ETHICS RULES, ETHIC RSUD

DILEMMA, PRINCIPAL OF SIDOARJO I2

PROFESIONALISM
 Case
A premature baby born with hydrocephalus and
there is calcification in his brain, this baby treated in
the NICU. One day the doctor explained to the
patient’s father that his son condition was harmful
and risked brain damage so the doctor suggested
referring to a better hospital. However, the father
was constrained by the economy and the condition
of his wife who was still being treated at ICU so that
he intended to not refer his child to another hospital.
The doctor has explained the impact of not referring
and giving the father time to consider it
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 of Goal-Based √
 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 √

NON-MALEFICENCE
Criteria Yes No
1. Helping emergency patient √
2. The conditions for describing these criteria are:
a. The patient is in a dangerous condition. √
b. Doctors are able to prevent harm or loss. √
c. The medical action proved effective √
d. 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 √
 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 √

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 √
8 Allowing adult patients and competent to make their own decisions. √
9 Do not intervene or obstruct patient autonomy. √
Prevent other parties from intervening in patients and making decisions, including
10 √
the patient's own family.
Patiently waiting for the decision to be taken by the patient in a non-emergency
11 √
case.
12 Don't lie to the patient even for the benefit of the patient. √
13 Maintain relationship (contract) √
JUSTICE
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. √
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.
 ETHICS DILEMMA

Beneficence
Autonomy

PRIMA FACIE :
AUTONOMY
BENEFICENCE
• The patient still treated in NICU and the
doctor suggested referring to a better
hospital because the condition was harmful.

AUTONOMY
• The father intended to not refer his child
because economy factors and bad condition
of his wife. So, the doctor giving the father
time to consider it
 4 BOX METHOD OF CLINICAL ETHICS
Medical Indication Client Preferences
• The condition was harmful. • The patient cannot make a
• The patient need to be referred decision. His father is in represent
for better treatment because his for making a decision.
hydrocephalus and brain damage.
• If his father refused, the patient
still treated at the NICU with the
possibility getting worst condition.
Quality of Life Contextual Features
• In the NICU, the patient possibility Social and economic condition affect
getting worst condition. the father for making decision to
• If the patient can be saved, maybe refer his child to the better hospital.
have brain damage and it will
affect to his motoric system.
 PRINSIP PROFESIONALISME
1. Alturism (+) : the doctor suggested referring to a
better hospital because the patient condition was
harmful and risked brain damage.
2. Accountability (+) : the doctor is full of
responsibility for patient safety
3. Duty (+) : the doctor very responsive about that
his patient need better treatment at the time.
4. Respect for others (+): respect the opinion of the
patient’s father and wait patiently for the
decision.
5. Humanity (+) : the doctor have empaty for the
economic condition of patient’s family.
 Extra-ordinary Treatment
• Because in this case the treatment of the patient
need more cost such as for transportation, cost of
living, and cost for NICU maintenance. And the
patient need special care to save his life.
CASE 2
 Case
A 58 years old woman came to emergency room with
pain in her upper abdominal and chest accompanied
by nausea, vomiting, excessive sweating, and
trembling. The woman has a history of hypertension.
So, the doctor in ER diagnose the patient suspect
coronary heart disease and recommend
hospitalization. After being given medication the
patient has hypotension. Finally, this patient is
treated by cardiologist. Cardiologist performs
advanced ecocardiography examination to preserve.
Cardiologist say that the patient’s heart condition is
okay. The patient only has an attack of chronic
gastritis.
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 of Goal-Based √
 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 √

NON-MALEFICENCE
Criteria Yes No
1. Helping emergency patient √
2. The conditions for describing these criteria are:
a. The patient is in a dangerous condition. √
b. Doctors are able to prevent harm or loss.
√
c. The medical action proved effective
√
d. 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 √
 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 √

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 √
8 Allowing adult patients and competent to make their own decisions. √
9 Do not intervene or obstruct patient autonomy. √
Prevent other parties from intervening in patients and making decisions, including
10 √
the patient's own family.
Patiently waiting for the decision to be taken by the patient in a non-emergency
11 √
case.
12 Don't lie to the patient even for the benefit of the patient. √
13 Maintain relationship (contract) √
JUSTICE
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. √
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.
 ETHICS DILEMMA

Beneficence Non-
Maleficence

PRIMA FACIE :
NON-MALEFICENCE
BENEFICENCE
• The doctor at emergency room try to provide
the best tharepy according to their abilities.
But, the therapy was not succesful so the
doctor was consulted to the cardiologist.
NON-MALEFICENCE
• The doctor may be less careful in examining
so that the diagnosis is wrong and it can
endanger the patient.
4 BOX METHOD OF CLINICAL ETHICS
Medical Indication Client Preferences
• The patient diagnosed with • The patient can make decision for
suspected coronary hearth her treatment including agree to
disease with doctor at emergency be examined by cardiologist.
room
• After give some drug, the patient
have hypotension
• And then, cardiologist checks and
diagnose with chronis gastriris.
Quality of Life Contextual Features
• The patient looks uncomfortable Social and economic condition,
due to the pain. religion and cultural factors cot affect
• After give some drug, the patient the patient to make decision.
feeling dizzy and weak.
 PRINSIP PROFESIONALISME
1. Alturism (+) : the doctor was consulted to
cardiologist because he feel his theraphy is
incorrect.
2. Accountability (+) : the doctor is full of
responsibility for patient safety
3. Duty (+) : the doctor very responsive when
patient need some help at emergency room
4. Humanity (-) : the doctor make a mistake in
diagnosis because it is less thorough
• This case is extra-ordinary treatment
Thank
you