ASSIGMENT BLOCK 2

By : Yudi Pranata 54081001014

Medical Faculty of Sriwidjaya University 2008

Hypothetic case 1: Beneficence (Patient benefit oriented)

Doc, dont get me operated

Abdul, a parking officer came to doctor Ayu with complain, a wart at his foot. The doctor examined it using pincet and pushed it until Abdul felt pain, and doctor Ayu made a prescription for 2 weeks of medication. Abdul has followed all of doctors advises, but the wart is not cured still. When he returned for consultation, doctor Ayu said that Abdul didnt follow the treatment correctly and suggested for operation. Abdul rejected it and went out of the examination room feeling unsatisfied.
Wart : 1. a lobulated hyperplastic epidermal lesion with a horny surface caused by a human papillomavirus,transmitted by contact or autoinoculation, and usually occurring on the dorsa of the fingers and hands. Called also wart and verruga. 2. any of various nonviral epidermal proliferations resembling this lesion. (based on Dorland medical dictionary)

Case analysis based on Basic Principles of Bioethics : Firstly, doctor Ayu must considered who is her patient (social background). Abdul (doctor Ayus patient) is a parking officer with low income. Doctor Ayus job is give efficient, honourable, and the best treatment based on affordable, effective side and comfortable for Abdul. In this case, doctor Ayu ignored some point in beneficence cathegory based on basic principles of bioethics : 1. Do primarily altruism and ensure the primer values of human being: doctor Ayu didnt applied do primarily altruism and ensure the primer values of humen being. Because she gave painfull and long treatment (a prescription for 2 weeks of medication) for Abdul only for wart problem. Considered that Abdul is parking officer, these treatment will give new problem for Abdul (cost and time) beside wart problem. 2. Look the patient/family/something, not only giving benefit to doctor: Based on doctor ayus decision (treatment), factually she didnt look who is her patient (parking officer with low income). She only taken

benefit for herself (I had done my job to give health care and treatment). 3. Apply the golden rule principle (the highest standard) : doctor Ayu didnt applied the golden rule principle, because she give treatment only based on her perspective and her rule. She didnt appreciate patient perspective. Her treatment actually not success and give worse and unsatisfied for the patient. If doctor Ayu apply the golden rule principle, of coursely it can avoided. 4. Maximalize satisfication of patients happiness and minimalize worse effect : doctor ayu made her patient unsatisfied. Because the patient had paid for 2 weeks prescription, come to doctor (abdul cannot work and get money for his life) for 2 times and the doctor didnt believed him that he followed the instruction. 5. Struggle for getting more benefit than worse : In this case, doctor ayus treatment get more worse than benefit. Abdul take painfull treatment,paid for 2 weeks prescrisption and wart wasnt cured still. Conclusion : doctor Ayu didnt applied basic principles of

bioethics well. She gave more worse than benefit for the patient. She only take advantage for herself (I had done my job to give health care and treatment). She didnt belived her patient and suggest to operation, how can her patient belive her and take operation.

Hypothetic case 2: Non maleficence (Do No Harm Patient)

Doctor who hesitated to do anamnese

Doctor Andi met a patient, a middle age man, look cachexia, limping and continued coughing in front of him. The man accompanied by his skinny daughter. The doctor hesitated to do anamnese and straight to performed examination. When the daughter asked about her father illness, doctor Andi only suggested him to take his medicine regularly and gave a prescription. The daughter asked the doctor again about how to take the medicine, but the doctor told her to ask about it to the pharmacy attendant. Felling underestimated, the father and daughter went out of the doctors room without saying goodbye. And the look of their face seemed unsatisfied.
Anamnese/anamnesis : 1. recollection. 2. a medical or psychiatric patient case history, particularly using the patient's recollections; cf. catamnesis. 3. immunologic memory. Cachexia : a profound and marked state of constitutional disorder; general ill health and malnutrition.(Based on Dorland medical dictionary)

Case analysis based on Basic Principles of Bioethics : Doctor guide to give health care based on standard operating procedure (SOP), not in own standard. Andi has the duty to explain patients problem if the patient required and how to take the medicine. In this case, if we relate to No maleficence cathegory based on basic principles of bioethics, doctor Andi made some mistakes : 1. Give treatment not in proportion and placed patient as an object : in this case, doctor Andi give treatment not in proportion. Why ? he hesitated to do anamnese and straight to performed examination. He gave a prescription without explaination and asked pharmacy attendant to do it. He placed patient as an object/commodity.

2.

