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REFLEKSI KASUS
FORENSIK
Siska Marina
18712036

Daring Periode 29 Juni-04 Juli 2020

IDENTITAS PASIEN

Anamnesis dilakukan pada 14 Mei 2019 pukul 13.00 WIB

Nama : Tn. DS
Jenis Kelamin : Laki-laki
No. RM : 668***
Usia : 23 tahun
Ras : Jawa
St. Pernikahan : Belum menikah
Pekerjaan : Karyawan swasta
Alamat : Bamban 01/03 Girikikis, Giriwoyo,
Wonogiri
Resume Anamnesis

Pasien merupakan pasien rujukan dari RS MH datang ke IGD

untuk mendapatkan perawatan lanjutan dari keluhan pasien
yaitu demam 8 hari SMRS dengan B20. Karakteristik demam
pasien adalah demam naik turun biasanya pada sore dan malam
hari, demam timbul semakin hari semakin tinggi dari hari
sebelumnya dengan suhu mencapai 39 0C pada hari ke 5. Pasien
juga merasa badannya agak kedinginan.
Resume Anamnesis

Demam memberat ketika sore dan malam hari. Keluhan

demam mereda setelah minum obat namun muncul kembali
di hari berikutnya. Pasien sudah mendapatkan pengobatan
rawat inap di RS MH selama 3 hari dan keluhan membaik.
Pasien juga merasakan keluhan lain berupa BAB cair, batuk
berdah ak, kepala pusing, badan lemas, hampir seluruh tubuh
pegal-pegal (punggung, kaki, tangan), mual, dan nyeri perut.
 HASIL PEMERIKSAAN
Px. KU dan Tanda Vital (Vital Sign)

Dilakukan pada 24 Mei 2019, pukul 13.30 WIB

Keadaan Umum : Tampak sakit ringan

Kesadaran : Compos Mentis
Tekanan darah : 102/60 mmHg
Frekuensi nadi : 84 x/menit
Frekuensi napas : 20 x/menit
Suhu tubuh : 37 oC
 Pemeriksaan Fisik Diagnostik
Kepala
Konjungtiva anemis (+/+), sklera ikterik (-/-)
Lidah kotor (+)

Leher
Inspeksi : Benjolan (-/-)
Palpasi
: Massa (-/-), pembesaran KGB (-/-), trakea simetris,
pembesaran kel. tiroid (-/-)
Lanjutan Px. Status generalis

Thoraks (Paru)
Inspeksi : Normochest, simetris kanan kiri, diameter lateral >
AP, retraksi (-)
Palpasi : Nyeri tekan (-/-), fremitus (+/+), pengembangan
paru(+)
: Sonor (+/+),
Auskultasi
Perkusi : SDV (+/+), ronki (-/-), wheezing (-/-)
Thoraks (Jantung)
Inspeksi : Iktus kordis tidak tampak
Palpasi : Iktus kordir tidak teraba
: Batas bawah jantung SIC IV linea sternalis dextra
Perkusi Batas atas jantung SIC II linea sternalis sinistra
Pinggang jantung SIC III linea parasternalis sinistra
Batas kiri jantung SIC V linea mid klavikularis sinistra
Auskultasi : S1-S2 reguler, bising jantung (-)
Abdomen
Inspeksi : Dinding abdomen sejajar dengan dinding toraks,
massa (-)
Auskultasi : Bising usus (+) dg frekuensi normal
Perkusi : Timpani semua kuadran
Palpasi : Nyeri tekan epigastrium (+), hepar
& lien tidak teraba
Ekstremitas
- Kulit kering (-)
- Akral teraba hangat
- Capillary refill time (CRT) <2 detik
- Vulnus ekskoriatum (-)
- Prurigo (-)
- Onikomikosis (-)
- Erupsi papular pruritik (-)
PEMERIKSAAN PENUNJANG
DIAGNOSIS
1. B20 stadium I
2. Susp. Demam Tifoid

