Business Ethics [Raboan Discussion Forum]

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Wednesday (05/4), the Center for Medical Bioethics and Humanities held the Raboan Discussion Forum again. The topic discussed at this event was Business Ethics. The speaker on this topic is Dr. Peter Johannes Manoppo, a Bioethicist from the Indonesian Bioethics Forum. Meanwhile, the moderator was Nathan Agwin Khenda.

The business makes one’s living because it can make money, products, and services. However, the increase in population is inversely proportional to the amount of human and natural resources; this can cause ethical problems. The thing to note is that when we study science, we will find gold fields, while when we look at ethics, we will find minefields.

A business person must have creativity, innovation, novelty, value, execution, pioneering, ethical ground, and empowering business. In addition, companies must respect all business stakeholders, including management, workforce, customers, suppliers, competitors, regulators, other corporate citizens, and society because all of these things can do a business last a long time.

The UNDP goals contain 17 SDGs, namely sustainable growth. Here there are many themes on health, education, and climate change; there are also themes concerning economic development and infrastructure. Right now, the industry has to innovate, but human resources don’t exist, and there are more and more human resources. Moreover, the principle of the UNDP Global Goals is to seek peace for all human beings. Therefore, it can be used as a guide in business ethics.

There are four pillars of business management, business analysis, learning and leadership development, strategic partnerships, and funding opportunities. These four Pilat must have the correct ethical foundation to run well. Therefore it is necessary to have an ethics committee conducting business to pay attention to the following matters, Sexual harassment, Diversity & discrimination, Bullying, Health & Safety, Environmental protection, Accounting practices, Data privacy, and Theft.

Businesses should improve human welfare & prosperity through good business governance based on the four pillars of business management. When doing business, sometimes there are competing or conflicts of interest in business, but all business stakeholders should avoid this. Social responsibility is essential to the morality of business, internally & externally.

 

Download material here

dr. Peter Johannes Manoppo, SpB, MBIO, FINACS, FiCS. – Business Ethics

 

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https://youtube.com/live/7HPV3BjqJzU?feature=share

Seeking Treatment in a Neighboring Country, What Are the Ethical Aspects? [Raboan Discussion Forum]

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On Wednesday (29/03),  Center for Medical Bioethics and Humanities held the Raboan Discussion Forum again. This time, the topic raised was Ethical Aspects When Seeking Treatment In A Neighboring Country. The speaker of the discussion was dr. Effiana with the moderator dr. Tiea Khatija.

Every year the number of Indonesian people seeking treatment in neighboring countries such as Malaysia, Singapore, and Thailand increases. In this discussion, the object of discussion is the city of Pontianak which is near Kuching city in Malaysia.

There are four terms for medical treatment abroad namely health tourism, medical tourism, medical travel (feeling that doctors cannot handle the disease in their origin city), and medical exile (considered as refugees). Nowadays, generally, it’s more common to call it a medical trip.

According to Ormond, two reasons can motivate people to seek treatment abroad: dissatisfaction (dissatisfaction) and limited access or services (disfranchisement). It is also influenced by two factors such as the pull factor perspective (availability of world-class health facilities/services in the country you want to go to) and the push factor perspective (dissatisfaction with health facilities/services in the origin city).

There are several phenomena of medical travel carried out by Indonesian people (especially in Pontianak), namely having experience of being misdiagnosed by doctors in their country of origin, not trusting medical personnel in their country of origin, having experience of being students abroad, having foreign spouses, and working immigrant.

Those who seek treatment abroad have a higher trust in doctors in the destination country. Some of them had satisfying experiences of being treated abroad so that if they got sick again in the future, they would return for treatment there. Feeling that the price is the same as going to Java for treatment, they can already travel together. They also have experience trading in the country, so they seek treatment there because they feel more familiar with the environment.

Medical trips carried out by Indonesian people have a wide impact, so in deciding to seek treatment abroad, careful consideration of ethical issues/aspects is required to carry out the treatment appropriately.

Climate Change and Rural Health Care [Raboan Discussion Forum]

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Wednesday (1/03), the Center for Medical Bioethics and Humanities held the Raboan Discussion Forum. This time, the topic that we raised was Climate Change and Rural Health Care. The speaker for this discussion was dr. I Nyoman Sutarsa, Ph.D and moderated by dr. Tiea Khatija.

Climate change is anthropogenic emission, such as coal burning activities. So that it will increase in rainfall which causes flooding, prolonged drought can cause food insecurities. If food insecurities have occurred, those who feel the biggest impact are the vulnerable people. Climate change can also cause extreme weathers such as storms, hailstorms, heat waves, and bush fires.

