TUTORIAL REPORT

BIOETHIC, HUMANITIES & PROFFESIONALISM BLOCK

Makassar, January 11th 2016

2nd Modul
ETHIC DILLEMA

Left Gauze led to Osteomyelitis

Members of group 15 :
INNAL HAMDA
NISRINA NUR AZISAH
DIAH RINDAYANI HASBI
ALVI KAMAL FIKRI
MAFTUHATUL AFIAH
DESI TRIUTAMI SALEH
DONITA RIAN UTAMI
MUHAMMAD FUAD ALAMSYAH
A. MUH. FADILAH M.
GITA REFINA RAHMADINI
MUHAMMAD FAUZAN
Tutor: dr. Lisa Yuniaty, SpKK, M. Kes
MEDICAL FACULTY
MUSLIM UNIVERSITY of INDONESIA
MAKASSAR
2016

(110 2015 0019)

(110 2015 0026)
(110 2015 0028)
(110 2015 0043)
(110 2015 0061)
(110 2015 0068)
(110 2015 0080)
(110 2015 0113)
(110 2015 0126)
(110 2015 0130)
(110 2015 0151)

Preface
Thanks to the Allah the Almighty, we pray over abundance of grace, bless,
and His guidance so this Problem Based Learning (PBL) report from group 15th
can be resolved properly. And we also send greetings and blessings to our master
the Prophet Muhammad SAW which has brought us from a state of ignorance to a
state of intelligence.
We also would like to thanks to all those who helped in the creation of this
report and who helped during TUTORIAL especially to dr. Lisa Yuliati, SpKK,
M.Kes who have helped during the PBL process. And we also would like to
apologize to any part of the PBL process has done wrong either intentionally or
unintentionally.
Hopefully this TUTORIAL report can be beneficial to anyone who read
this report and especially for his own drafting team. Our hope is that readers can
broaden their knowledge of the Humanities, Ethics and Medical Professionalism.
Makassar, January 11rh 2016
Group15

A. SCENARIO

Left Gauze led to Osteomyelitis

Parjo came to the Remen Waras Hospital because he had fractures in
femur. Doctor Ndang Sun Tiken, Sp.B who handle these cases, is the only
surgeon in the Sarwo Saras City. Parjo scheduled operations, through routine
procedures the hospital, informed consent was signed by Parjo himself. Parjo
very aware of what he signed. Before operated Parjo at 10:00, dr. Ndang Sun
Tiken already done three elective surgery one cito operation. In the evening
dr. Ndang Sun Tiken operated two operations cito. Parjo repositioning
operation has been successful, from post-operative x-rays, the pen has been
stuck in the right place, the alignment of the bones has been as expected.
Parjo after recovery and adequate care ward could eventually repatriated.
There has not been a week, at a surgical site, at any time there is always pus
come out, and made the wound dressings are always replaced.
Parjo intends to control again to Remen Waras Hospital, but he found
the queue was so long, and he already wait from 8:00 until 11:00, but Doctor
Ndang Sun Tiken, Sp.B not come. He asked the nurse clinic several times, but
always the answer is still operating. Because he felt uncomfortable with his
condition, and uneasy with the people looking that seems disgusted to see his
thighs, Parjo and his family decided to check themselves into Arto Wedi
Hospital that is located hundreds of kilometers from their home.
Entering Arto Wedi Hospital, with higher costs, Parjo directly examined
by dr.Hangabehi, SpBO.FICS. Orthopedist who has been known far beyond
the region. By dr.Hangabehi, Parjo immediately conducted a routine
procedure, x-ray and immediately re-scheduled operations. Back conducted
routine procedures, including the informed consent was signed and Parjo
fully aware of what he was doing. Generally, the condition Parjo well ahead
of the operation.

Only from previous surgery wounds are continually flowing pus.

Finally, debridement surgery to address the pus that constantly flows from the
bone diagnosed with osteomyelitis done. During debridement is performed
how surprising faced dr.Hangabehi operations team, they found the gauze left
behind in the bones that have been repositioned. Thanks to God the bones still
unite.
The patient's family wants to know why this such a bad luck
happened to Parjo. Dr.Hangabehi, SpBO.FICS forced to explain that this is all
because of the gauze is left behind in the space between the bones and
muscles. Hearing that, Parjos family get mad and did not accept the dr.
Ndang Sun Tiken and his teams performances. They agreed to do a subpoena
with a letter to the doctor's alleged malpractice dr. Ndang Sun Tiken along
with the director of the Remen Waras Hospital through their legal
representatives Gawe Hurricane SH. They are demanding compensation of $
1 billion over the material and immaterial losses suffered.

