4 box metode dalam

penentuan etika
Meivy Isnoviana,MD
LANDASAN TEORI
MEDICAL
INDICATIONS
CLIENT
PREFERENCES
QUALITY OF LIFE
CONTEXTUAL
FEATURES
4-BOX METHOD OF CLINICAL
ETHICS
"4-Box" Method of Clinical Ethics
Medical Indications:
State the clients medical problem, history, and
diagnosis; is it acute, chronic, critical, emergent, and
reversible? Goals of treatment? Probabilities of
success? Plans in case of therapeutic failure? Potential
benefits of care? How can harm be avoided? Medical
risks if service is discontinued?
Client Preferences:
State the clients preferences. Do they have the
capacity to decide? If yes, are clients wishes
informed, understood, voluntary? If not, who is
substitute decision maker? Does the client have prior,
expressed wishes? Is clients right to choose being
respected?
Quality of Life:
Describe quality of life in clients term, clients
subjective acceptance of likely quality of life, and
views and concerns of care providers. Examine the
emotional factors influencing each individual, such as
exiting feelings, values, biases and prior experiences.
Contextual Features:
Any other family involved or significant relationships?
Any care plans put in place so far? Relevant social,
legal, economic, and institutional circumstances?
Other relevant features, e.g. religious & cultural
factors, limits on confidentiality, resource allocation
issues, legal implications, research or teaching
involved, provider conflicts of interest? Organizational
values to consider?
LANDASAN TEORI (contd)
4-BOX METHOD OF CLINICAL
ETHICS
Medical Indications, didasarkan pada penetapan permasalahan medis &
diagnosis;
Apakah tergolong akut, kronis, kritis ataupun darurat ?
Tujuan akhir dari pengobatan ?
Rencana jika saja pengobatan atau tindakan mengalami kegagalan ?
Keuntungan tindakan yang diambil ?
Bagaimana resikonya jika tindakan medis tidak dilakukan ?

Client Preferences, didasarkan pada pilihan pasien;
Apakah pasien memiliki kemampuan untuk memutuskan ?
Jika iya, apakah pasien sudah diberi penjelasan secara cukup dan dimengerti ?
Jika tidak, siapa yang berhak menggantikan ?
Apakah terdapat persetujuan tindakan terlebih dahulu ?


LANDASAN TEORI (contd)
4-BOX METHOD OF CLINICAL
ETHICS
Quality of Life, mendiskripsikan kualitas hidup pasien setelah mengalami
pengobatan;
Apakah pasien dapat terselamatkan ?
Bagaimana perasaan pasien setelah dilakukan pengobatan ?
Apakah value yang didapatkan oleh pasien setelah menjalani pengobatan ?

Contextual Features, menggambarkan pengaruh keadaan sosial, hukum,
ekonomi serta institusi dalam pengambilan keputusan pada hubungan
terapeutik antara dokter dengan pasien;
Apakah ada hubungan antara keadaan sosial ekonomi pasien dalam mengambil
keputusan pengobatan ?