CBMH FK-KMK UGM and Unesco Chair on Bioethics UGM Encouraging Palliative Care in Indonesia [Event]

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The Center for Bioethics & Medical Humanities Faculty of Medicine, Public Health and Nursing with the Unesco Chair on Bioethics Universitias Gadjah Mada organized a symposium titled “Palliative Care Symposium: Investing in Palliative Care, Improving Health for The Elderly”. The symposium, which was held for two days (29th-30th September) was also held in collaboration with professors and researchers from the University Medical Center Amsterdam University. The event took place at the 8th floor of the North Wing Tahir Building and the Zoom Meeting.

In this event, CBMH FK-KMK UGM invited palliative care experts from various backgrounds. The symposium keynote speaker was Professor Dr. DL (Dick) Willems, professor of Bioethics at UMC University of Amsterdam. In addition, the invited speakers include Xanthe de Voogd, Ph.D researcher from UMC University of Amsterdam, Dr Christantie Effendy, Health and Nursing, Universitas Gadjah Mada, Dr. dr Maria Astheria N.L Witjaksono, MPALLC(FU) physician from Dharma’s Cancer Hospital and Dr. dr. Darwin, S.H., Sp.B(K)Onk. Chief Director of Universitas Gadkah Mada Academic Hospital.

The symposium was divided into four sessions. Each session discusses a prominent topic regarding palliative care. Among them were: a comparison of palliative care in Indonesia and in the Netherlands, palliative care education, business in the field of palliative care, and research in palliative care. Participants who attended in person or through zoom were highly enthusiastic about all presentations.

Ethics in Primary Health Care [Raboan Discussion Forum]

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The Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held the Raboan Discussion Forum again. The event which was held on Wednesday (28/09) invited Prof. Dr. Dick Willems from Amsterdam University Medical Center with the theme Ethics in Primary Health Care. On that occasion, the moderator was drg. Agnes B Pratiwi, MPH.

Prof. Dr. Dick Willems explained that health services at the primary level have several characteristics of their own. The first characteristic is that the services provided in primary care tend to be personal and closer. The relationship between doctor and patient prioritizes the important things
“Take into account personal patient find it important,” said Prof. Dr. Dick Willems

In addition, Prof. Dr. Dick Willems said that the relationship between doctors and patients in primary care is characterized by trust.

The second characteristic of primary care is that the medical services provided are general. Primary care is a place where patients get the first service for all types of health problems.

Third, services in primary care are continuous and available for 24 hours. The four services in primary care are cooperative. This means that all parties such as specialists, nurses, social workers, and spiritual care work together in providing services to patients.

 

Abortion for Rape Victims in Indonesia: Changes in Legal Procedures and Rules [Raboan Discussion Forum]

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The Center for Bioethics and Medical Humanities (CBMH), Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada held another regular Raboan Discussion Forum on Wednesday (21/09). In the virtual event, CBMH invited dr. Agung Dewanto., Sp.OG(K)., Ph.D to give a presentation entitled Abortion for Rape Victims in Indonesia: Is there a need to change legal procedures and rules?. Meanwhile, the moderator was dr. Wika Hartanti MIH.

The discussion was a continuation of the previous discussion session about the perspective of human rights on abortion for rape victims. dr. Agung highlighted cases that occurred in Indonesia where many rape victims did not receive their human rights. in particular is their right to access necessary health care such as abortion.

dr. Agung gave an example of what happened to a teenage girl named Melati (not her real name) who suffered from severe depression after an abortion application submitted to the police was rejected. Melati, who is 12 years old, is a victim of rape by her neighbor. Not only refused to have an abortion, Jasmine was even asked by the school to resign because she was pregnant.

One of the problems that makes abortion difficult to implement is that abortion is considered to be untrue and prohibited by the moral and religious values ​​held by the majority of the Indonesian population. Meanwhile, the legal umbrella that can be used by rape victims currently states that abortion can be carried out if the gestational age is no later than 40 days from the first day of the last menstruation.

