TUGAS BIOETIK DAN HUMANIORA

DOKTER MUDA

I Gusti Agung Wira Utama Putra

18710043

GROUP I2 RSUD SIDOARJO

 CASE 1

A 50-year-old male patient came to the clinic with complaints of

nausea, vomiting, pain in the intestine. The pain felt by the
patient in the stomach is not accompanied by chest pain.
Patients admit that they often eat late and previously
experience the same symptoms. By doctor A the patient is
thoroughly examined and the patient is diagnosed with gastritis,
so the patient must be treated. However, because patients are
only pedicab drivers, doctor A recommends treatment, but uses
generic drugs that are more affordable. The patient agrees, so
doctor A also prescribes medication for underprivileged
patients.
 BENEFICIENCE
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. Goal-based restrictions √
 Criteria Yes No

8. Maximizing the satisfaction of happiness / patient preferences √

9. Minimize adverse consequences. √

10. Obligation to help emergency patient √

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- MALEFICIENCE

Criteria Yes No

Helping emergency patient √

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 patient > doctor's loss (only experiencing minimal
risk).
Treat injured patient √
Do not kill patient (do not do euthanasia) √
Not insulting √
Do not view patient as objects √

Treating disproportionately √
 NON- MALEFICIENCE

Criteria Yes No

Do not prevent patient dangerously √

Avoid misrepresentation of patient √
Do not endanger the patient's life due to √
negligence
Does not give life spirit √
Does not protect patient from attacks √

Do not do white collar in the health field √

 AUTONOMY
Criteria yes No

Respecting the right to self-determination, respecting the √

dignity of patient.
Do not intervene in patient in making decisions (under elective √
conditions)
Put on the line √
Appreciate privacy. √
Keep personal secrets √
Appreciate patient rationality. √
Carry out informed consent √
 AUTONOMY

Criteria Yes No

Allowing adult patients and competent to make their own √

decisions.
Do not intervene or obstruct patient autonomy. √

Prevent other parties from intervening in patients and √

making decisions, including, including the patient's own
family.
Patiently waiting for the decision to be taken by the patient in √
a non-emergency case.
Don't lie to the patient even for the benefit of the patient. √
Maintain relationship (contract) √
 JUSTICE

Criteria Yes No

Enact everything universally √

Take the last portion of the dividing process he has
done.
Giving equal opportunities to individuals in the same √
position.
Respecting patients' health rights (affordability, √
equality, accessibility, availability, quality)
Appreciate the legal rights of patients. √
Respect the rights of others. √
Maintain vulnerable groups (the most disadvantaged) √
Do not abuse. √
 JUSTICE
Criteria Yes No

Wise in macro allocations. √

Provide a contribution that is relatively the same as the √
patient's needs
Request patient participation according to ability. √
The obligation to distribute profits and losses (costs, √
expenses, sanctions) fairly
Return rights to the owner at the right time and √
competent.
Does not give heavy burden unevenly without valid √
reasons
Respect the rights of the population who are equally √
susceptible to diseases / health problems.
Does not distinguish patient services on the basis of SARA, √
social status etc.
Ethical principal

Benificience :
The doctor has provided an explanation of the
patient's illness and has been given therapy for the
disease.

Justice :
The doctors advise patients to use cheaper generic
drugs so as not to burden the patient's finances.
Prima facie

JUSTICE
4 BOX METHOD OF CLINICAL
ETHICS
Medical Indications Quality Of Life
A 50-year-old male patient came to the With these generic drugs, patients are
clinic with complaints of nausea, expected to feel comfortable, but the
vomiting, pain in the pit of the effect cannot be seen.
stomach. The patient admitted that he
often ate late and had previously
experienced the same symptoms. By
doctor A the patient was examined
thoroughly and the patient was
diagnosed with gastritis.
Client Preferences Contextual features
Competent patient (old enough) The patient is unable
In a conscious state and agree when Pay for the therapy that will be given
advised to use generic drugs so that for fear that the price is expensive,
treatment prices are more affordable because the patient only works as a
becak driver.
PRINCIPLE OF PROFESSIONALISM

– Alturism (+): Doctor recommends that patient continue to do the

therapy that is needed but by using generic drugs because of limited
costs
– Accountability (-) Doctor provides patient with a solution to the
limitations of their costs in purchasing drugs
– DUTY (+): The doctor performs a thorough examination of the
patient.
– Humanity (+): Because patient only work as becak driver and have
limited costs, they still encourage patient to be treated using generic
drugs that are more affordable.
– Respect for other (+): Doctor provides alternative advice to patients
in drug selection, because of the lack of costs.
Emergency/Non Emergency

