Case 1

A man 30 year old was sent by police to the emergency room after a traffic
accident. When the patient arrives he is aware of an open fracture in the right leg.
The doctor who guarded immediately checked the condition of the patient and the
wound on his right leg. After that the doctor did first aid. The ER doctor explains
the situation and subsequent actions that must be taken. Previously the ED doctor
had consulted with an orthopedic specialist. From the results of the consensus, the
patient must be operated immediately. The ER doctor explained to the patient and
his family the result of a consul from an orthopedic specialist, then the family
asked for time to negotiate it. After that the patient and the patient's family agreed
to refuse surgery because they wanted to take the patient to Sanggal putung . The
ER doctor explained the risk that the patient would receive again if he did not
perform the surgery immediately but they still refused. And the patient signs a
letter of refusal for surgery.
Bio 1 (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 

KDB 1 (Beneficence)
Criteria Yes No

8. Maximizing the satisfaction of happiness / 

patient preferences
9. Minimize adverse consequences. 

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. Applying the Golden Rule Principle 
KDB 2 Non-Maleficence
No Kriteria YES NO

1 Helping emergency patients 

2 The conditions for describing 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 

6 Do not view patients as objects 

7 Treating disproportionately 
KDB 2 Non-Maleficence
NO Criteria Yes No
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 

KDB 3 Autonomy
No 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 Put on the line 

4 Appreciate privacy. 

5 Keep personal secrets 

6 Appreciate patient rationality. 

7 Carry out informed consent 

KDB 3 Autonomy
No Criteria YES NO

8 Allowing adult patients and competent to make 

their own decisions.
9 Do not intervene or obstruct patient autonomy. 

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.
13 Maintain relationship (contract) 
KDB 4 Justice
No 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.
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. 
KDB 4 Justice
No Criteria YES NO

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.
Ethical Dilemma
• Autonomy :
The doctor explains the condition of the disease that the patient is
currently experiencing to the patient himself. The doctor also
advises the patient to perform surgery and gives the patient the
opportunity to consider the actions that the doctor will take to
himself and ultimately the patient refuses.

• Beneficence :
Doctors education for patients about the conditions experienced
by the patient at this time and suggest the best course of action is
to do surgery.
Ethical Dilemma
• Dilema Etik : Autonomy, Beneficence
• Prima Facie : Autonomy
4 BOX METHODE
Medical Indications: Client Preferences:
A man 30 years old with an Medical action is carried out
open fracture in the right leg for with the patient's own consent
surgery immediately

Quality of Life: Contextual Features: there isn’t

Patients reject surgery that can economic issue or conflict with
make things worse the hospital. The family’s
patient just want to take the
patient to Sanggal putung
PRINSIP PROFESIONALISME
1. Alturism: Yes, doctors are concerned with the interests of
patients
2. Duty: Yes, the doctor in charge of the patient performs his
duties according to the procedure.
3. Respect for others: yes, the emergency room respects the
patient's decision
4. Accountable: Yes, the doctor is responsible for the patient
5. Humanity: Yes, doctors have integrity because they realize
that they and the hospital are able to handle the case.
ORDINARY OR EXTRAORDINARY
EXTRAORDINARY
CASE 2
a man, 68 years old came to the doctor with complaints, coughing since 2
months ago, sweating especially at night, accompanied by weight loss. The
doctor conducted a thorough examination, including examination of smear in
the phlegm of the patient's patient. The result is a positive patient suffering
from pulmonary TB. Doctors recommend doing routine treatment by taking
medication regularly and controlling once a month. Besides that the doctor
also suggested to maintain the cleanliness of his residence, as well as to
prevent transmission to those around him by using a face cover. And it is
attempted that the residence will get enough sunlight. And the patient agree
for the treatment.
KDB 1 (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 

KDB 1 (Beneficence)
Criteria Yes No

8. Maximizing the satisfaction of happiness / 

patient preferences
9. Minimize adverse consequences. 

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. Applying the Golden Rule Principle 
KDB 2 Non-Maleficence
No Criteria Yes No

1 Helping emergency patients 

2 The conditions for describing 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 

6 Do not view patients as objects 

7 Treating disproportionately 
KDB 2 Non-Maleficence
NO Criteria Yes No

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 

KDB 3 Autonomi
No 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 Put on the line 

4 Appreciate privacy. 

5 Keep personal secrets 

6 Appreciate patient rationality. 

7 Carry out informed consent 

KDB 3 Autonomi
No Criteria Yes No

8 Allowing adult patients and competent to make 

their own decisions.
9 Do not intervene or obstruct patient autonomy. 

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.
13 Maintain relationship (contract) 
KDB 4 Justice
No 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.
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. 
KDB 4 Justice
No Criteria Yes No

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.
Ethical Dilemma
• Beneficence :
Doctors education for patients about the conditions. Doctors recommend doing
routine treatment by taking medication regularly and controlling once a month.
Besides that the doctor also suggested to maintain the cleanliness of his residence,
as well as to prevent transmission to those around him by using a face cover. And it
is attempted that the residence will get enough sunlight.

• Autonomy :

Doctors explain The result is a positive patient suffering from pulmonary TB. And
agree with the treatment.
Ethical Dilemma
• Dilema Etik : Beneficence, Autonomy
• Prima Facie : Beneficence
4 BOX METHODE
Medical Indications: Client Preferences:
a man, 68 years old a positive patient Medical action is carried out with the
suffering from pulmonary TB. patient's own consent

Quality of Life: Contextual Features:

Patient is agree with the treatment. there isn’t economic issue or
conflict with the hospital.
PRINSIP PROFESIONALISME
1. Alturism: Yes, doctors are concerned with the interests of
patients
2. Duty: Yes, the doctor in charge of the patient performs his
duties according to the procedure.
3. Respect for others: yes, the emergency room respects the
patient's decision
4. Accountable: Yes, the doctor is responsible for the patient
5. Humanity: Yes, doctors have integrity because they realize
that they and the hospital are able to handle the case.
ORDINARY OR EXTRAORDINARY
ORDINARY
THANK YOU