Angelina Christianty

Kurniadi
17710250
 CASE 1
Ms. S in her early 20 came into the emergency room at RSUD Wahidin Sudiro
Husodo Mojokerto with a x-ray from another clinic and asking for a treatment after
she felt from her motorbike. The doctor checked the picture and asked the patient to
re-take the x-ray since the previous one didn’t show clearly both of her clavicula.
After re-taking the picture, the doctor diagnose the patient with close fracture
clavicula dextra and advice the patient to stay at the hospital and schedule for
surgery, yet the patient refuse the offer and said she doesn’t want to take any surgery
and choose to go to sangkal putung or get a massage. Then the doctor explain to her
and her family why surgery is the better option for her. After some discussion with
her family she still refuse the treatment that the doctor told her and decided to go
home.
 KDB 1 (BENEFICENCE)
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 evil. 

5. Responsible 

6. Ensure a good minimum human life 

7. Limitation 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 


 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 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
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:

Diagnose:Close Fracture To making decision about
Clavicula dextra patient, families can discuss

4 box methode

Quality of life: Contextual features:

good The patient refuse to surgery
and decided to go home
 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 health 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 : yes
• Humanity : there is empathy
CASE 2
 A male patient 60 years old was taken by her family to the emergency room of
Sidoarjo regional hospital came with a complaint that half of her body could not be moved.
According to the family information, the patient had fallen in the gardeb 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. The physical examination was performed to find the right limb left behind.

Patients receive fluid and oxygen therapy. The doctor advises the patient to be
hospitalized and explain everything about the patient's disease to the family. The family
agreed to hospitalization but the patient think he already feel better and refuse for futher
treatment. The family tried to convince the patient to stay but the patient get angry to
everyone even trying to take off the oxygen mask. The doctor again explained the reason the
patient had to be hospitalized but the patient still insisted on going home and signing the “by
own request” 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.Limitation 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

Beneficence Autonomi

PRIMARY FACE

Autonomi
 4 BOX METHODE
Medical Indications:
Dx stroke
Liquid and oxygen therapy, the
patient’s condition improve
Client Preferences:
Medical action is carried out with the
approval of the family because the
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
 Client preferences:
Medical indications:
Medical action is carried out with the approval of
Diagnose: Cerebro Vascular Accident the family because the patient has difficulty
Infark dd Transient Ischaemic Attack
speaking

4 box methode

Quality of life:
After therapy with fluid and oxygen, the patient’s Contextual features:
condition improved but the patient refused to be She is a government insurance(BPJS) patient, but
hospitalized and signed a “by own request” letter she ignores the medication
 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