Addressing Ethical Challenges in Healthcare

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Yogyakarta, February 26, 2025 – The Center for Bioethics and Medical Humanities (CBMH) Universitas Gadjah Mada once again held its regular webinar, Raboan Sharing & Perspective Sharing. This webinar was conducted online via Zoom Meeting and featured Dr. Bondan Agus Suryanto, S.E., M.A. (Lecturer at the Faculty of Medicine, UII and FMPHN UGM) as the main speaker, with Mahmasoni Masdar, S.Kep., Ns., M.Kep as the moderator.

Presentation by dr. Bondan Agus Suryanto, S.E., M.A.

This session explored “Ethical Issues in Healthcare Services”, highlighting challenges and solutions in achieving fairness in the distribution of healthcare services. In his presentation, dr. Bondan emphasized the importance of a bioethical approach based on social justice to ensure equitable healthcare access amid limited resources. Additionally, he discussed the role of professional organizations in maintaining a balance between the interests of healthcare professionals and the needs of the broader community.

Interactive Discussion with Participants

Mahmasoni Masdar, as the moderator, led an interactive discussion involving participants from various backgrounds, including healthcare professionals, academics, and students. The session delved deeply into different perspectives on healthcare ethics in Indonesia, covering public policy roles, the influence of culture and religion, and challenges in implementing a health insurance-based system such as BPJS.

The discussion on ethical issues in healthcare services aligns with the Sustainable Development Goals (SDGs), particularly SDG 3: Good Health and Well-being and SDG 10: Reduced Inequalities. This webinar aimed to foster cross-sector dialogue to help design more equitable healthcare policies, ensuring that every individual, regardless of social and economic background, can access quality healthcare services.

CBMH UGM hopes this forum will serve as a platform for stakeholders to engage in discussions and share insights on bioethics in Indonesia. Through cross-sector collaboration, the goal is to develop healthcare policies that are fair and easily accessible to all.

Reporter          : Alvira Rahmasari, S.H.G.

Editor              : Rafi Khairuna Wibisono, S.Kom.

Understanding the Concept of Do Not Resuscitate (DNR) in Terminal Patients: Ethical and Medical Practice Perspectives

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Presentation of Raboan material by dr. Lucia.Yogyakarta, 19 February 2025 – As part of the Raboan: Research and Perspective Sharing series, a discussion was held on the topic The Concept of Do Not Resuscitate (DNR) Orders in Terminal Patients with DPJP”. The event featured dr. Lucia Pudyastuti Retraningtyas, SpA., M.Bio.Et, a lecturer at the Faculty of Medicine, Universitas Surabaya, as the keynote speaker. The discussion was moderated by drg. Agnes Bhakti Pratiwi, MPH, Ph.D., from the Center for Bioethics and Medical Humanities (CBMH), Faculty of Medicine, Public Health, and Nursing (FKKMK), Universitas Gadjah Mada, as well as the UNESCO Chair on Bioethics at UGM.

This webinar highlighted various perspectives on DNR orders for terminal patients. DNR is a medical decision made by the medical team after consulting with a team appointed by the Medical Committee or Ethics Committee. Ideally, the decision-making process should involve both the patient and their family. Communication between the patient, family, and healthcare providers is crucial in identifying the patient’s values, preferences, and critical medical care decisions. dr. Lucia emphasized that DNR orders must be clearly documented and recorded in the patient’s medical records.

Discussion Session With Participant

One key point discussed was the importance of respecting patient dignity in end-of-life care. Physicians have different perspectives on DNR orders, with some agreeing and disagreeing them. Reasons for agreeing DNR Orders : reducing patient suffering and ensuring a peaceful passing; alleviating the burden on the family during the patient’s final moments, facilitating the work of other medical personnel in providing appropriate care; religious considerations that align with end-of-life dignity; legal aspects that support the implementation of DNR. Reasons for disagreeing DNR Orders: concerns over family misconceptions and potential conflicts; the belief that doctors must provide the maximum possible care to every patient; fear of causing family distress or uncertainty regarding medical decisions.

DNR is also linked to the Sustainable Development Goals (SDGs), particularly:  SDG No. 3: Good Health and Well-Being, which emphasizes the importance of access to quality healthcare services, including palliative care and the patient’s right to decide on end-of-life care. SDG No. 10: Reduced Inequalities, which highlights that every patient has the right to make medical decisions without pressure or discrimination, including decisions regarding DNR orders.

This Raboan discussion reaffirmed that a bioethical approach to implementing DNR orders is essential in end-of-life nursing and medical decision-making. Through effective communication between doctors, patients, and families, it is hoped that medical decisions can be made ethically and in alignment with human values.

 

Reporter          : Ardhini Nugrahaeni,M.K.M

Editor              : Alvira Rahmasari, S.H.G.

