A man 58 years old has heart disease came

to Probolinggo district general hospital. But He was

rejected by the hospital because he doesn’t have
a referral from health facilities grade 1 which is
puskesmas as BPJS new regulation. Then the family
of this patient take him to puskesmas for get a
referral. But, unfortunatelly, the patient past away
on the way to puskesmas.
 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
No Maleficence 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 √

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) √

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 √
 Ethical Dilemma

Non maleficent Autonomy

Non
Prima facie maleficent
Medical Indications Client Preferences
• A man 58 years old has heart disease. • the patient needs treatment as
• Patient life may be saved if they help soon as possible.
him on time.
• His case is a emergency case who need
• The patient have not an options
an medical treatment immadiately. except rush to puskesmas for the
referral.

Quality of Life Contextual Features

• the patient can be saved if he got a • He need an emergency treatment but
treatment immadiately. he doesn’t have a referral.
A little girl patient 5 years old suffering from
dengue fever. She is being treated at the Probolinggo
district general hospital but she placed at hospital
hallway because the hospital room is full. They said,
she will be moved when there is room available.
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
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 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 √
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 √

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

Justice Autonomy

Prima facie Justice

Medical Indications
• A little girl patient 5 years old
suffering from dengue fever. She
is being treated at the hospital,
but she placed at hospital
hallway because the hospital
room is full.
• They will be move her when
there is a room available.
Quality of Life
• the patient can rest more
comfortable if she move as soon
a possible to the hospital room
Client Preferences
• the patient hope a better
treatment and room.
• They (the hospital) explain
the room unavailability
clearly to them.
Contextual Features
• The hospital do the justice for all
their patient. The patient should
queued.