Case No. Ethical Problem1. places 2 patient beds in his medical spractice room which are divided by a curtain.2. the first 3 patients came with common cold. Then Tenar gave three of them their

medicine, with advice: having enough rest, drinking plain water and consuming

fruits.

3. Tenar gave a presenting letter to her for the laboratory examination. Tenar referred her to a laboratory namely: "Titrasi Cepat" Clinical Laboratory, where he usually did, not far away from his practical place.

4. From this clinical laboratory he received “cake present”, in which if he evaluated, the amount was equal with the number of patients he has sent there

5. The young man didn't follow the queuing number because he confessed that he was Tenar's junior high school's friend, so that Tenar's assistant took him to the left room, the room for the special patients

6. Without telling Ms.Menor what the content of her head scanning result, Tenar gave her a referral letter to the neurological department of a hospital.

7. Mrs.Modis, without receiving blood pressure measurement, got a prescription letter for her urinary tract infection that she has suffered for the last 5 years. Tenar examined her shortly and just copied prescription from her medical record that was given by his assistant.

8. He ordered his assistant after having convincing the security man for being

hospitalized.

(Information and reference letter)

9. He helped Mr. Malthus first for about 45 minutes, meanwhile Rana was alone because Tenar's assistant was also busy assisting Tenar to cope with the bleeding problem of Mr. Malthus in the left side room. Tenar didn’t have any chance to talk with Miss.

10. Tenar was rather stunned to answer the innocent question of her, "Oh, just abdominal discomfort", answered by Tenar, gently

11 He give an envelope containing Rp.25.000,- money for the security. "For your transport, Mr. Tala. Recover soonly

12 By sweating, Tenar at last listened to Miss. Rana's symptoms

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Case No. Alternative Based On Values System1. Beneficence

1. should maximize patient’s satisfactionautonomy1. should respect to patient’s privacy2. should keep confidentiality

non maleficence1. should cure proportionally

justice1. fair to every patient2. appreciate human autonomy3. give same contribution to every patient

2 Beneficence1. should check goal-based specificallyautonomy

1. should informed about disease to patientnonmaleficence

1. should not assume patient as an object2. should cure proportionally3. should not put the patient in danger condition because of misconduct4. prevent patient from danger

justice1. should asking patient participation according patient capability

3 Beneficence1. should put altruism on prioritynon maleficence1. should not assume patient as an object

autonomy1. should respect to patient autonomy2. should not intervention on decision makingjustice1. should appreciate patient’s law2. should responsible to distribute the benefits and maleficence fairly

4 -5 Beneficence

1. should maximize patient’s satisfaction 2. should do golden rule principle

non maleficence1. should priority on patient’s benefit2. Should cure proportionally

Autonomy1. –

Justice1. Fair to every patient2. appreciate another person autonomy

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3. shouldn’t differ the treat to the patient

6 Beneficence1. paternalism responsibility2. minimize the negative effect

non maleficience1. should not put the patient in danger condition because of misconduct

Autonomy1. Veracity2. should Informed

Justice1. appreciate human autonomy to health2. should asking patient participation according patient capability

7 Beneficence1. insure human live quality2. minimize negative effect

non maleficience1. should cured the patient2. should prevent patient from harm3. should cured the patient proportionality4. should not put the patient in danger condition because of misconduct

Autonomy1. should informed

Justice1. Respect to the patient’s right to health

8 Beneficence1. Should minimize bad effect2. Paternalism and responsibility to the patient3. Maximize patient’s satisfaction4. Should Help emergency patient5. Should respect patient’s right6. Based on golden rule principle

Non maleficience1. Should help emergency patient2. Prevent patient from harm3. Should treat patient proportionally4. should not put the patient in danger condition because of misconduct

Autonomy1. Should respect patient’s dignity2. Not do intervention or disturb patient’s autonomy3. Build relationship to patient

Justice1. Respect human’s autonomy2. Give contribution based on patient’s need3. Not treat patient with different way based on social status

9 Beneficence

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1. Should duty to help emergency patientNon maleficience

1. should not put the patient in danger condition because of misconduct2. Prevent patient form harm3. help emergency patient

Autonomy1. Should informed

Justice1. Respect to the patient’s right to health

10. Beneficence1. enhances the dignity of human2. should respect to patient’s right

nonmaleficence1. avoid patient’s misrepresentation2. should do medical conduct effectively

11. Beneficence1. Enhances the dignity of the patients2. Respect to the overall patient’s right

Non maleficience1. should not put the patient in danger condition because of misconduct2. Should prevent the patient from dangerous3. should cured the patient proportionality4. should cured the patient