The relationship between climate change and health: in some areas where food supply is difficult, if climate change occurs it will reduce the quantity of products from the agricultural sector. Then if the salt level in the soil increases beyond the limit, it will affect the quality of the food.

Rural Area Challenges: access for health services is still difficult due to its geographical location and making it more difficult to get there. The second challenge is economic welfare, the job opportunities are limited and in the event of a natural disaster it is directly affected and suffers losses (climate dependent sectors). Then there is the cultural background, a family/group that usually suffers from hereditary losses. The last is health equities, the high incidence of infections and disease complications because they are not treated quickly.

There are several Intersecting vulnerabilities such as:

  1. Extreme weather: if there is long drought and too much rainfall, it will affect water or food scarcity.
  2. Food insecurity: when there is a flood, then the transportation route is cut off so that food production and supply chain is disrupted.
  3. Vector borne diseases: causing the expansion of vectors such as dengue or malaria.
  4. Regional increase in pollens and spores causes an exacerbation of respiratory diseases in people who already have congenital asthma. Because there is no pulmonologist in rural areas.

Meanwhile the adaptation strategies strategies are:

  1. Monitoring climate health capacity and vulnerability
  2. Trying to prepare primary care when a sudden disaster occurs.
  3. Strengthen the function of the primary health care (Puskesmas) and oversee the distribution of vaccines.
  4. Increasing public education and awareness supported by the community to provide education about the indirect and direct impacts of climate changes.
  5. Develop alert systems or warning systems.
  6. Strengthen food safety control, vaccine programs, vector control, case detection and treatment.
  7. Identify risk indicators and health outcomes from the community.
  8. Improving health workforce capacity in rural areas.

 

Gendered Care and Ethics in Social Research [Raboan Discussion Forum]

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Wednesday (22/02) Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) just held Raboan Discussion Forum. The weekly online forum invited Gita Nasution, Ph.D from Australia National University. She presented her research titled Gendered Care and Ethics in Social Research. The discussion was lead by Erlin Erlina, Ph.D from FK-KMK UGM.

Gita presented her ethnographic study that explores the emergence and dynamics of the baby sitter profession in Indonesia, with a focus on the social and economic factors driving its growth and the aspirations of both employers and workers. The study highlights the gendered nature of care work, with women primarily taking on the role of careers in both domestic and public settings.

The study finds that the rise of the service sector in Indonesia has created a need for child care, which is particularly acute in middle-class families where both parents work. Hiring a child carer/nanny is seen as crucial to support dual income families in looking after their children. Meanwhile, from the worker’s perspective, becoming a baby sitter is often a result of limited employment opportunities and the need to provide for their families.

The study also reveals the dual role of agencies in the baby sitter profession: as a supplier of workers and as a training institution. However, there are challenges in the industry, including mismatched expectations, unskilled workers versus demanding employers, and persisting issues of discrimination and class hierarchy.

Overall, the study shows that the baby sitter profession is a social phenomenon that reflects the transformation of domestic work and sheds light on how people adapt to changing social and economic circumstances. While care work has become more professionalized, there remains a power dynamic between employers and employees, and care work remains a gendered profession.

 

A Dialogical Approach to Clinical Ethics Support for Critical Yet Respectful Learning [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held Raboan Discussion Forum last Wednesday (15/2). The discussed topic on the forum was “A Dialogical Approach to Clinical Ethics Support for Critical Yet Respectful Learning.” CBMH FK-KMK UGM, as the organizer, invited Prof. Bert Molewijk from UMC University of Amsterdam as the speaker. dr. Wika Hartanti MIH also moderated the online discussion forum.

Prof. Bert said that a dialogical approach to ethics is crucial for meaningful engagement and understanding. Ethics plays a vital role in clinical practice. Ethics can provides a framework for making morally sound decisions and ensures the well-being of patients. In addition, ethics is important because it upholds the integrity of the healthcare professionals and fosters trust in professional relationships.

Ethical challenges can arise in healthcare, and addressing them requires open dialogue, reflection, and a consideration of theoretical frameworks. There are various areas of ethics, such as decision-making, resource allocation, and end-of-life care. In healthcare in Norway, for example, ethical challenges include patient autonomy, confidentiality, and balancing individual rights with societal interests.

Moral distress can occur when healthcare professionals face personal values conflict with their professional duties. It highlights the significance of ethical discussions and decision-making processes to address moral dilemmas effectively. By engaging in ethics discussions and decision-making processes, healthcare professionals can navigate moral dilemmas, promote fairness and justice, and strive for the best possible outcomes for individuals.

