Angelina Christianty Kurn

iadi
17710250
 CASE 1
Ms. S in her early 20 came into the emergency room at RSUD Wahidin Sudiro Husodo
Mojokerto with a x-ray from another clinic and asking for a treatment after she felt fro
m her motorbike. The doctor checked the picture and asked the patient to re-take the x-
ray since the previous one didn’t show clearly both of her clavicula. After re-taking the
picture, the doctor diagnose the patient with close fracture clavicula dextra and advice t
he patient to stay at the hospital and schedule for surgery, yet the patient refuse the offe
r and said she doesn’t want to take any surgery and choose to go to sangkal putung or g
et a massage. Then the doctor explain to her and her family why surgery is the better o
ption for her. After some discussion with her family she still refuse the treatment that t
he doctor told her and decided to go home.
 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. Limitation Goal-Based 
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 Kriteria 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 Kriteria 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 Kriteria 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 Kriteria 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 Kriteria 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.
 DILEMA ETIK

Beneficence Justice

PRIMARY FACE

Justice
4 BOX METHOD OF CLINICAL ETHICS

Client preferences:
Medical indications:
To making decision about
Diagnose:Close Fracture patient, families can
Clavicula dextra discuss

4 box methode

Contextual features:
Quality of life:
The patient refuse to
good
surgery and decided to go
home
 PROFESIONALISME

• Altruism : Nothing
• Accountability: the doctor explains about the condition of the
patient, the actions that must be done and made informed cons
ent.
• Excellence : the doctor diligently attend health seminars
• Duty: the doctor recommend hospitalization and surgery on th
e other days
• Honour and integrity: the doctor do not deviate from patient
• Respect for others : yes
• Humanity : there is empathy
CASE 2
 A male patient 60 years old was taken by her family to the emergency room of Sidoarjo
regional hospital came with a complaint that half of her body could not be moved. According
to the family information, the patient had fallen in the gardeb and half of his body could not b
e moved. In addition the patient also complained that it was difficult to speak and open his m
outh. The physical examination was performed to find the right limb left behind.

Patients receive fluid and oxygen therapy. The doctor advises the patient to be hospitali
zed and explain everything about the patient's disease to the family. The family agreed to hos
pitalization but the patient think he already feel better and refuse for futher treatment. The fa
mily tried to convince the patient to stay but the patient get angry to everyone even trying to t
ake off the oxygen mask. The doctor again explained the reason the patient had to be hospital
ized but the patient still insisted on going home and signing the “by own request” letter
 KDB 1 (BENEFICENCE)
Kriteria 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.Limitation Goal-Based 
 KDB 1 (BENEFICENCE)
Kriteria 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
N Kriteria Yes No
o

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 Kriteria 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 Kriteria 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 Kriteria 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 Kriteria 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
N Kriteria Yes No
o
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.
 DILEMA ETIK

Beneficence Autonomi

PRIMARY FACE

Autonomi
 4 BOX METHODE
Medical Indications:
Dx stroke
Liquid and oxygen therapy, the
patient’s condition improve
Client Preferences:
Medical action is carried out with the
approval of the family because the
patient has difficulty speaking

Quality of Life: Contextual Features:

After therapy with fluid and oxygen, She is a BPJS patient, but she ignores
the patient’s condition improved but the illness
the patient refused to be hospitalized
and signed a forced return letter
 Quality of life:
After therapy with fluid and
oxygen, the patient’s condition
improved but the p atient
refused to be hospitalized and
signed a “b y own request” letter

She is a government
Contextual features:
she ignores the medicati on
insura nce(BPJS) patient, but
4 box methode
difficulty speaking
because the patient has
with the appro val of th e family
Medical action is carried out
Atta ck

Client preferences:
Diagn ose: Cerebro
Medical in di cati on s:

dd Transien t Ischaemic
Vascular Accident Infa rk
 PRINSIP PROFESIONALISME

• Accountability :
the doctor explain about the condition of the patient
• Duty :
The doctor take medical measures to deal with the patient’s con
dition
• Altruism :
the doctor prioritize the interest of patient
• Respect for others:
The doctor appreciate the patient’s refusal to be hospitalized
THANK YO
U