B. DIFFICULT WORD CLARIFICATION and KEYWORD

Difficult Word
1. Cito Operation
A surgical procedure that cannot be delayed or emergency operation, for
which there is no alternative therapy or treatment, and for which a delay
could result in death or permanent impairment of health
Examples Open fracture of skull, some gunshot and stab wounds,
extensive burns, urinary obstruction, intestinal obstruction, ruptured
appendix, twisted ovarian cyst, ruptured fallopian tube
Reference : medical-dictionary.thefreedictionary.com
2. Osteomyelitis
Osteomyelitis refers to a bone infection, almost always caused by bacteria.
Over time, the result can be destruction of the bone itself.
Reference : medical-dictionary.thefreedictionary.com
3. Elective Operation
Elective surgeries may extend life or improve the quality of life physically
and/or psychologically. Cosmetic and reconstructive procedures, such as a
facelift (rhytidectomy), tummy tuck ( abdominoplasty ), or nose surgery (
rhinoplasty ) may not be medically indicated, but they may benefit the
patient in terms of raising self-esteem. Other procedures, such as cataract
surgery, improve functional quality of life even though they are technically
an "optional" or elective procedure. Some elective procedures are
necessary to prolong life, such as an angioplasty . However, unlike
emergency surgery (e.g., appendectomy ), which must be performed
immediately, a required elective procedure can be scheduled at the
patient's and surgeon's convenience.
Reference : Surgeryencyclopedia.com
4. Debridement Operation

This is the process of removing damaged or dying tissue surgically. In this

case, a surgeon visually inspects the tissue, determines what tissue is
viable, and removes the tissue that is not salvageable.
Reference : Surgery.about.com
5. Pen
Pen point for fixing between two parts of a broken bone. Mounted directly
to the bone using screws. Will be released when the bones are connecting
perfectly.
Reference : Meetdocter.com
6. Subpoena
An order directed to an individual commanding him to appear in court on
a certain day to testify or produce documents in a pending lawsuit. A
process to cause a witness to appear and give testimony, commanding him
to lay aside all pretenses and excuses, and appear before a court or
magistrate therein named, at a time therein mentioned, to testify for the
party named, under a penalty therein mentioned. This is usually called a
subpoena ad testificandum.
Reference : The law dictionary
Key words
1. Parjo came to the Remen Waras Hospital because he had fractures in
femur
2. Informed consent was signed by Parjo himself and he very aware of what
he was doing
3. Parjo repositioning operation has been successful, from post-operative xrays, the pen has been stuck in the right place, the alignment of the bones
has been as expected
4. Parjo already waited from 8:00 until 11:00 , but Doctor Ndang Sun Tiken,
Sp.B not come

5. Entering Arto Wedi Hospital, with higher costs, Parjo directly examined by
dr.Hangabehi, SpBO.FICS
6. Finally, debridement surgery to address the pus that constantly flows from
the bone diagnosed with osteomyelitis done
7. Dr.Hangabehi, SpBO.FICS forced to explain that this is all because of the
gauze is left behind in the space between the bones and muscles
8. Parjos family upset and decided to do a subpoena with a letter to the
doctor's alleged malpractice dr. Ndang Sun Tiken along with the director
of the Remen Waras Hospital

C. Identification of Problems
Questions:
1. Summarized the dilemma etic center based on scenario!
2. From scenario above, try to analyze according to:
a. Base principle of Bioethic and Prima Facia (use characteristics
table of base principle of Bioethic)
b. Clinical ethic Jonson Siegler Winslad (Use Jonson Siegler
Winslads ethical questions Four Box)
3. How the Islamic perspectives (ethic in Islam) based on case above?
Answer:
1. Summarized the dilemma etic center based on scenario!
The dilemma ethics from the scenario is ,Mr.parjo had fractures in
the femur and done his operation in Remen Waras Hospital by Doctor
Ndang Sun Tiken but something happened after operation which he felt
annoyed by this. Parjo then decided to check up, he has waited for the
doctor from 08:00 until 11:00. But he cant meet the doctor because the
doctor is still doing operation. He then went to another hospital and done
debridement surgery. The surgery was successful, but his family want to
know why Parjo can have Osteomyelitis. Dr.Hangabehi, SpBO.FICS
forced to explain that this is all because of the gauze is left behind in the
space between the bones and muscles during Parjos femur operation.
Hearing that, Parjos family get mad and did not accept the dr. Ndang Sun
Tiken and his teams performances. They then agreed to do a subpoena
with a letter to the doctor's alleged malpractice dr. Ndang Sun Tiken along
with the director of the Remen Waras Hospital.

2. From scenario above, try to analyze according to:

a.

Base principle of Bioethic and Prima Facia (use characteristics

table of base principle of Bioethic).