 

Bioethical Problems in Women’s Surgical Methods of Contraception [Raboan Discussion Forum]

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Wednesday (8/2), the Center for Medical Bioethics and Humanities held the Raboan Discussion Forum. The topic that we raised was Bioethical Problems in Women’s Surgical Methods of Contraception. The speaker for this discussion was Dr. Annisa Ullya Rasyida, dr., M.Si. and moderated by dr. Tiea Khatija.

Women’s Surgical Methods of Contraception (MOW) or female tubectomy or sterilization to close the fallopian tubes, to preventing the pregnancy, because the ovum can’t meet sperm cells. Contraception can be done if there are indications and/or the couple doesn’t want to have more children (BKKBN, 2011). One of the indications for someone that use the MOW contraception is the presence of psychological/physical disturbances when the woman is pregnant again. Only 44.5% of MOW acceptors knew about the side effects of using that contraception. MOW contraceptive users can only give birth with caesarean section method is maximum of 3 times. The use of MOW contraception is recommended for mothers who have heart defects that are quite serious.

New Sense of Bioethics:

  1. Belief in God or Faith: doctors being an intermediator to help patients, but God determines the outcome. Patient like to stubborn, because they feel that death is in God’s hand, so they still want to try.
  2. Respect for others: doctors respect the wishes of patients and do not force patients to sign informed consent. The patient has been explained the action procedure, but when the formula Is not clearly written and there is a risk, the patient blames the doctor.
  3. Beneficence: doctor tries to help patient, in this case the patient feels loss in the future because she can’t get pregnant again
  4. Non maleficence: the doctor tries to save the patient’s life. In this case the patient was saved by being advised to be sterile because he had a history of the disease. But, turns out patient wants to get pregnant again and she knows that she can’t, the patient feels aggrieved.
  5. Social justice for all: doctors help patients regardless of status.

The absence of the word “permanent sterile” on the informed consent sheet make an opportunity to bring the matter into the realm of law. The response: verbal consent is sufficient, so written informed consent is only a confirmation of what has been previously agreed upon. However, it would be better if the informed consent was written in full of the purpose, benefits and risks of an action/operation. Then effective communication builds trust between doctors and patients.

Abandonment of Ethics, Early Directions to Violation of the Law [Raboan Discussion Forum]

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Wednesday (01/02) Center for Bioethics and Medical Humanities Faculty of Medicine Public Health and Nursing held a Raboan Discussion Forum. The virtual forum raised the topic Abandonment of Ethics, Early Directions to Violation of the Law, presented by Dr. dr. Siswanto Sastrowijoto, Sp. ENT-KL (K), MH. Meanwhile, the moderator for the discussion was dr. Galuh Dyah Fatmala.

The dominant factor in professionalism is a combination of relevant intellectual capacity, necessary skills, adherence to moral and ethical standards, and the ability to act as an agent of change. In the context of medical professionals, neglecting ethical standards can lead to unprofessional behavior, which may result in malpractice. Several criteria support the legal action of medical malpractice, such as violating professional standards, operational procedures, informed consent, doctor-patient confidentiality, and ethical and moral principles. In addition, failure to meet patients’ medical needs and violating their rights are grounds for legal action.

Indonesian Law No. 29/2004 stipulates the obligations of doctors and patient’s rights, including providing medical services according to professional and standard procedures, referring patients to other doctors with better expertise, maintaining patient confidentiality, providing emergency medical assistance, and continually improving their knowledge. Ethical violations by medical professionals against patients are classified as mild, moderate, and severe, with corresponding sanctions ranging from counseling to dismissal from professional organizations. Ethics violations can lead to disciplinary and legal sanctions, including revocation of practice permits and imprisonment. In addition, providing false medical statements is punishable by up to four years in prison under the Penal Code.

Digital Health Transformation Impact on Health and Inclusion: Some Moral Considerations [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities held Raboan Discussion Forum on Wednesday (25/01). The weekly discussion forum raised topic Digital Health Transformation Impact on Health and Inclusion: Some Moral Considerations. The topic was presented by Abdul Rohman, PhD. and lead by moderator Erlin Erlina, PhD.

