Tugas Etik Koas Baru

Presentation
“Moral Basic Principle”
By:
Group L4
RSUD Sidoarjo
Medical Faculty
Wijaya Kusuma Surabaya University
Presentation
By:
Neilavery Winda Suci Parameswari
17710086
RSUD Sidoarjo Group L4
Medical Faculty
CASE 1
One day, a patient came to emergency unit RSUD with decrease of
consciousness, the GCS was 1-1-1, from heteroanamnesis doctor got
information that before came to RSUD, patient had an accident, while drove
motorcycle, suddenly he dropped from motorcycle and his head crushed the
road then the patient got unconscious, from medical record he had CHD. The
doctor checked for primary survey and found no pulses and no breath, the
doctor did CPR and no response, then the doctor said that the patient was died
before came to RSUD. Then at the same time, an accident patient came with
bleeding from his head, and seem hematome behind his ears, the doctor did
primary survey and directly gave therapy to the patient. And while, one family
from the first patient got complained to the doctor about why his family didn’t had
any therapy while the other patient with same case seem had a complete
therapy, the family got angry about that and told that the doctor seem didn’t do
any effort to save the patient, then the doctor explained about differences of
patient condition and told that their relative was died before came to RSUD, so
doctors could do nothing, but the other patient had a possibility to life when had
proper therapy, then the patient family understand.
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 √
7. Restriction Goal-Based √
Beneficience
Criteria Yes No
8. Maximizing the satisfaction of happiness / patient preferences √
9. Minimize adverse consequences. √
10. Obligation to help emergency patient √
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 √

Non Maleficence
Criteria YES NO
1. Helping emergency patient √
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 patient > doctor's loss (only experiencing minimal
risk).
3. Treat injured patient √
4. Do not kill patient (do not do euthanasia) √
5. Not insulting √
6. Do not view patient as objects √
7. Treating disproportionately √
Non Maleficence
Criteria Yes No
8. Do not prevent patient dangerously √
9. Avoid misrepresentation of patient √
10. Do not endanger the patient's life due to negligence √
11. Does not give life spirit √
12. Does not protect patient from attacks √
13. Do not do white collar in the health field √

Autonomy
Criteria yes No
1. Respecting the right to self-determination, respecting the dignity of patient. √
2. Do not intervene in patient 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 √

Autonomy
Allowing adult patients and competent to make their own √

decisions.
Do not intervene or obstruct patient autonomy. √
Prevent other parties from intervening in patients and making √

decisions, including, including the patient's own family.
Patiently waiting for the decision to be taken by the patient in a √

non-emergency case.
Don't lie to the patient even for the benefit of the patient. √
Maintain relationship (contract) √

Justice
Criteria Yes No
Enact everything universally √
Take the last portion of the dividing process he has done. √
Giving equal opportunities to individuals in the same position. √
Respecting patients' health rights (affordability, equality, √

accessibility, availability, quality)
Appreciate the legal rights of patients. √

Respect the rights of others. √
Maintain vulnerable groups (the most disadvantaged) √
Do not abuse. √
Justice
Wise in macro allocations. √
Provide a contribution that is relatively the same as the patient's needs √
Request patient participation according to ability. √
The obligation to distribute profits and losses (costs, expenses, √

sanctions) fairly
Return rights to the owner at the right time and competent. √
Does not give heavy burden unevenly without valid reasons √
Respect the rights of the population who are equally susceptible to √

diseases / health problems.
Does not distinguish patient services on the basis of SARA, social √

status etc.
NON-
JUSTICE
MALEFICIENCE
PRIMA FACIE JUSTICE

Ethical priciples
Non- Maleficence:
Doctors prioritize treating patients with severe head
injuries.
Justice :
Doctors prioritize an accidental patients because although he had
severe bleeding, he still had a possibility to life beside the other
patient who passed away.
4 Box Method
Medical Indications
Client Preference
An accidental patient who had severe bleeding
The patient case was emergency
The doctor gave supporting therapy such as - The patient can´t determine
gave oxygen mask, stabilization, iv line, his opinion
catheter, then did additional examination
Quality Of Life Contextual Features
One of the patient's family of DOA complained

The patient could be better because the doctor about why his relative didn’t had any saving
save him first. therapy meanwhile the others had.
Professionalism
• Accountability : Doctors always prioritize patients with emergency

conditions.
• Alturism : Doctors are very concerned about the patient's condition.
• Duty : The doctor follows a medical procedure.
• Respect for others : Doctors always try to understand the patient's condition.
Ordinary or Extraordinary
EXTRAORDINARY
Case 2
• A 55 y.o male patient came to doctor practice with symptoms found blood in
urine, urination hesitancy, numbness of leg, decrease force of urination, and
erectile dysfunction. The doctor suspected the patient had a malignancy
process, then the doctor permitted to checked by rectal toucher, the result
were palpable mass with uneven surface and found blood in handscoon when
it out. Then the doctor suggested the patient went to urology doctor to got
surgery and explained the pro and contra of surgery and effect if the patient
didn’t had therapy such as worsened symptoms and possibility of metastases,
but the patient said that he won’t do any therapy or went to urology doctor
because he was too afraid and said his family didn’t had insurance and
couldn’t paid of expensive surgery cost so he wanted the alternative therapy
such as drugs. The doctor explained again but the patient ignored and wont
do the doctor suggestion, so the doctor just gave the patient symptomatical
drug to decrease the symptoms.
Beneficence
Criteria Yes No
5. Responsible √
Criteria Yes No

Non-malaficience
Criteria YES NO
risk).