DISCUSSION 1 :
BASIC RULES BIOETHICS I (ALTRUISM IN PRACTICE)
BENEFICENCE
Criteria

Exist

1) Prioritizing altruism is helped

without

profit,

willing

to

Not

Analysis
Yes, it is existing in the
scenario.

sacrifice for others interest

Where

the

doctor done the operation,

while

based

on

the

scenario we see that even

if

Doctor Ndang Sun

Tiken, Sp.B having and

tired

with

with

his

operations, but he still

done the operations. Which
mean that d.Ndang Sun
Tiken

still

done

his

obligation as doctor to
make sure that the patient
safety is as doctors first
2) Ensure the principal value

human dignity.

priority.
Yes, it is existing in the
scenario. Because based
on scenario, the doctor
helping

the

patient

without

seeing

the

patients background and

ensuring

the

principal

value human dignity.

3) Looking at the patient /
family / something not only

From the scenario we see

that

dr.Hangabehi,

profitable physician.

SpBO.FICS

done

the

surgery and he also saw

the patient / family / as
something not profitable
for him (patient as object)
but also for the patient
health.
4) Ensuring that goodness /

benefit more

Yes, it is existing in the

scenario. Where that both
doctor trying to ensuring

compared to the worsen

the

goodness

patient

by

of

the

done

the

surgery as their obligation

to the patient.
5) Paternalism responsible /

compassion

Yes, it is existing in the

scenario. Where that the
dr.Hangabehi wanted to
taking responsibility and
also giving compassion to
the patient. Paternalism
actually not exist in the
scenario because we do
believed that there is a
informed
back

6) To ensure minimal human

life-good-

consent

clash

with

that
the

essence of paternalism.
Yes there is exist in the
scenario

where

the

purpose of the surgery is

to

ensuring

good

healthy live of patient.

and

7) restriction goal-based.

No there is not exist in the

scenario where goal based
is not restricted by the
doctor and the patient.

8)

Maximization

satisfying

Yes there is exist in the

happiness / patient preferences..

scenario where the second

doctor giving satisfying to

9) Minimize bad consequences

the patient.
Yes there is exist in the

scenario where the doctor

Minimize
10) The obligation to help
patients

department

consequences
Yes there is exist in the

scenario where because

emergency.

the doctor The obligation

to

11)

Respect

bad

the

rights

of

help

patients

department - emergency.
Yes there is exist in the

patients overall

scenario where the second

doctor Respect the rights
of

patients

letting
12) Not interesting honorarium

beyond decency..

overall satisfaction

him

by

having

subpoena in law.
No there is not exist in the
scenario where the doctor
did

13) Maximization of the highest

overall

not

accept

extra

budget
Yes there is exist in the
scenario where the second
doctor doing the surgery
with all his power and
skill so the operation was

14)

Develop

the

profession

continuously
15)

Provide

successful.
No there is exist in the
scenario

efficacious

but

inexpensive medicine

No there is exist in the

scenario

16) Apply the Golden Rule

Yes there is exist in the

Principle

scenario where the doctor

doing the operation and
Apply the Golden Rule
Principle.

DISCUSSION 2 :
BASIC RULES BIOETHICS 2 ( DO NO HARM IN EMERGENCY SITUATION
AND CLINICAL PRACTICE )
NONMALEFICENCE

Characteristic
1)

Helping

emergency.

Exist
the

patient

Not

Analysis
Yes, it is exist in the
scenario

where

the

doctor

Helping

emergency

patients

exist because in the

scenario described that
dr. Hangabehi help Mr.
Parjo that in emergencies
where there is infection
in the femur because of
lagging gauze in it

2) Conditions to illustrate these

Yes, it is exist in the

criteria are: the patient is in a

scenario where As in the

very dangerous or at risk of loss

scenario described that

of something essential (critical),

dr. Hangabehi has saved

doctors could prevent hazards or

Mr. Parjo are in a state of

loss of the action of medicine that

emergency

proven

to

be

effective,

the

benefits for patients> loss doctor

or suffered only minimal risks.
3)

Treating

patients

with

wounds.

Yes, it is exist in the

scenario where As in the
scenario described that
dr.

Hangabehi

treating

wounds

been
Mr.

Parjo although dr. Ndang

Sun Tiken was negligent
in helping Mr. Parjo

4) Do not kill the patient (not

perform euthanasia).

Yes, it is exist in the

scenario where As has
been described in the
scenario

that

dr.

Hangabehi have saved

the lives of Mr. Parjo
although dr. Ndang Sun
Tiken was negligent but
he was trying to help Mr.
Parjo

5) Do not insult / berate / harness

patient.

the scenario

6) Do not look at the patient only

as an object.
7) Treating disproportionately.

No, it doesnt exist in

No, it doesnt exist in

the scenario

Yes, it is exist in the

scenario where As in the
scenario described that
dr. Endang Sun Tiken
help Mr. Parjo with the
maximum not so behind
the screen in the femur of
Mr. Parjo

8) Do not prevent the patient

from harm.

Yes, it is exist in the

scenario where as in the
scenario described that
dr. Endang Sun Tiken not
prevent

Mr. Parjo

in

danger by not resolve the

problem
9) Avoid misrepresentation of

patients.

Yes, it is exist in the

scenario where As in the
scenario described that
Mr.

