CASE 1

◦ A 69 Years – old women came to emergency room. The patient told the
doctor she have protusion falling out of her anus since a week ago, and the
protusion is can’t back to the inside. Because of that patient can’t poop
since the last few days. The doctor had done physical examination and
diagnosed that she had rectal prolapse. The doctor suggest him to do the
surgery, but the patient refused it because she afraid do the surgery, even
her daughter persuade her but she still refused it.
 Beneficence
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
 Beneficiene
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   √

2 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 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     
 Non Maleficence
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    √
 Autonomy
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.
 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. √
 Justice
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 √

 Ethical
Dilemma

beneficence Autonomy
 Ethical Priciples
Beneficence : Doctor give the therapy for patient health
and advising patients for the surgery

Autonomy : the patient has the right to determine her

choice and the doctor respects the patient's decision

Primafacie : Autonomy
 4 box method
Medical Indications Client Preferences
• 69-year-old women had pertusion out of • The patient can determine her own
her anus. Diameter 12x5cm decision
• Patient had a rectal prolapse (chronic) and • The doctor educated the patient but she
the doctor advise him to do surgery still refused it.

Quality of Life Contextual Features

it can prevent complications in the future if • The patient is afraid doing the surgery
she agree do the surgery
 Professionalism
Accountability: Doctor advise patients to do
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: Doctor is following the procedure
Respect for other: Doctor value the patient's
decision.
Humanity: The doctor empathizes with the
Ordinary Extraordinary

Extraordinary
THANKYOU