DIANITA ARIANI

17710030
RST SOEPRAOEN MALANG

SMF ILMU KEDOKTERAN FORENSIK

FAKULTAS KEDOKTERAN WIJAYA KUSUMA SURABAYA
RUMAH SAKIT UMUM DAERAH SIDOARJO
2018
 A 50 year old woman enters the emergency room with stomach pain.
She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm,
a weakening in the wall of the aorta which causes it to stretch and bulge. The
physicians inform her that the only way to fix the problem is surgically, and
that the chances of survival are about 50/50. They also inform her that time is
of the essence, and that should the aneurysm burst, she would be dead in a few
short minutes. The woman is an erotic dancer; she worries that the surgery will
leave a scar that will negatively affect her work; therefore, she refuses any
surgical treatment. Even after much pressuring from the physicians, she
adamantly refuses surgery. Feeling that the woman is not in her correct state of
mind and knowing that time is of the essence, the surgeons decide to perform
the procedure without consent. They anesthetize her and surgically repair the
aneurysm. She survives, and sues the hospital for millions of dollars.
 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. Restriction 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 √

Criteria Yes No
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).
Treat injured patient √
Do not kill patient (do not do euthanasia) √
Not insulting √
Do not view patient as objects √

Treating disproportionately √
Criteria Yes No
Do not prevent patient dangerously √
Avoid misrepresentation of patient √
Do not endanger the patient’s life due to √
negligence

Does not give life spirit √

Does not protect patient from attacks √
Do not no white collar in the health field √
 Criteria yes No
Respecting the right to self-determination, respecting the √
dignity of patient.
Do not intervene in patient in making decisions (under √
elective conditions)
Put on the line √
Appreciate privacy. √
Keep personal secrets √
Appreciate patient rationality. √
Carry out informed consent √
Allowing adult patients and competent to make √
their own decisions.
Do not intervene or obstruct patient autonomy. √
Prevent other parties from intervening in patients √
and making decisions, including, including
the patient's own family.
Patiently waiting for the decision to be taken by √
the patient in a non-emergency case.
Don't lie to the patient even for the benefit of the √
patient.
Maintain relationship (contract) √
 Criteria Yes No
Enact everything universally √
Take the last portion of the dividing process he √
has done.
Giving equal opportunities to individuals in the √
same position.
Respecting patients' health rights (affordability, √
equality, accessibility, availability, quality)
Appreciate the legal rights of patients. √
Respect the rights of others. √
Maintain vulnerable groups (the most √
disadvantaged)
Do not abuse. √
Wise in macro allocations. √
Provide a contribution that is relatively the same √
as the patient's needs
Request patient participation according to ability. √
The obligation to distribute profits and losses √
(costs, expenses, sanctions) fairly
Return rights to the owner at the right time and √
competent.
Does not give heavy burden unevenly without √
valid reasons
Respect the rights of the population who are √
equally susceptible to diseases / health
problems.
Does not distinguish patient services on the basis √
of SARA, social status etc.
 Beneficience
VS
Non- Maleficence

From a beneficence perspective, the physicians suggest a

surgery as a procedure that be provided with the intent of doing good
for the patient involved.
From a non-maleficence perspective, the physicians didn’t do
anything that would purposely harm patient as the surgery had been
done successfully and certainly improve the patient’s life.
Beneficence
Doctors still responsible enough to be aware of the
Accountability
negligence and still decided to run the surgery.

Selfish concern to the welfare of patient Alturism

The doctor empathizes with the patient's condition Humanity

Doctors endured unavoidable risks to oneself when a

Duty
patient’s welfare is at stake.