DIAGNOSIS BANDING
- Hepatitis A
- Hepatitis B
REFLEKSI
HIV-AIDS
 HIV/AIDS

Definisi
Human immunodeficiency virus (HIV) merupakan patogen
yang menyerang sistem imun manusia, terutama semua sel
yang memiliki penanda CD4+ di permukaan sel seperti
makrofag dan limfosit T.
 Pemilihan KasusHIV/AIDS

Latar Belakang

Pada tahun 2017 tercatat lebih dari 35 juta penderita HIV

dan 940.000 penderita HIV meninggal, jumlah ini tersebar
diseluruh belahan dunia. Di akhir tahun 2017, diperkirakan
sebanyak 36,9 juta orang hidup dengan virus HIV
ditubuhnya. Angka insidensi HIV pada 2017 sekitar 1,8
juta orang.
Total kumulatif infeksi HIV dilaporkan sampai dengan Desember
2017 (Indonesia) :
1. DKI Jakarta ( 280.623 )
2. Jawa Timur (39.633)
3. Papua (29.083)
4. Jawa Barat (28.964)
5. Jawa Tengah
(22.292)

Sementara jumlah AIDS cenderung stabil tiap tahunnya dengan

jumlah kumulatif 102.667 orang dalam kurun 12 tahun (Kemenkes,
2017)
 Aspek Sosial Ekonomi

Selama 5 tahun pasien tinggal di kos selama bekerja di Jakarta,

selama itu pula pasien tinggal jauh dari keluarga dan kurang
mendapatkan pengawasan dari orangtuanya, sehingga orang
tua sulit untuk monitoring hal-hal yang dilakukan sang anak.

'Friedman (2010) menyebutkan bahwa keluarga memiliki

fungsi yaitu fungsi afektif, fungsi sosialisasi, fungsi
reproduksi, fungsi ekonomi dan fungsi perawatan kesehatan'.
 Aspek Bioetik
• Beneficence (berbuat baik)
Prinsipnya adalah mengutamakan tindakan demi kebaikan pasien,
tidak hanya berhenti pada kebaikan saja namun senantiasa perbuat
-an dari sisi kebaikan lebih besar daripada sisi buruk.

Pada kasus ini upaya yang dilakukan dokter berupa mengusahakan

terapi yang sesuai (simptomatik) untuk pasien agar kondisi fisiknya
terus mengalami perbaikan serta memberikan profilaksis primer
dalam rangka mencegah perkembangan infeksi lanjutan dari
penyakit pasien.
 Aspek Bioetik
• Non-maleficence (tidak merugikan orang lain)
Prinsip kedua (non-maleficence) yang juga dikenal primun non
nocere/’above all do no harm’ merupakan larangan terhadap
tindakan yang dapat memperburuk kondisi pasien

Dokter belum memberikan terapi ARV untuk pasien dan hanya

memberikan profilaksis untuk mencegah infeksi oportunistik.
Meskipun pasien sudah positif terdiagnosis B20 dokter tidak
terburu-buru memberikan terapi definitifnya karena hal itu dirasa
belum perlu untuk ODHA dengan stadium I
 Aspek Bioetik
• Justice (keadilan)
Beuchamp dan Childress :
Pendekatan yang adil lebih berarti pada tindakan berdasarkan
prioritas memutuskan siapa yang akan mendapat pertolongan
kesehatan terlebih dahulu dinilai dari derajat keparahan penyakit

Pengobatan B20 dengan antiretroviral namun pada pasien ini tidak

diberikan. Adil tidak selalu berarti sama, apabila semua pasien
diperlakukan sama justru itu tidak adil sebab keperluan diagnostik
dan terapetik setiap pasien di RS berbeda-beda walaupun dengan
penyakit yang sama
 Aspek Bioetik
•Respect for autonomy (menghormati autonomi pasien)
Prinsip autonomi artinya menghormati hak-hak pasien, prinsip ini
juga yang melahirkan inform consent yang merujuk pada dokter
wajib menghormati hak dan martabat manusia.