Parjo

clearly

been
what

told
has

happened to him by dr.

Hangabehi

so

no

misrepresentation
10) Do not endanger the lives of
patients due to negligence.

Yes, it is exist in the

scenario where As in the
scenario described that

there were omissions by

dr. Ndang Sun Tiken and
cause

Mr.

Parjo

increasingly serious
11) Do not give the spirit of life.

No, it doesnt exist in

12) Does not protect the patient

the scenario
No, it doesnt exist in

from attacks.
13) Not doing white collar crime

the scenario
Yes, it is exist in the

in the areas of health / home

scenario. Where there is

sickly that harm the patient and

no any financial crime

family.

DISCUSSION 3 :
BASIC RULES BIOETHICS 3 (PATIENT AUTONOMY ON VARIOUS
SITUATION)
AUTONOMY
Characteristic
1) Respect the right of self-

Exist

Not

Analysis
Yes,

it

is

exist

in

the

determination, respect the dignity

scenario where the doctor

of the patient.

Respect the right of selfdetermination,

respect

the

dignity of the patient by

giving the patient informed
consent

2) Do not intervene patients in

Yes,

it

is

exist

where

in

the

In

the

making decisions (on condition

scenario

elective).

scenario, patient (Parjo) took

his own decision

3) Forthright.

Yes,

it

is

exist

in

the

scenario where There is exist

in

scenario,

dr.Hangabehi

explain to patient about his

condition about gauze left in
his body
4) Respect the privacy.

Yes,

it

scenario
scenario

is

exist

where
tell

in

the

In

the

dr.Hangabehi

perforce to explain about

Parjos
5) Keep the secret patient.

family.
Yes, it

condition
is

exist

to

his

in

the

scenario where Theres exist

in the scenario, Parjos family
want to know what happen to
the parjo, not very perforce
dr.Hangabehi explain it.
6) Respect rationality patients.

Yes,

it

is

exist

in

the

scenario where the doctor

giving the patient clue where
the patient wanted to doing
the operation or not
7) Carry out informed consent.

Yes,

it

is

exist

in

the

scenario where Theres exist

in the scenario, Parjo knows

with what he handwrite.

8) Allowing competent adult

Yes,

it

patients and taking his own

scenario.

decisions.

handwrite

is

exist

in

Where
the

the

patient
informed

consent, make control to the

hospital.
9) Do not intervene or impede the

autonomy of the patient.

Yes,

it

is

exist

in

the

scenario where he patient

got informed consent.

10)

Preventing

other

parties

Yes,

it

is

exist

in

the

intervened patients in making

scenario where the doctor

decisions, including the patient's

and patient family giving

own family.

total responsibility to the

11) Patient waiting for a decision

patient to taking decision.

Yes, it is exist in the

to be taken in case of non-

scenario where at the very

emergency patients

first time patient have to

12) Do not lie to a patient even

though the patient's sake

earn informed consent.

Yes, it is exist in

the

scenario,

dr.

where

Hangebehi be honest to the

patient explain about Parjo
condition when dr.Hangabehi
found the gauze left in parjo
body to his patient and
family.
13) Maintain the relationship
(contract).

Yes,

it

is

exist

in

the

scenario where there is a

relationship between patient

and doctor

DISCUSSION 4 :
BASIC RULES BIOETHICS 4 (JUSTICE PRINCIPLE IN DOCTOR
PATIENT RELATION CONTEXT)
JUSTICE
Criteria

Exist

1) Put into everything universally.

Not

Analysis
Yes, it is exist in the
scenario

where

this

hospital

making

its

services

universally

with no discrimination
to the patient
2) Take the last portion of the

Yes, it is exist in the

process of dividing what he had

scenario where another

done.

doctor

doing

the

operation while this first

doctor who doing the
operation is too busy to
continue and meet to his
3) Giving equal opportunity to the

person in the same position.

patient
Yes, it is exist in the
scenario

where

the

doctor accept the patient

and healing them giving
4) Respect the rights of healthy

them treatment equally.

Yes, it is exist in the

patients (affordability, equality,

scenario

accessibility,

doctor Respect the rights

availability,

and

where

the

quality).

of

healthy

patients

(affordability,

equality,

accessibility, availability,
and quality).
5) Respect the legal rights of

Yes, it is exist in the

patients.

scenario where Respect

the

legal

rights

of

patients by letting the

patient having subpoena
in law to have the doctor
6) respect rights of others.

responsibility.
Yes, it is exist in the

scenario

where

the

treatment giving equal

and also there is queue
up
7) Maintain vulnerable groups

(most disadvantaged).

to

have

the

treatment.
No, it doesnt exist in
scenario. Where there is
no Maintain vulnerable
groups

8) Do not commit abuse.

(most

disadvantaged).
No, it doesnt exist in
scenario. Where there is

9) Wise in the macro allocation.

not commit abuse.

No, it doesnt exist in
scenario. Where there is
macro allocation.

