Presentation

“Moral Basic Principle”

By:
Kadek Parpita Sani
Sidoarjo D2 Groups

Medical Faculty
Wijaya Kusuma Surabaya University
 CASE 1
A 50-year-old man has a traffic accident. The patient was found by local residents and
reported to the police. The police have not managed to find the patient's identity. When
taken to the hospital the patient's vital signs continue to deteriorate and is thought to
have internal bleeding. Examination of CT scan was found to detect damage to the right
kidney. The doctor performs surgery on the patient. During the operation the doctor
tried to save the kidney. But the damage that occurs is quite severe and several times
experience cardiac arrest. After examining the laboratory results of kidney function, the
doctor decided to remove the right kidney to save the patient's life.
 Beneficience
No Criteria 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 adverse effect. 
5 Responsible 
6 Ensure a good minimum human life 
7 Restriction 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 
 Non Maleficence
No Criteria Yes No
1 Helping emergency patients 
The conditions for describing these criteria are:
• The patient is in a dangerous condition.
2 • 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 
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 
 Autonomy
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 Be honest 
4 Appreciate privacy. 
5 Keep personal secrets 
6 Appreciate patient rationality. 
7 Carry out informed consent 
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) 
 Justice
No Kriteria Yes No
1 Give 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. √
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. √
 Ethical Dilemma

Non-Maleficence Autonomy

Prima Non-
Facie Maleficence
 ETHICAL PRINCIPLES
Non-Maleficence :
•Doctors want to save patient’s life who are in an emergency.

Autonomy:
•The patient has the right to determine his own decisions

Prima Facie
•Non-Maleficence
 4 box method
Medical Indications
• 50-year-old man had an accident
• Patients experience massive bleeding due to kidney damage
and several times experience cardiac arrest (Acute)
• If the damaged kidney is not removed, it is difficult to stop
bleeding and can cause death.
Quality of Life
• With the removal of the kidneys that have damaged lives, • There is no relationship between the socio-economic
the patient can be helped
• Patients can still live with one kidney because seen from the
laboratory results the kidney condition is still good
Client Preferences
• The patient is unconscious so he cannot make his own
decisions
• The patient's family cannot be contacted because the
patient's identity has not been found
• Actions are still carried out even if they do not get approval
because it is an emergency condition
Contextual Features
conditions of patients in making treatment decisions
 Professionalism
 Accountability: During the operation the doctor tries to make the best decision for
the patient
 Alturism: Doctors try to save the lives of patients
 Duty: Doctors do help according to emergency patient procedures
 Respect for other: Doctors value peer opinions
 Humanity: Doctors have empathy for patients
Ordinary Extraordinary
or

ordinary
 CASE 2
A man aged 65 years is taken to the hospital complaining that he cannot urinate. Previously
patients also often had pain and blood when urinating. After an examination the doctor diagnoses
the patient experiencing BPH. In addition, laboratory results show a decrease in kidney function.
The doctor explains to the patient about his condition and the treatment plan including the
surgery and the risks if no treatment is taken.
The patient asks for time to discuss with his family. Patients come from families with middle
to lower economies. Because he felt old and saw the family's economic condition and did not want
to bother his family, the patient refused to do the surgery.
The family asks the doctor's help to persuade the patient to accept treatment. The doctor
again explained to Mr. R about his illness. For the cost problem, the doctor suggested that Mr. R
take care of the BPJS. After getting an explanation the patient still refused.
The doctor asked the patient to sign a letter of refusal to operate.
 Beneficience
No Criteria 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 adverse effect. √
5 Responsible √
6 Ensure a good minimum human life √
7 Restriction 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 √
 Non Maleficence
No Criteria Yes No
1 Helping emergency patients √
The conditions for describing these criteria are:
• The patient is in a dangerous condition.
√
2 • 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 √
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 √
 Autonomy
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 Be honest √
4 Appreciate privacy. √
5 Keep personal secrets √
6 Appreciate patient rationality. √
7 Carry out informed consent √
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) √
 Justice
No Kriteria Yes No
1 Give 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. √
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. √
 Ethical Dilemma

Autonomy Beneficence

Prima Autonomy
Facie
 ETHICAL PRINCIPLES
Beneficence :
•Doctors want to safe patient’s life

Autonomy :
•The patient has the right to determine his choice
and the doctor must respects the patient's decision
 4 box method
Medical Indications Client Preferences
• A man aged 65 years is taken to the hospital complaining that • the patient can determine his decision
he cannot urinate. • the doctor has educated the patient but the patient still
• Patients also often had pain and blood when urinating. refused
• He diagnosed experiencing BPH (Chornic)
• Laboratory results show a decrease in kidney function.
• The better treatment is surgery because, the patient already
got complication, such as decrease in kidney function.
• If no treatment is taken, more severe complications can occur
such as kidney failure
• The second opinion is treatment with drugs.
Quality of Life Contextual Features
• if treatment is done it can prevent worse complications • Patients come from families with middle to lower
economies.
• He doesn’t have insurance
• He didn’t want to bother his family
 Professionalism
 Accountability: Doctor advise patients to have surgery even though the patient
refuses the doctor to try to educate the patient
 Alturism: doctors try to provide the best actions for the health of patients
 Duty: The doctor act due to patient’s decision and asked patient to sign letter of
refusal
 Respect for other: Doctor value the patient's decision
 Humanity:The doctor empathizes with the patient's condition
Ordinary Extraordinary
or

Extraordinary
Thank
You