TUGAS BIOETIK

DOKTER MUDA RSUD SIDOARJO

CINDYESTI LARISSA
18710021

18/11/2018 1
 CASE 1
• A patient is hospitalized with a diagnosis of kidney failure. After
anamnesa, physical examination, and supporting examination in the
form of a lab, the DPJP, a doctor of Sp.PD, suggested hemodialysis.
After being explained, the two patients' children were guarding
patients who were their mothers, asking for time to discuss with
their families. The next day, when asked by the DPJP, the two
children refused to do hemodialysis, arguing that their mother was
sick during hemodialysis, and was afraid when told that
hemodialysis should be done regularly every week. They asked
doctors to treat their mothers only with drugs. The doctor then
once again explained to the patient and the two children of the
mother about hemodialysis which is the most appropriate way to
treat their mother, after the doctor explained for a long time, then
the two children "agreed" to do hemodialysis, then the doctor
handed over an informed consent to be signed by patient.

18/11/2018 2
 CASE 1
• But apparently, the patient refused to sign with the reason to wait
for his son to come first.
• On the third day, early in the morning, the DPJP visiteed the patient,
whose condition had greatly decreased and called the two children,
who apparently had not signed the informed consent for
hemodialysis. Then the doctor once again explained and confirmed
about hemodialysis, finally the doctor once again asked the patient
to immediately sign a letter of approval or rejection of the action.
Finally the two children signed an informed consent. And the
patient was immediately planned for hemodialysis that day. After
hemodialysis, the patient improves. And the two children thanked
the DPJP.

18/11/2018 3
 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 

7. Goal-Based restrictions 
18/11/2018 4
 KDB 1 (Beneficence)
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

18/11/2018
 5
 KDB 2 Non-Maleficence
N Criteria Yes No
o
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 
18/11/2018 6
 KDB 2 Non-Maleficence
NO 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 

18/11/2018 7
 KDB 3 Autonomy
No 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 

18/11/2018 8
 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) 
18/11/2018 9
 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
18/11/2018 not abuse.  10
 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.
1618/11/2018
Does not distinguish patient services on the basis of SARA,  11
social status etc.
 ETHICAL DILEMMA
•Beneficence :
Doctors carry out continuous IEC to the patient's
family regarding the most appropriate therapy for
renal failure at the V stage / classification is
hemodialysis.
•Autonomy :
Doctors explain the condition of the disease that is
experienced by the patient to the family, as well as
the therapy that should be done, and provide
opportunities for families and patients to discuss.
18/11/2018 12
 ETHICAL DILEMMA
• Ethical Dilemma: Beneficense, Autonomy
• Prima Facie : Beneficense

18/11/2018 13
 4 BOX METHODE
Medical Indications: Client Preferences:
Dx CKD V + anemia + hypoalbumin Medical action is carried out with the
Hemodialysis must be done due to approval of the family because the
blood pressure, HB, BUN, SC, patient has decreased consciousness
albumin that exceeds normal limits
Patients are chronic emergency
patients

Quality of Life: Contextual Features:

After hemodialysis, the patient's The families who were involved are
condition has improved. children, and relatives of patients.

18/11/2018 14
 PRINCIPLE OF PROFESSIONALISM
1. Altruisme : Yes, doctors put the interests of patients first.
2. Duty : Yes, the doctor responsible for the patient carries out his
duties according to procedures, starting from the history,
physical examination, supporting examination, and
appropriate therapy.
3. Respect for others : Yes, Doctors respect the rights and healing of
patients and have knowledge of the pain,
especially the complications that can occur
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
6. Emphaty : there is a sense of empathy from the doctor
towards the patient

18/11/2018 15
 CASE 2

18/11/2018 16
 CASE 2
• A patient comes to poly obstetrics and gynecology for routine pregnancy
control. Patient is 20 years old. The patient came with a younger brother
of an 18-year-old. While waiting to be carried out anamnesa, the patient
said she felt tight. When examined by Sp.OG, the gestational age was
34/35 weeks, but had experienced second opening. the doctor asked the
patient's husband who was working, then the doctor asked the patient's
family who at that time turned out to be only her father who was still
sleeping at home. The doctor then asks the patient to call her family to
immediately come to the hospital, because the patient cannot be
discharged and it will be dangerous for the patient. It turned out that the
patient did not carry a cellphone, then when offered using a hospital
telephone, it turned out that the patient also did not memorize the
telephone number. Then, finally the doctor advised the patient's sister to
return home and contact the family, while the patient was immediately
planned to enter the hospital in the maternity room.
• Finally in the afternoon, the patient's sister returned with her husband
and her father.

18/11/2018 17
 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 

7. Goal-Based restrictions 

18/11/2018 18
 KDB 1 (Beneficence)
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
18/11/2018 the Golden Rule Principle  19
 KDB 2 Non-Maleficence
N Criteria Yes No
o
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 
18/11/2018 20
 KDB 2 Non-Maleficence
NO 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 

18/11/2018 21
 KDB 3 Autonomy
No 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 

18/11/2018 22
 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) 
18/11/2018 23
 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
18/11/2018 not abuse.  24
 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.
1618/11/2018
Does not distinguish patient services on the basis of SARA,  25
social status etc.
 ETHICAL DILEMMA
• Non Maleficense
The doctor advises the patient to be hospitalized
immediately, and the patient's sister contacts the
patient's family, for the sake of making decisions all
actions, because the patient is underage.
• Beneficence :
The doctor performs IEC for the patient and her
family regarding the current state of the patient,
and the best course of action is to be hospitalized.
18/11/2018 26
 ETHICAL DILEMMA
• Ethical Dilemma : Beneficense, Non maleficense
• Prima Facie : Non maleficense

18/11/2018 27
 4 BOX METHODE
Medical Indications: Client Preferences:
Dx G1P0A0 34/35 weeks + T / H / IU Medical action is carried out with the
+ stage II Latent phase approval of the patient, because the
The patient was immediately patient is 20 years old and married..
hospitalized in the delivery room
because he had 2 cm cervical opening.

Quality of Life: Contextual Features:

After being treated in the delivery The family involved is the patient's
room, the patient becomes calmer, biological father.
because he is always accompanied by
a 24-hour midwife and doctors who
18/11/2018 28
are ready to be alert if the emergency
 PRINCIPLE OF PROFESSIONALISM
1. Altruisme : Yes, doctors put the interests of patients first.
2. Duty : Yes, the doctor responsible for the patient carries out his
duties according to procedures, starting from the history,
physical examination, supporting examination, and
appropriate therapy.
3. Respect for others : Yes, Doctors respect the rights and healing of
patients and have knowledge of the pain,
especially the complications that can occur
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
6. Emphaty : there is a sense of empathy from the doctor
towards the patient.

18/11/2018 29
 THANK YOU

18/11/2018 30