10) To contribute relatively the

same as the needs of the patient.

Yes, it is exist in the

scenario
doctor

where

the

contribute

relatively the same as the

needs of the patient.

11) Ask for the participation of

Yes, it is exist in the

the patient according to his

scenario

ability.

informed consent giving

12) The obligation to distribute

to the patient
Yes, it is exist in the

advantages

and

where

disadvantages

scenario where there is a

(costs, charges, and penalties) are

justice to the patient by

fair.

the

13) Restore the rights to its owner

existence

of

informed consent
Yes, it is exist in the

at the right time and competent.

scenario where human

have right to having a

14) Do not place heavy demand is

not evenly without valid reason /

healthier life.
No, it doesnt exist in
scenario.

right.
15) Respect the rights of the

population are equally vulnerable

16) do not discriminate on the

No, it doesnt exist in

scenario.

Yes, it is exist in the

basis of patient care SARA,

scenario where all the

social status, etc.

treatment and service

giving by the doctor is
balance

and

do

not

discriminate on the basis

of patient care SARA,
social status, etc.

b.

Clinical ethic Jonson Siegler Winslad (Use Jonson Siegler

Winslads ethical questions Four Box)!

MEDICAL INDICATION
NO

ETHICS QUESTION

ANALYSIS

What is the patient's

Patient (Parjo) diagnosed with Osteomyelitis

medical problems?

that caused by left gauze in previous surgery.

History ? Diagnosis?

Patients (Parjo) hospital sheet showed that he

Prognosis?

had femur fracture.

According to (source) with early diagnosis and
appropriate

treatment,

the

prognosis

for

osteomyelitis is good. Antibiotics is enough. But

in patient (Parjo) conditions, there is a long
delay in the diagnosis or treatment, or if there is
significant bone or soft tissue injury due to
trauma with compromised local blood supply it
can led to permanent functional deficits and or
made the patient more prone to reoccurrence. If
surgery or bone grafting is needed, this will
prolong the time it takes to recover.
2

Is the problem acute? Patient (Parjo) suffered for acute Osteomyelitis,

Chronic?
emergency

critical
?

curable?
3

? because he immediately realizes that there is

still something wrong with his scar. It is cure able
with debridement operation and right treatment.

What the final purpose The aim of the treatment where the patient
of the treatment?

(Parjo) had debridement surgery to take off the

died tissue is to stop the overflowing pus and
healing the patient.

How likely it will be Based on our analyze there is a big opportunity

success?

for the patient to heal. Because according to

scenario, patients (Parjo) condition is good and
the fracture bone is already unite. And because

patient (Parjo) is not letting his condition

(osteomyelitis) getting worst that may led the
infection spread to other tissue and worst to the
bone.
5

Are there any other Yes, there is. That is if the debridement
plans if the therapy operation didnt make it or fail, the infection
fails?

may spread to other tissue and the bone. And the

other treatment for this is to do bone grafting
and removing more died tissue.

In addition, how these The patient absolutely having benefit from the
patients can get benefit treatment when the surgery is going well with
from the medical care, no obstacle. The family and also the patient can
and how the loss of asking to the doctor about what treatment that
treatment

can

be would be done and who want to doing the

avoided?

surgery so that is why by doing this the patient

could clearly know what would he got from the
treatment and it is what we called informed
consent.

QUALITY OF LIFE
No.

Ethical questions

Analysis

How the prospect, with

Scar on the patient there is pus which constantly

or without treatment to

out so after first operation the patient is in need of

return to normal life?

examination several times and even the direct

action of the doctor, the pus kept out of the former
surgery patients.
The second surgery to resolve the problem in the
first situation has been successfully performed by
dr. Hangabehi.

What is the physical

Based on scenario, the operation has been

disorders, mental, and

success, and when the operation had been done

social that patient have

which left scar.

when the treatment is

successful?
3

Is there any prejudice

Because of the taste that remains between the

that might give rise to

muscles and bones are repositioned, it creates a

suspicion that the service

feeling of trauma that continues to be felt because

provider evaluation of

of fear of infection.-

the quality of life of

patients?
4

How is the condition of

The operation has been successfully carried out

the patients present or

despite the survival of the patient is not entirely as

future, whether the

expected

patients life can be

postoperatively.

because

some

things

happened

assessed as expected?
5

Is there any rational

Because after the first operation carried out

reason for the next

theres a pus that continuously flow then takes

treatment?

action continues from doctors.

Is there any plans for

Because the error occurs after the first operation

comfort and palliative

so that the scar continues to ooze pus, then

care ?

treatment or ongoing care done with a second

operation to find and stop the discharge of pus.

PATIENT PREFERRENCES
NO

ETHICS QUESTION

ANALYSIS

Does the patient is

Yes, the patient capable can have a competence

mentally capable and

for a legal, because the patient willing to fill and

legally competent? And

agree to the informed consent, in conscious

whether there are

situation without intervention from other people.

circumstances that leads

There is no condition that raise inability because

to the inability

based on the scenario written clearly that the

patient agree in aware condition.

