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 PROBLEMS SOLVING PROCESS

Problems
Interventions
Outcomes

Dia
Thera
Progn

Chain of Decision Maki

System
Logic
Medical Logic

LOGIC
Observation = empirical data
cognition concept
empirical concept
Relationship of concepts
cognition inference
new concept
theoretical concept
Logic line of thought = cognition process
The concept is reliable
the inferences will be correct
the new concept is true

LOGIC
Concept x (empirical or theory)
premise
Concept y (empirical or theory)
premise
Cognition process of the premises
Inferences conclusion
Assumed conclusion = hypothesis
Hypothesis (assumed outcome of inferences)
Stimulate premise identification

MEDICAL LOGIC
@ Generating hypothesis:
formulating clinical question
Identifying relevant premises
empirical premises:
What to be examined
theoritical premises:
which knowledge is relevant
cognition / inferences process
conclusion
= answer to clinical question

MEDICAL LOGIC
Pathway of Cognition Process

Could be understood through

compehension of
Natural history of the diseases/
Clinical history of the diseases

NATURAL HISTORY OF THE DISEASES

Pathogenesis: Etiologic invasion
vs defense mechanisms

Etiology
Pat.Anatomy

Pat.Physiol
Clin.Mnifes

assumptions

Outcome

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

LINE OF THOUGHT IN PROBLEMS SOLVING

Diagnostic process
Pathogenesis:
Etiologic invasion vs
defense mechanisms

Etiology
Pat.Anatomy
Pat.physiol.

Clin.Mnifes
CLINICAL MANIFESTATION
empirical concets premises
THEORY / EXPERIENCES
theoritical concepts
INFERENCES
PATOPHYSIOLOGY
PATOANATOMY
ETIOLOGY
PATOGENESIS DEFENCE MECHANISM

Outcome

LINE OF THOUGHT IN PROBLEMS SOLVING

Therapeutic Process Diagnosis

Pathogenesis:
Pathogenesis
vs
Etiologic invasion
vs
defense
defense mechanisms
mechanisms

Etiology
Pat.anatomy
Pat.physiol.
Pat.physiol.

Clin.Mnifes

INTERVENSIONS

supportive,

Symptomatic,

Better
Outcome

LINE OF THOUGHT IN PROBLEMS SOLVING

Prognostic Process Diagnosis/ Therapy

Pathogenesis:
Pathogenesis
vs
Etiologic invasion
vs
defense
defense mechanisms
mechanisms

Etiology
Pat.Anatomy
Pat,physiol.

Clin.Mnifes
Outcome

ESTIMATE THE SITUATION (EMPIRICAL DATA)

diagnosis and therapy
IDENTIFY RELEVANT EXPERIENCES
ESTIMATE THE OUTCOMES

FRAMEWORK OF MEDICAL LOGIC

Clinical Questions Premises

Empirical concept Clinical
Manifestations
Available Knowledge
theoritical
concept
Cognition
process
conclusion
= CLINICAL DECICION MAKING
Diagnosis
Therapy
Prognosis

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

Supported by
STANDARD + ALGORYTHM
EVIDENCE BASED MEDICINE

WORKING STANDARD
Standard

Medical
Guidelines

Technical
Guidelines

Set up
Guidelines

Profession

++++

Procedure

++

++++

++

Care

++++

fessional standard: subject: diseas

How to manage the diseases
gorythm: subject: signs/ symptoms
How to elaborate a sign/ symptom

Appropriate premises
Valid inferences
Valid
Important
Applicable

Critical
Appraisal

Problem
Intervention
Comparative
Outcome

Clinical
Reasoning

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

THE ROLE OF MEDICAL LOGIC

KNOWLEDGE
SKILLS
DIRECTIONS
FOCUS
SYSTEMATICS

Problems
Identification Cinical Decision

Problems
Solving

MEDICAL PROBLEMS SOLVING

MORAL IMPLICATIONS

ETHICAL JUDGEMENTS

Medical Problems
Solving Process
moral implications?
impacts to human
being/ humanity
Ethical Judgement
Ethical Decision

Ethical judgement Ethical

decision

Medical problem solving activities

Impact to human being/ humanities
moral facts empirical premises
Morally appropriate? ethical issue
ethical question
What is the appropriate one? ethica
ethic principle, ethic guidelines, eth
previous cases theoritical prem
Cognition process Inferemces eth
conclusions
Process = ethical judgement

Ethical Judgment Ethical

Decisions

Ethically inappropriate
abort/ modified the activity
Proactive

Compared to clinical decision

Clinical question Ethica
Empirical premise mor
Theoritical premise refe
Analysis = deduction or in

Ethical Judgment
Ethical Decision

Required competency:
Attitude (empathy) skill in ide
moral implications ethical qu
Mastering the references
Conducting analysis ethical d
appropriate follow up
The process analogue to clinical

Ethical Judegement Technique

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 analysis process

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: Bagaimana
mengungkapkan kenyataan ini pada
keluarga/ pasien.
Apakah akan dilakukan juga
appendektomi pada appendik sehat?
Tolong bantu menganalisanya dari sudut
Ethical issues
pandang etik.
Bantulah dokter mengambil keputusan
Bioethics
dari sudut pandang etik.
Principles
Ethics Code
Indication?

Tuan Abul jatuh keselokan . Alis

kanannya robek. Luka ditangani
dengan rapi oleh dokter bedah muda di
RS Kabupaten. Dan menutup dengan
baik.
Tapi Tuan Abul kesulitan mengangkat
alis kanannya.
Akhirnya berkonsultasi ke Ahli Syaraf
dan oleh Dokter Spesialis Syaraf di
Rujuk kepada dr. Bedah Plastik, karena
menduga terjadi robekan pada otot
ekstensor alis yang kelupaan dijahit,.
Dokter Bedah Plastik setuju dengan
diagnosa ini. Sebagai dpkter
berpengalaman Sang Dokter Bedah

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