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I Nyoman Trihana Pawitra Jaya

17710218
CASE 1
Mr.A is 35 years old was brought to the emergency room of a regional hospital
by his family with complaints of lower right abdominal pain. Arriving at the
emergency room, Mr.A was then examined by a doctor on duty according to the
procedure, then acute appendicitis was diagnosed. After the doctor on duty at
emergency room, the doctor contacted the specialist could not do the surgery
immediately, so the patient was advised to hospitalize and the given temporary
medication. The doctor then explains to the patient about the patient’s condition
and agree to hospitalization.
KDB 1 (Beneficence)
Kriteria Yes No
1. Prioritizing altruism (helping selflessly, willing to sacrifice) 

2. Guaranteeing the basic values of human dignity 

3. Looking at the patient / family and something not to the 


advantage of the doctor
4. Trying to make the benefits more than the evil. 

5. Responsible 

6. Ensure a good minimum human life 


7.Pembatasan Goal-Based 
8. Maximizing the satisfaction of happiness / patient preferences 

9. Minimize adverse consequences. 

10. Obligation to help emergency patients 

11. Respect the patient's rights as a whole 

12. Do not withdraw honoraria beyond appropriateness 

13. Maximizing the highest satisfaction overall 

14. Develop the profession continuously 

15. Providing nutritious yet inexpensive medicine 

16. Applying the Golden Rule Principle 


KDB 2 Non-Maleficence
No Kriteria YES NO

1 Helping emergency patients 

2 The conditions for describing these criteria are:


• The patient is in a dangerous condition. 
• Doctors are able to prevent harm or loss. 
• The medical action proved effective 
• Benefits for patients> doctor's loss (only experiencing 
minimal risk).

3 Treat injured patients. 

4 Do not kill patients (do not do euthanasia) 

5 Not insulting 

6 Do not view patients as objects 

7 Treating disproportionately 
KDB 2 Non-Maleficence

NO Kriteria Ada Tidak Ada


8 Do not prevent patients dangerously 

9 Avoid misrepresentation of patients 

10 Do not endanger the patient's life due to 


negligence

11 Does not give life spirit 

12 Does not protect patients from attacks 

13 Do not do white collar in the health field 


KDB 3 Autonomi
No Kriteria YES NO

1 Respecting the right to self-determination, 


respecting the dignity of patients.
2 Do not intervene in patients in making 
decisions (under elective conditions)
3 Put on the line 

4 Appreciate privacy. 

5 Keep personal secrets 

6 Appreciate patient rationality. 

7 Carry out informed consent 


KDB 3 Autonomi
No Kriteria YES NO

8 Allowing adult patients and competent to make 


their own decisions.
9 Do not intervene or obstruct patient autonomy. 

10 Prevent other parties from intervening in patients 


and making decisions, including, including the
patient's own family.
11 Patiently waiting for the decision to be taken by 
the patient in a non-emergency case.
12 Don't lie to the patient even for the benefit of the 
patient.
13 Maintain relationship (contract) 
KDB 4 Justice
No Kriteria YES NO
1 Enact everything universally 

2 Take the last portion of the dividing process he 


has done.
3 Giving equal opportunities to individuals in the 
same position.
4 Respecting patients' health rights (affordability, 
equality, accessibility, availability, quality)
5 Appreciate the legal rights of patients. 

6 Respect the rights of others. 

7 Maintain vulnerable groups (the most 


disadvantaged)
8 Do not abuse. 
KDB 4 Justice
No Kriteria YES NO

9 Wise in macro allocations. 

10 Provide a contribution that is relatively the same as the 


patient's needs
11 Request patient participation according to ability. 

12 The obligation to distribute profits and losses (costs, 


expenses, sanctions) fairly
13 Return rights to the owner at the right time and 
competent.

14 Does not give heavy burden unevenly without valid


reasons
15 Respect the rights of the population who are equally 
susceptible to diseases / health problems.
16 Does not distinguish patient services on the basis of SARA, 
social status etc.
DILEMA ETIK

Beneficence Justice

PRIMARY FACE

Justice
4 BOX METHOD OF CLINICAL ETHICS

Medical Indications:
Client Preferences:
Dx: Apendisitis Akut
In making decisions about
Emergensi patient, the families discuss
Planning to surgery

4 BOX
METHODE

Quality of Life: Contextual Features:


Poor, because the patient The family agrees to
hospitalization and arranges the
does not perform cito surgery schedule with the doctor
surgery specialist
PROFESIONALISME

• Altruism : Nothing
• Accountability: the doctor explains about the condition of the patient,
the actions that must be done and made informed consent.
• Excellence : the doctor diligently attend helath seminars
• Duty: the doctor recommend hospitalization and surgery on the other
days
• Honour and integrity: the doctor do not deviate from patient
• Respect for others : nothing
• Humanity : there is empathy
CASE 2
A female patient 66 years old was taken by her family to the Emergency Room
Dr.Soepraoen Malang Hospital came with a complaint that half of its body could not be moved.
According to the family who drove, the patient had fallen in the rice field and half of his body
could not be moved. In addition the patient also complained that it was difficult to speak and
open his mouth. Upon arrival at the hospital, a physical examination was performed to find the
right limb left behind.

