Presentation

“Moral Basic Principle”

By:
Luh Kadek Permata Dwi Putri
17710069
RST MALANG D Groups

Medical Faculty
Wijaya Kusuma Surabaya University
 CASE 1
 A female patient aged 13 years came to the emergency room
accompanied by her father with an open wound on the heel of his
right foot after falling off a motorcycle. Physical and supporting
examinations were carried out by the doctor on duty when the
patient arrived at the ED and was diagnosed with Achilles Tendon
Rupture and Dextra Degloving Pedis.
 Then the doctor at the emergency department contacted an
orthopedic specialist to plan the surgery because the wound
appeared deep with a wound width of 5cm and a length of wound
10cm, making it difficult to do at the emergency room. However, the
patient's family refused to do the surgery because of the operating
costs and requested only wound handling and stitching on the
emergency room.
 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 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) 
 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

Non-Maleficence Autonomy

Prima Non-
Facie Maleficence
 ETHICAL PRINCIPLES
Non-Maleficence :
•The doctors gave the patient the best suggestion about
treatment so the patient didn’t suffer.

Autonomy:
•The patient has the right to determine his own decisions

Prima Facie
•Non-Maleficence
 4 box method
Medical Indications Client Preferences
• 13-year-old female had an accident • The patient is underage so she cannot make his
• The patient has an open wound on the right foot own decisions
• Doctors recommend the surgery because the • The patient's family make her decisions and
wound appeared deep with a wound width of 5cm refused to do surgery
and a length of wound 10cm.

Quality of Life Contextual Features

• The patient have to take surgery treatment. If she • Patients refused operation because of economic
doesn’t infection can happen. issues.
• And if the operation is carried scars will be gets
better.
 Professionalism
 Accountability: During the operation the doctor tries to make the best decision for
the patient
 Alturism: Doctors try to save the lives of patients
 Duty: Doctors do help according to emergency patient procedures
 Respect for other: Doctors value peer opinions
 Humanity: Doctors have empathy for patients
Ordinary OR Extraordinary

Ordinary
 CASE 2
 Mrs. R age 25 years come to the obstetric department with complaints of menstrual
disorders since 5 years ago and sometimes accompanied by abdominal pain during
menstruation and spread to the waist.
 the doctor then performs a thorough examination and diagnoses the patient with
ovarian cysts, so the doctor recommends the patient to do the surgery. The patient
rejects the recommendations given by the doctor for surgery because she is unable
to pay.
 However, patients only asked for therapy in the form of drugs to reduce symptoms,
so the obstetrician only gave a prescription in the form of oral medication for these
poor patients.
 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 √
 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:
The doctors gave the patient the best suggestion
about treatment so the patient didn’t suffer.

Autonomy :
The patient has the right to determine his choice and
the doctor must respects the patient's decision
 4 box method

Medical Indications Client Preferences

• A 25 yo, menstrual disorders and diagnosed • the patient can determine his decision
with ovarian cysts, doctor suggested to do the • the doctor has educated the patient but the
surgery patient still refused

Quality of Life Contextual Features

• The patient have to take surgery treatment. If • Patients refused operation because of
she doesn’t cysts will be enlarged. economic issues.
 Professionalism
 Accountability: Doctor advise patients to have surgery even though the patient
refuses the doctor to try to educate the patient
 Alturism: doctors try to provide the best actions for the health of patients
 Duty: The doctor act due to patient’s decision
 Respect for other: Doctor value the patient's decision
 Humanity: The doctor empathizes with the patient's condition
Ordinary OR Extraordinary

Extraordinary
Thank
You