Non-malaficience
Criteria Yes No

autonomi
Criteria yes No

autonomi

decisions.

Patiently waiting for the decision to be taken by the patient in √

a non-emergency case.

justice
Criteria Yes No


Do not abuse. √
justice

sanctions) fairly

Does not distinguish patient services on the basis of SARA, social status √
etc.
ETHICAL DILEMMA
NON-MALEFICIENCE AUTONOMY
PRIMA FACIE AUTONOMY

Ethical priciples
Non-Maleficence:
The doctor gave the man the best suggestion about
treatment so the patient didn’t suffer
Autonomy :
The doctors respect about the patient decision
4 Box Method
Medical Indication
- A man 50 years old suggested malignancy

symptoms Client Preference
- The case was chronic disease case which if
didn’t cured, it possible to be worse both of -The patient is the decision
symptoms and it progress maker
- The doctor suggest to consult in urology to
did surgery or the other therapy
Contextual Features
Quality Of Life
The doctor explained to the patient

The socioeconomic make him could not
about the condition and he must had
afford expensive surgery cost
surgery to therapy
Professionalism
Accountability : Doctor explain the patient condition
Alturism : Doctor are very concerned about the patients
condition.
Duty : The doctor following the procedure and very
contactable.
Respect for other : The doctor decided to give supporting medicines so
that the man did not suffer
Humanity : The doctor empathizes with the patient's condition
Extraordinary
Presentation
By:
Putu Ayu Riska Pusvita Suandiwi
17710050
Medical Faculty
Case 3
A patient, Z, 11 years old, came to the emergency room at the RSUD Sidoarjo delivered by his parents with a
history of falling from a bicycle while playing bicycle racing with his friends around 1 hour before going to
Sidoarjo Hospital. The patient complains of pain in the right hand and is difficult to move. The patient also
complained of abrasions on the right elbow and leg knees. No dizziness, no nausea, no vomiting and no
chance to faint. From the results of the initial examination of patient awareness, GCS: 4-5-6, vital signs TD:
110/80, RR: 18 x / m, N: 85x / m temperature: 36.50C. When the examination is done, the patient's right hand
is swollen, difficult to move and when examined the patient complains of pain. Doctors recommend an
examination of X-rays and the family agrees while waiting for the results of the patient's photo of pain
medication and wound care. The doctor diagnoses close fracture radius ulna dextra with multiple vulnus
excoriasion. Then the doctor tells the patient's family that the patient's condition will be consulted by
orthopedic for treatment. Seeing the results of the X-ray photo of the responsible doctor recommends that
patients be operated for better healing. This is because the broken hand is the right hand, for the future to be
better and there is no disability. In addition to seeing his young age, healing is expected to be faster.
The doctor then gives an explanation that this broken bone can be reconnected but it cannot be
ascertained whether to connect in the right place or not, feared that if it does not connect in the right
place it will become a disability even though sometimes it can still be moved. For the problem of moving
out of town the doctor explained that the patient could control the hospital or the nearest bone specialist.
But after getting a family explanation the patient refused to be operated on and wanted to be sent home
immediately. So the doctor can only give symptomatic medication and the family continues the next
procedure so that the patient can go home.
After hearing the explanation from the family doctor, they did not agree to be operated on for various
reasons, Patient’s and his family will move to a place outside the city, the left hand The patient must be
dislocated and taken by a masseuse. having a broken bone and being brought in a cage can heal as before.
The doctor then gives an explanation that this broken bone can be reconnected but it cannot be
ascertained whether to connect in the right place or not, feared that if it does not connect in the right
place it will become a disability even though sometimes it can still be moved. For the problem of moving
out of town the doctor explained that the patient could control the hospital or the nearest bone specialist.
But after getting a family explanation the patient refused to be operated on and wanted to be sent home
immediately. So the doctor can only give symptomatic medication and the family continues the next
procedure so that the patient can go home.
Beneficence
Criteria Yes No
5. Responsible √
Criteria Yes No

Non Maleficence
Criteria YES NO
• Benefits for patient > doctor's loss (only experiencing minimal risk).

Criteria Yes No

Autonomy
Criteria yes No

Allowing adult patients and competent to make their own decisions. √
Prevent other parties from intervening in patients and making decisions, √

including, including the patient's own family.
Patiently waiting for the decision to be taken by the patient in a non- √

emergency case.

Justice
Criteria Yes No
Respecting patients' health rights (affordability, equality, accessibility, availability, √

quality)
Do not abuse. √
The obligation to distribute profits and losses (costs, expenses, sanctions) fairly √
Respect the rights of the population who are equally susceptible to diseases / √
health problems.
Does not distinguish patient services on the basis of SARA, social status etc. √
Beneficence Autonomy
PRIMA FACIE Autonomy

