Medico-legal

aspects of
Special Senses
wibisana widiatmaka, SpF (K)
Dept of Forensic Medicine
and Medico Legal FMUI
Medico Legal
relating to, or concerned with
medicine and law.
pertaining to legal aspects of the
practice of medicine (as malpractice
or patient consent for operations or
patient information)
Five Special Sense Organs
According to Indonesian Criminal
Law (Kitab Undang Undang
Hukum Pidana)There are 5 special
Sense:
Sight (Penglihatan)
Hearing (Pendengaran)
Smell (Penghiduan)
Taste (Pengecapan)
Touch (Perabaan)
Of five senses, there are only
Sight and Hearing seems to
have important issues related
with Medico Legal Aspects
The other three usually not
raising serious medico legal
problem.
Medico Legal Aspects of Sight
VISUAL ACUITY
Visual acuity eligibility levels is a policy
decision (not a scientific one)
In USA:
20/20 is commonly used for a pilots
license
20/40 for a drivers license,
20/80 may be used for special
educational assistance
20/200 (with best correction, or Visual
field of less than 20
o
) is defined as
legal blindness (for tax benefits)
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WHO ICD 10
th
ed:
Low vision : visual acuity of less
than 6/18, but equal to or better than
3/60, or corresponding visual field
loss to less than 20 degrees, in the
better eye with best possible
correction.
Blindness : visual acuity of less than
3/60, or corresponding to visual field
loss to less than 10 degrees, in the
better eye with best possible
correction
Visual Impairment
Visual impairment : Vision with
eyeglasses of 20/60 or worse.
Limitation of side vision, abnormal
color vision, or presence of
double vision in one eye also may
determined as visual impairment.
Visual Disability
If one can not perform certain
tasks because of visual
impairment, then he is
considered visually disabled.
This rating or quantification of
the disability is necessary to
receive worker's compensation,
insurance disability benefits,
legal claims or certain forms of
government assistance.
Visual Disability
Visual disability is expressed in
percentages to determine how
much the whole person is disabled
by this handicap.
In USA, total loss of vision in both
eyes is a 100% disability of vision,
but only an 85% disability of the
whole person.
ISHIHARA COLOR PLATE
COLOR BLINDNESS
Total color blindness
Partial color blindness
Red-green
Dichromacy (protanopia and
deuteranopia)
Anomalous trichromacy (protanomaly
and deuteranomaly)
Blue-yellow
Dichromacy (tritanopia)
Anomalous trichromacy (tritanomaly)
COLOR BLINDNESS and MEDICINE
There is no reason to restrict one
with color blindness to study
medicine (In Western countries you
are unlikely to be screened for
CCVD), but you should give
thought to the specialty you enter
In some Eastern countries,
admission to medical school may
not be allowed if the deficiency is
severe. J apan has recently relaxed
such rules
CCVD = Congenital Color Vision Deficiency
Hearing Impairment
Mild:
for adults: between 25 and 40 dB
for children: between 15 and 40 dB
Moderate: between 41 and 55 dB
Moderately severe: between 56
and 70 dB
Severe: between 71 and 90 dB
Profound: 90 dB or greater
ARISE of MEDICO LEGAL PROBLEM
If impairment of the special
sense is a result of trauma,
occupational related or caused
by mistreatment
Severity of injury:
Kehilangan salah satu indera = luka
berat (KUHP art. 90)
Workman compensation
Pedoman IDI 2004
Calon Presiden / Calon Kepala
Daerah:
Disabilitas bidang penglihatan sbb:
Tajam penglihatan jauh dengan koreksi
masih lebih buruk dari 6/18 dan/atau
tajam penglihatan dekat dengan koreksi
masih lebih buruk dari J aeger 2 pada
mata terbaik;
Lapang pandangan kurang dari 50 %
yang tidak dapat dikoreksi;
Diplopia pada posisi sentral 30 yang
tidak dapat dikoreksi;
Disabilitas bidang pendengaran:
Tuli yang tidak dapat dikoreksi dengan
alat bantu dengar;
Anosmia and Gustatory problems
Loss of smelling ability (olfactory
impairment) can be a result of
head trauma, medication or
infection.
These causes may have medico
legal aspects if resulted from
criminal act (violence etc) or
wrong doing by physician
Other Medico Legal Problems
Restriction to certain education or
jobs opportunity: pilot, army etc
Restriction for obtaining Driving
License
Impairment in one eye ?
Color Blindness ?
Restriction to certain Govermental
position: president, Governor etc
Other issues
Transplantation of human organ,
regulated by PP 18/1981 tentang
Bedah Mayat Anatomis, Bedah Mayat
Klinis dan Transplantasi J aringan
tubuh Manusia
Regulation which set an obligation for
employer of companies to hire certain
percentage of the employee who are
from disabled (including those with
impairment in special sense)
Regulation for the workplace to have
proper preventive measures to avoid
or diminish impairment
Pasal 90 KUHP
Luka berat berarti:
jatuh sakit atau mendapat luka yang tidak
memberi harapan akan sembuh sama sekali,
atau yang menimbulkan bahaya maut;
tidak mampu terus-menerus untuk
menjalankan tugas jabatan atau pekerjaan
pencarian;
kehilangan salah satu pancaindera;
mendapat cacat berat;
menderita sakit lumpuh;
terganggunya daya pikir selama empat
minggu lebih;
gugur atau matinya kandungan seorang
perempuan.
Pasal 89 KUHP
Membuat orang pingsan atau tidak berdaya
disamakan dengan menggunakan kekerasan.
Pasal 352 KUHP
Penganiayaan ringan adalah
penganiayaan yang tidak menimbulkan
penyakit dan atau halangan melakukan
pekerjaan jabatan atau mata
pencaharian sehari-hari
TERIMA KASIH