People with disabilities (PwD) have faced challenges accessing information related to the pandemic, including vaccination programs, indicating an inconsistent implementation of social inclusion principles in the pandemic response plans. In response, three organizations of PwD in Vietnam organized five online information sessions between late 2021 and early 2022 when major cities in Vietnam were on lockdown. During each session, medical experts shared pandemic and vaccination-related information with 209 participants. After the session, participants were asked to rate their confidence in COVID-19 vaccines, share what information they needed, what information sources they used, and how to improve the inclusiveness of vaccination programs. The study found that PwD in Vietnam are willing to take vaccines, but making a range of information sources accessible to them can help communicate the side effects of the vaccines to their specific health conditions. It is important to consistently implement disability rights in vaccination programs as part of the pandemic response plans to become more inclusive. The study recommends strengthening the capacity of organizations of PwD to produce accessible information independently to better protect them in future pandemics.

 

Ethical Perspective on Artificial Womb [Raboan Discussion Forum]

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On Wednesday (18/1), the Center for Medical Bioethics and Humanities held the Raboan Discussion Forum. The topic discussed was the Ethical Perspective on Artificial Womb. The speaker for this discussion was Dr. Theza Elizianno Andrew Pellondo’u, Sp.KF, and it was moderated by Dr. Tiea Khatija.

DNA & RNA are chemical molecules that have the property of self-replication. Cells have the inherent instinct to reproduce themselves through mitosis or meiosis.

Effects of science and technology developments in medicine:

  • Improved accuracy of MRI and CT scans
  • CSISPR
  • 3d printing

The development of science and technology in reproduction:

  • Section Caesarea
  • IVF
  • Sperm/ovum/embryo storage
  • Surrogate mother
  • Baby Incubator
  • Clone
  • Stem Cells

IVF/IVF has helped many couples who have difficulty having children. Artificial uterus is a tool to accommodate the womb outside the uterus so that it can develop normally.

The Ways of Artificial Womb working:

  • The artificial womb is placed in a vessel filled with circulating artificial amniotic fluid.
  • The umbilical cord is connected to a tube to supply oxygen and nutrients while removing carbon dioxide and other metabolic waste.
  • The hose is connected to a blood pump and filtration device.

Limitations of the artificial uterus: Currently, it is only feasible for fetuses with a strong heart capable of pumping blood throughout the body and blood vessels that are large enough to accommodate a catheter.

Advantages of an artificial uterus:

  • Reduce infant mortality caused by premature birth.
  • Reduce abortion rates for maternal indications.
  • Eliminate the practice of surrogate motherhood.
  • Anyone can have biological offspring, for example, women with uterine problems or gay partners.
  • Embryo development can be directly observed.

Disadvantages of Artificial Uterus:

  • Depends on electricity, filters, artificial materials.
  • Limited
  • Expensive

Ethical Aspect :

  • Respect for Autonomy: Embryo transfers must have the patient’s consent and respect the patient’s rights.
  • Justice: Not everyone can access the health procedures/measures they need. Patients are free to determine their rights to have or not have children.
  • Beneficence: Protecting human life and prioritizing patient health.
  • Non-maleficence: It will be fulfilled if it is practiced perfectly. Doctors need to be careful when applying new, untested methods.

Ethical Issue in Assessment [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities held Raboan Discussion Forum on Wednesday (11/01). The weekly discussion forum raised topic Ethical Issue in Assesment. The topic was presented by dr. Yoyo Suhoyo, M.Med.Ed, PhD. and lead by moderator dr. Galuh Dyah Fatmala.

Ethical behavior in assessment requires individuals to act based on their obligation to protect the rights of those affected by the evaluation, treat them with respect, and incorporate principles of fairness. The first principle of assessment is to do no harm, meaning that assessments should accurately reflect mastery of content, be administered fairly, and treated confidentially to avoid score pollution. Score pollution is any practice that artificially improves test performance without increasing actual mastery of content, resulting in scores that do not represent actual student achievement.

Assessment principles include validity, which ensures that the assessment measures what it is intended to measure, reproducibility, which ensures consistency in measurement, equivalence, which ensures that different forms of the assessment measure the same construct, feasibility, which ensures that the assessment can be practically administered, educational effect, which considers the impact of assessment on learning, and catalytic effect, which considers the impact of assessment on instruction. Acceptability, which considers the stakeholders’ perceptions of the assessment, is also a crucial principle.

In summary, ethical behavior in assessment requires individuals to protect the rights of those affected by the evaluation, avoid score pollution, and incorporate principles of fairness. Assessment principles such as validity, reproducibility, equivalence, feasibility, educational effect, catalytic effect, and acceptability ensure that assessments accurately measure what they intend to measure, are administered consistently and fairly, and have a positive impact on learning and instruction.