ILMU KEDOKTERAN FORENSIK

DAN MEDIKOLEGAL

PEMBIMBING
DR MEIVY ISNOVIANA, S.H, M.H
OLEH
THOM L. S. D.
19710004
CASE 1
A 45-year-old female patient came to the ER of Tuban
Hospital with her child. The patient has advanced stage
breast cancer. Previously the patient had surgery at the
hospital x, but the patient's family stopped treatment
because of cost reasons. Doctors recommend
chemotherapy, but the patient's family cannot afford
expensive chemotherapeutic treatment, but the patient's
child wants his mother to get further treatment. The doctor
explained to the patient's child that his mother's condition
was not good and the possibility of recovery was very small
so the doctor decided to give supporting drugs so that the
patient did not suffer.
Beneficence :
Doctors have suggested doing chemotherapy.
Autonomy :
The doctor explained the condition of the patient's illness to the family that
the possibility of recovery was very small, but the patient and his family still
asked not to do chemotherapy because of the cost. Doctors respect the
patient's choice not to do chemotherapy.
Prima Facie : Autonomy
 BENEFICENCE
Kriteria Ada Tidak Ada
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 √

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 BENEFICENCE

Kriteria Ada Tidak Ada

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 √

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 NON-MALEFICENCE
Tidak
Kriteria Ada
Ada
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 √

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 Kriteria Ada Tidak Ada
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 √

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 AUTONOMY
Kriteria Ada Tidak Ada
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.

8
 Kriteria Ada Tidak Ada
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) √

9
 JUSTICE
Kriteria Ada Tidak Ada
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
√

10
 Kriteria Ada Tidak Ada
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. √

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 4 BOX METHODE OF CLINICAL ETHIC
Medical Indication Client Preference

A 45-year-old female patient

came to the emergency room at
Tuban Hospital with her family In making decisions, patients
accompanied by advanced stage discuss with their families. The
breast cancer. Doctor B family involved is the patient's
recommends doing child.
chemotherapy.

Quality of Life Contextual Features

The patient is classified as a

family from underprivileged,
Poor, because patients refuse
because he refuses to do
chemotherapeutic measures and
chemotherapeutic due to being
are less likely to recover.
unable to buy chemotherapeutic
drugs.

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KEY PRINCIPLES OF PROFESIONALISM
Accountability :
The doctor explains about the patient's condition.
Duty : The doctor performs the examination
according to the procedure
Alturims : Doctors put the interests of patients
first
Humanity : The doctor empathizes with the
patient so the doctor advises the family to do
chemotherapy.
Respect to each other : Doctors respect the rights of patients.

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CASE 2
A 21-year-old woman with complaints of not having
menstruation for two months. Usually menstruation is
regular, but since the last three months always in pain during
menstruation. After examination, it is known that the patient
has cervical cancer. Doctors recommend to be referred to
hospitals that have more complete facilities to get further
therapy to prevent complications, but patients refuse out of
fear and only want to be treated at home. Finally the patient
came home after the patient's mother signed the rejection of
the action. And only get pain medication.
 BENEFICIENCE

KDB 1 BENEFICENCE
Kriteria Ada Tidak ada
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
Kriteria Non-Maleficience Ada Tidak ada
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 
 AUTONOMY
Kriteria Ada Tidak ada

KDB 3 AUTONOMI 
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) 
Kriteria
JUSTICE
Ada Tidak ada
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
Dilema etik : Beneficience vs Autonomi

Beneficience :
The doctor's action suggested to be referred to a hospital with
more complete facilities to get further therapy to prevent
complications

Autonomi :
Patients can make their own decisions

Prima fasia : Autonomi

 4 BOX METHOD
Medical indication :
• 20-year-old female patient presents with no menstruation for 2 months
and has been diagnosed with cervical cancer.
• It’s not emergency but chronic
• The goal is giving medicine to minimize the pain.
Quality of life :
• Patients can be saved from medication to minimize pain except that the
chances of a cure are low.
• Patients after treatment can relieve the pain felt.
Client preference : the doctor suggested to be referred to a hospital with
more complete facilities to get further therapy to prevent complications but
the patient refused because he was afraid and signed a letter of refusal of
action.
Contextual feature : the patient is afraid of undergoing therapy and so
refuses to be referred
 PROFESIONALISM
Accountability : the doctor suggested to be referred to the
hospital
Duty : doctors do according to procedure
Alturism : doctors serve professionally
Respect for other : the doctor respects the patient's decision
Humanity : the doctor empathizes with the patient so it is
recommended to be referred to the hospital to prevent
complications

extraordinary
THANKYOU