Ethical priciples
Beneficence
Doctors do a good action and do not harm the patient. Doctors want
healing to be fast and to avoid disability.
Autonomy
The doctor must respect what is the decision of the patient's family
because the patient is underage all the decisions are in the patient's
parents and the doctor must prioritize the patient's rights.
4 Box Method
Medical Indications
• A patient, Z, 11 years old had an

accidentally accident. The doctor diagnoses Client Preference
close fracture radius ulna dextra.
• This is an acute case
- The patient can´t determine
• The patient must be operated on to position
the bones that they can return to normal his opinion
and there will be no disability
Quality Of Life
Contextual Features
The socioeconomic make his family could not
the patient's hands can return to normal and
afford expensive surgery cost
disability can be avoided if the patient wants to
be operated on
Professionalism
Accountability :
Yes, Doctors always prioritize patients with emergency conditions.
Alturism :
Yes, Doctors are very concerned about the patient's condition.
Duty :
Yes, The doctor follows a medical procedure.
Respect for others :
Yes, Doctors always try to understand the patient's condition.
Extraordinary
Case 4
A 58th woman came with a complaint of headache for 2 years. patients complain that
headaches are increasing, patient also complain of gradual weakness of both hands
and feet. Patient go to the Sidoarjo General Hospital to be treated by a neurologist,
after carrying out a doctor's examination he proposed to do a CT scan, the result of a
CT scan of the head was a large size brain tumor. the neurologist then consulted the
neurosurgeon because the tumor size was quite large. after the neurosurgeon saw
the patient's condition and the results of the CT scan the neurosurgeon provided
information to the patient's family, especially to their children, about the patient's
condition. The doctors diagnose meningioma. the patient's condition is not possible
to do surgery because the tumor is too large and there is a greater risk of surgery. but
the family wants the patient to be operated on so that the tumor can be removed, but
the doctor explains the possibility of a greater risk if the surgery is done because of
the large tumor size and location that is very prone to severe bleeding. then the
doctor proposed chemotherapy and symptomatic therapy. doctors still do not do
surgery.
Beneficence
Criteria Yes No
5. Responsible √
Criteria Yes No

Non Maleficence
Criteria YES NO
• Benefits for patient > doctor's loss (only experiencing minimal risk).

Criteria Yes No

Autonomy
Criteria yes No

Allowing adult patients and competent to make their own decisions. √
Prevent other parties from intervening in patients and making decisions, √

including, including the patient's own family.
Patiently waiting for the decision to be taken by the patient in a non- √

emergency case.

Justice
Criteria Yes No
Respecting patients' health rights (affordability, equality, accessibility, availability, √

quality)
Do not abuse. √
The obligation to distribute profits and losses (costs, expenses, sanctions) fairly √
Respect the rights of the population who are equally susceptible to diseases / √
health problems.
Does not distinguish patient services on the basis of SARA, social status etc. √
Non Maleficence Autonomy
PRIMA FACIE Non Maleficence

Ethical priciples
Non Maleficence
The doctor gave patient the best advice about treatment and not surgery
because the risk of surgery is greater than not being operated. Because
the size of the tumor is large and the location is prone to severe
bleeding.
Autonomy
The doctors respect about the patient decision.
4 Box Method
Medical Indications
- A women 58 years old has a very large tumor in
her head. The doctors diagnose meningioma
- The case was chronic disease Client Preference
- The doctors gave supporting therapy such as
gave symptomatic drugs to reduce complaints The patient can´t determine
and suggest chemotherapy her opinion
- The doctors do not recommend surgery because
the size of the tumor is large and the location is
prone to severe bleeding.
Contextual Features
Quality Of Life
Patients can get better after getting symptomatic her family wants the patient to remain
drugs that are expected to reduce the risk of operated because they wants the patient to
chemotherapy can provide a more minimal risk. no longer experience pain and the tumor can
be removed immediately.
Professionalism
Accountability : yes
• Doctor explain the patient condition
• Doctors always prioritize patient safety
Alturism : yes
• Doctors are very concerned about the patient's condition.
• Doctors give therapeutic options that there are no worse problems
Duty : yes
• The doctor follows a medical procedure.
Respect for others : yes
• The doctor decided to give supporting medicines so that the women
did not suffer
Extraordinary
Presentation
By:
W. ROY DARMINTO
17710106
Medical Faculty
CASE 5
There was a doctor in a hospital around Surabaya. He is very clever and always
make a good decision about diagnosis and therapy to his patients. There were many good
reviews about his work but for one thing, he had a little care about his patients privacy. He
had a habit to put 2 patients at once to his diagnosis and examination room. He did it for
efficiency and said it is a solution for a problem in BPJS era , which is too many patients.
Beneficence
Criteria Yes No
5. Responsible √
Beneficience
Criteria Yes No

Non Maleficence
Criteria YES NO
risk).
Non Maleficence
Criteria Yes No

Autonomy
Criteria yes No

Autonomy

decisions.


non-emergency case.

Justice
Criteria Yes No


Do not abuse. √
Justice

sanctions) fairly


status etc.
AUTONOMY BENEFICENCE
PRIMA FACIE AUTONOMY

Ethical priciples
Autonomy:
The doctor did not keep privacies and secrets among his
patients by did examine 2 patients at once.
Beneficence :
The doctor tried to cut the line so his patients did not
have to wait for hours to be examined.
4 Box Method
Medical Indications Client Preference
Examined two patients at once - The patient is the decision

maker
Quality Of Life
Contextual Features
The doctor did not care about his patients’

The patients had better quality of life after
privacy.
treatment because they were treated equaly..
Professionalism
• Accountability : Doctors always prioritize patients with emergency

conditions.
• Respect for others : Doctors doesn’t try to understand the patient's privacy.
EXTRAORDINARY
CASE 6
A plague of dengue has attacked the city of Sidoarjo. In the recent report, there was 27
patients entered the hospital of Sidoarjo with a dengue in one day. Doctor X work in
that hospital. He is a new GP for the emergency unit. When this plague hit the city, he is
nervous. He had a little experience about dengue, only know a view theories and forget
about the management therapy of dengue. So he always refuse to examine every
specific fever which is it point to a suspect dengue patients and let another GP to do the
examination. When a patient’s family criticize him, then he said, “ your son has been
handled by the right doctor who has better experience in dengue fever”.
Beneficence
Criteria Yes No
5. Responsible √
Beneficience
Criteria Yes No

Non Maleficence
Criteria YES NO
2. The conditions for describing these criteria are:
• The patient is in a dangerous condition. √
risk).
Non Maleficence
Criteria Yes No

Autonomy
Criteria yes No

Autonomy

decisions.


non-emergency case.

