Drug and Food Control in Indonesia [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held Raboan Discussion Forum on Wednesday (21/12). CBMH FK-KMK UGM invited Dr. Sampurno, MBA, Apt, ex-head of Badan Pengawas Obat dan Makanan Republic Indonesia (2001-2006). Dr. Sampurno presented topic Drug and Food Control. The discussion was lead by Prof. Dr. Sismindari, SU, Apt., Professor at Faculty of Pharmacy UGM.

Drug and food control is crucial because it involves the safety of millions of human lives and the value of large commodity circulation. The monitoring system must be carried out in a systematic, strict, and comprehensive manner based on an efficient system. The purpose of the drug and food control system is to protect people’s health and safety from products that do not meet the requirements and increase national industry excellence.

Business/industry actors must be fully responsible for the quality of their products and be able to check the safety, efficacy, and quality of the products they produce and market. All production and quality control results must be recorded as important company documents. Products that must be controlled and supervised are all medicinal products, traditional medicines, food, cosmetics, and medical devices circulating in the country as well as those exported.

Recommendations for drug and food control include the development of a system-based BPOM equipped with up-to-date and sophisticated IT and AI, the development of BPOM institutions throughout Indonesia as a unified monitoring/laboratory network with an effective line of command, the development of BPOM as a learning organization with human capital as the main actors, BPOM’s ability as an initiator of cross-sectoral collaboration and synergy, and the development of leadership with a strategic vision that is broad-minded and able to mobilize public participation and awareness.

Update on Stem Cell Therapy in Indonesia [Raboan Discussion Forum]

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On Wednesday (14/12), the Center for Medical Bioethics and Humanities held the Raboan Discussion Forum. The topic discussed was Update on Stem Cell Therapy in Indonesia. The speaker for this discussion was dr. Nur Azid Mahardinat and it was moderated by dr. Galuh Dyah Fatmala.

Stem cells are cells that have not properly differentiated and can multiply and differentiate into other cells that are more specific in the human body. They are essential for the development, growth, and repair of cells or tissues in the body. Stem cell technology has sparked new enthusiasm in the development of therapies for various types of diseases. However, it is important to remember that for a therapeutic technique or procedure to become a standard therapy, it must meet all scientific requirements.

Stem Cell Services in the world:

  • The policies in different countries vary.
  • This means that patients who are in a country where the use of stem cells is banned will need to go to another country that allows it.
  • For the patient’s country of origin, this results in a loss in terms of income.
  • For the destination countries of the patients, the potential for exploitation must be watched out for as a direct impact of the medical services provided.

In Indonesia, over the last decade, there has been a tremendous increase in enthusiasm for self-therapy. Some hospitals even invite experts from other countries to provide these services in Indonesia. The government, through the health courts and BPOM, has responded to this development with various regulations.

Main goals of stem cell therapy:

  1. No patient choice (no new treatment options)
  2. Rejuvenation and anti-aging (healthy patients, who do not have life-threatening diseases)

Ethical questions:

  1. What ethical considerations should be considered when applying new techniques or technologies in healthcare?

The answer: A new medical technique/technology is more likely to be adopted if it is safer, more effective, faster, cheaper, and improves cosmetic outcomes. The physician-patient relationship should prioritize the quality of care provided to patients and their families.

  1. Is it ethical to use ‘no option’ patients in therapy-based services?

The answer: There are ethical concerns regarding the inefficient allocation of medical resources, the potential for patients to experience therapy that could burden the economy or have side effects, and the possibility of patients being exploited for the benefit of certain parties.

To prevent unethical practices such as experimental procedures, considerations for clinical use and additional guidelines have been developed, including discussions on recipient selection and addressing the concerns raised in this context.

 

Humanist Doctors Views on Secularism in Indonesia [Raboan Discussion Forum]

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The Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) again held the Raboan Discussion Forum on Wednesday (07/12). The weekly forum raised the topic When Secular Humanist Doctors Talk About Bioethics in Indonesia. On this occasion, the speaker was Albert Adiputra, M.Sc. Meanwhile, the moderator of the discussion was dr. Tiea Khatija.

The existence of a secular humanist minority is considered inappropriate in public discourse, so it lags in formulating policies related to bioethics in Indonesia. Albert’s qualitative research aims to explore the views of secular humanist doctors on bioethics issues as well as their positions, perceptions, and knowledge of the functions, benefits, and developments of bioethics in Indonesia. In his study, the sample consisted of 11 secular humanist doctors who were selected purposively snowball. The results show that secular humanist doctors have different positions and attitudes towards bioethical issues based on non-uniform claims within the spectrum of secularism. Although there is no consensus regarding attitudes and positions towards elective abortion and voluntary active euthanasia, respondents have a relatively consistent pattern of views regarding technology supporting the transhumanism movement. In this respect, the secular humanist doctor is not as monolithic as the public narrative suggests. The hope for medical secularism to materialize in the future is the response of secular humanist doctors to the problems of education and the medical profession that are not secular today. Thus, this study provides an overview of the views of secular humanist doctors on bioethics and its social implications for public discourse and policy in Indonesia.