Patients receive fluid and oxygen therapy. The treating doctor advises the patient to be
hospitalized and explain everything about the patient's disease to the family. The family agreed
to hospitalization but when the patient began to feel that the patient was forced to go home.
The patient gets angry and removes the oxygen mask used. The doctor again explained the
reason the patient had to be hospitalized but the patient still insisted on going home and signing
the forced return letter
KDB 1 (Beneficence)
Kriteria Yes No
1. Prioritizing altruism (helping selflessly, willing to 
sacrifice)
2. Guaranteeing the basic values of human dignity 

3. Looking at the patient / family and something not 


to the advantage of the doctor

4. Trying to make the benefits more than the evil. 

5. Responsible 

6. Ensure a good minimum human life 

7.Pembatasan Goal-Based 
KDB 1 (Beneficence)
Kriteria Yes No

8. Maximizing the satisfaction of happiness / 


patient preferences
9. Minimize adverse consequences. 

10. Obligation to help emergency patients 

11. Respect the patient's rights as a whole 

12. Do not withdraw honoraria beyond 


appropriateness
13. Maximizing the highest satisfaction overall 

14. Develop the profession continuously 

15. Providing nutritious yet inexpensive 


medicine
16. Applying the Golden Rule Principle 
KDB 2 Non-Maleficence
N Kriteria Yes No
o

1 Helping emergency patients 

2 The conditions for describing these criteria are:


• The patient is in a dangerous condition. 
• Doctors are able to prevent harm or loss.

• The medical action proved effective 
• Benefits for patients> doctor's loss (only experiencing minimal
risk). 

3 Treat injured patients. 


4 Do not kill patients (do not do euthanasia) 

5 Not insulting 

6 Do not view patients as objects 

7 Treating disproportionately 
KDB 2 Non-Maleficence
NO Kriteria Yes No
8 Do not prevent patients dangerously 

9 Avoid misrepresentation of patients 

10 Do not endanger the patient's life due to 


negligence

11 Does not give life spirit 

12 Does not protect patients from attacks 

13 Do not do white collar in the health field 


KDB 3 Autonomi
No Kriteria Yes No

1 Respecting the right to self-determination, 


respecting the dignity of patients.
2 Do not intervene in patients in making decisions 
(under elective conditions)
3 Put on the line 

4 Appreciate privacy. 

5 Keep personal secrets 

6 Appreciate patient rationality. 

7 Carry out informed consent 


KDB 3 Autonomi

No Kriteria Yes No

8 Allowing adult patients and competent to make 


their own decisions.
9 Do not intervene or obstruct patient autonomy. 

10 Prevent other parties from intervening in patients 


and making decisions, including, including the
patient's own family.
11 Patiently waiting for the decision to be taken by the 
patient in a non-emergency case.
12 Don't lie to the patient even for the benefit of the 
patient.
13 Maintain relationship (contract) 
KDB 4 Justice
No Kriteria Yes No

1 Enact everything universally 

2 Take the last portion of the dividing process he has 


done.
3 Giving equal opportunities to individuals in the 
same position.
4 Respecting patients' health rights (affordability, 
equality, accessibility, availability, quality)
5 Appreciate the legal rights of patients. 

6 Respect the rights of others. 

7 Maintain vulnerable groups (the most 


disadvantaged)
8 Do not abuse. 
KDB 4 Justice
N Kriteria Yes No
o
9 Wise in macro allocations. 

10 Provide a contribution that is relatively the same as the 


patient's needs
11 Request patient participation according to ability. 

12 The obligation to distribute profits and losses (costs, 


expenses, sanctions) fairly
13 Return rights to the owner at the right time and 
competent.
14 Does not give heavy burden unevenly without valid 
reasons
15 Respect the rights of the population who are equally 
susceptible to diseases / health problems.
16 Does not distinguish patient services on the basis of 
SARA, social status etc.
DILEMA ETIK

Non-Maleficence Autonomi

PRIMARY FACE

Justice
4 BOX METHODE
Medical Indications: Client Preferences:
Dx stroke Medical action is carried out with the
Liquid and oxygen therapy, the approval of the family because the
patient’s condition improve patient has difficulty speaking

Quality of Life: Contextual Features:


After therapy with fluid and oxygen, She is a BPJS patient, but she ignores
the patient’s condition improved but the illness
the patient refused to be hospitalized
and signed a forced return letter
PRINSIP PROFESIONALISME

• Accountability :
the doctor explain about the condition of the patient
• Duty :
The doctor take medical measures to deal with the patient’s
condition
• Altruism :
the doctor prioritize the interest of patient
• Respect for others:
The doctor appreciate the patient’s refusal to be hospitalized
Thank You

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