Oleh :

Hari Sucandra
19710071
Pembimbing :
Dr. Meivy Isnoviana, S.H, M.H

SMF ILMU KEDOKTERAN FORENSIK DAN MEDIKOLEGAL

FAKULTAS KEDOKTERAN WIJAYA KUSUMA SURABAYA
RUMAH SAKIT UMUM DAERAH GRESIK IBNU SINA
2019
A 26 year old woman came to the IGD Y at 9 pm
delivered by her husband. The patient complained of
headaches and nausea and vomiting since this morning.
Currently the patient is pregnant with her first child, the
womb is about 9 months because the patient does not
remember when the last menstruation. After the
examination was obtained 170/90 mmhg weight. The
doctor then advised to be hospitalized and immediately
administer the womb to prevent adverse effects on the
mother and baby. The patient agreed to be admitted. The
doctor also suggested installing a catheter but the patient
refused because of the pain when the catheter was
installed. Finally the catheter is removed after the
patient's family signs a letter of refusal of action.
 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. Goal-Based restrictions 

8. Maximizing the satisfaction of happiness / 

patient preferences
 Criteria Yes No
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 Criteria Yes No
1 Helping emergency patient 
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 patient > doctor's loss (only experiencing
minimal risk).
2 Treat injured patient 

3 Do not kill patient (do not do euthanasia) 

4 Not insulting 

5 Do not view patient as objects 

6 Treating disproportionately 
NO Criteria Yes No

7 Do not prevent patient dangerously 

8 Avoid misrepresentation of patient 

9 Do not endanger the patient's life due to 

negligence
10 Does not give life spirit 

11 Does not protect patient from attacks 

12 Do not do white collar in the health field 

No Criteria Yes No
1 Respecting the right to self-determination, 
respecting the dignity of patient.

2 Do not intervene in patient 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 

No Criteria 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) 
No Criteria 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. 
No Criteria 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.
Ethical Dilemma: Non maleficience vs Autonomy

Non maleficience: doctors recommend

hospitalization and immediate obstetricization to
prevent adverse effects on the mother and baby
Autonomy: the patient agrees to be hospitalized

Prima facia: Non maleficience

 Medical indication: 26-year-old female patient
presents with headaches, nausea and vomiting.
 Client preference: patients are competent in
making decisions.
 Quality of life: doctors recommend to be
hospitalized and immediately administer the
womb to prevent adverse effects on the mother
and baby.
 Contextual feature: the patient agrees to be
hospitalized
 Accountability: doctors recommend to be
admitted and catheterized
 Duty: the doctor does his job according to the
procedure
 Alturism: doctors serve professionally
 Respect for other: doctors respect patient
decisions
 Humanity: the doctor empathizes with the
patient and thus suggests hospitalization
 EXTRAORDINARY