Immune Status of PLWHA and The Challenges of Its Therapy

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The Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) again held a virtual discussion forum, Raboan Discussion Forum on Wednesday (27/04). The topic raised on the occasion was the Immune Status of PLWHA and the challenges of therapy. CBMH FK-KMK UGM as the committee invited Ns. Dyah Ika Krisnawati, S.Kep, M.Si, Ph.D., lecturer at the Dharma Husada Nursing Academy in Kediri, East Java. Meanwhile, the event was guided by moderator Nabila Puspakesuma, S.Psi, M.Sc.

Providing treatment to patients with HIV-AIDS has its difficulties for the health workers. This is because of the characteristics of the HIV-AIDS disease that attacks the human immune system. A patient with HIV-AIDS has a condition where he is required to take drugs or other therapies so that the development of the HIV does not get worse. This obligation can burden the patient’s life so that the patient often feels tired during his treatment.

Ns. Dyah Ika Krisnawati explained that three therapies can be used to treat HIV/AIDS patients. These therapies include drug therapy, complementary therapy, and immunotherapy.

HIV/AIDS patients require antiretroviral (ARV) treatment. These treatments can slow the growth of HIV or make the virus fail to form new viruses. Currently, the use of ARV treatment with a high level is increasingly being used. This therapy is known as Highly Active Antiretroviral Therapy (HAART).

During ARV/HAART therapy, patients will experience side effects such as nausea, vomiting, fatigue, rash, weight loss, sleep disturbances, depression, muscle aches, and so on. These side effects can reduce the patient’s interest in being disciplined in taking drugs. So it takes the patience of health workers to help patients.

In addition to health workers, patients also need support from other parties, including family, friends, and peer groups, to financial support so that patients can continue to have the motivation to take their treatment.

In addition to drug therapy, complementary therapies and immunotherapy can also help patients improve their quality of life. In particular, complementary therapies in the form of traditional medicines can be used to improve the patient’s immune system through herbal medicines.

Other complementary therapies such as therapeutic information therapy can increase the patient’s self-confidence and motivation to be able to carry out the treatment. Providing accurate and appropriate information for patients can treat misunderstandings about the patient’s condition, treat depression, and restore the soul of HIV sufferers. The therapy can also be supplemented with spiritual remedies such as prayer and meditation.

In addition, there is physical therapy such as exercise that can be used by patients to calm their anxiety about their HIV/AIDS disease.

Ethical Concern on Generating Chimera Organ (Raboan Discussion Forum)

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Wednesday (13/04), the weekly routine program, Raboan Discussion Forum was again held by the Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM). The virtual event raised the topic of Generating Chimera, Is it Solution for Organ Donor Shortage, which was presented by dr. Yudha Nur Patria, DHC, MMed (ClinEpi), MMS, PhD. The discussion forum was led by dr. Galuh Dyah Fatmala as moderator.

 

dr. Yudha Nur Patria explained that the number of organ donor needs continues to increase every year. Even though this is not balanced with the number of available donor organs. In the United States, for example, only a third of patients requiring organ donors successfully undergo organ replacement surgery.

Some researchers see this problem and try to do research using genetic engineering technology. One of the research carried out is the formation of chimera organisms. This research caused various reactions from the bioethicist based on several considerations. One of them is the concern of producing organisms that are like humans.

Countries such as France, UK, and Germany tend not to recommend and even prohibit this action. Meanwhile, the United States and Japan did not prohibit it, but only imposed restrictions.

Chimera is a term used to refer to creatures from Greek mythology that have the bodies of several animal species. For example, a lion with bird wings and a snake-shaped tail. The term chimera is used to describe an organism formed from several combinations of other organisms.

In his presentation, Dr. Yudha Nur Patria gave an illustration of the formation of chimera organs from human and pig cells. In the early phase of fetal formation called a blastocyst, human cells will be injected into pig cells so that a pig is born that has an organism with the characteristics of human cells. These organisms are then taken to be transplanted into the human body in need of organ donors.

Research on the formation of chimera organisms has been carried out previously in rats and mice by the Salk Institute for Biological Studies, California.