Application of the Value of Altruism and Doctor’s Responsibility in Handling Patient Complaints at the Hospital [Raboan Discussion Forum]

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The Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) again held the Raboan Discussion Forum on Wednesday (30/11). The weekly forum raised the topic Application of the Value of Altruism and Doctor’s Responsibility in Handling Patient Complaints at the Hospital. On this occasion, the speaker was dr. Rizka Putri Pratiwi, M.Sc. Meanwhile, the moderator of the discussion was dr. Tiea Khatija.

In her presentastion, dr Rizka explain the aims of her study is to identify the types of patient complaints and the process of handling them in the hospital, as well as evaluate the application of altruism and responsibility values in handling these complaints. The method used is qualitative research with a phenomenological approach, by collecting data through in-depth interviews with 15 doctors and several patients, as well as secondary data from Standard Operational Procedure documents. The results showed that there were four sub-themes in the types of patient complaints, namely types of complaints in three domains (clinical, management, and relationships), ways of submitting complaints, flow of complaint handling, and doctors’ perceptions of complaints as an important part of service. The complaint handling process includes identification, finding solutions, delivering solutions, patient feedback, documentation, and evaluation, and the values of altruism and responsibility have been applied. However, there are still some obstacles in the implementation of the value of responsibility that require improvement and improvement. Overall, the handling of patient complaints at the hospital has been carried out well, but still requires improvement to improve service quality.

Humanist Education [Raboan Discussion Forum]

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Wednesday (23/11), the Center for Medical Bioethics and Humanities held the Raboan Discussion Forum. The topic raised was Humanist Education. The speaker for this discussion was dr. C.B. Mulyatno, Pr. and moderated by Noviyanti Fahdilla, S. Tr.Keb, MPH.

Experimental School is a school that focuses on human and experience. The core of the school built by YB Mangunwijaya is the development of the character of solidarity. The reason is because Indonesian society is plural, so it has religious riches such as respecting, celebrating, and giving meaning to life. So far, education in Indonesia has only prioritized by the value of rivalry through the ranking. That’s why, YB Mangunwijaya want to create a happy school and every student was involved in self-development.

Students were invited to make some agreement like classroom rules, so we let the children to contribute. Thus the class becomes an exploratory space. An integral aspect of the experimental school is children get the value from the activities that they do, so children can express it by understanding the meaning of sharing, empathy and friendship.

Mangunan experimental school is a school that has a basic education system by developing children’s creativity. The main goal of the experimental school is the ability to value and live life. According to YB Mangunwijaya, the meaning of school is convivium (learning community), which is a place to interact with teachers, students, parents, and the community. The experimental school didn’t use any fences because they thought that children can directly interact with the people around the school.

There are 7 basic modalities applied by experimental schools:

  1. Have good mental and spiritual character.
  2. Understanding the language so they can express themselves in a polite communication.
  3. Independent, honest, critical, and creative
  4. Able to understand and appreciate useful items in life.
  5. Like to help someone and doing good.
  6. Respect each other and work together to keep the environment in a good term.
  7. Physically and spiritually healthy

Predicting the Future of Telemedicine in Indonesia Post COVID-19 [Raboan Discussion Forum]

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Wednesday (16/11) Center for Bioethics and Medical Humanities Faculty of Medicine Public Health and Nursing held a Raboan Discussion Forum. The virtual forum raised the topic Measuring the Future of Telemedicine in Indonesia Post COVID-19, presented by dr. Dony Septriana Rosady MH.Kes MBA M.AP M.Sc. Meanwhile, the moderator for the discussion was Nathan Agwin Khenda, Ftr.

Telemedicine refers to remote healthcare services provided by healthcare professionals using information and communication technology. The Ministry of Health’s regulation on Telemedicine (Permenkes 20/2019) covers teleradiology, tele-electrocardiography, tele-ultrasonography, teleclinical consultations, and other telemedicine services as per advancements in science and technology. Research development with various public-private ownership characteristics, geographic locations, and service levels is necessary to strengthen telemedicine implementation. Regulatory guidance on clinical teleconsultation, the development of online PNPK (National Standardization of Health Facility), and strengthening health information management policies, including financing and digital literacy, are also necessary. Collaboration across academic, business, community, government, and media sectors is crucial for developing clinical teleconsultation.

During the COVID-19 pandemic, clinical teleconsultation has adhered to bioethical principles and ethical guidelines set by professional organizations. Respect for patient autonomy, non-maleficence, beneficence, and justice in providing easy access to all while ensuring the provision of face-to-face services for those in need have been maintained. The practice of teleconsultation during the pandemic is in line with existing regulations and does not violate medical ethics. Post-pandemic regulation review is necessary for the sustainable implementation of clinical teleconsultation.

 

The Ethical Perspective of Medical Personnel on the Crisis of Personal Protective Equipment at the Beginning of the COVID-19 Pandemic [Raboan Discussion Forum]

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Wednesday (09/11), the Center for Bioethics and Medical Humanities again held the Raboan Discussion Forum. The topic discussed at this event was the Ethical Perspective of Medical Personnel on the Crisis of Personal Protective Equipment at the Beginning of the COVID-19 Pandemic. Dr explained this topic. Paramita Sari M.Sc, Lecturer at the Faculty of Medicine, Nahdalatul Ulama University in Surabaya and also an Alumni of the UGM Bioethics Masters Study Program. Meanwhile, acting as moderator is Desy Putri Ratnasari, S.Si, M.Si.

