ILMU KEDOKTERAN FORENSIK

DAN MEDIKOLEGAL
M E D Y Z A L M A N A L FA R I Z Y
18710128

SMF ILMU KEDOKTERAN FORENSIK

FA K U LTA S K E D O K T E R A N W I J AYA K U S U M A S U R A B AYA
RUMAH SAKIT UMUM DAERAH SIDOARJO
2019
CASE I
A man aged 35 years was brought to IGD HOSPITAL by his family with complaints there
was a lump in his genitals. The patient seemed pain. Previously the lump was only in the thigh
folds. Complaints have been felt for a long time but are not required because there are no
complaints of pain. In the IGD the male was examined by the doctor in accordance with the
procedure, after the physical examination was then obtained diagnosis of scrothalis hernia. The
doctor should advise to control to poly in order to be examined by specialists who are experts in
the field to do the treatment in order not to occur complications. The patient's family insisted on
the operation of the day as well. The Doctor of Care explained to the patient's family that the
condition is not indicative of surgery immediately. The patient's family received a doctor's
explanation. The doctor will prescribe anti-pain medication and the patient is taken home.
 KDB 1 BENEFICENCE
Criteria Yes No
1. prioritize aulturism (helping selflessly, willing to sacrifice. √
2. Ensure the core values ​of human dignity. √
3. Look at the patient / family and something not to the advantage of √
the doctor.
4. Strive for more good / benefit compared to badness. √

5. Paternalism is responsible / affectionate. √

6 Ensure a good minimum human life. √
7. Goal-Based restrictions. √

8. Maximizing patient satisfaction / preference. √

9. Minimization of bad results. √
10. Obligation to help emergency patients. √
 KDB 1 BENEFICENCE

Criteria Yes No

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. To apply Golden Rule Principle √

 KDB 2 NON MALEFICENCE
Criteria Yes No

1. Helping emergency patients √

2. 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 / insulting. √
6. Do not view patients as objects √
7. Treating disproportionately √
8. Do not prevent patients dangerously √
 KDB 2 NON MALEFICENCE

Criteria Yes No

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 AUTONOMY
Criteria 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
3. conditions) √
4. Be bright √
5. Appreciate privacy. √
6. Keep personal secrets √
7. Appreciate patient rationality. √
8. √
Carry out informed consent
9. Allowing adult patients and competent to make their own decisions √
10. Do not intervene or hinder patient outonomy √
Prevent other parties from intervening in patients and making
decisions, including, including the patient's own family.
 KDB 3 AUTONOMY

Criteria Yes No
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.
Maintain relationship (contract)
 KDB 4 JUSTICE
Criteria 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.
Respecting patients' health rights (affordability, equality, √
4.
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 √
 KDB 4 JUSTICE
Criteria Yes No
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. √
Does not give heavy burden unevenly without valid reasons.
14. Respect the rights of the population who are equally susceptible to √
diseases / health problems.
15. Does not distinguish patient services on the basis of SARA, social √
status etc.
DILEMA ETIK

Beneficence
VS
Autonomy
Prima Facei

Beneficence
 Ordinary

Summum Bonum
 PRINSIP PROFESIONALISME

Doctors advise to control to poly in order to be examined by

specialists who are experts in the field to be carried out the Accountability
treatment in order not to occur complications.

Doctors serve patients professionally Alturism

Doctors empathize the patient so that the doctor advises the

family to control to Poly to be examined by specialists who are
Humanity
experts in the field to do the treatment in order to avoid
complications
The doctor conducts inspections according to the existing
procedures Duty

Respect for
Patients and family
Other
4 BOX METHOD OF CLINICAL ETHICS
Medical Indications Quality of life

A man aged 35 years was brought to IGD

HOSPITAL by his family with complaints there
was a lump in his genitals. The patient examined
the doctor in accordance with the procedure, and
the diagnosis of Scrotalis. The doctor should
advise to control to poly in order to be examined
by specialists who are experts in the field to do the
treatment in order not to occur complications.
Doctor Guard prescribe pain medication. This case
is a non emergency case.
The doctor recommends the control to a
specialist who is skilled in the field to do
the treatment in order to avoid
complications and the doctor only
prescribes pain killer medications.
.

