TUGAS MATA KULIAH DASAR UMUM

FILSAFAT ILMU
Dosen Pengampu Mata Kuliah :
Prof. Dr. Nancy Margarita Rehatta, dr.,SpAn.,KNA.,KMN
CASE 7

Disusun Oleh:
dr. Sapta Faradillah
012018056305

FAKULTAS KEDOKTERAN UNIVERSITAS AIRLANGGA

MATA KULIAH DASAR UMUM (MKDU) PERIODE SEMESTER GASAL 2020/2021
SURABAYA
JANUARI 2021
CASE:
Mrs. Gould is 92 years old and has had Alzheimer’s disease for fifteen years.
 She has lived in a nursing home for the past seven years. She has had help with her
meals for two years, but over the last month has intermittently refused food. As a
result she has lost 15% of her body weight in the past 6 weeks.
 The Physician Orders for Life-Sustaining Treatment (POLST) form that she
completed when she was able to make her own decisions indicated that she did not
want a feeding tube if she was unable to eat on her own. Her son has durable power of
attorney to make decisions for her when she is no longer able to do so. He wants her
kept alive as long as possible and wants a feeding tube inserted.

DISCUSSION
Before talking about my point of views as a doctor, if i on duty at that time. I will talk about
4 basic ethical principles, which become my consideration in making decision.
1. Respect for autonomy is a norm that obliges us to respect the decisions (self-
determination) of adults who have decision-making capacity. Three conditions must
exist for autonomous action by those with capacity to choose: Intentionality,
Understanding, Absence of controlling influences that determine their action. The
following moral rules or obligations are derived from the application of the principle
of respect for autonomy: Tell the truth, Respect the privacy of others, Protect
confidential information, Obtain consent for interventions with patients.

2. The principle of beneficence is a moral obligation to act for the benefit of others.
There are 2 aspects of beneficence: Providing benefits, benefits and risks/harms. The
principle of beneficence supports the following moral rules or obligations: Protect and
defend the rights of others, Prevent harm from occurring to others, Remove conditions
that will cause harm, Help persons with disabilities, Rescue persons in danger.

3. The principle of nonmaleficence holds that there is an obligation not to inflict harm on
others. It is closely associated with the maxim primum non Nocera (first do no harm).
The principle of nonmaleficence supports the following rules: Do not kill, Do not
cause pain or suffering, Do not incapacitate, Do not cause offense.

4. The principle of justice obliges us to equitably distribute benefits, risks, costs, and
resources. The following arguments (rules) are supported by the principle of justice:
To each person an equal share, To each person according to need, To each person
according to effort, To each person according to contribution, To each person
according to merit.
After considering the 4 basic ethical principles above in making decisions. If I was on duty,
the first thing I would do is make sure to recheck the explanation in more detail to the patient
about the actions to be taken including the advantages and disadvantages but if after listening
to the explanation the patient still refuse the actions to be taken then as a doctor in charge I
choose to prioritize Nonmaleficence sees on the negative impact of progressive loss on the
body weight of patient who refuse to eat and can be corrected by inserting a feeding tube. I
do this not only because it prioritizes nonmaleficence and overrides the autonomy and justice
of the patient but considering that the patient's disease there is a possibility of a decrease in
the ability to make the right decisions at this time, where in dementia, the key to patient
autonomy is the ability to make adequate Given the decline in cognition and thus the ability
to make decisions. a person may not be able to adequately make choices even though they
have been given sufficient information (informed choice). My decision making will also not
have an impact on law violations because it has been approved by Her son to have a durable
power of attorney to make decisions for her when she is no longer able to do so.