The Covid-19 pandemic in Hubei, China, spread quickly and resulted in high morbidity and mortality rates. According to Dr. Paramita, this is a new challenge for medical personnel, especially at the forefront of health facilities. Health systems in various countries, including Indonesia, are not ready to face the Covid-19 Pandemic.

At the beginning of the spread of Covid-19, medical workers faced the problem of a shortage of logistics for personal protective equipment (PPE) even though tools such as masks, gloves, hand sanitizers, and so on are urgently needed so that health workers are not infected with Covid-19.

“Covid-19 spreads rapidly with high morbidity and mortality rates, while the readiness of personal protective equipment at the start of the pandemic was not close and is said to be in a crisis condition.” Dr. Paramita said.

Many ethical dilemmas were faced by medical personnel at that time. Medical personnel should save patients during a crisis for personal protective equipment. Limited personal protective equipment makes the risk of contracting Covid-19 even higher.

Even though the principle is that medical personnel must save themselves before helping others. Before meeting the patient, personal protective equipment is a mandatory requirement to help patients who need help and care.

 

Application of Virtue Ethics in Health Service For Persons With Disabilities of Medula Spinalis Injury [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada (CBMH FK-KMK UGM) again held a Raboan Discussion Forum on Wednesday (2/11). The event which was held virtually raised the topic of Application of Virtue Ethics in Health Services for Persons with Disabilities Spinal Cord Injury, which was presented by Dr. dr. Maria Regina Rachmawati, Sp.KFR, M.Sc. Meanwhile, acting as a moderator is dr. Tiea Khatija.

At the beginning of her presentation, Dr. Maria explained that disability is a decline in the function of the human body which can be categorized into three, namely mild, moderate and severe. Spinal cord injuries are included in the category of severe disability. Patients with spinal cord injuries are unable to carry out activities of daily living. They experience loss of sensory and autonomic motor function, resulting in dependence on other people or medical devices. In her research, Dr. Maria tries to find out the application of virtue ethical principles by doctors in health services to sufferers of spinal cord injuries. dr. Maria also saw whether the doctor’s virtue character and service to Specialist Medula Injury patients followed the egalitarian concept. To find out this, Dr. Maria distributed questionnaires and interviewed doctors in the Jakarta, Bogor, Depok, Tangerang, Bekasi, and Banten areas.

The results of the study show that there are good virtue characteristics that are adhered to by doctors in serving people with spinal cord injuries, namely: love, gratitude, spiritualism, passion, justice, and kindness. However, these characters do not fulfill the egalitarian concept of justice and objectivity. Meanwhile, for patients with spinal cord injuries, three virtue characteristics are expected from doctors: prioritizing the patient’s interests over personal interests, compassion and loyalty, and being trusted. This view needs to fulfill the egalitarian concept that patients are expected to be active, logical, and wise.

Based on the results of Dr. Maria’s research, she recommended that there should be an increase in doctors’ understanding of virtue character, which supports an egalitarian concept. Not only doctors, but patients with spinal cord injuries also need to receive education to support an egalitarian concept, namely being active, logical, and wise patients in long-term health services.

Humanitarian Forensic Action [Raboan Discussion Forum]

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Wednesday (26/10) the Center for Bioethics and Medical Humanities again held a Raboan Discussion Forum with the topic ICRC and Humanitarian Forensic Action. The event, which was held virtually, invited the speaker, dr. Tjiang Sari Lestari, Sp.FM from the International Committee of the Red Cross (ICRC) Regional Delegation to Indonesia and Timor Leste. Meanwhile, the moderator was Desy Putri Ratnasari S.Si M.Sc.

The International Committee of the Red Cross (ICRC) is a humanitarian organization born out of concern for the fate of war victims. In Indonesia, the ICRC was established in 1987.
dr. Tjiang Sari Lestari explained that the ICRC is engaged in four focus activities, namely Protection, Assistance, Prevention, and Cooperation.

One of the focuses of activities carried out by the ICRC is conducting Humanitarian Forensic Action. This activity aims to ensure that the victims’ bodies can be treated with respect and dignity. Referring to International Humanitarian Law, improper handling of corpses can result in the bodies being unrecognized, or incorrectly identified. Bodies whose status is not identified will be recorded as missing persons so they cannot be returned to their families for proper and proper burial.

dr. Tjiang Sari Lestari explained that the ICRC already has a guide used by volunteers with the title Management of The Dead after Disaster (MotD). The guidelines cover the process that must be followed to handle the bodies of victims of natural disasters or war, from the time the bodies are found until they are returned to their families. The process is divided into four which is: the discovery of the body by the first responder team, information collection, data management and forensic identification, and last is returning the body to the family.

Genetics and Ethics [Raboan Discussion Forum]

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