MEDICAL ETHICS

SMF ILMU KEDOKTERAN FORENSIK

FAKULTAS KEDOKTERAN WIJAYA KUSUMA SURABAYA
Case
A 58 years old woman came to emergency room with pain
in her upper abdominal and chest accompanied by nausea,
vomiting, excessive sweating, and trembling. The woman
has a history of hypertension. So, the doctor in ER diagnose
the patient suspect coronary heart disease and recommend
hospitalization. After being given medication the patient
has hypotension. Finally, this patient is treated by
cardiologist. Cardiologist performs advanced
ecocardiography examination to preserve. Cardiologist say
that the patient’s heart condition is okay. The patient only
has an attack of chronic gastritis.
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 of Goal-Based √
 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
1. Helping emergency patient √
2. The conditions for describing these
criteria are: √
a. The patient is in a dangerous √
condition. √
b. Doctors are able to prevent harm or √
loss.
c. The medical action proved effective
d. Benefits for patient > doctor's loss
(only experiencing minimal risk).
3. Treat injured patient √
4. Do not kill patient (do not do euthanasia) √
5. Not insulting √
6. Do not view patient as objects √
 Criteria Yes No

8. Do not prevent patient dangerously √

9. Avoid misrepresentation of patient √

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

12. Does not protect patient from attacks √

13. Do not do white collar in the health

√
field
 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 √
Allowing adult patients and competent to make their own
8 √
decisions.
9 Do not intervene or obstruct patient autonomy. √
Prevent other parties from intervening in patients and making
10 √
decisions, including the patient's own family.
Patiently waiting for the decision to be taken by the patient in a
11 √
non-emergency case.
12 Don't lie to the patient even for the benefit of the patient. √
13 Maintain relationship (contract) √
JUSTICE
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. √
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.
 ETHICS DILEMMA

Beneficen
ce Non-
Maleficence

PRIMA FACIE :
NON-
MALEFICENCE
BENEFICENCE
• The doctor at emergency room try to
provide the best tharepy according to
their abilities. But, the therapy was not
succesful so the doctor was consulted
to the cardiologist.

NON-MALEFICENCE
• The doctor may be less careful in
examining so that the diagnosis is
wrong and it can endanger the patient.
4 BOX METHOD OF CLINICAL
ETHICS
Medical Indication Client Preferences
• A 58 years old woman • The patient can make
diagnosed with suspected decision for her treatment
coronary hearth disease including agree to be
with doctor at emergency examined by cardiologist.
room
• After give some drug, the
patient have hypotension
• And then, cardiologist
checks and diagnose with
chronis gastriris.
Quality of Life Contextual Features
• The patient looks Social and economic
uncomfortable due to the condition, religion and
pain. cultural factors cot affect the
• After give some drug, the patient to make decision.
patient feeling dizzy and
weak.
 PRINSIP PROFESIONALISME

1. Alturism (+) : the doctor was consulted to cardiologist

because he feel his theraphy is incorrect.
2. Accountability (+) : the doctor is full of responsibility for
patient safety
3. Duty (+) : the doctor very responsive when patient need
some help at emergency room
4. Humanity (-) : the doctor make a mistake in diagnosis
because it is less thorough
Ordinary or Extraordinary

Extraordinary