BIOETHICS

Gatot S Lawrence
Hp WA 08124588 6088

Dept of Forensic Medicine-Medicolegal

Dept of Pathology-Vascular Research Unit
Universitas Hasanuddin

3 Mei 2023
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 The practice of medicine is not a
business and can never be one ...
Our fellow creatures cannot be dealt
with as a man deals in corn and coal;
the human heart by which we live
must control our professional
relations.

Sir William Osler, 1903

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Pillars of Professionalism
Arnold and Stern, 2006

Professional Doctor
(Physician)
Professionalism

Accountability*
Humanism*
Excellence

Altruism *
Ethic
Autonomy
Competence

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 MORALE PRINCIPLES IN MEDICAL ETHICS
(Beauchamp and Childress 1970; Gillon 1986; Lawrence 2008)

1. Autonomy of the patient

It requires health professionals to assist patients come to their
own decisions and respect and follow those decisions (even the
health professional believes that the decision is wrong)
2. Beneficence: the promotion of what is best for the patient
Doing the best and providing benefit for the patients (who will be
the judge of what is best for the patient?)
3. Non-maleficence: avoiding harm
We should not harm the patients: ‘primum non nocere (Above
all, do no harm)
4. Justice Patients should have access to the same health care
fairly
5. Honesty: All measurement should be delivered with the highest
truth and honesty
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CLINICAL ETHICS: A Practical Approach in Ethical Decisions

Albert R. Jonsen, Ph.D.

Professor Emeritus of Ethics in Medicine
University of Washington School of Medicine
Seattle, Washington

Mark Siegler, M.D.

Lindy Bergman Distinguished Service Professor of Medicine and
Surgery
Director, MacLean Center for Clinical Medical Ethics
University of Chicago
Chicago, Illinois

William J. Winslade, Ph.D., J.D.

James Wade Rockwell Professor of Philosophy in Medicine
Institute for the Medical Humanities
University of Texas Medical Branch
Galveston, Texas

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 CLINICAL ETHICS:
A Practical Approach in Ethical Decisions

Every clinical case, especially those raising an

ethical problem, is recommended be analyzed
by means of the following four topics:

1. Medical indications
2. Patient preferences
3. Quality of life, and
4. Contextual features, meaning the social,
economic, legal, and administrative
context in which the case occurs.
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 1. Medical Indications
The Principles of Beneficence and Non-maleficence
1. What is the patient’s medical problem? history?
diagnosis? prognosis?
2. Is the problem acute? chronic? critical? emergent?
reversible?
3. What are goals of treatment?
4. What are the probabilities of success?
5. What are the plans in case of therapeutic failure?
6. In sum, how can this patient be benefit by medical
and nursing care, and how can harm be avoided?

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 2. Patient Preferences
The Principles of Respect for Autonomy
1. Is the patient mentally capable and legally competent?
Is there evidence of incapability?
2. If competent, what is the patient stating about
preferences for treatment?
3. Has the patient been informed of benefits and risks,
understood this information, and given consent?
4. If incapacitated, who is appropriate surrogate? Is the
surrogate using appropriate standards for decision
making?
5. Has the patient expressed prior preferences, e.g.
Advance Directives?
6. Is the patient unwilling or unable to cooperate with
medical treatment? If so why?
7. In sum, is the patient’s right to choose being respected
to the extend possible in ethics and law. Gatot S Lawrence 08
 3. Quality of Life

The Principles of Beneficence and Non-Maleficence and

Respect for Autonomy

1. What are the prospects, with or without treatment, for a

return to normal life?
2. What physical, mental, and social deficits is the patient
likely to experience if treatment succeeds?
3. Are there biases that might prejudice the provider’s
evaluation of the patient’s quality of life?
4. Is the patient’s present or future condition such that his
or her contined life might be judged undesirable?
5. Is there any plan and rationale to forgo treatment?
6. Are there plans for comfort and palliative care?
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 4. Contextual Features

The Principles of Loyalty and Fairness

1. Are there family issues that might influence treatment
decisions?
2. Are there provider (physicians and nurses) issues that
might influence treatment decisions?
3. Are there financial and economic factors?
4. Are there religious or cultural factors?
5. Are there limits on confidentiality?
6. Are there problems of allocation of resources?
7. How does the law affect treament decisions?
8. Is clinical research or teaching involved?
9. Is there any conflic of interest on the part of the
providers or the institution?
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 CASE
FOR DISCUSSION

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 Sudden lost of eye vision
• Ms. Obesto visited her routine physician, Dr. G due to
sudden lost of her left eye vision.
• She is 36 yr, H 165 cm; BW: 76 kg; BP 150/90 mmHg
• Often complaints nausea and ‘stomachache’
• History of frequent headache since high-school, the
condition gettting worse the last 2 months.
• She wears spectacles since elementary school (severe
myopia D=17)
• Ms. Obesto was given anti-emetic agent and admitted to
the hospital by Dr. G
• The next day she was consulted to an Opthalmologist in
the hospital.
• What is your opinion in the above scenario?

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 “Wissen ist nicht
genug; wir müssen uns
bewerben.
Das Wollen ist nicht
genug; wir müssen tun”

“Knowing is not
enough;
we must apply. Goethe
Willing is not enough;
we must do.”

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 • Unhas, 3 Mei 2023

Soal:
Sebutkan 3 kasus yang pernah anda alami
sendiri, yang menurut anda ada masalah
dilemma Etik Mediknya.
Tidak perlu sebutkan nama dokter dan RS>

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