Case 1

A 40-year-old man came to the Hospital emergency room at 7:30 p.m. with a complaint of
pain and swelling in his left lower limb since 4:40 p.m. after being bitten by a snake. The
patient said when cutting the grass in the rice field the left lower leg of the patient was
bitten by a snake. The patient said the color of the snake biting it was green red tail, the
patient had time to kill the snake. Patients complain of pain, swelling, blueness around the
bite, and tingling (+). Before coming to the emergency room the patient had to go to the
snake bar. When I arrived at the emergency room, GCS of patient 456 was full of pain while
holding his left foot and attached a cloth loop to the left leg. The doctor keeps the IGD
directly doing first aid, explaining to the family to do a complete blood examination and
advising the patient and family that the patient must be MRS due to close monitoring of vital
signs, worsening of local and systemic symptoms. The patient's family asks to negotiate first,
and the doctor gives the opportunity to negotiate. Then the patient's family asked to go
home forcibly and opted for outpatient care. In the end he signed a forced return letter.
 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)
Kriteria Ada Tidak Ada

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 Kriteria Ada Tidak Ada
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 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 

 KDB 3 Autonomi
No Kriteria 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 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. 
 KDB 4 Justice
No Kriteria 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.
 DILEMA ETIK
• Autonomy :
The doctor explains the condition of the patient's current
condition to the family, as well as the therapy that should
be done, and gives the family and patient the opportunity
to discuss and ultimately the patient's family refuses.
Beneficence :
The doctor performs education for patients and families of
patients regarding the condition of the disease that the
patient is currently experiencing and suggests the best
course of action is MRS.
 DILEMA ETIK
• Dilema Etik : Autonomy, Beneficence
• Prima Facie : Autonomy
 4 BOX METHODE
Medical Indications: Client Preferences:
Patients diagnosed with bite grade II Medical action is carried out with the
snake were advised by the MRS to
monitor the patient's condition for consent of the patient and the
vital signs, worsen local and systemic patient's family
symptoms.

Quality of Life: Contextual Features:

The patient's family rejects medical The family involved is the wife,
measures that can make things worse.
and the patient's brother.
 PRINSIP PROFESIONALISME
1. Alturism: there is, doctors are concerned with the
interests of patients
2. Duty: There, the doctor in charge of the patient performs
his duties according to the procedure.
3. Respect for others: there is a doctor, the IGD respects the
patient's decision
4. Accountable: there is, the doctor is responsible for the
patient
5. Humanity: there is, doctors have integrity because they
realize that they and the RS are able to handle the case.
CASE 2
 KASUS 2
The patient of a 45-year-old woman came to the Hospital emergency room brought by the
family with complaints of diabetes mellitus (diabetic ulcer) on the right foot, which had been
suffered for 3 months, with routine control, the last 3 days and only cleaned this morning by
medical personnel . The patient said Complaints were accompanied by nausea and dizziness
since this afternoon. When I arrived at the emergency room, GCS of 456 patients, a physical
examination found diabetic ulcer in the I pedis dextra clinic. The doctor keeps the IGD directly
doing first aid, explaining to the family to do a complete blood check. Then the patient's family
agreed to the examination. While the results waited for about half an hour. The patient's family
asks the doctor to take care of it first until it is complete while angry and says that his family (the
patient's husband) is a DPR while the doctor is still handling patients with impaired
consciousness (P1). The doctor tried to explain and told the family to remain patient that the
condition of the patient was not critical and had previously been given an injection for
complaints of nausea and dizziness.
 KDB 1 (Beneficence)
Kriteria Ada Tidak ada
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)
Kriteria Ada Tidak Ada

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
N Kriteria Ada Tidak
o Ada
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 Kriteria Ada Tidak Ada
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 Kriteria Ada Tidak Ada

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 Kriteria Ada Tidak Ada

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 Kriteria Ada Tidak Ada

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
N Kriteria Ada Tidak
o Ada
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.
 DILEMA ETIK
 M :Autonomy
 B : Justice
 DILEMA ETIK
• Dilema Etik : Autonomy, Justice , Non
Maleficiece
• Prima Facie :Justice
 4 BOX METHODE
Medical Indications: Client Preferences:
Medical action is carried out with the
consent of the patient and the
patient's family

Quality of Life: Contextual Features:

The patient's family rejects medical The family involved is the wife,
measures that can make things worse.
and the patient's brother.
 PRINSIP PROFESIONALISME
1. Alturism: there is, doctors are concerned with the
interests of patients
2. Duty: There, the doctor in charge of the patient performs
his duties according to the procedure.
3. Respect for others: there is a doctor, the IGD respects the
patient's decision
4. Accountable: there is, the doctor is responsible for the
patient
5. Humanity: there is, doctors have integrity because they
realize that they and the RS are able to handle the case.