Autonomy1. Should inform to the patient2. Keep contract

Justice1. Respect to the patient’s right to health2. Should fair to patient

12. Beneficence1. Respect patient/family/things not only to get profit from patient2. Maximize the high patient’s satisfaction3. Based on Golden rule principle

Non maleficience1. Should treat proportionally2. should not assume patient as an object

Autonomy1. Should respect patient’s dignity2. Should keep relationship

Justice1. Shouldn’t differ social status

Case no. Alternative Decision

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1. - The room will be better if it has one bed only

- Build wall to divide the room if it really necessary to use 2 beds

2. -Every patients have to examined well and specifically -Giving prescribe should be suitable with the disease not only from the general symptoms

3. -Give right to patients to choose the laboratory for their lab examinations-the doctor can give the information about the labs, but the doctor mustn’t give suggestion for one lab only.

4. -doctor shouldn’t receive the “cake present” as a “thank you” for the patients he sent there.-

5. - The doctor should treat the patients according to queuing number- If its emergency case it is fine to treat him first.

6. -the doctor should informed the patient about the result from the head scanning.-The doctor make the negotiation with the patient about the next treatment.

7. -The doctor must examine depend on the standard operational procedure and give the prescriptions according to her condition

8. -he should inform the disease of the patient-give patient reference letter to be threatened more intensive on the hospital

9. -the doctor should ask his assistant to tell miss rana that he has emergency patient.-the doctor should inform miss rana that he has emergency patient.

10. -the doctor did the right thing with keep patient confidentiality. 11. -the doctor has good charity to other.12. -the doctor should tidy him self before meet the patient

-the doctor at least clean the sweat.

Case No. Self Assessment

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1. He just put 2 bed that divided by curtain2 He has Check 3 patient in same way and give same advice3 He suggest the patient to the laboratory4 He get the present from laboratory5 He receive the patient that don’t follow the queuing6 He gave Mrs. Menor referral letter without informed 7 He assume the patient have same condition

8 He order Garputala go to hospital sonly9 He help Malthus first than Miss. Rana that comes first

10. He keep patient confidentiality11. He gave amount of money12. He didn’t prepare himself first

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Case NO Verification1 Utilitarian

He think that he can treat many patients easily without thinking about the maximal satisfaction for patients

2 UtilitarianBecause he doesn’t want to waste the time for knowing more about patient’s condition deeply

3 UtilitarianBecause he think about the distance’s advantages for patient

4 UtilitarianBecause he accepted the profit from what his done

5 UtilitarianBecause he doesn’t want have bad relationship with his friends

6 DeontologyBecause he wants the best treatment to Mrs. Menor so Mrs. Menor heal completely.

7 UtilitarianBecause he thing it will be useless if he check up the patient

8 UtilitarianHe only think the best for other personCommunitarianBecause he think to help another people is the responsibility with otherDeontologyBecause he has pure intention to help each otherFeminismBecause he want to best

9 UtilitarianDeontologyCommunitarianFeminism

10 DeontologyCommunitarian

11 DeontologyCommunitarian

12 DeontologyFeminism

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Case No. Reason1. The room will be better if it has one bed only, because the patient has privacy and

the doctors should appreciate patient autonomy.2. Every patients have to examined well and specifically which is standardized by SOP

and the prescribe should be suitable with the disease, not only from the general

symptoms, because every symptoms has a different type of disease.

3. -the doctor can give the information about the labs, but the doctor mustn’t give suggestion for one lab only, because it’s contradict with the patient autonomy to choose the lab.

4. -doctor shouldn’t receive the “cake present” as a “thank you” for the patients he sent there, because it will consider as a collusion.

5. - The doctor should treat the patients according to queuing number, If it is emergency case it is fine to treat him first, because it’s the doctor should obey the rule of humanity.

6. the doctor should informed the patient about the result from the head scanning and doctor should make the negotiation with the patient about the next treatment, because knowing the result and the information about the treatment is patient right and doctor should respect it.

7. -The doctor must examine depend on the standard operational procedure and give the prescriptions according to her condition, because

8. give patient reference letter to be threatened more intensive on the hospital and also give an information about his disease, because it is patient right to get the information about his disease.

9. the doctor should ask his assistant to tell miss rana that he has emergency patient, because if the doctor didn’t tell the condition, so it’s look like the doctor neglected miss rana.

10. The doctor did the right thing with keep patient confidentiality, because the patient confidentiality is very important and prohibited to speak up in public.

11 The doctor has good charity to other, because the charity is needed to be a good doctor.

12 The doctor should tidy him self before meet the patient, because the doctor must respect the patient with polite and tidy.

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