Hak otonomi pasien contohnya pasien tidak mengijinkan untuk

memberitahu orangtua terkait penyakitnya, itu juga merupakan hak
pasien karena dalam kasus B20 hasil pemeriksaan tidak boleh
diketahui oleh selain pasien, lembaga konseling, dan dokter dan
tenaga paramedis yang merawat. Oleh karena itu dokter harus
menjaga privasi pasien dan tidak boleh memberitahukan kepada
yang tidak bersangkutan.
 Aspek Keislaman

QS Al-anbiya: 35 bahwa Allah akan menurunkan ujian untuk hamba-Nya.

“Tiap-tiap yang berjiwa akan merasakan mati. Kami akan menguji kamu
dengan keburukan dan kebaikan sebagai cobaan (yang sebenar-benarnya).
Dan hanya kepada Kamilah kamu dikembalikan.”

Kondisi sakit akibat adanya penyakit merupakan pemberian Allah SWT, agar
setiap orang menyadari bahwa adanya sakit untuk mengingat bahwa sehat
merupakan harta yang tidak ternilai.
 Aspek Keislaman

Q.S Al- an’am: 42, Allah mengingatkan hamba atas kelalaiannya

“Dan sesungguhnya Kami telah mengutus (rasul-rasul) kepada umat-umat

yang sebelum kamu, kemudian Kami siksa mereka dengan
(menimpakan) kesengsaraan dan kemelaratan, supaya mereka
memohon (kepada Allah) dengan tunduk merendahkan diri. .”

Dalam kondisi sehat pula manusia sering tenggelam dalam perbuatan

maksiat dan mengikuti hawa nafsunya, sibuk dengan dunia, lupa akhirat
dan melalaikan Rabb-nya.
 Referensi
Afandi, Dedi. Kaidah dasar bioetika dalam mengambil keputusan
klinis yang etis. Majalah Kedokteran Andalas, 2017;40
(2):111-121.
Bahruddin, M. Tinjauan Hukum Islam terhadap Penderita HIV/AIDS
dan Upaya Pencegahannya. ASAS, 2010; Vol 2, No 2.
Djoerban, Z., Djauzi, S. 2014. Ilmu Penyakit Dalam: HIV/AIDS di
Indonesia Edisi VI. Jakarta: Interna Publishing.
Fakultas Kedokteran UI. 2014. Kapita Selekta Kedokteran essential
of medicine Edisi IV. Jakarta : Media Aesculapius.
Kementrian Kesehatan Republik Indonesia. 2017. Laporan Perkem
-bangan HIV/AIDS dan Penyakit Infeksi Menular Seksual (IMS)
tahun 2017. Jakarta : Departemen Kesehatan.
Rahmawati, P., Muljohardjono, H. Meaning of Illness dalam Perspektif
Komunikasi Kesehatan dan Islam. Jurnal Komunikasi Islam,
Volume 06 Nomor 02 ISBN 2088-6314.
Sistiarani, C., Hariyadi , B., Munasib, Sari., S., M. Peran Keluarga
dalam Pencegahan HIV/AIDS di Kecamatan Purwokerto
Selatan. Jurnal Ilmu Keluarga dan Konseling, 2018; Vol. 11,
No.2, 96-107. ISSN : 1907 –6037.
Wakiran, M., Tomuka, D., Kristanto, E. Pendekatan Bioetik tentang
Eutanasia. Jurnal Biomedik (JBM), 2013; Volume 05 Nomor
01, hlm. S23-28.
World Health Organization. 2018. Human Immunodeficiency Virus/
Acquired immunodeficiency Syndrome (HIV/AIDS). https://
www.who.int/news-room/fact-sheets.
Thank you
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