Contextual features
Client Preference

Patients belong to a family that can afford in

A man aged 35 years is able to implement finance
informed consent.
CASE II
A 30-year-old man was brought to the IGD hospital by the residents around due to a motorcycle

accident. The condition of the patient was weak with the GCS 356 and there were open wounds on the

right thigh. After an Anamnesa, physical examination and supporting examination by the doctor, the

patient is diagnosed with an open bone fracture on the right thigh. The doctor takes care of the

patient's condition to the orthopaedic surgeon and specialist doctor advises to take action

immediately. The doctor finally calls the patient's family and explains the patient's condition and

suggests surgery for the patient. Hearing a doctor family explanation the patient wants the patient to

be referred to the hospital which is closer to home. Hearing the doctor's answer back to give KIE the

condition and risk that can occur in the patient is on the way, but the family still wants the patient to

be referred. At such consideration, the doctor approves the patient to be referred and performed

sewing action situation to cover the wound while

 KDB 1 BENEFICENCE
Criteria Yes No
1. Prioritize alturism (helping selflessly, willing to sacrifice) √
2. Ensure the core values ​of human dignity √
3. Look at the patient / family and something not to the advantage of √
the doctor
4. Strive for more good / benefit compared to its ugliness. √
5. Paternalism is responsible / affectionate √
6. Ensure a good minimum human life √
7. Goal-Based Restrictions √
8. Maximizing happiness / patient preference satisfaction √
9. Minimization of bad results √
10. Obligation to help emergency patients √
 KDB 1 BENEFICENCE
Criteria Yes No

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
Criteria Yes No

1. Helping emergency patients √

2. 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 / insulting. √
6. Do not view patients as objects √
7. Treating disproportionately √
8. Do not prevent patients dangerously √
 KDB 2 NON MALEFICENCE

Criteria Yes No

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 AUTONOMY
Criteria 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. Be bright
4. Appreciate privacy. √
5. Keep personal secrets √
6. Appreciate patient rationality. √
√
7. Carry out informed consent
8. Allowing adult patients and competent to make their own √
decisions
9. Do not intervene or hinder patient outonomy √
10. Prevent other parties from intervening in patients and making √
decisions, including, including the patient's own family.
KDB 3 AUTONOMY
Criteria Yes No
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
Criteria Yes No
1. Enact everything universally √
2. Take the last portion of the dividing process he has done. √
Giving equal opportunities to individuals in the same
3. √
position.
4. Respecting patients' health rights (affordability, equality, √
5. accessibility, availability, quality) √
6. Appreciate the legal rights of patients. √
7. Respect the rights of others. √
8. Maintain vulnerable groups (the most disadvantaged) √
9. Do not abuse. √
10. Wise in macro allocations √
Provide a contribution that is relatively the same as the
patient's needs
 KDB 4 JUSTICE
Criteria Yes No

11. Request patient participation according to ability. √

12. The obligation to distribute profits and losses (costs, √
expenses, sanctions) fairly
Return rights to the owner at the right time and √
13.
competent.
Does not give heavy burden unevenly without valid √
14. 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.
 Justice
VS
Autonomy
PRIMA FACEI

AUTONOMY
 PRINSIP PROFESIONALISME
Accountabilit
Doctor explains the condition of the patient
y

Doctors put the patient's interests first Alturism

Doctors empathize the patient so that the doctor suggests to the family to
do surgery in the hospital but wants the patient to be referred to a hospital Humanity
that is closer to the patient's home

Doctor conducts inspections according to the existing procedures Duty

Respect for
Doctors respect the patient's
other
4 BOX METHOD OF CLINICAL ETHICS
Medical Indications
A 30-year-old man was brought to the IGD
hospital by residents around due to a
motorcycle accident and suffered an open
bone fracture on the right thigh and had to
immediately carry out surgical action to
prevent complications. The doctor treats
temporary patient wounds with the sewing
action situation. This case is a case of
emergency.
Client Preference
The patient of a 30 year old man
was able to carry out informed
consent.
Quality of life
Doctors advise to perform the
surgery but the family asks to be
referred and the doctor performs the
sewing actions of the situation to
close the wound temporarily and
alleviate the adverse effects that
occur in the passage when referred.
Contextual features
The patient is classified as a capable
family, and the family wants the
patient to be referred to the hospital
which is closer to home.
THANKYOU