If competent, what will The patient agree to do the operation with a

patients say about the accept the informed consent that given by doctor
treatment options?

Ndang Sun Tiken.

Does the patient has The patient doesnt get any information about
been informed about the the advantages and the risk of the operation.
benefits

and

risks,

understand

the

information

provided

and give the consent?

4

If not competent, who There is no one can replace the patient position
should

replace

the as decision maker because the patient has made

patient? And does that a decision for him self.

competent person uses
appropriate standards in
decision-making?
5

Does the patient have Patient just make a decision by an emergency

shown something more situation that happened to him self in that time.
to his liking?

Does

the

patient

is After operation, the patient has infected in his

unwilling / unable to operated area because of pus that continuously

cooperate

with

the flowing, so that patient choose to done check up

treatment given? If so, to dr.Ndang Sun Tiken but that doctor not
why?

coming to met him, so the patient choose to went

to another doctor.

In addition, does the Yes, because its the basic right of patient. As a
patient's

right

is

to good and professional doctor they must to obey

choose to be respected, the ethic code and also KODEKI because on that
regardless of ethnicity there is said that as a doctor we must to respect
and religion?

for the patient right and respected the culture

and religion background of patient

CONTEXTUAL FEATURES
NO

ETHICS QUESTION

ANALYSIS

Is there any family

In this case the problem appears when the found

problems that might

of gauze were left behind in the bones that have

affect treatment

been repositioned which led to a discharge of pus.

decisions?

Thus, the Parjo's family are not accept and

demand to dr. Ndang Sun Tiken.

Is there a problem of There is no explanation in scenario

data sources (clinicians
and nurses) that may
affect

treatment

decisions?
3

Is there a problem of There is no explanation in scenario

financial and economic
factors?

Is there a problem of There is no explanation in scenario

religious and cultural
factors ?

Is there any confidence There is no explanation in scenario

limits ?

Is there a problem of There is no explanation in scenario

resource allocation ?

How the law affects the The act taken by dr. Endang Sun Tiken according
treatment decisions ?

SPO since the doctor do surgery after parjo signed

an informed consent

What is clinical

There is no explanation in scenario

research or teaching
involved ?
9

Is there a conflict of
interest in part of the
decision making in an
institution ?

There is no explanation in scenario

3. Basic Ethical Principles of Islam List

1. PRINCIPLE OF INTENTION

Messenger of Allah said, "Allah will not accept other than the charity
sincere charity and are due to seek God ridho". Therefore, the practice in
everything we do depends on our intentions, and must be with a sincere

intention to seek Allah ridho

Messenger of Allah said, "And a lot of practice visible world practice but
eventually became the practice hereafter as well intentioned. And how
many deeds of the hereafter but in the end become the world due intend

wrong practice ".

"Allah does not look at your body and appearance, but God sees is your

heart" (HR. Muslim)

"Charity is not going to be good but with three conditions: piety, good

intentions and correct in doing so" (cleric Salam):

"Say: verily my pray, worship, my life and my death are for Allah, the
Lord of hosts .--- There is no partner for Him; and so that is commanded,
and I was the first surrendered (to Allah). "(Surah Al An'am 6: 162-163).
Through this verse Allah is telling us is that our prayers, our life and our
death was only for him and no one can match his, and we surrender unto
him. meant to worship is not just prayers, practice zakat and fasting alone,
but all the works that do not disobey Allah if done with sincerity for Allah

is called worship.
Messenger of Allah said, "Verily, legitimate or not something the charity
depends on the intention. And considered for everyone is what is intended.
So whoever emigrated only in obedience to Allah and His Messenger, then
the emigration received Allah and His Messenger ".

2. PRINCIPLE OF SECURITY

Prophet said:
"repent to him, Allah created the disease is accompanied by the
medicine except one, namely the elderly".

"...... Those who fear Allah, He will hold for him a way out. And give him
sustenance from unexpected directions-but thought nothing. And whoever
sole trust in Allah Allah will suffice (purposes) it. Verily Allah carry out
affairs (desired) Him. Allah has appointed a measure for all things. "(Surah
At-Thalaq (65): 2-3).
"So each one (they were) We seized due to his sin, then among
them there that we inflicted to him rain gravel and among them there were
overwritten loud sounds of thunder, and among them there are we
immersed into the earth, and among them were drowned, and Allah is not
going to persecute them, but they who wronged themselves ". (QS. AlAnkabut (29): 40).
That is the second promise of God will definitely be fulfilled. Ease of
affairs and success both in this world and in the Hereafter for those who
are pious and misery and contempt in the world especially in the hereafter
for those who disobey Him.

Here is the promise of God to people and people who fear Him.
"And (remember well), when your Lord proclaimed:" Except ye be
thankful, I would add (favors) unto you, and if ye deny (My favor), verily
My punishment is severe. " (QS.Ibrahim (14): 7).