Justice
Criteria Yes No


Do not abuse. √
Justice

sanctions) fairly


status etc.
NON-
BENEFICENCE
MALEFICIENCE
NON-
PRIMA FACIE
MALEFICIENCE
Ethical priciples
Non- Maleficence:
The doctor wanted his dengue patients handled by the
right doctors because of his lack of knowledge, to
minimize mistreatment.
Beneficence :
The doctor did not develop his medical skills and knowledges.
4 Box Method
Client Preference
Medical Indications
- The patient can´t determine
A patient with a dengue fever. his opinion
- The familly is the decision
maker
Quality Of Life Contextual Features
A doctor who are not competent in dengue let

The patient could be better because he/she other doctors who are more competent to
has been treated by a more competent doctor. treat his dengue patients.
Professionalism
• Accountability : The doctor could not do one of his standard competency,

which is DF.
• Respect for others : Doctors always try to understand the patient's condition.
EXTRAORDINARY
Presentation
By:
CHRISTIN MERRINA LETTE
17710108
Medical Faculty
KASUS
• Dokter Y yang sedang berjaga di poli disebuah RS menerima seorang pasien Ny.A usia 34 tahun dengan
keadaan muncul lesi pucat menebal dan mati rasa, dan disertai kelemmahan otot pada tangan dan kaki, dan
penebalan saraf tepi pada lutut dan siku. Pasien merupakan pasien BPJS. Pasien datang dengan diantar oleh
anaknya nya dengan membawa hasil pemeriksaan laboratorium BTA . Dokter Y yang menerima langsung
memeriksa pasien tanpa melakukan anamnesis dan tanpa melihat hasil laboratorium hanya memberikan resep
dan menyarankan minum obat teratur selama 6 bulan. Ketika anaknya menanyakan kembali tentang cara
meminum obat, si dokter hanya mengatakan agar bertanya pada apoteker saat nanti mengambil obat.
DILEMA ETIK
Autonomy vs Beneficience
Prima facie : Autonomy
No Kriteria Ada Tidak ada
1 Mengutamakan alturism X
B 2 Menjamin nilai pokok harkat & martabat manusia X
3 Memandang pasien/keluarga/sesuatu tak hanya sejauh menguntungkan X
E
dokter
N 4 Mengusahakan agar kebaikan/manfaatnya lebih banyak dibandingkan X
E dengan keburukannya
F 5 Paternalisme bertanggung jawab/berkasih sayang X
6 Menjamin kehidupan baik minimal manusia X
I 7 Pembatasan goal-based X
C 8 Maksimalisasi pemuasan kebahagiaan/preferensi pasien X
I 9 Minimalisasi akibat buruk X
10 Kewajiban menolong pasien gawat darurat X
E 11 Menghargai hak-hak pasien secara keseluruhan X
N 12 Tidak menarik honorarium di luar kepantasan X
C 13 Maksimalisasi kepuasan tertinggi secara keseluruhan X
E 14 Mengembangkan profesi secara terus-menerus X
15 Memberikan obat berkhasiat namun murah X
16 Menerapkan Golden Rule Principle X
N
O 1 Menolong pasien emergensi X
2 Kondisi untuk menggambarkan kriteria ini adalah: X
N  Pasien dalam keadaan amat berbahaya (darurat)/ beresiko hilangnya sesuatu
yang penting (gawat) X
 Dokter sanggup mencegah bahaya atau kehilangan tersebut X
M
 Tindakan dokter tersebut terbukti efektif
A
 Manfaat bagi pasien > kerugian dokter (hanya mengalami resiko minimal) X
L
E 3 Mengobati pasien yang luka X
4 Tidak membunuh pasien (tidak melakukan euthanasia) X
F 5 Tidak menghina/mencaci maki/memanfaatkan pasien X
I 6 Tidak memandang pasien sebagai objek X
7 Mengobati secara tidak proporsional X
C 8 Tidak mencegah pasien dari bahaya X
E 9 Menghindari misrepresentasi dari pasien X
10 Tidak membahayakan kehidupan pasien karena kelalaian X
N 11 Tidak memberikan semangat hidup X
C 12 Tidak melindungi pasien dari serangan X
13 Tidak melakukan white collar crime dalam bidang kesehatan/kerumah sakitan yang X
E merugikan pihak pasien/keluarganya
1 Menghargai hak menentukan nasib sendiri, menghargai martabat pasien X
2 Tidak mengintervensi pasien dalam membuat keputusan (pada kondisi X

elektif)
A 3 Berterus terang X
U 4 Menghargai privasi X
5 Menjaga rahasia pasien X
T 6 Menghargai rasionalitas pasien X
O 7 Melaksanakan informed consent X
N 8 Membiarkan pasien dewasa dan kompeten mengambil keputusan sendiri X
O 9 Tidak mengintervensi atau menghalangi autonomi pasien X

