Case 1

Doctor A is a doctor of Hospital emergency department, doctor A treats patients with a

decrease in traffic accidents, patients experience decreased consciousness with a diagnosis
of severe brain injury, patients have been given temporary therapy and a supporting
examination by doctor A, then doctor A consults general surgeon ,general surgeon advised
to be referred to another hospital with a neurosurgeon and complete facilities but the
patient's family refused it because the patient's condition was bad, the patient's family was
angry because he felt there was no serious action from the hospital, doctor A explained if
the patient's condition will not be worse, the patient's family is angry again and proposes to
move to the ICU room only
 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.
 DILEMA ETIK
• Dilema Etik : Autonomy, Beneficence
• Prima Facie : Autonomy
 4 BOX METHODE
Medical Indications: Client Preferences:
the patient is diagnosed with severe Medical action is carried out with the
brain injury and is advised to be
referred to another hospital which has consent of the patient's family
a neurologist and complete equipment

Quality of Life: Contextual Features:

The patient's family rejects medical The family involved is the
measures that can make things worse.
mother, and father.
 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, the doctor realized that the
equipment for surgery was incomplete and there was no
neurosurgery specialist
CASE 2
 CASE 2
A 36-year-old woman came to the general surgery clinic with a complaint of a lump in the right
breast since 3 months ago, 1 month later the lump was enlarged, there was no pain or other
than lumps, Doctor N explained that the investigation must be done first, then the patient
agreed, after the results came out, doctor N explained that the lump was pointing towards a
benign tumor and doctor N suggested that surgery be done then the patient agreed and doctor
N gave an operating schedule 1 month later but the patient refused to have surgery
immediately, the patient felt scared if no surgery is done immediately it will be even worse,
doctor N explains that many patients will be operated on and the patient's tumor is a benign and
harmless tumor but the patient still wants to be operated immediately if the patient refuses to
do surgery and asks for medication
 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:
patients diagnosed with benign Medical action is carried out with the
consent of the patient
tumors and no harm

Quality of Life: Contextual Features:

The patient rejects medical measures Patient only
that can make things worse.
 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, general surgery poly
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.