 

Criticism on Indonesian Doctors’ Protection Law (Raboan Discussion Forum)

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The Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) again held an online discussion forum Raboan Discussion Forum on Wednesday (06/04). On that occasion, the forum raised the topic of discussion on Quo Vadis Legal Protection for Doctors and Dentists in Running their Profession. The topic material was presented by the speaker, dr. Sofwan Dahlan, SpF(K) who is a lecturer at the Faculty of Medicine, Sultan Agung University, Semarang. Meanwhile, the discussion was led by dr. Sigid Kirana Lintang Bhima, Sp.FM(K) who is the Secretary of MKEK IDI Central Java Region.

dr. Sofwan Dahlan highlighted the problem of legal protection for doctors and dentists in Indonesia, which have not succeeded in providing a sense of security in the implementation of medical practice. Legal protection should reflect the law as a set of rules that have a function to provide justice, order, certainty, benefit and peace.

According to dr. Sofwan Dahlan, when an adverse event or unexpected event occurs, patients tend to take criminal law routes to increase their bargaining position to demand compensation. This situation is exacerbated by the actions of law enforcement officers who often apply articles 365 and 360 of the Criminal Code or criminal articles outside the Criminal Code such as the Medical Practice Act or the Hospital Law with more severe sanctions.

These conditions necessitate a legal dialectic with the formation of ius constituendum or laws that are planned in the future. The establishment is intended to make the current law (ius constituum) better. According to dr. Sofwan Dahlan, currently there are several shortcomings of the Medical Practice Act, including:
1. The UUPK applies many criminal articles that carry a heavier penalty.
2. UUPK often criminalizes the actions of doctors which should not be criminal acts (eg not putting up a sign).
3. UUPK applies formal offenses (not material offenses), so that substandard actions can be punished, even though wrongful death / personal injury does not occur.
4. UUPK has not succeeded in formulating lex specialis based on the right concept (because it has not been able to separate professional Negligence from general Negligence, so that any negligence is subject to Article 359 or 360 of the Criminal Code).

dr. Sofwan Dahlan concluded that there is a need for a good and fair Medical Practice Law for all parties, so that it can answer the concerns of doctors and dentists in terms of medical practice. The law needs to be carefully drafted in order to establish a criminal policy and a penal policy, provide a clear distinction between general negligence and professional negligence (professional misconduct), and be able to fill legal voids related to the “No Fault Compensation” doctrine.

 

Policies for Controling Influenza during the Colonial Period (Raboan Discussion Forum)

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The weekly program Raboan Discussion Forum program was again held by the Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) on Wednesday (30/03). The virtual forum presented Nur Aini Setiawati, PhD, a historian from the History Department, Gadjah Mada University. He raised a topic with the title Policy for Handling Influenza, Epidemic and Pandemic Diseases in Yogyakarta. The event was guided by moderator dr. Galuh Dyah Fatmala from CBMH FK-KMK UGM and Unesco Chair on Bioethics UGM.

Nur Aini found that influenza epidemics have a long history in Indonesia. The outbreak became a recurring event and had the same policy patterns at the time it occurred. In his presentation, Nur Aini gave an example of the Influenza pandemic that emerged during the colonial period in 1918, then 1957, and the Covid-19 pandemic in 2020 until now.

According to Nur Aini, by looking at the historical view of the Influenza handling policy, it is hoped that the government will be able to make the right decisions for current problems.

“What kind of Influenza policy in Yogyakarta in 1918 is expected to provide solutions for the present.” Nur Aini said.

The influenza pandemic that occurred in 1918 prompted the colonial government to issue policies to prevent infectious diseases. Under the direction of Dienst der Pestbestijding (Pest Eradication Service), the colonial government issued several policies, including quarantine policies, mandatory reporting policies, and treatment policies by doctors and paramedics.

First, the government prohibits the public from visiting their relatives or neighbors who have influenza in the hospital. The policy taken by the Dutch East Indies government was known as the Quarantine Ordinance. Its implementation was published in the Staatblad van Nederlands no 277 of 1911 which explained the granting of authority to the government to carry out quarantine in areas affected by the outbreak. This policy also emerged during the current Covid 19 pandemic where people’s movements were restricted through the lockdown policy (PPKM and PSBB).

The second policy is the obligation to report to the paramedic if there are residents who contract influenza or die. This policy can also be found today when the government has formed a task force tasked with collecting data on patients who are positive for Covid 19.

The third policy is for doctors and paramedics to control each barracks and monitor developments in villages affected by influenza outbreaks.