M 10 Mencegah pihak lain mengintervensi pasien dalam membuat keputusan, X
termasuk keluarga pasien sendiri
Y
11 Sabar menunggu keputusan yang akan diambil pasien pada kasus non X
emergensi
12 Tidak berbohong ke pasien meskipun demi kebaikan pasien X
13 Menjaga hubungan (kontrak) X

1 Memberlakukan segala sesuatu secara universal X
2 Mengambil porsi terakhir dari proses membagi yang telah ia lakukan X
3 Memberi kesempatan yang sama terhadap pribadi dalam posisi yang sama X
4 Menghargai hak sehat pasien (affordability, equality, accessibility, availability, quality) X
J 5 Menghargai hak hukum pasien X

6 Menghargai hak orang lain X
U 7 Menjaga kelompok yang rentan (paling dirugikan) X
S 8 Tidak melakukan penyalahgunaan X
T 9 Bijak dalam makro alokasi X
10 Memberikan kontribusi yang relatif sama dengan kebutuhan pasien X
I 11 Meminta partisipasi pasien sesuai dengan kebutuhan pasien X
C 12 Kewajiban mendistribusi keuntungan dan kerugian (biaya, beban, sanksi) secara adil X
E 13 Mengembalikan hak kepada pemiliknya pada saat yang tepat dan kompeten X
14 Tidak memberi beban berat secara tidak merata tanpa alasan sah/tepat X
15 Menghormati hak populasi yang sama-sama rentan penyakit/gangguan kesehatan X
16 Tidak membedakan pelayanan pasien atas dasar SARA, status sosial, dll X
4 BOX METHODE
Indikasi Medis Quality of Life
Ny. A merupakan pasien yang menderita dokter hanya melakukan pemeriksaan

Morbus Hansen. fisik pada pasien dan memberi resep obat.
Client Preference Contextual Feature
Pasien usia 34 tahun dan dapat mengambil Pasien berasal dari keluarga dengan sosial
keputusan sendiri. ekonomi menengah kebawah. Pasien menggunakan
BPJS.
Prinsip profesionalisme:
• Alturisme : Ada. Perhatian terhadap pasien tanpa memperhatikan diri sendiri

• Duty : Ada. Dokter melakukan pemeriksaan fisik.
• Respect for others : Tidak ada. Dokter tidak memberikan penjelasan mengenai penyakit
yang diderita pasien dan bagaimana proses pengobatannya yang merupakan hak dari
pasien
• Accountable : Ada. Dokter hanya menjelaskan jika pasien harus minum obat teratur
selama 6 bulan.
• Humanity : Ada. Dokter tidak membedakan perlakuan terhadap pasiennya
• Prima facie :Autonomy
KASUS
Pasien perempuan usia sekitar 35 tahun dibawa ke IGD RSUD S oleh keluarganya
dengan keadaan lemah dan pucat. Pasien merupakan pasien BPJS . Pasien menderita
Perdarahan setelah melahirkan didukun. Setelah dilakukan pemeriksaan darah dan
Hb hasilnya menunjukkan 5 gr/dl. Dokter menyarankan agar dilakukan transfusi
darah PRC. Dokter menyuruh perawat untuk memberikan informed consent kepada
pasien tanpa menjelaskan komplikasi yang dapat terjadi. Kemudian saat dilakukan
transfusi darah pasien mengalami panas disertai sesak nafas, sehingga keluarga
pasien panik. Akhirnya dokter kemudian melakukan tindakan dengan menghentikan
transfusi dan memberikan injeksi kortikosteroid dan anti histamin.
DILEMA ETIK
Non Malificence vs Autonomy

E
dokter
F 5 Paternalisme bertanggung jawab/berkasih sayang X
6 Menjamin kehidupan baik minimal manusia X
C 8 Maksimalisasi pemuasan kebahagiaan/preferensi pasien X
10 Kewajiban menolong pasien gawat darurat X
E 11 Menghargai hak-hak pasien secara keseluruhan X
N 12 Tidak menarik honorarium di luar kepantasan x
N
1 Menolong pasien emergensi X
O 2 Kondisi untuk menggambarkan kriteria ini adalah:
X
N  Pasien dalam keadaan amat berbahaya (darurat)/ beresiko hilangnya sesuatu yang penting
(gawat)
X
 Dokter sanggup mencegah bahaya atau kehilangan tersebut
X
M  Tindakan dokter tersebut terbukti efektif
 Manfaat bagi pasien > kerugian dokter (hanya mengalami resiko minimal) X
A
L 3 Mengobati pasien yang luka X
E 4 Tidak membunuh pasien (tidak melakukan euthanasia) X
5 Tidak menghina/mencaci maki/memanfaatkan pasien X
F 6 Tidak memandang pasien sebagai objek X
I 7 Mengobati secara tidak proporsional X
8 Tidak mencegah pasien dari bahaya X
C 9 Menghindari misrepresentasi dari pasien X
E 10 Tidak membahayakan kehidupan pasien karena kelalaian X
12 Tidak melindungi pasien dari serangan X
C 13 Tidak melakukan white collar crime dalam bidang kesehatan/kerumah sakitan yang merugikan X
E pihak pasien/keluarganya

elektif)

M 10 Mencegah pihak lain mengintervensi pasien dalam membuat keputusan, X
termasuk keluarga pasien sendiri
Y
emergensi
13 Menjaga hubungan (kontrak) X