Doctors didn’t respect the patient’s rights to choose Respect for

whether they’d like to get the treatment or not. Other
 Client Preferences
Medical Indication
The patient refused to get
treatment (surgery) due to
Patients with a stomach pain. The
her profession even the
diagnosis is Aorta Abdominal
physicians already tried to
Aneurysm.
explain and told her it’s a
life-threatening condition.
Quality of Life
Contextual Features
The prognosis is usually good
The patient is concerned how
if the AAA is found before it
the scar from the surgery
ruptures. The surgery may take
would affect her profession.
up to 2 or 6 weeks to recover.
 Ordinary care; legal decision – competent
adults have the right to refuse even lifesaving
treatment involving ordinary care under the
right of bodily integrity and intangibility.
 A 17-year-old boy was severely injured when he jumped from a
moving train and was caught and dragged 80 ft by an iron step protruding from
behind the train car. The boy suffered a crushed elbow joint and a 2-to-3-in
scalp laceration from which he was bleeding profusely. The boy was
subsequently brought to the operating room and anesthetized so that the
physicians could stop the bleeding from the scalp wound. While the boy was
under anesthesia, the physicians determined that the boy’s arm needed to be
amputated because of the immediate danger it posed to his life. After the arm
was amputated, the boy and his parents brought suit against the physicians
based on the theory that the procedure was performed without their informed
consent.
 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. Restriction 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 √

Criteria Yes No
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).
Treat injured patient √
Do not kill patient (do not do euthanasia) √
Not insulting √
Do not view patient as objects √

Treating disproportionately √
Criteria Yes No
Do not prevent patient dangerously √
Avoid misrepresentation of patient √
Do not endanger the patient’s life due to √
negligence

Does not give life spirit √

Does not protect patient from attacks √
Do not no white collar in the health field √
 Criteria yes No
Respecting the right to self-determination, respecting the √
dignity of patient.
Do not intervene in patient in making decisions (under √
elective conditions)
Put on the line √
Appreciate privacy. √
Keep personal secrets √
Appreciate patient rationality. √
Carry out informed consent √
Allowing adult patients and competent to make √
their own decisions.
Do not intervene or obstruct patient autonomy. √
Prevent other parties from intervening in patients √
and making decisions, including, including
the patient's own family.
Patiently waiting for the decision to be taken by √
the patient in a non-emergency case.
Don't lie to the patient even for the benefit of the √
patient.
Maintain relationship (contract) √
 Criteria Yes No
Enact everything universally √
Take the last portion of the dividing process he √
has done.
Giving equal opportunities to individuals in the √
same position.
Respecting patients' health rights (affordability, √
equality, accessibility, availability, quality)
Appreciate the legal rights of patients. √
Respect the rights of others. √
Maintain vulnerable groups (the most √
disadvantaged)
Do not abuse. √
Wise in macro allocations. √
Provide a contribution that is relatively the same √
as the patient's needs
Request patient participation according to ability. √
The obligation to distribute profits and losses √
(costs, expenses, sanctions) fairly
Return rights to the owner at the right time and √
competent.
Does not give heavy burden unevenly without √
valid reasons
Respect the rights of the population who are √
equally susceptible to diseases / health
problems.
Does not distinguish patient services on the basis √
of SARA, social status etc.
 Beneficience
VS
Non- Maleficence

From a beneficence perspective, the physicians did the

surgery after knowing the fact that the condition was endangered
patient’s life.
From a non-maleficence perspective, the physicians acted
with skilled judgment by deciding to do the surgery and amputate the
arm.
Beneficence
Doctor’s accountability to one’s patients and to their families also to
the profession to ensure that the ethical precepts of practice are Accountability
upheld.

Doctor concerned to the welfare of patient Alturism

The doctor empathizes with the patient's condition Humanity

Doctors endured unavoidable risks to oneself when a

Duty
patient’s welfare is at stake.

Doctors didn't respect the patient’s rights due to Respect for

emergency situation. Other
 Medical Indication Client Preferences

Patients with severely injured The patient cannot determine

with a crushed elbow joint and scalp his choice regarding his
laceration. condition.

Contextual Features
Quality of Life
The patient and his family are
The patient's life is improved
furious by the fact that the
even he had one of his hand
doctor did the procedure
amputated.
without their consent.
 Morally the patient might feel free to
refuse surgery but legally it would probably be
ordinary care which would be lifesaving, and the
surgery to treat his injuries may be done
without his consent because they were incurred
as a result of a emergency situation.