CASE OF BASIC BIOETHICS

FATMAWATI
18710015

DOKTER MUDA RSUD DR MOH SALEH PROBOLINGGO

 CASE 1

Patients on behalf of A with the age of 4,5 years old came to the mergency room of the RSUD
Dr.moh Saleh Probolinggo virtuous on Friday at 18.00 p.m patients present with cold acral,
decreased conscuiousness, and heavy breathing (dypsneu). Based on this condition, the
emergency department wanted to enter the patient into the RSU PICU. After the doctor
guarded the patient’s condition, this child’s father refused to enter the patient into the PICU
room and chose to be treated in a regular inpatient room. After being given treatment in the
emergency room, the patient’s family finally wanted to be treated in the inpatient room with a
note that the patient was given oxygen assistance. At 01.00 a.m patient arrived at the inpatient
room and the condition of the patient worsened. Around 05.30 a.m the patient died in the
inpatient room. Thankful the patient’s family accepts the condition of the child who has left the
family forever.
KDB 1 BENEFICENCE

Criteria Yes No
1. Emphasize altism (helping selflessly, willing to sacrifice) √
2. Ensuring basic values of human dignity √
3.Viewing patients/families and things not as far as benefiting doctors √
4. Damaging so that the benefits/ benefits are greater than ugliness √
5. Paternalism interferes with responsibility / affection √
6. Guarantees a good minimum human life √
7. Goal – based limitations √
8. Maximizes happines satisfaction / patient preferences √
Criteria Yes No
9. Minimizes adverse consequences √
10. Obligations to help emergency patients √
11. Respecting the patients rights as a whole √
12. Not withdrawing honoraria outside appropriateness √
13. Maximizing the highest satisfaction in a consistents manner √
14. Developing the profession continuously √
15. Providing nutritious but inexpensive medicine √
16. Applying the golden rule principle √
 KDB 2 : NON MALIFECENCE
Criteria Yes No
1.Helping emergency patients √
2.Conditions to describe this criterion are : √
a.Patients are in a dangerous condition. √
b.Doctors are able to prevent harm or loss. √
c. The medical action was proven effective. √
d.Benefits for patients > loss of doctors (only experiencing minimal risk). √
3. Treating injured patients. √
4. Not killing patients (not doing euthanasia) √
5. Not insulting / cursing. √
6. Not looking at patient as an object. √
7. Treating disproportionately. √
8. Do not prevent patients from being dangerous √
Criteria Yes No
9. Avoid misrepresentation of patients √
10. Not endangering the patients life due to negligence. √
11. Not giving a spirit of life. √
12. Not protecting a patient from attacks. √
13. Do not do white collar in the health field √
KDB 3 : AUTONOMY

Criteria Yes No
1. Respecting the right to self – determination, respecting the dignity of the patient. √
2. Not intervening in the patient in making decisions ( in elective conditions) √
3. Being candid. √
4. Respecting privacy. √
5. Keeping personal secrets. √
6. Respecting the rationality of patients. √
7. Carrying out informed consent √
8. Allowing adult patients and competent to make their own decisions √
Criteria Yes No
9. Do not intervene or hinder patient autonomy √
10. Prevent others from intervening in patients and making decisions, including the √
patients own family.
11. Patience awaits the decision that the patient will take in a non emergency case. √
12. don’t lie to the patient even for the benefit of the patient. √
13. Maintain a relationship (contract) √
KDB 4 : JUSTICE

Criteria Yes No
1. Enacting everything universally. √
2. Taking 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 groups, the vulnerable ( the most disadvantaged) √
8. Do not abuse √
9. Wise in macro allocation √
Criteria Yes No
10. Contribute relatively the same as the patients needs √
11. Requesting the participation of patients in accordance with ability √
12. The obligation to fairly distribute profits and losses ( costs, expenses, sanctions) √
13. Return rights to the owner at the right time and competently √
14. Does not give a heavy burden unevenly without valid reasons √
15. Respecting popular rights that are equally susceptible to health/ health problems √
16. Not differentiating patient services on the basis of SARA. Social status and others √
ETHICAL DILEMMA

• Non maleficence
• Beneficence

Prima facie : Non Maleficence

4 BOX METHODE OF CLINICAL ETHIC

Medical Indication Client Preferences

Male patient on behalf of A, 6 years old came to The patient is a 6 years old boy who has not
the Bojonegoro General hospital emergency been able to make his own decision so that a
department with dextra radius fracture medical decision is based on a parents decision
Quality of Life Contextual Features
After joint treatment is expected to improve the Patients were adverse event BPJS patients
patients condition
KEY PRINCIPLES OF PROFESIONALISM

• Excelence (-)
• Accountability (+)
• Duty (+)
• Alturism (+)
• Respect for other (+)
• Humanity (+)
CASE 2

