in cases like this.

3. Mengoreksi PENGOBATAN BERLEBIHAN rekan kerja PASIEN A Dokter: Kadang-kadang Anda melihat pasien yang telah dilihat oleh dokter lain. Dan mereka datang dengan resep. Kadang-kadang resep yang telah diberikan kepada pasien mengandung banyak obat, yang mungkin tidak diperlukan. Seorang ibu datang bersama anaknya yang telah diresepkan banyak obat yang tidak perlu. Sekarang, muncul pertanyaan: Apakah saya harus memberitahu ibu bahwa "Jangan memberikan obat-obatan, maka akan membahayakan anak Anda", karena jika Anda mengatakan itu, maka hubungan pribadi Anda dengan rekan Anda mungkin tegang. Tapi Anda tahu bahwa begitu banyak obat tidak baik untuk anak dan karena itu tidak harus digunakan. Ini adalah situasi sulit. Saya mengatakan kepada ibu bahwa "mungkin obat-obat yang diresepkan dokter bila Anda melihat anak untuk pertama kalinya Tapi saya tidak berpikir obat-obat ini harus diambil lagi.. Sehingga Anda dapat menghentikan semua obat-obatan dan hanya memberikan obat ini." Q Diskusikan masalah berlebihan, overprescription tidak perlu dan berpotensi berbahaya dari narkoba. Mengidentifikasi faktor yang mungkin akan menyebabkan masalah ini. Daftar semua isu-isu etis yang terlibat dan membahas bagaimana dokter individu harus berurusan dengan masalah. Q Apakah dokter yang benar dalam melindungi rekannya dengan cara
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ini? Diskusikan konflik etika profesional versus kewajiban untuk melayani kepentingan pasien dalam kasus-kasus seperti ini.

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