No Kriteria Ada Tidak
ada
3 Memberi kesempatan yang sama terhadap pribadi dalam posisi yang sama X
4 Menghargai hak sehat pasien (affordability, equality, accessibility, availability, quality) X

J
5 Menghargai hak hukum pasien X
U 6 Menghargai hak orang lain X
7 Menjaga kelompok yang rentan (paling dirugikan) X
10 Memberikan kontribusi yang relatif sama dengan kebutuhan pasien X
I
11 Meminta partisipasi pasien sesuai dengan kebutuhan pasien X
C 12 Kewajiban mendistribusi keuntungan dan kerugian (biaya, beban, sanksi) secara adil X
E
13 Mengembalikan hak kepada pemiliknya pada saat yang tepat dan kompeten X
15 Menghormati hak populasi yang sama-sama rentan penyakit/gangguan kesehatan X
4 BOX METHODE
Pasien perempuan 35 tahun mengalami Diberikan transfusi PRC namun pasien

perdrahan post partum dengan Hb 5 mg/dl. mengalami reaksi tranfusi yaitu sesak sehingga
dokter memberikan anti histamin dan kortikosteroid
secara IV dan pasien bisa diselamatkan
Pasien sudah dewasa dimana dia dapat Pasien merupakan pasien BPJS.
mengambil keputusan medis sendiri
 Accountability : Dokter menjelaskan tentang kondisi pasien akan teta

pi dokter menyuruh perawat untuk memberikan informed consent, da
n saat terjadi hal yang tidak diharapkan, dokter tidak menjelaskan ko
ndisi itu kepada keluarga.
 Duty : dokter melakukan tidakan untuk mengatasi kondisi pasiendan p
asien dapat diselamatkan.
 Altruism : dokter mendahulukan kepentingan pasien
Terjadi adverse event atau kejadian yang tidak diharapkan karena reak
si tranfusi yaitu sesak nafas karena efek samping dari transfusi darah.
Presentation
By:
KHAIRUL WAFA MUSTHOFA
17710105
Medical Faculty
Kasus
• Pasien anak usia 2 tahun datang ke IGD dengan penurunan kesadaran, setelah diperiksa oleh dokter, dari anamnesa
didapatkan pasien mengalami muntah dan diare sudah lebih dari 2 minggu, dan pada pemeriksaan ternyata pasien
mengalami dehidrasi berat dan membutuhkan terapi cairan. Dokter menjelaskan kondisi penyakit yang dialami pasien
kepada keluarga, serta penanganan dan resiko terberat yang mungkin terjadi, dengan meminta informed consent
keluarga untuk melaksanakan tindakan medis yang nantinya diperlukan.
• Saat rehidrasi perut pasien membesar dan kembung, dan diperiksa oleh dokter, pasien mengalami udem pulmo,
sehingga dokter menghentikan pemberian cairan untuk sementara. Saat ayah pasien melihat infus tidak menetes, ia
menanyakkan kepada perawat yang saat itu berstatus mahasiswa praktek, “ Kata dokter tadi anak saya butuh cairan,
kok infusnya gak netes?”, kemudian perawat tersebut menjawab,”maaf saya lupa menghidupkan”, kemudian perawat
tersebut menghidupkan infus tanpa menanyakan dan menginformasikan kepada dokter penanggung jawab pasien
tersebut.
• Beberapa jam kemudian kondisi pasien makin memburuk dan mengalami sesak nafas. Saat diperiksa dokter, udem
pulmo yang diderita pasin makin berat, dokter tidak menginformasikan hal ini ke keluarga pasien, dan akhirnya pasien
meninggal. Beberapa bulan kemudian ayah pasien menuntut rumah sakit karena kelalaian berupa lupa menyalakan
infus yang menyebabkan kematian anaknya.
Beneficence
Kriteria Ada Tidak ada
1.Utamakan alturisme (menolong tanpa pamrih, rela berkorban) 
2.Menjamin nilai pokok harkat dan martabat manusia 
3.Memandang pasien/keluarga dan sesuatu tak sejauh menguntung dokter 
4.Mengusakan agar kebaikan/manfaatnya lebih banyak dibandingkan dengan keburukannya. 
5.Paternalisme bertanggung jawab/ kasih sayang 

6.Menjamin kehidupan baik minimal manusia 
7.Pembatasan Goal-Based 
8.Maksimalisasi pemuasan kebahagiaan/preferensi pasein 
9.Minimalisasi akibat buruk. 
10.Kewajiban menolong pasien gawat darurat 
11. Menghargai hak pasien secara keseluruhan 
12. Tidak menarik honorarium diluar kepantasan 
13.Maksimalisasi kepuasan tertinggi secara keseluruhan 
14.Mengembangkan profesi secara terus-menerus 
15. Memberikan obat berkhasiat namun murah 
16. Menerapkan Golden Rule Principle 
Non-Maleficence
Kriteria Ada Tidak Ada
1. Menolong pasien emergensi 

2. Kondisi untuk menggambarkan kriteria ini adalah:
• Pasien dalam keadaan berbahaya. 
• Dokter sanggup mencegah bahaya atau kehilangan. 
• Tindakan Kedokteran tadi terbukti efektif 
• Manfaat bagi pasien > kerugian dokter (hanya mengalami risiko minimal). 
3. Mengobati pasien yang luka. 
4. Tidak membunuh pasien (tidak melakukan euthanasia) 
5. Tidak menghina/caci maki. 
6. Tidak memandang pasien sebagai objek 
7. Mengobati secara tidak proporsional 
8. Tidak mencegah pasien secara berbahaya 
9. Menghindari misrepresentasi dari pasien 
10. Tidak membahayakan kehidupan pasien karena kelalaian 
11. Tidak memberikan semangat hidup 
12. Tidak melindungi pasien dari serangan 
13. Tidak melakukan white collar dalam bidang kesehatan 
Autonomi
Kriteria Ada Tidak Ada
1. Menghargai hak menentukan nasib sendiri, menghargai martabat pasien. 

