Presentation

“Moral Basic Principle”

By:
Ni Kadek Yunita Kencana Dewi
17710125
RSUD IBNU SINA GRESIK

Mentor :
dr. Meivy Isnoviana, S.H, M.H

Medical Faculty
Wijaya Kusuma Surabaya University
 Cases 1
 A 55 years old woman who has a traffic accident and comes to
the emergency unit. The patient suffered an injury to her right
leg and the patient cannot withstand the pain in her right leg.
The doctor had done a physical examination and diagnosed that
she had a Tibia and Fibula fracture. The doctor advised her to
do the surgery, but the patient did not want to do it and ignored
it because she did not have enough money to do surgery and
afraid to do the surgery. Patient decided to go massage
(Sangkal Putung), while the doctor has explained the worst
possibility if he does not immediately carry out surgery, the
patient still refuses and chooses to go home.
 Cases 1
 After a few months the patient returned to the Orthopedic clinic
at the RSUD Ibnu Sina Gresik with the condition that the
patient was difficult to walk and her right leg experienced a
change of rotation inward. Finally the patient asked the
orthopedic doctor to do the surgery so that the patient could
return to normally.
 No. Kriteria Ada Tidak
1. Prioritize Aulturism √ 
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. √
N

N
B

C
E

E
F
I

8. Maximizing patient satisfaction / preference. √

9. Minimization of bad results. √

10. Obligation to help emergency patients. √
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 √
No. Kriteria Ada Tidak
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.

M

√
N
O

N
C

C
L
E

E
F
N
-

I
6. Do not view patients as objects √
7. Treating disproportionately
√
8. Do not prevent patients dangerously
√
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.
√
 No. Kriteria Ada Tidak
J 1. Enact everything universally √

U 2. Take the last portion of the dividing process he has done. √

Giving equal opportunities to individuals in the same position.
S 3. √

T 4. Respecting patients' health rights (affordability, equality, accessibility √

I 5. Appreciate the legal rights of patients. √

C 6. Respect the rights of others. √

E 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.
No. Kriteria Ada Tidak
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.
M Keep personal secrets √
A
U

O
N
O

Y
T

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.
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. √
 Ethical Dilemma

Non-
Autonomy
Maleficence

Prima
FacieAutonomy
 ETHICAL
PRINCIPLES
Non-Maleficence :
•The doctor gave the woman the best suggestion about treatment
so the patient didn’t suffer

Autonomy:
•The patient has the right to determine her own decisions

Prima Facie
•Autonomy
 4 Box Method
Clinical A woman 55 years old had an accident. Patient had Tibia and Fibula
Indication fracture and the doctor advise her to do surgery.

Quality of If surgery is done it can prevent worse complications

Life

Client • The patient can determine his decision

Preferences • The doctor has educated the patient but the patient still refused

Contextual The patient did not have enough money and afraid to do surgery.
Features
 Professional Principal
 Accountability: Doctor advise patients to have surgery even
though the patient refuses the doctor to try to educate the
patient
 Alturism: doctors try to provide the best actions for the health
of patients
 Duty: Doctor is following the procedure

 Respect for other: Doctor value the patient's decision.

 Humanity: The doctor empathizes with the patient's condition

Ordinary/Extraordinary

Extraordinary
 Cases 2
Mrs.S, 65 years old came to eye clinic at RSUD Ibnu Sina Gresik
with a complaint, blurred eyesight from 3 months ago. After the
examination, the doctor diagnosed Cataract Sinistra Mature and
planned for Cataract Surgery. The doctor then explains everything
about the patient's illness. Then the patient asks for time to think
about it and discuss with her family because of the costs involved
in the operation. Then the doctor suggested that Mrs. S register
with the BPJS, and get the surgery using the BPJS. A few days
later an surgery was held for Mrs. S
 No. Kriteria Ada Tidak
1. Prioritize Aulturism √ 
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. √
N

N
B

C
E

E
F
I

8. Maximizing patient satisfaction / preference. √

9. Minimization of bad results. √

10. Obligation to help emergency patients. √
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 √
No. Kriteria Ada Tidak
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.

M

√
N
O

N
C

C
L
E

E
F
N
-

I
6. Do not view patients as objects √
7. Treating disproportionately
√
8. Do not prevent patients dangerously
√
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.
√
 No. Kriteria Ada Tidak
J 1. Enact everything universally √

U 2. Take the last portion of the dividing process he has done. √

Giving equal opportunities to individuals in the same position.
S 3. √

T 4. Respecting patients' health rights (affordability, equality, accessibility √

I 5. Appreciate the legal rights of patients. √

C 6. Respect the rights of others. √

E 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.
No. Kriteria Ada Tidak
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.
M Keep personal secrets √
A
U

O
N
O

Y
T

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.
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. √
 Ethical Dilemma
Beneficence

The doctor explains the condition of patient, recommend the

necessary treatment, and gives the patient the opportunity to
discuss with the family because of the costs required for surgery.
Then the doctor recommends that the patient get surgery using
BPJS, so the treatment can be received immediately by the patient.

Autonomy

Doctors give patients the opportunity to discuss with family about

treatment actions that will be used later.

Prima Facie : Beneficence

 4 Box Method
A woman 65 years old with Cataract Sinistra Mature, patients
Clinical recover from her illness with Cataract Surgery. If the patient was not
Indication operated on it would likely worsen the patient's condition and after a
while the patient will experience blindness.

Quality of The patient getting better after she doing the treatment
Life

Client The patient can determine her opinion

Preferences

Contextual Because economic problems make patients to get surgery using BPJS
Features
 Professional Principal
 Accountable : doctor did surgery on patient according to the
procedure and the doctor followed up the patient until the patient
is get out from the hospital
 Alturism : doctor are very concerned about the patients
condition.
 Duty : the doctor following the procedure and very contactable.
 Respect for Others: doctors recommend ways that patients can
still get surgery, but doctors still respect patient decisions
 Humanity : the doctor empathizes with the patient's condition
Ordinary/Extraordinary

ORDINARY