Not prevent patients form dangerous situation : doctor Andi knows that mistake about how to take the medicine make patients in dangerous situation. But he was ignored it. 3. Not avoid misrepresentation from patient : doctor Andi didnt avoid misrepresentation from patient, contadictively he build a misrepresentation and unsatisfied. 4. place patient life in dangerous with misaction : doctor Andi made patients life in dangerous with misaction. He hestitated to do anamnese and straight to performed examination. Absolutely it wouldnt make the best treatment and get high risk for patients life. 5. Not giving spirit of life : doctor Andi didnt gave spirit of life, he really selfish and didnt respect the patient/patient family. Conclusion : doctor Andi didnt applied basic principles of bioethics well. He act (give treatment) not in proportion, place patient in dangerous situation, build misrepresentation, build unsatisfied, and place the patient as object.

Hypothetic case 3: Autonomy (Respecting patients rights)

Old Woman that doesnt want to do the surgery

A patient comes to a doctor with major complain vulva displacia that was suspected as a malignancy. Doctor do the biopsy and the result is a carcinoma. Then doctor explained to her that she has to be operated. The woman doesnt want to do the that. She said, No, I dont want to do the second surgery. Shes already 70 years old. I dont have a complain, its small, so why I have to do the surgery?. The doctors already explained that this surgery will not harm the patient, but she still refused it. At that time, we-the husband, her sister and doctor still keep trying to make sure the patient to get operated. At the same time we do not want to say that she got a cancer. If she doesnt agree to do the surgery, the disease will be more severe dan become invasive one day. We will got a bigger problem and more extensive surgery. Now its just a simple vulvectomie, but not impossible the she have to do radical vulvectomie later. Vulva : the region of the external genital organs of the female, including the labia majora, labia minora, mons pubis, clitoris, bulb of the vestibule, vestibule of the vagina, greater and lesser vestibular glands, and vaginal orifice. Malignancy : 1. a tendency to progress in virulence. 2. the quality of being malignant. 3. a cancer, especially one with the potential to cause death. Biopsy : the removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. Carcinoma : a malignant new growth made up of epithelial. cells tending to infiltrate the surrounding tissues and give rise to metastases. Vulvectomie : excision of the vulva. (Based on Dorland medical dictionary) Case analysis based on Basic Principles of Bioethics : In this case, doctor has dilemma, absolutely he/she want the best decision (get operated) for the patient, but patient refused. The other side, doctor keep secret about malignancy at the patient.Considered that patient high potentially in dangerous situation, doctor build cooperation with patients family to make sure the patient to get operated. From this case, we can

analyze that the doctor had applied some point of autonomy cathegory in basic principles of bioethic : 1. Appreciate the rights to decide, appreciate patients dignity : the doctor had appreciated the right of patient to decide. He explained to the patient that she has to be operated and already explained that this surgery will not harm the patient. The decision let back in patient.(before the doctor intervent in decision making caused non-eletive condition) 2. Get informed consent : I think the doctor asked the informed consent, but the patient refused. We know the doctor explained not at all about the disease but it exceptional considered phsycological and mentality of patient. 3. Not prevent others from interfering the patient decision-making,
including his/her own family : from this case, we know that patients family already known about the disease and keep cooperation with doctor to help patient to get the best decision. 4. Not to intervene or to inhibit patients autonomy (in decisionmaking),except in non-elective condition: In this case,the doctor intervent patient by suggested to get operated without give another alternative. But,malignancy is very dangerous disease and the doctor think get operated was the best one or the patient. If the doctor didnt intervent patient in decision making, it will placed patient in dangerous condition at the next time. 5. Keeping up the relationship: the doctor kept up relationship with the patient Criteria Appreciate the rights to decide, appreciate patients dignity Not to intervene patients in decision-making (in elective condition) Be Open Appreciate privacy Keeping patients secrets Appreciate patients rationality Get informed consent To let adult and competent patient to make his/her decision Not to intervene or to inhibit patients autonomy To prevent others form interfering the patient decision-making, including his/her own family To be patient in waiting for the decision from the patient conserving non-emergency cases Not to lie to the patient even for his/her own sake Yes

No

1. 2.

3. 4. 5. 6. 7. 8. 9. 10 . 11 . 12 . 13 Keeping up the relationship (contract) .

Hypothetic case 4: Justice (Eliminate discrimination)

Beautiful woman that sued the doctor

Mss. Pretty, a 30 years old midwive, still young and beautiful. She came alone to doctor Surya, the one and only obstetrician in that city for consultation about her pregnancy. After ultrasonography examination, accidently the doctors hand flattery hers abdomen. Mss. Pretty get mad at the time and showed her dislike to the doctor for what his done. Then she reported about that to the local police. Case analysis based on Basic Principles of Bioethics :