Making Ethical Decisions in Obstetrics and Gynecology (Raboan Discussion Forum)

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Wednesday (26/01), the Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held a routine Raboan Discussion Forum program with the theme Ethical Decision Making in Obstetrics and Gynecology. The theme was presented by the speaker, dr. Azharul Yusri Sp.OG, Chair of Dewan Kehormatan Etik Kedokteran Riau Ikatan Dokter Indonesia. Meanwhile, the moderator is Dr. dr. B. Triagung Ruddy Prabantoro, Sp.OG(K) student at Master of Bioethics Program Universitas Gadjah Mada and Lecturer at Universitas Kristen Widya Mandala.

At the beginning of his presentation, dr. Azharul explained the basis for the emergence of ethical biomedical practices in the medical field. The practice of biomedical ethics has been around for 2500 years. The practice is based on the Hippocratic tradition which is a virtue as a guide for a doctor.

Biomedical ethics is becoming increasingly complex as technology advances in obstetrics and gynecology. This requires doctors to posses skills in making decisions quickly because it will greatly affect the condition of the baby and mother.

“Not to mention that a female patient is very vulnerable, and we also often make decisions during a terminal state,” said dr. Azharul.

Dr. Azharul then explained the ethical framework that can be used as a basis for analyzing ethical problems faced by ob-gyn doctors. The basic principles that can be used are the 4 basic principles of Bioethics by Beauchamp and Childress (2019) which consist of Respect for Autonomy, Nonmaleficence, Beneficence, and Justice.

Four basic principles of Bioethics are indispensable when facing ethical dilemmas. In obstetrics, doctors must consider the conditions of two patients, the baby and the mother, so that conflicts often occur which leads to ethical dilemmas. To deal with this ethical dilemma, doctors must establish a prima facie principle. Prima Facie is a condition when doctors are faced with a difficult choice because it occurs between two basic principles of bioethics.

Dr. Azharul is an example of a prima facie condition, namely providing a complementary diagnosis to pregnant women. Examinations such as radiography, CT scan, and MRIs are very useful for mothers to see their health condition. However, this examination can affect the fetus

“It can interfere with organogenesis which can lead to the induction of malformations, IUGR babies, and others when given a dose of more than 100 mg,” said dr. Azharul.

In order to ob-gyn specialists can train their ethical framework skills, dr. Azharul provides one method that can be used, namely the four-box method. The method is applied by analyzing Medical Indications, Patient References, Quality of Life, Contextual Features. The doctor will identify the facts based on these four things, then the doctor will determine the conflicting ethical principles and explore options. At the end, the doctor will take action by deciding an action and the result.

 

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Human Rights and Fundamental Human Rights in Bioethics (Raboan Discussion Forum)

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Improvement of Human Rights terminology which is often translated into Indonesian ‘Hak Asasi’ is very much needed. It is as said by Dr. CB Kusmaryanto SCJ, a Bioethics expert and lecturer in the Sanata Dharma University School of philosophy at the Raboan Discussion Forum organized by the Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM), Wednesday (19/01). The weekly forum, which is held virtually, takes the theme of Human Rights and Human Rights Fundamentals in Bioethics. The forum is led by dr. Ouve Rahadiani Permana, M.H.Kes., M.Sc, alumni of the Bioethics Masters Study Program as moderator.

Romo Kus, Dr. CB Kusmaryanto SCJ often called, said that there is a discrepancy in the translation of Human Rights terminology commonly used in Indonesia. Generally, the terminology is translated with the phrase ‘Hak Asasi’. In fact, according to Romo Kus, the correct English word for ‘Hak Asasi’ must be Fundamental Human Rights. Romo Kus also explained that the phrase Human Rights is more accurately translated into the phrase Hak Manusiawi.

According to Romo Kus, from a grammatical point of view, the word human can be a noun or an adjective. When the word is placed in front of the word rights which is a noun, then the word human functions as an adjective.

“So, the translation of Human Rights in Indonesian should be Human Rights, while the translation of Human Rights is Fundamental Human Rights,” said Romo Kus.

Father Kus then explained the difference between the two phrases. According to Romo Kus, human rights are only a small part of fundamental human rights. Human rights are the most basic rights for humans. In this case, Romo Kus explained that the most basic right for humans is the right to life. Meanwhile, human rights are very diverse.

