Case 1

A 45 year old male patient came with a complaint of not being able to urinate since
two days ago. The patient had previously come to the doctor with a complaint like
this before and the doctor diagnosed the patient with BPH. The doctor advises the
patient to immediately perform surgery. However, patients are afraid because they
are not strong enough to resist the pain. The doctor has also explained that
anesthesia will be carried out and during the operation the patient will not feel pain
and if the patient does not perform surgery the complaint can reappear. However,
despite knowing that the patient still does not want to do surgery. After a short
period of time, the patient returns with the same complaint and the doctor still
advises the patient to do the surgery. The patient continues to refuse and only asks
the doctor to install a catheter. The doctor finally only makes a recipe for catheter
placement and prescribes medication to reduce the pain.
 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 do KIE 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:
Patients diagnosed with BPH Medical action is carried out
Suggestions for surgery so that with the patient's own consent
no local and systemic
symptoms of labor occur.

Quality of Life: Contextual Features:

Patients reject medical
measures that can make things
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 emergency room
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 hospital are able to handle the
case.
CASE 2
 CASE 2
A 35 year old female patient came to the emergency room at Hospital with
complaints that her right foot was pierced by a nail while cutting grass in her
yard. The patient before, did not use footwear. After the doctor conducts
anamnesa to the patient, the doctor advises the patient to cross the incision by
injecting the anesthetic and slicing the affected part of the nail with a crossing
pattern on the tissue to clean and give an anti tetanus injection. However, the
patient refused on the grounds that the patient was afraid to be injected and
did not want his leg to be sliced. The doctor also said that if the cross is not
done the foot incision of the patient will experience an infection. However,
patients continue to refuse and still do not want to be given drugs through
injections, doctors only prescribe antibiotics and anti-pain drugs to patients.
 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
• Autonomy :
Doctors explain the conditions that occur at this time to the patient. The doctor
also advises the patient to cross the incision and give anti tetanus injection.
The doctor also gives the patient the opportunity to consider the actions that
the doctor will take to him and eventually the patient refuses.

• Beneficence :
Doctors do KIE for patients about the conditions experienced by the patient at
this time and suggest the best course of action is to do a cross incision and anti
tetanus injection.
 Ethical Dilemma
• Dilema Etik : Autonomy, Beneficence
• Prima Facie : Autonomy
 4 BOX METHODE
Medical Indications: Client Preferences:
The patient came with a complaint Medical action is carried out with the
punctured by a nail in the right foot patient's own consent
and the doctor suggested crossing the
incision and injecting anti tetanus so
that the patient's leg was not infected.

Quality of Life: Contextual Features:

Patients reject medical measures 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, the emergency room 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 Hospital are able to handle the case.