Non Emergency
Case 2
A 32-year-old (women) patient came to an ENT specialist. The patient works
as a professional singer. He came to see a doctor to check his throat
condition. He suffered a sore throat that was very painful and did not heal. He
also experienced a cough accompanied by a small amount of blood. This
situation has lasted more than 2 weeks. After the examination, the doctor
suspected that the patient had a tumor in the throat. After a thorough
examination, patient A was tested positive for advanced stage of throat
cancer. To prevent the spread of cancer cells, the only way that can be done is
to do surgery. However, the doctor explained that if surgery is performed on
the patient's throat, chances are the patient cannot sing anymore because
some of the vocal cords will be removed. The patient is so surprised and asks
for time to think. The doctor provides an opportunity for the patient to decide
whether he wants surgery or not. The patient asks the doctor to keep his
condition secret, so as not to spread to the media and the doctor approves it.
 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. Goal-based restrictions √
 BENEFICENCE
Criteria Yes No
8. Maximizing the satisfaction of happiness / patient preferences √

9. Minimize adverse consequences. √

10. Obligation to help emergency patient √

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
Criteria Yes No
Helping emergency patient √
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 patient > doctor's loss (only experiencing minimal
risk).
Treat injured patient √
Do not kill patient (do not do euthanasia) √
Not insulting √
Do not view patient as objects √

Treating disproportionately √
 NON MALEFICENCE
Criteria Yes No
Do not prevent patient dangerously √

Avoid misrepresentation of patient √

Do not endanger the patient's life due to √
negligence
Does not give life spirit √

Does not protect patient from attacks √

Do not do white collar in the health field √

 AUTONOMY

Criteria Yes No
Respecting the right to self-determination, respecting the √
dignity of patient.
Do not intervene in patient in making decisions (under √
elective conditions)
Put on the line √
Appreciate privacy. √
Keep personal secrets √
Appreciate patient rationality. √
Carry out informed consent √
 AUTONOMY

Criteria Yes No

Allowing adult patients and competent to make their own √

decisions
Do not intervene or obstruct patient autonomy. √
Prevent other parties from intervening in patients and √
making decisions, including, including the patient's
own family.
Patiently waiting for the decision to be taken by the patient √
in a non-emergency case.
Don't lie to the patient even for the benefit of the patient. √
Maintain relationship (contract) √
 JUSTICE

Criteria Yes No
Enact everything universally √
Take the last portion of the dividing process he has done. √
Giving equal opportunities to individuals in the same √
position.
Respecting patients' health rights (affordability, equality, √
accessibility, availability, quality)
Appreciate the legal rights of patients. √
Respect the rights of others. √
Maintain vulnerable groups (the most disadvantaged) √
Do not abuse. √
 JUSTICE
Criteria Yes No
Wise in macro allocations. √
Provide a contribution that is relatively the same as the √
patient's needs
Request patient participation according to ability. √

The obligation to distribute profits and losses (costs, √

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

Does not give heavy burden unevenly without valid reasons √

Respect the rights of the population who are equally √

susceptible to diseases / health problems.

Does not distinguish patient services on the basis of SARA, √

social status etc.
Dilema Etik

Beneficence Vs Autonomy

Prima Facie
Autonomy
Ethical principal

Beneficence :
The doctor has provided an explanation of the
patient's illness and treatment to prevent the
spread of cancer cells.
Autonomy :
The patient asks for time to think about the next
action the doctor will take, and asks the doctor to
keep the current state of the media confidential.
Prima facie

Autonomy
4 BOX METHOD OF CLINICAL ETHICS
Medical Indications
A 32-year-old woman came to the THT
clinics to check his sore throat, and cough
with blood for 2 weeks. After doing the
examination the doctor diagnoses this
patient with advanced throat cancer
Client Preferences
Competent patient (old enough)
The patient has been given an explanation
by the doctor about further treatment, and
also the risks.

Quality of Life Contextual Features

The patient's condition is expected to The patient asks for time to think about the
improve if the operation runs smoothly doctor's advice for surgery because the
patient is worried that he cannot sing again
after surgery
PRINCIPLE OF PROFESSIONALISM

– Alturism (+): The doctors have provided a solution for further

treatment for patients' diseases in order to avoid the situation
getting worse
– DUTY (+): The doctor performs a thorough examination of the
patient.
– Humanity (+): Because after surgery the patient is at risk of not
being able to sing again, the doctor allows the patient to rethink
the follow-up actions suggested by the doctor, and the doctor
while maintaining the confidentiality of the patient.
– Respect for other (+): Doctors respect all patient decisions.
.
Emergency/Non Emergency

Non Emergency