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BENEFICIENCE

KRITERIA
1.Mengutamakan altruisme
2. Menjamin nilai pokok harkat dan martabat manusia
3. Memandang pasien/keluarga/sesuatu tak hanya

YA

TIDAK

YA

TIDAK

sejauh menguntungkan dokter


4. Mengusahakan agar kebaikan/manfaatnya lebih
banyak dibandingkan dengan keburukannya
5. Paternalisme bertanggung jawab / berkasih sayang
6. Menjaga kehidupan baik minimal manusia
7. Pembatasan goal based
8. Maksimalisasi pemuasan kebahagiaan/preferensi
pasien
9. Minimalisasi akibat buruk
10. Kewajiban menolong pasien gawat darurat
11. Menghargai hak-hak pasien secara keseluruhan
12. Tidak menarik honorarium diluar kepantasan
13. Maksimalisasi kepuasan tertinggi secara
keseluruhan
14. Mengembangkan profesi secara terus menerus
15. Memberikan obat berkhasiat namun murah
16. Menerapkan Golden Rule Principle

NONMALEFICIENCE
KRITERIA
1.Menolong pasien emergensi
2. Kondisi untuk menggambarkan kriteria ini adalah

Pasien dalam keadaan amat berbahaya/beresiko

Dokter sanggup mencegah bahaya atau


kehilangan tersebut

Tindakan kedokteran tadi terbukti efektif

Manfaat bagi pasien > kerugian pasien dokter


3. Mengobati pasien yang luka
4. Tidak membunuh pasien (tidak melakukan
euthanasia)
5. Tidak menghina/mencaci maki/memanfaatkan pasien
6. Tidak memandang pasien hanya sebagai objek
7. Mengobati secara tidak proporsional
8. Tidak mencegah pasien dari bahaya
9. Menghindari misrepresentasi kehidupan pasien
10. Tidak membahayakan kehidupan pasien karena
kelalaian
11. Tidak memberikan semangat hidup
12. Tidak melindungi pasien dari serangan
13. Tidak melakukan white collar crime dalam bidang
kesehatan/kerumah sakitan yang akan merugikan
pihak pasien/ keluarganya

AUTONOMI
KRITERIA
1.Menghargai hak menentukan nasib sendiri,
menghargai martabat pasien
2. Tidak mengintervensi pasien dalam membuat
keputusan (pada kondisi elektif)
3. Berterus terang
4. Menghargai privasi
5. Menjaga rahasia pasien
6. Menghargai rasionalitas pasien
7. Melaksanakan informed consent

YA

TIDAK

8. Membiarkan pasien dewasa dan kompeten


mengambil keputusan sendiri
9. Tidak mengintervensi atau menghalangi autonomi
pasien
10. Mencegah pihak lain mengintervensi pasien dalam
membuat keputusan, termasuk keluarga pasien
sendiri
11. Sabar menunggu keputusan yang akan diambil
pasien pada kasus non emergensi
12. Tidak berbohong ke pasien meskipun demi
kebaikan pasien
13. Menjaga hubungan (kontrak)

JUSTICE
KRITERIA
1.Memberlakukan segala sesuatu secara universal
2. Mengambil porsi terakhir dari proses membagi yang
telah ia lakukan
3. Memberi kesempatan yang sama terhadap pribadi
dalam posisi yang sama
4. Menghargai hak sehat pasien
( affordabiality,equality,accessibility, availability,quality)
5. Menghargai hak hukum pasien
6. Menghargai hak orang lain
7. Menjaga kelompok yang rentan
8. Tidak melakukan penyalahgunaan
9. Bijak dalam makro alokasi
10.Memberikan kontribusi yang relatif sama dengan
kebutuhan pasien
11.Meminta partisipasi pasien sesuai dengan

YA

TIDAK

kemampuannya
12. Kewajiban mendistribusikan keuntungan dan
kerugian ( biaya, beban, sanksi) secara adil
13. Mengembalikan hak kepada pemiliknya pada saat
yang tepat dan kompeten
14.Tidak memberi beban berat secara tidak merata
tanpa alasan sah /tepat
15. Menghormati hak populasi yang sama-sama rentan
penyakit/ gangguan kesehatan
16. Tidak membedakan pelayanan pasien atas dasar
SARA, status sosial dll
KETERANGAN
A physician

B
+

accompanied patient
(1,2,3 )
when he was referred
for treatment here.
Physician had been
explained to patient
that there was no
+
problem
and
we
would provide the (3,4,5,9
facilities
for
the )
surgical intervention
Patient refused to
be treated by
physician
Physician advised
the patient and his
family that if no
intervention
was
performed,
the
configuration of the
patients knee would
change,
and
this
would
result
in
disturbance of his
movement.
There
would also be some
pain if the patient
took a long walk.
There would be posttrauma arthritis. A
deformity
would

NM
+

(3,5,6)

(6,9,10

(3,12)

+
(7)

occur which would


cause the patient to
walk unsteadily.
Patient
remained
adamant even though
he was advised about
all these things.
Patient asked to be
sent to a place to be
treated by a famous
traditional healer. His
family agreed with
him
Physician
was
unable
to
change
their
minds,
so
physician left it to
them to decide.

(1,2,6,8,9,11,13

(1,3,4,6,8,16

3. Metode Pendekatan Johnson Sigler


MEDICAL INDICATION
The Principles of Beneficience and Nonmaleficience
1. What is the patients medical problem ? history? diagnosis ?
prognosis?
2. Is the problem acut ? chronic ? critical ? emergent ? reversible ?
3. What are the goal of treatment ?
4. What are probabilities of success?
5. What are the plans in case of therapeutic failure?
6. In sum, how can this patient be benefited by medical and nursing
care, and how harm be avoided ?
PATIENT PREFERENCES
The Principle of Respect for Autonomy
1. Is the patient mentally capable and legally competent ? Is there
evidence of incapacity ?
2. If competent, what is the patient stating about preferences for
treatment ?

3. Has the patient been informed of benefits and risks, understood this
information and given consent
4. If incapasitated who is the appropriate surrogated? Is the surrogated
using appropriated standars for decision making ?
5. Has the patient expressed prior preferences, e.g Advance Directives
?
6. Is the patient unwilling or unable to cooperate with medical
treatment? If so, why?
7. In sum, is the patients right to chooce being respected to the
extent possible in ethics and law?

QUALITY OF LIFE
The Principles of Beneficience and Nonmaleficience and Respect for
Autonomy
1. What are the prospects, with or without treatment for areturn to
normal life ?
2. What physical, mental and social deficits is the patient likely to
experience if treatment succeeds ?
3. Are there biases that might prejudice the providers

evaluation

of the patients quality of life?


4. Is the patients present or future condition such that his or her
continued life might be judge undesirable ?
5. Is there any plan and rationale to forgo treatment ?
6. Are there plans for comfort and palliative care ?
CONTEXTUAL FEATURE
The Pinciple of Loyality and Fairness
1. Are there family issue that might influence treatment decisions ?

2. Are there provider ( physician and nurses ) issue that might


influence treatment decision ?
3. Are there financial and economic factor ?
4. Are there religious or culture factors ?
5. Are there limits on confidentiality?
6. Are there problems of allocation of resources ?
7. How does the law affect treatment decisions ?
8. Is clinical research or teaching involved ?
9. Is ther any conflict of interest on the part of the providers or the
institution ?