Moral Basic Principle

Oleh:
Arif Setyawan Putra Utama / 18710017

PEMBIMBING:
dr. Meivy Isnoviana, S.H., M.H.

SMF ETIKA HUKUM KEDOKTERAN DAN MEDIKOLEGAL

FAKULTAS KEDOKTERAN
UNIVERSITAS WIJAYA KUSUMA SURABAYA
2019
 CASE 1
 A 43 year old man came to the Emergency Room of Regional General
Hospital of S. The patient complained he felt pain in his lower back. Pain in
the lower back since 5 days ago and has not been treated. The patient goes
limping and dragging.The patient's back is stiff.
 Doctor diagnoses the patient is suffering from LBP (low back pain), doctor
advises patient not to lift heavy loads, and exercises such as walking or
cycling. Doctor recommend doing CT scans the next day to find out if there
are bone abnormalities or complications. But the patient refused to do a
CT scan for fear of not being able to pay the fee.
 Patient works as construction laborer and have limited budget. Doctor still
encourage patient to be treated, but by using generic drugs that are cheaper.
The patient agreed, then the doctor prescribe medication for the patient.
 Beneficience
No 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 adverse effect. 
5 Responsible 
6 Ensure a good minimum human life 
7 Restriction 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 
 Non Maleficence
No Criteria Yes No
1 Helping emergency patients 
The conditions for describing these criteria are:
• The patient is in a dangerous condition.
2 • 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 √
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 
 Autonomy
No Criteria 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 Be honest 
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. 
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) 
 Justice
No Kriteria Yes No
1 Give 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. √
 Ethical Dilemma

Beneficence Autonomy

Prima Beneficience
Facie
 ETHICAL PRINCIPLES

Beneficience :
•The doctor have explained the education to patients to do therapy
so that the patient’s pain is reduced

Autonomy:
•The doctor appreciate the patient’s decision not to join a medical
rehabilitation program and patients prefer to use generic drugs
Prima Facie
•Beneficience
 4 box method
Medical Indications Quality Of Life
A 43-year-old man came to a emergency room With these generic drugs, patients are
with a complaint of lower back pain. Pain in expected to feel comfortable, but the effect
the lower back has been felt since 5 days ago cannot be seen
and has not had time to seek treatment. The
way the patient limps and is dragged and feels
stiff on his back.

Client Preferences Contextual features

Competent patient (old enough) The patient is unable pay for the therapy that will be
The patient was in a conscious state and agreed given for fear that the price is expensive, because the
when advised to use generic drugs so that treatment patient work as a construction worker.
prices could be more affordable.
 Professionalism
 Alturism (+): Doctor recommends that patient to continue to do the therapy
that is needed but by using generic drugs because of limited cost.
 Accountability (+) Doctor provides patient with a solution to the limitations of
their cost in purchasing drugs.
 DUTY (+): The doctor performs a thorough examination of the patient.
 Humanity (+): Because patient’s occupation is a contruction worker and have
limited budget, he still encourage patient to be treated using generic drugs that
are more affordable.
 Respect for other (+): Doctor provides alternative advice to patients in drug
selection, because of the lack of cost.
Ordinary Extraordinary
or

Ordinary
 In this case, it was ordinary because the patient recieved
generic drugs as a therapy of his low back pain.
 CASE 2
 A 14 years old paediatric inpatient in Regional General Hospital of S
diagnosed with accute viral diarrhea. He came in a moderate dehydration
state, and after one day of treatment he was getting better, but still need to
be treated in the hospital for observation and further recovery.
 His parents came to the doctor asking for his son to go home in the
second day because of monetary issues. Doctor then explained that the
patient is getting better, but still need to be treated in the hospital for
further observation and recovery. After long discussion, the parents ended
up taking their son home by signing a forced discgarge letter.
 Beneficience
No 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 adverse effect. √
5 Responsible √
6 Ensure a good minimum human life √
7 Restriction 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 √
No
Non Maleficence
Criteria Yes No
1 Helping emergency patients √
The conditions for describing these criteria are:
• The patient is in a dangerous condition. √
2 • 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 √
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 √
 Justice
No Kriteria Yes No
1 Give 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. √
 Autonomy
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 Be honest √
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. √
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) √
 Ethical Dilemma

Non maleficence Autonomy

Prima Autonomy
Facie
 ETHICAL PRINCIPLES

Non maleficence :
Doctor want to give the best treatment for the
patient.

Autonomy :
Doctors value the patient decision to leave the
hospital.
 4 BOX METHOD
Medical Indication
• A 14 years old paediatric inpatient
in Regional General Hospital of S
diagnosed with accute viral
diarrhea.
Quality of Life
After one day of treatment in the hospital, the
patient is getting better.
Client Preference
• The doctor suggested the patient to be
treated in the hospital.The patient agreed,
but in the second day the patient’s parents
asked to leave the hospital.
Contextual Features
• The patient’s parents said that they were
unable to pay for the treatent cost on the
hospital.
 PROFESSIONALISM
 Accountability: Doctors want to give the best treatment for the
patient.

 Alturism: Doctor try to save the patient’s life.

 Duty: Doctor is following the standard operational procedure.

 Respect for other: Doctor value the patient decision.

 Humanity: Doctor have empathy for the patient.

Ordinary Extraordinary

Extraordinary
 In this case, it was extraordinary, because the patient
ended up leaving the hospital in the second day against
the doctor’s advice to get treatment in the hospital for
further observation and recovery.