SCENARIO 1

BY GROUP 5TH
MEMBERS

• Ketua Putri Faiqotul Hikmah 6130015055

• Sekertaris I Maulidatul Mubarokah 6130015045
• Sekertaris II Sa’adah Fiddaaraini 6130015020
• Aufar Zimamuzzaman AL Hajiri 6130015005
• Rusdiana Silaban 6130015010
• Hafizh Auliyan Sodali 6130015015
• Ardhita Faradhika H 6130015025
• Ilma Nafia 6130015030
• Wahyu Firmansyah 6130015035
• Khoirun Nanik Agustina T 6130015040
• Ikbar Fatimah Az Zahra 6130015050
SCENARIO
A boy named Yoga, aged 13 months, is a referral patient who has been treated at Bagas Waras
Hospital for more than 2 months, with the main diagnosis of "abdominal burst", Yoga is the second
child, parents work as farm laborers, with low economic conditions.
Yoga was referred from the First Hospital with a history of recurrent laparotomy (initial
medical indication of Hirschprung Disease, with NEC grade 2) and surgical suture that did not
heal.
With the condition of the digestive tract that is not functioning well after surgery, Yoga
suffers from malnutrition and also ultimately causes difficulty in healing surgical wounds. During
hospital treatment, Yoga does not show improvement, it tends to show deterioration in the
situation. The general condition of Yoga in full awareness, being able to communicate, but unable to
get out of bed. The weight continues to decline, with the main nutrient input parenterally.
Postoperative wounds on the stomach get worse and open, a source of infection and sepsis.
The team of treating medical personnel has tried to make various efforts to improve
Yoga's condition, but has not shown significant improvement and difficulty deciding on follow-up
Yoga treatment. The medical team was confused with 2 choices: 1) continuing aggressive therapy
(CVC and laparotomy plan) 2) stopping invasive intervention and providing palliative therapy.
STEP 1
• DIFFICULT WORD IDENTIFICATION –
• KEYWORD
1. Burst the abdomen
2. Cared for> 2 months
3. History of repeated laparotomy
4. Seams that do not heal
5. The second child of an elderly person works as a farm laborer, with low economic conditions
6. Digestion does not function postoperatively
7. As long as the treatment gets worse
8. Can not get out of bed
9. Malnutrition
10. Postoperative wounds on the stomach get worse and open, a source of infection and sepsis
11. Early medical indications of Hirschprung Disease, with NEC grade 2
12. Weight loss
13. Difficulty deciding on follow-up treatment
STEP 2
PROBLEMS?
1. What caused the medical team to be
confused in taking action?
2. How is the solution about the medical team
confused in taking action?
3. What ethical dilemmas are there in the
scenario?
STEP 3
ANSWER TO PROBLEM FORMULATION
1. The medical team is confused in taking action because if forced to do aggressive
therapy we certainly violate the bioetic principle where patient autonomy and non-
malficence are not met, this is because the background of the patient's economy,
and invasive treatment done cannot guarantee the prognosis to be more well.
2. The medical team should first educate the patient's parents about the patient's
illness. In addition, the medical team must provide insight for each choice that will
be made. Providing education about the prognosis of the patient's disease and the
results of the actions and objectives of the action are very important for further
decision making.
3. The ethical dilemma found here is how we act as medical personnel in handling the
case. If forced to do aggressive therapy we certainly violate bioetic principles
where patient autonomy and non-malficence are not met, this is because the
background of the patient's economy, as well as the invasive treatment done
cannot guarantee a better prognosis. However, if only palliative therapy is carried
out, the aspects of justice and respect autonomy of patients are also not fulfilled,
where patients do not get equal treatment.
STEP 4
13-month-old Yoga has been treated at Bagas Waras Hospital
with a major diagnosis of "abdominal burst". referred from First
Hospital with repeated laparotomy (early medical indication of
Hirschprung Disease, with NEC grade 2) and non-healing
surgical sutures

Problem

Medical action

Ethical
dilemma Results

Evaluation
Solution
STEP 5
LEARNING OBJECTIVE
1. Able to know and explain ethical dilemmas according to the scenario
2. Able to know and explain the principles of medical bioethics
3. Able to know and explain solving ethical dilemmas based on scenarios
LO 1: ABLE TO KNOW AND EXPLAIN ETHICAL DILEMMAS
ACCORDING TO THE SCENARIO

The ethical dilemma found here is how we act as medical personnel in

handling the case. If forced to do aggressive therapy we certainly violate
bioetic principles where patient autonomy and non-malficence are
not met, this is because the background of the patient's economy, as
well as the invasive treatment done cannot guarantee a better
prognosis. However, if only palliative therapy is carried out, aspects of
justice and respect autonomy of patients are also not fulfilled,
where patients do not get equal treatment with other patients, and the
patient's right to receive a treatment by the substance of health
LO 2: ABLE TO KNOW AND EXPLAIN THE PRINCIPLES OF
MEDICAL BIOETHICS
LO 3: ABLE TO KNOW AND EXPLAIN SOLVING ETHICAL
DILEMMAS BASED ON SCENARIOS

Here is the solution to the case in the scenario:

 Identify health problems.

1. Yoga, 13 months in hospital for more than 2 months.
2. Yoga parents have a weak economy.
3. Main diagnosis:Abdominal burst.
4. Repeated history of laparotomy and surgical suture have not healed.
5. The situation is getting worse.

 Identifying ethical problems.

The medical team was confused with two choices. If continuing aggressive therapy, the medical team needs to
consider the patient's prognosis and family economy that supports treatment. But if the medical team stops
invasive intervention and provides palliative care, the medical team seems to give up and resign to the state of Yoga.
 LO 3: ABLE TO KNOW AND EXPLAIN SOLVING ETHICAL
DILEMMAS BASED ON SCENARIOS
Here is the solution to the case in the scenario:
 Who is involved in decision making.

 Identify health problems.

1. Doctors as decision makers are legal in the treatment of
1. Yoga, 13 months in hospital for more than 2 months. actions.
2. Yoga parents have a weak economy. 2. Parents have the right to service and autonomy
3. Main diagnosis:Abdominal burst.
4. Repeated history of laparotomy and surgical suture have not  Give a decision.
healed.
The medical team should first educate the patient's parents about
5. The situation is getting worse. the patient's illness. In addition, the medical team must provide
insight for each choice that will be made. Providing education
about the prognosis of the patient's disease and the results of the
 Identifying ethical problems. actions and objectives of the action are very important for further
decision making.
The medical team was confused with two choices. If continuing
aggressive therapy, the medical team needs to consider the patient's
prognosis and family economy that supports treatment. But if the
medical team stops invasive intervention and provides palliative care,
the medical team seems to give up and resign to the state of Yoga.
THANK YOUUU
ANY QUESTION?