4 box methode untuk membuat

keputusan klinik
Meivy isnoviana
"4-Box" Method of Clinical Ethics
Medical Indications:
State the client’s medical problem, history, and
diagnosis; is it acute, chronic, critical, emergent, and
reversible? Goals of treatment? Probabilities of
success? Plans in case of therapeutic failure? Potential
benefits of care? How can harm be avoided? Medical
risks if service is discontinued?
Quality of Life:
Describe quality of life in client’s term, client’s
subjective acceptance of likely quality of life, and
views and concerns of care providers. Examine the
emotional factors influencing each individual, such as
exiting feelings, values, biases and prior experiences.
Client Preferences:
State the client’s preferences. Do they have the
capacity to decide? If yes, are client’s wishes
informed, understood, voluntary? If not, who is
substitute decision maker? Does the client have prior,
expressed wishes? Is client’s right to choose being
respected?
Contextual Features:
Any other family involved or significant relationships?
Any care plans put in place so far? Relevant social,
legal, economic, and institutional circumstances?
Other relevant features, e.g. religious & cultural
factors, limits on confidentiality, resource allocation
issues, legal implications, research or teaching
involved, provider conflicts of interest? Organizational
values to consider?
Sejarah kesehatan pasien
diagnosis , apakah kronis, akut, reversible ?
 Tujuan terapi untuk apa? Probabilitas keberhasilannya
bagaimana? Rencana terapi?
Manfaat perawatannya bagaimana
Bila gagal apa ada alternatif lain, apakah bisa
menghindari kondisi yg berbahaya
Risiko medis apa bila layanan dihentikan
Box 2 preferency pasien
Apakah pasien punya kapasitas untuk memutuskan?
Jika ia apakah pasien mengerti/memahami penjelasan
dokter? Apakah memutuskan secara sukarela
Jika tidak kompeten siapa yang memutuskan? Apakah
keinginan pasien sudah diakomodasi?
Apakah keingingan pasien untuk memilih dihormati
Box 3 kualitas hidup
Jelaskan kualitas hidup pasien , kemungkinan
penerimaan ttg kualitas hidupnya, concern pelayanan
kesehatan terhadap pasien bagaimana? Apakah
pelayanankesehatan mampu menanganinya
Faktor2 emosional yg mempengaruhi individu
Fiturs Kontektual
Apakah ada keluarga lain yg terikat hubunga yg
signifikan, terkait dengan rencana perawatan
Apakah ada konflik kepentingan yang terjadi ?
Nilai nilai yang dipertimbangkan