3. PRINCIPLES LOSSES

Imam ash-Shafi'i rahimahullah said,

"If any man contemplating this letter, surely it would be sufficient
for them." [Tafsir Ibn Kathir 8/499].
Allah ta'ala says:
"For the sake of time. Behold, the man really is in loss. Except
those who believe and do charity Salih and admonish one another in order

to obey the truth and exhort one another so that the honor of patience
"(QS. Al 'Asr)

At the end of the commentary surah Al 'Asr this, Shaykh Abdurrahman AsSa'di rahimahullah said, "So with the first two (science and charity),
humans can perfect itself. While the latter two things (preaching and
patient), humans can improve others. And by improving the four criteria,
humans can survive the loss and get great benefits "[Taisiir Karimir
Rohmaan things. 934]

Imam ash-Shafi'i rahimahullah said,

"If any man contemplating this letter, surely it would be sufficient
for them." [Tafsir Ibn Kathir 8/499].

Shaykh Muhammad bin Salih Al 'Uthaymeen rahimahullah said, "the

words of Imam Shafi'i mean is this letter has been enough for people to
encourage them to adhere to the religion of God with faith, charity Salih,
preaching to God, and the patience for that. He did not mean that humans
are pretty contemplate this letter without practicing throughout the
shari'ah. Because a reasonable person when hearing or reading this letter,
then he would strive to free themselves from losses by way of adorning
themselves with the four criteria mentioned in this letter, which is faith, do
good deeds, edify each other in order to establish the truth (da'wah) and
mutual advised to be patient "[Sharh Usul Tsalatsatul].
Therefore, a charity who have knowledge but not classified in the
category that is in loss, because it could be that science will actually turn
sue. Prophet sallallaahu 'alaihi wa sallam said:
"A servant will not budge from its place on the Day of Judgment
until he is asked about his knowledge, what he has to resume practicing of
the art." (HR. Ad Darimi number 537 with a saheeh sanad).
In essence, people who neglect their obligation to preach is still in a loss
even though he was among those who have knowledge and practice it. He
is still in a loss because he is only concerned with the good of themselves
(selfish) and do not want to think about how to lift people from the abyss

of ignorance of the religion. He did not want to think about how so that
others can understand and implement the true Islamic teachings like
himself. So that people who do not care about the mission is people who
are not able to take a lesson from the words of the Prophet:
"Not perfect faith of one of you, until he is happy when his brother
also gained something he enjoys." (HR. Bukhari number 13).
If you feel happy with the guidance which God gives such pleasure to
know Islam that is true, then one of the characteristics of Islamic
perfection that you have is that you actively participate in the activities of
propaganda no matter how small the contribution that you provide.

4. PRINCIPLE difficulty

Ibn Kathir said:

"The promise of God is sure and maybe he deny it."

The Prophet sallallaahu 'alaihi wa sallam said:

"With difficulty, there is relief." Therefore, there is no doubt
masihkah with the promise of Allah and His Messenger is this?

Allah said:
"And those who put their trust in Allah Allah will suffice
(purposes) it". (QS. Ath Tholaq: 3).
This is the secret that most of us probably do not know. So basically,
resignation that was the biggest reason someone out of trouble and

narrowness.
"... Allah desires ease with you and does not want hardship with you ..."

(Al-Baqarah 2: 185)
"Because the real hardship comes ease." (QS. Natural Nasyroh: 5)
laludiulanglagi in the next verse, namely "Verily with every difficulty
there is relief." (QS. Natural Nasyroh: 6).

Allah said :
"Allah will soon give after the narrowness of spaciousness." (QS.
Ath Tholaq: 7) Ibn Jauziy, Ash Syaukani and other commentators said,
"After the narrowness and difficulty, there will be ease and spaciousness."

5. PRINCIPLES habituation

Habituation prayer, for example, should be initiated as early as possible.

Prophet Muhammad. Ordered to parents and educators so that they tell the
children prayers, when only seven years old, his saying as Tirmidhi
narrated:
"Have ye children's prayer when he was seven years old, and when
he was ten years old, so be ye o'clock when he left prayers".

In verse 6 Surah Al-A'la, God insists that habituation method:

"We will recite (the Quran) to you (Muhammad) then you will not forget".
This verse confirms that Allah recited the Koran to prophet
Muhammad., Then the Prophet repeat it again until he does not forget what
has been taught. In verses 1-5 Surah Al Alaq, Gabriel Prophet recited the
verse and repeat it by heart.