Mr. dony is one of the patients suffering from wet diabetes. Until one day mr. dony fell off
the motorbike and suffereda wound, but mr. dony ignored the wound. After one week the
wound did not heal, even worse. Finally, mr.dony ventured to check the wound to doctor
Andi. After examining the wound mr.dony, doctor andi finally explained that if diabetic
person has a wet wound, the wound is difficult to heal even if the wound extends to the
other part of the hand and doctor Andi recommends amputation in Mr.dony’s hand before
late. Doctor andi also suggested taking this decision carefully and without coercion or
encouragement from others. A few days later mr. dony came with this wife to see doctor
andi to express his intention that he was ready to be amputated. Finally the doctors
performed the operation, and the amputation process went smoothly.
 KDB 1 : BENEFICENCE
Criteria Yes No
1. Prioritizing altruism (helping selflessly, willing to sacrifice) √
2. Securing basic values of human dignity and dignity √
3.Viewing patients / families and things not as far as benefiting doctors √
4. Damage so that the good or benefit is more than the badness √
5. Responsible paternalism or affection √
6. Guaranteeing a good minimum human life √
7. Goal based restrictions √
8. Maximizing happiness satisfaction / patient preferences √
9. Minimizing adverse consequences √
10. Obligation to help emergency patients √
Criteria Yes No
11. Respecting the patient’s rights as a whole √
12. Not withdrawing honoraria outside appropriateness √
13. Maximizing the highest satisfaction as a whole √
14. Developing the profession continuously √
15. Providing nutritious yet inexpensive medicine √
16. Applying the golden rule principle √
KDB 2 : NON MALIFECENCE
Criteria Yes No
1. Helping emergency patients √
2. Conditions to describe this criterion are : √
a. Patients are in a dangerous condition
b. Doctors are able to prevent harm or loss
√
c. The medical action proved effective √
d. Benefits for patients > doctor’s loss (only experiencing minimal risk ) √
3. Treat injured patients √
4. Not killing ( not doing euthanasia ) √
5. Not insulting / abusing √
6. Not looking at the patients as an object √
7. Treating disproportionately √
8. Do not prevent patients from being dangerous √
9. Avoid misrepresentation of patients √
10. Do not endanger the patient’s life due to negligence √
11. Does not give enthusiasm for life √
12. Does not protect patients from attacks √
13. Do not do white collar in the health field √
 KDB 3 : AUTONOMY
Criteria Yes No
1. Respecting the right to self – determination, respecting the dignity of the patient. √
2. Not intervening in the patient in making decisions ( in elective conditions) √
3. Being candid. √
4. Respecting privacy. √
5. Keeping personal secrets. √
6. Respecting the rationality of patients. √
7. Carrying out informed consent √
8. Allowing adult patients and competent to make their own decisions √
9. Do not intervene or hinder patient autonomy √
10. Prevent others from intervening in patients and making decisions, including the patients own family. √
11. Patience awaits the decision that the patient will take in a non emergency case. √
12. don’t lie to the patient even for the benefit of the patient. √
13. Maintain a relationship (contract) √
KDB 4 : JUSTICE
Criteria Yes No
1. Enacting everything universally. √
2. Taking 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 groups, the vulnerable ( the most disadvantaged) √
8. Do not abuse √
9. Wise in macro allocation √
10. Contribute relatively the same as the patients needs √
Criteria Yes No
11. Requesting the participation of patients in accordance with ability √
12. The obligation to fairly distribute profits and losses ( costs, expenses, sanctions) √
13. Return rights to the owner at the right time and competently √
14. Does not give a heavy burden unevenly without valid reasons √
15. Respecting popular rights that are equally susceptible to health/ health problems √
16. Not differentiating patient services on the basis of SARA. Social status and others √
ETHICAL DILEMMA

• Autonomy
• Non Maleficience

• Prima Facie = ?
4 BOX METHODE OF CLINICAL ETHIC

Mr. dony is one of the patients suffering from wet diabetes. Until one day mr. dony fell off
the motorbike and suffered a wound, but mr.dony ignored the wound. After one week the
wound did not healt, even worse. When examined by a doctor, mr. dony’s hand must be
amputated to prevent complications. Doctor’s attitude ?
 MEDICAL INDICATION CLIENT PREFERENCES
Based on the determination of medical Based on patient choice :
problems and diagnosis :  Does the patient have the ability to
 Is it classified as acute, chronic,critical or decide ? Yes
emergency ? Emergency  If so, has the patient been adequately
 The ultimate goal of treatment ? explained and understood ? Already
Prevent life threatening complicatins  If not, who has the right place ? Wife
 Plan if treatment or action fails ?  Is there an agreement beforehand ? Yes
Evaluation based on guidelines and TS
consultations from dr. internal and
surgical specialists
 Benefits of action taken ? Wounds will
not spread, infection is prevented
 What is the risk if medical action is not
done ? The patient can die
 QUALITY OF LIFE
Describe the quality of life of patients after
undergoing treatment :
 Can the patient be saved ? Can survive
or die
 How do you feel after treatment ?
 What is the value obtained by the
patient after underdoging treatment ? It
is expected that the patient’s quality of
life will improve
CONTEXTUAL FEATURES
Describe the influence of socio legal,
economic and institutional conditions in
decision making on therapeutic
relationships between the doctors and
patients :
 Is there a relationship between the
patient’s socio economic conditions in
making treatment decisions ? Yes
KEY PRINCIPLES OF PROFESIONALISM

1. Altruisme : (+)
2. Duty : (+)
3. Respect for others : (+)
4. Accountable : (+)
5. Humanity: (+)