Building Bioethics for All through Cultural Sensitivity

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Yogyakarta, February 12, 2025 – The Raboan Perspective Sharing session once again sparked an insightful discussion on bioethics with the theme “FOR ALL HUMANITY: Toward a Culturally Sensitive Bioethics.” This event featured Prof. Syafaatun Almirzanah, MA, M.Th, Ph.D, D.Min, Head of the Center for Spirituality, Science, and Humanity at UIN Sunan Kalijaga Yogyakarta, as the keynote speaker. The discussion was moderated by dr. Galuh Dyah Fatmala from the Center for Bioethics and Medical Humanities (CBMH), Faculty of Medicine, Public Health, and Nursing (FKKMK) UGM, as well as the UNESCO Chair on Bioethics UGM.

This webinar highlighted the importance of a culturally sensitive approach to bioethics in an increasingly pluralistic and complex society. Bioethics is not solely a concern of the medical field but extends to various disciplines, including social sciences, politics, and religion. In her presentation, Prof. Syafaatun emphasized that bioethical understanding must consider the diverse identities present in society, as each individual carries unique cultural, religious, and social values.

One key takeaway from the discussion was the need to respect and appreciate diversity in society. In this context, Prof. Syafaatun underscored the importance of inclusive democracy and active participation from all groups to create a more just social order. The discussion also explored human rights in bioethics, particularly regarding equal access to healthcare and education without discrimination.

This topic is closely linked to the United Nations’ Sustainable Development Goals (SDGs), particularly SDG 3: Good Health and Well-Being and SDG 16: Peace, Justice, and Strong Institutions. A culturally sensitive approach to bioethics ensures that healthcare services are delivered fairly and with dignity, supporting the well-being of all individuals regardless of their backgrounds. Additionally, through the lens of pluralism, the discussion emphasized the importance of building inclusive and strong institutions to sustain better healthcare and social systems.

The session also addressed various ethical dilemmas in medicine, including euthanasia, physician-assisted suicide, and organ transplantation challenges. Prof. Syafaatun stressed that despite the differing perspectives on these issues, justice, empathy, and respect for human rights should always be prioritized.

Through this discussion, CBMH UGM aims to continuously promote awareness and understanding of the importance of an inclusive and culturally based bioethics. Collaboration between academics, practitioners, and the wider community is key to developing a fairer and more sustainable bioethics system in the future.

This Raboan discussion reaffirmed that a culturally sensitive approach to bioethics is crucial in building a more inclusive and harmonious society. By understanding the intersection of cultural identity, religion, and social values, we can create a more human-centered and just ethical system for all.

Reporter : Rafi Khairuna Wibisono, S.Kom
Editor : Alvira Rahmasari, S.H.G.

Explores the Distinction Between Medicine and Health, Emphasizing Ethics and Human Rights

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Yogyakarta, February 5th, 2025 – Raboan Research and Perspective Sharing returns at the beginning of February, raising an important topic related to medicine and health. This event features a distinguished speaker, dr. Noorman Herryadi, Sp.F, S.H, the Chairman of the Honorary Council of Indonesian Medical Ethics (MKEK) and a Forensic Ethical-Legal Consultant. The discussion is moderated by Fahmi Baiquni, S.Psi., M.P.H, from the Center for Bioethics and Medical Humanities (CBMH) Faculty of Medicine Public Health and Nursing FK-KMK UGM.

In this discussion, dr. Noorman Herryadi elaborates on the definitions and differences between medicine and health, which are often sources of confusion among medical professionals and the general public. Medicine is not just a science, but also an art in understanding diseases and their cures. The speaker explains that medicine encompasses various aspects, ranging from disease prediction, the relationship between humans, to the ethical principles that every doctor must uphold.

During his presentation, dr. Noorman quotes several sources, including Dorland’s Medical Dictionary and the philosophy of Paracelsus, who stated that: 

“Medicine is not only a science, but an art.” 

He emphasizes that medicine is not only limited to curative aspects but also includes other medical efforts such as promotive, preventive, and rehabilitative measures.

Furthermore, dr. Noorman stresses that medicine must be based on ethics. Medical ethics is rooted in the doctor’s oath and humanitarian principles, where doctors are required to practice their profession with high integrity.

In addition to discussing medicine, the session also highlights the definition of health based on Law No. 17 of 2023, which includes physical, mental, and social aspects. The speaker underscores that health is a fundamental human right, and the government has the obligation to provide adequate healthcare services for the public.

This session of Raboan Research and Perspective Sharing provides a deep understanding that medicine and health are interrelated but have different scopes. Medicine focuses on diagnosis and treatment, while health encompasses broader aspects, including social well-being and public policy.

In conclusion, this Raboan Research and Perspective Sharing session reaffirms that a proper understanding of medicine and health is crucial to improving the quality of healthcare services in Indonesia. A broader understanding of medicine aligns with the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), which emphasizes the importance of access to quality healthcare for everyone.