2. Tidak mengintervensi pasien dalam membuat keputusan (pada kondisi elektif)
3. Berterus terang 
4. Menghargai privasi.
5. Menjaga rahasia pribadi 
6. Menghargai rasionalitas pasien. 
7. Melaksanakan informed consent 
8. Membiarkan pasien dewasa dan kompeten mengambil keputusan sendiri. 
9. Tidak mengintervensi atau meghalangi outonomi pasien. 
10. Mencegah pihak lain mengintervensi pasien dan membuat keputusan, termasuk, termasuk 
keluarga pasien sendiri.
11. Sabar menunggu keputusan yang akan diambil pasien pada kasus non emergensi. 
12. Tidak berbohong ke pasien meskipun demi kebaikan pasien. 
13. Menjaga hubungan (kontrak)



Justice
Kriteria Ada Tidak ada
1. Memberlakukan segala sesuatu secara universal 

2. Mengambil porsi terakhir dari proses membagi yang telah ia lakukan. 
3. Memberi kesempatan yang sama terhadap pribadi dalam posisi yang sama. 
4. Menghargai hak sehat pasien (affordability, equality, accessibility, availability, quality) 
5. Menghargai hak hukum pasien.
6. Menghargai hak orang lain. 
7. Menjaga kelompok yang rentan (yang paling dirugikan) 
8. Tidak melakukan penyalahgunaan. 
9. Bijak dalam makro alokasi. 
10. Memberikan kontribusi yang relatif sama dengan kebutuhan pasien 
11. Meminta partisipasi pasien seusai dengan kemampuan. 
12. Kewajiban mendistribusi keuntungan dan kerugian (biaya, beban , sanki) secara adil 
13. Mengembalikan hak kepada pemiliknya pada saat yang tepat dan kompeten. 
14. Tidak memberi beban berat secara tidak merata tanpa alasan sah/tepat. 
15. Menghormati hak populasi yang sama-sama rentan penyakit/ggn kesehatan. 
16. Tidak membedakan pelayanan pasien atas dasar SARA, status sosial dll. 

• Dilema Etik: Non –Malficence, Autonomi
• Prima Facie : Non –Malficence

4 BOX METHODE
Medical Indications: Client Preferences:
Dx Dehidrasi berat Tindakan medis dilakukan atas persetujuan keluarga
Emergensi karena pasien masih di bawah umur untuk melakukukan
Dilakukan rehidrasi, saat rehidrasi berlangsung terjadi keputusan.
udem pulmo
Quality of Life: Contextual Features:

Setelah direhidrasi, pasien mengalami udem pulmo dan Keluarga yang terlibat adalah orang tua pasien.
rehidrasi dihentikan. Keluarga menuntut dokter karena melakukan kelalaian
Keadaan pasien memburuk setelah perawat menghidupkan yang menyebabkan pasien meninggal.
kembali infusnya.
Pasien meninggal
Profesionalisme
Accountability : Dokter menjelaskan tentang kondisi pasien, dan melakukan

informed consent, tetapi saat terjadi hal yang tidak diharapkan, dokter tidak
menjelaskan kondisi itu kepada keluarga.
Duty : dokter melakukan tidakan untuk mengatasi kondisi pasien, tetapi
terjadi hal yang tidak diharapkan
Altruism : dokter mendahulukan kepentingan pasien
Terjadi Preventable adverse event atau kejadian yang tidak diharapkan karena
ada active error (kesalahan yang disebabkan oleh operator (dokter dan perawat)
Kasus 2
KASUS
Ny.B umur 35 tahun datang keklinik dokter spesialis THT. Ny.B ini berprofesi sebagai seorang penyanyi dangdut
profesional. Ny.B datang menemui dokter untuk memeriksakan kondisi tenggorokannya.Ny.B mengalami sakit
tenggorakan yang amat sakit dan tidak sembuh-sembuh. Ny.B juga mengalami batuk yang disertai keluarnya sedikit
darah. Keadaan ini sudah berlangsung lebih dari 2 minggu. Setelah mendengar masalah dari Ny.B,dokter segera
melakukan pemeriksaan. Dokter menduga bahwa ditenggorokan Ny.B terdapat tumor.
Setelah melakukan pemeriksaan yang mendalam, Ny.B dinyatakan positif menderita kanker tenggorokan
stadium lanjut. Untuk mencegah terjadinya penyebaran sel kanker,jalan satu-satunya yang dapat dilakukan adalah
dengan melakukan pembedahan. Namun, dokter menjelaskan bahwa jika dilakukan pembedahan pada tenggorokan
Ny.B, kemungkinan besar Ny.B tidak akan bisa bernyanyi lagi karena sebagian pita suaranya akan diangkat. Pasien
begitu terkejut dan meminta waktu untuk berpikir. Dokter memberi kesempatan kepada Ny.B untuk memutuskan
apakah ia mau dioperasi atau tidak. Ny.B meminta dokter tersebut untuk merahasiakan kondisinya, agar jangan
sampai tersebarluas ke media dan dokter itu menyetujuinya.
DILEMA ETIK
vs Beneficence
Autonomy
E dokter
5 Paternalisme bertanggung jawab/berkasih sayang X
F 6 Menjamin kehidupan baik minimal manusia X
8 Maksimalisasi pemuasan kebahagiaan/preferensi pasien X
C
E 10 Kewajiban menolong pasien gawat darurat X
11 Menghargai hak-hak pasien secara keseluruhan X
N 12 Tidak menarik honorarium di luar kepantasan X
ada
1 Menolong pasien emergensi X
N 2 Kondisi untuk menggambarkan kriteria ini adalah: X
O  Pasien dalam keadaan amat berbahaya (darurat)/ beresiko hilangnya sesuatu
yang penting (gawat) X
N X
 Dokter sanggup mencegah bahaya atau kehilangan tersebut
X
 Tindakan dokter tersebut terbukti efektif
M  Manfaat bagi pasien > kerugian dokter (hanya mengalami resiko minimal)
A
L 3 Mengobati pasien yang luka X
E 4 Tidak membunuh pasien (tidak melakukan euthanasia) X
5 Tidak menghina/mencaci maki/memanfaatkan pasien X
F 6 Tidak memandang pasien sebagai objek X
I 7 Mengobati secara tidak proporsional X
8 Tidak mencegah pasien dari bahaya X
C 9 Menghindari misrepresentasi dari pasien X
E 10 Tidak membahayakan kehidupan pasien karena kelalaian X
C 12 Tidak melindungi pasien dari serangan X
13 Tidak melakukan white collar crime dalam bidang kesehatan/kerumah sakitan X
E yang merugikan pihak pasien/keluarganya