In the second application in the field of Bioethics, according to Romo Kus, a person’s fundamental human rights should be prioritized over his or her human rights. Violations of Human Rights become legal if they are carried out in order to defend Fundamental Human Rights, which is the right to life. Romo Kus added that respect for Fundamental Human Rights is a prima facie, meaning that if it does not conflict with Human Rights, it must be respected. But if it collides with Fundamental Human Rights, then Fundamental Human Rights must be respected.

 

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Ethical Issues in the Use of Social Media in the Health Sector (Raboan Disussion Forum)

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The Center for Bioethics and Medical Humanities (CBMH UGM) on Wednesday (16/11) held a Raboan Discussion Forum with the theme of Ethics Problems in the Use of Social Media related to Health. The theme was delivered by the speaker Prof. Dra. Yayi Surya Prabandari Ph.D. Meanwhile, the discussion forum was led by dr. Wika Hartini MIH as moderator.

Prof. Yayi sees that social media is now increasingly being used by practitioners in the health sector. The use of social media is very diverse but in general social media is a platform so that users can connect and share with each other. Some examples of the use of social media include Blogs, Networking Sites, Media Sharing Sites, Wikis, and so on.

Social media has both positive and negative sides. A positive example of the use of social media in the health sector is to be able to disseminate health education. On the other hand, social media also has a negative side that has the potential to violate ethical principles.

According to Prof. Yayi, the use of social media needs to be based on careful consideration. The use of social media creates the potential for misuse of data by irresponsible third parties. Personally owned data that is distributed through social media is prone to be used by third parties without the permission of the data owner.

“When we have an account there are some things we share that can be used without permission. For example, for marketing activities,” said Prof. Yayi.

This can be overcome by reading in detail the terms and conditions when creating a social media account. So that users can understand social media policies in protecting user privacy.

Apart from privacy concerns, Prof. Yayi also presented ethical issues by professional health practitioners. With social media, doctors also have the opportunity to spread health education to the public. Prof. Yayi gave an example of a doctor on Instagram who made a post about the condition of his patient’s illness. According to Prof. Yes, these activities are allowed when they are intended for educational purposes. However, doctors must be aware that there are ethical guidelines that need to be observed because they involve the patient’s personal data.

Prof. Yayi explained that there need to be standards that doctors and health care providers can adhere to in the use of social media so that there are no violations in maintaining the confidentiality and privacy of patient data.

 

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Informed Consent Implementation on Complementary Alternative Medicine (CAM) Homeophaty (Raboan Discussion Forum)

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Wednesday (05/02),  Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held the weekly routine program Raboan Discussion Forum for the first week of January 2022. The theme on the occasion was Implementation of Informed Consent on Complementary & Alternative Medicine (CAM) and Homeopathic Services. The virtual discussion forum presented by speakers Desy Putri Ratnasari, M.Sc., Bioethics Masters Study Program Alumni and UGM CBMH Research Assistant. Meanwhile, the moderator is dr. Nur Aziz Mahadinata.

Based on Desy’s  finding in Indonesia there is a fairly high demand for Complementary Alternative Medicine (CAM). One type of CAM that is quite large in demand is Homeopathic medicine. Although this treatment has been widely found in the community, research on the ethical aspects of this practice has not been done much. This prompted Desy to research aspects of patient autonomy in the form of  Informed Consent.

Homeopathy is a treatment that relies on herbal medicines that work together with the immune system to fight disease. In Indonesia, the most popular practice of Homeopathic medicine is the Homeopathy of the Ahmadiyya Community. The Ahmadiyya Homeopathy practitioners are under the auspices of the  Departemen Homeopati Nasional (DHN). Homeopathic Medicine is in demanded by both Ahmadiyya congregants and non-congregants. Because, this treatment is considered to have low side effects.

Desy’s research results show that the implementation of Informed Consent is also used in Homeopathy CAM treatment. The practice is in accordance with Peraturan Kementrian Kesehatan No. 290/MENKES/PER/III/2008 concerning informed consent, which includes the diagnosis of the disease, the purpose of the action, other alternative actions, risks or complications that may occur, the prognosis for the action and the estimated cost. From the results of interviews with Homeopathic Practitioners, Patients, and DHN administrators, it was found that the use of informed consent was carried out to anticipate undesirable things in the future. Informed consent in the practice of Homeopathy is done in two forms, oral and written (form). The written Informed consent is generally used for homeopathic patients outside the Ahmadiyya Community.

 

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