ANNEX PARAGRAPH, RASUL SUNNAH AND OTHER BASIC

From the scenario we have know that Mr. parjo has believed that we have to
looking for having a good health and live in our live by doing treatment and go to
the hospital when we have disease that have to be cure
1. Being well with three requirements: Taqwa, the intention is good and right to
do so "(Ulama Salam)

Sunnah of the Prophet:

"Allah created the disease is accompanied by the medicine UNLESS one is old"

"You sent for Easier and you are not sent to complicate". (HR. Bukhari no. 220).
so that is why in Islamic perspective, we have to know that allah swt sent
Easier to us and it is not complicated so that is why we can survive from gods
temptation.
People who treat someone then he must know and have medicine for
healing is not easy. Prophet sallallaahu 'alaihi wa sallam said :

"Those who take medication and he did not know his knowledge before that he
was responsible." (HR. An-Nasa'i, Abu Dawud, Ibn Majah and others, hasan
hadith no. 54 book Qulub Bahjah Al-Abrar)
If a health care worker made a mistake because it did not have the
medical knowledge of the health workers should be change loss for the patients
who have been harmed as a form of responsibility.
Ibn Qayyim al Jauziyah said, "So shall indemnify (responsible) for
doctors who practice medicine foolish and uninformed / previous study medicine
'[Tibb Nabawi pp. 88, al Maktab ats Tsaqafi, Cairo]
The task of becoming a doctor or in a nurse to treat the disease is not
easy. If you do not have the medicine or not experts in the field of health and still
practice and something goes wrong, then he is guilty and should be held
accountable.

Shaykh Abdurrahman bin Nasir as Sa'di said: "There should be for

someone to do a job in the practice where it is not qualified in this regard.
Likewise, the practice of medicine and others. Whoever violates sassy then he is a
sinner. And what that result from actions in the form of loss of life and damage to
limb or something then he should be responsible "[Bahjah Qulubil Abrar case.
155, Dar al Ilmiyah Pole, Beirut, mold 1st, 1423 H]
When a doctor or health worker made a mistake then he should be liable
to pay diyat (compensation). As Al Khathabi said, "I am not aware of any dispute
in treatment if a person makes a mistake, causing harm to the patient, then he shall
bear compensation. People who practice (medicine) that do not know the science
and its application then he is the one who goes beyond limit. In the event of
damage caused by his actions, then he should be responsible to replace diyat ''
[Tibb Nabawi pp. 88, al Maktab ats Tsaqafi, Cairo]
When a doctor who is an expert to get permission from the patient or the
patient's family do not make a mistake in praktenya and then damage to the
patient, the doctor does not have to reimburse because he has been practicing
appropriate health procedures. Although not to be responsible but the doctor who
has received permission from the patient or patient representative should not be
toying with the treatment on the patient.
As Sheikh Abdurrahman bin Nasir as Sa'di says, "Physicians are
proficient, if conduct (medical practice) and do not make mistakes, then happened
in practice damage / danger, then he does not have to compensate. As he got
permission from the patient or guardian patient. And any damages arising in acts
that permission, it would not have to compensate "[Bahjah Qulubil Abrar case.
156, Dar al Ilmiyah Pole, Beirut, mold 1st, 1423 H]
As the principle fiqhiyah:
In Al Qawaidul Ushwul Jaami'ah things. 21 Darul Wathan, Riyadh, mold 2nd,
1422 H

"Whatever (damages) arising out of anything that gets permission, then there must
indemnify, and its opposite"
5 division of medical practice according to Ibn Qayyim al Jauziyah:
1.
2.
3.
4.

Doctors are good at practice standards and do not commit faux pas
Doctors are stupid and do not make mistakes
The doctor who are adept and get permission then do carelessness
The doctor who are adept berijtihad provide a prescription drug then he is

wrong in ijtihad
5. The doctor who are adept treatment to a small child or a lunatic without
permission but the permission of her guardian
[Tibb Nabawi it. 88-90, Maktab al ats Tsaqafi, Cairo]
Actually doctors who make mistakes in practice (malpractice) can be
punished and put in jail so that people do not do the same. It is in Islam called
Ta'zir that the penalties prescribed by the government even though there was
nothing in the law or not described in syariah . A doctor or health workers need to
know and have a little medical science that may not make a mistake. And, doctor
or health worker will not practice medicine but must obtain permission from the
patient or patient representative.

CONCLUSION
From the scenario above, we can conclude that the concept of outbreaks
in these cases occurred in patients and doctors. The concept of autonomy in
question, namely Doctor ndang Sun Tiken, Sp.B been maintaining privacy and
respect the decision of the host parjo by informed consent prior to the pack parjo.
Then, the principle of beneficence, which can be seen from the actions of Doctor
ndang Sun Tiken, Sp.B who gives his best to pack parjo but result recovery from
fatigue and less conscientious doctor cause gauze left in the thigh during the
operation. In the aspect of non maleficence patients had osteomyelitis due to lack
of doctors carefully situations and cause the patient to suffer material and nonmaterial. In terms of justice by giving informed consent and notification to the

patient the truth of what he had accepted and in the case of legal action performed
by patients who are not satisfied with the action taken by the doctor doing the
subpoena.