elektif)

M
10 Mencegah pihak lain mengintervensi pasien dalam membuat keputusan, X
Y termasuk keluarga pasien sendiri
emergensi
3 Memberi kesempatan yang sama terhadap pribadi dalam posisi yang X
sama
4 Menghargai hak sehat pasien (affordability, equality, accessibility, X
availability, quality)
J 5 Menghargai hak hukum pasien X
U 6 Menghargai hak orang lain X
7 Menjaga kelompok yang rentan (paling dirugikan) X
I 10 Memberikan kontribusi yang relatif sama dengan kebutuhan pasien X
11 Meminta partisipasi pasien sesuai dengan kebutuhan pasien X
C 12 Kewajiban mendistribusi keuntungan dan kerugian (biaya, beban, sanksi) X
E secara adil
13 Mengembalikan hak kepada pemiliknya pada saat yang tepat dan X
kompeten
15 Menghormati hak populasi yang sama-sama rentan penyakit/gangguan X
kesehatan
4 BOX METHODE
Ny.B umur 35 tahun mengalami sakit dokter melakukan tindakan pebedahan,

tenggorakan yang amat sakit dan tidak sembuh- untuk mengangkat tumor yang ada di tengorokan
sembuh,batuk yang disertai keluarnya sedikit darah Ny.B
lebih dari 2 minggu.
Umur Ny.B 35 tahun sehingga sudah dapat

mengambil keputusan dalam segala tindakan yang Pasien merupakan pasien umum
akan dilakukan dokter.
• Alturisme : Ada
• Duty : Ada
• Respect for others : Ada
• Accountable : Ada
• Humanity : Ada
• Prima facie : Autonomy

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Presentation

“Moral Basic Principle”

2. Guaranteeing the basic values of human dignity √

4. Trying to make the benefits more than the evil. √

6. Ensure a good minimum human life √

9. Minimize adverse consequences. √

10. Obligation to help emergency patient √

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 √

8. Do not prevent patient dangerously √

9. Avoid misrepresentation of patient √

10. Do not endanger the patient's life due to negligence √

11. Does not give life spirit √

12. Does not protect patient from attacks √

13. Do not do white collar in the health field √

1. Respecting the right to self-determination, respecting the dignity of patient. √

2. Do not intervene in patient in making decisions (under elective conditions) √

3. Put on the line √

5. Keep personal secrets √

6. Appreciate patient rationality. √

7. Carry out informed consent √

Allowing adult patients and competent to make their own √

Do not intervene or obstruct patient autonomy. √

Prevent other parties from intervening in patients and making √

Patiently waiting for the decision to be taken by the patient in a √

Maintain relationship (contract) √

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

Giving equal opportunities to individuals in the same position. √

Respecting patients' health rights (affordability, equality, √

Appreciate the legal rights of patients. √

Provide a contribution that is relatively the same as the patient's needs √

Request patient participation according to ability. √

The obligation to distribute profits and losses (costs, expenses, √

Return rights to the owner at the right time and competent. √

Does not give heavy burden unevenly without valid reasons √

Respect the rights of the population who are equally susceptible to √

Does not distinguish patient services on the basis of SARA, social √

PRIMA FACIE JUSTICE

Quality Of Life Contextual Features

One of the patient's family of DOA complained

• Accountability : Doctors always prioritize patients with emergency

2. Guaranteeing the basic values of human dignity √

4. Trying to make the benefits more than the evil. √

6. Ensure a good minimum human life √

9. Minimize adverse consequences. √

10. Obligation to help emergency patient √

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 √

3. Treat injured patient √

8. Do not prevent patient dangerously √

9. Avoid misrepresentation of patient √

10. Do not endanger the patient's life due to negligence √

11. Does not give life spirit √

12. Does not protect patient from attacks √

13. Do not do white collar in the health field √