According to dr. Agung those facts makes the issue even more complicated and complex. Due to the pressure from public, rape victims often hide their pregnancy. Also due to the low number of sex education some even don’t know that they are pregnant thus makes the abortion is proposed later than the regulated time. It leads to refusal of abortion procedure from the police.

Another issue arose is the victim must go through a complicated process. To get legal abortion permission, several experts, including obstetrics, hospital ethics committees, psychologists, and legal experts, must be involved to making the decision. This process takes a lot of time and making it more difficult for the victim.

 

Ethics in Global Health Issues [Raboan Discussion Forum]

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Wednesday (21/09) the Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada again held the Raboan discussion forum. On that occasion, CBMH FK-KMK UGM invited the speaker, dr. Peter Johannes Manoppo SpB MBIO who is the founder of the Indonesia Bioethics Forum. dr. Peter raised the topic of Ethics in Global Health Issues. Meanwhile, the moderator was Dr. CB Kusmaryanto, SCJ.

dr. Peter explained that the UNDP (United Nation Development Program) has a draft Sustainable Development Goals that are implemented all over the world. These Goals are a reference for various parties to overcome various global challenges, including in Bioethics.

According to dr. Peter there are a number of global health issues that are a concern in the field of Bioethics. Among them is the ongoing Covid-19 pandemic. The Covid-19 pandemic has caused a surge in patients in various countries, thus overwhelming the health system. The result is a scarcity of medical equipment and health workers. Another issue of concern is Artificial Intelligence and Big Data. In the current digital era, the use of artificial intelligence is difficult to avoid. The benefits of technology can indeed help humans, but it can raise ethical issues in the future. Besides AI and Big Data, the issue of Human Genome Editing has also become a global concern. Genetic engineering can help human life, especially for therapeutic purposes. However, it should not be used for reproductive purposes.

Another issue of concern is proper medical research. Currently there is guidance from CIOMS (Council for International Organizations of Medical Sciences) but there are still many violations. In addition, now many studies end up being archives instead of being used to solve public problems. Another global issue in bioethics is inequality in health care. Until now, there are still many groups of people who do not have adequate access to health care. Drug Resistance is also an issue that needs attention. With the increase in communication and information technology, people can seek knowledge about health and carry out self-diagnosis.

Several other issues that were discussed were mental health issues. There is an increasing number of suicides in the world, including young people. Of course this requires serious handling. Another global issue is the Conscientious Objection to doctors or health workers. Then there is also the issue of Physical Burnout experienced by many health workers. Physical Burnout can cause a decrease in the quality of life of doctors and health workers.

Hierarchical Problems in Medical Service [Raboan Discussion Forum)

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Wednesday (14/09) the Center for Bioethics and Medical Humanities again held the Raboan Discussion Forum routine. On that occasion, CBMH FK-KMK UGM raised the topic of Hierarchical Problems in Medical Services. The topic was presented by dr. Nabil Bahasuan., Sp.FM., S.H., M.H from the Faculty of Medicine, Hang Tuah University, Surabaya. The event was moderated by Erlin Erlina, S.IP., M.A., Ph.D.

dr. Nabil explained that recently there is a stigma spread among the community that makes police doctors not trusted by the public. This is according to dr. Nabil can be explained by examining the hierarchical problem in police medicine and military medicine.

According to dr. Nabil, currently there are no definite regulations governing the authority of police doctors. In contrast to military doctors who are bound by a military oath, the current rules for police doctors are equivalent to civilian doctors and are bound by a doctor’s oath and the Kodeki (Indonesian Medical Ethics Code).

dr. Nabil explained that there are three examples of systems that regulate police authority in handling criminal investigations, namely the Coroner system, the Medical Examiner system and the Continental system. The Coronary System was implemented in England and its colonies. The system stipulates that the examination of criminal victims is handled by the coroner’s team. Meanwhile, the Medical Examiner team was applied in the United States, especially New York. The system stipulates that the examination of victims is handled by a Medical Examiner team consisting of specialist doctors. Meanwhile, Indonesia adheres to the continental system. the system stipulates that examinations of criminal victims are carried out by doctors appointed by the police.

Death Enforcement and End-of-Life Care [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities just held the Raboan Discussion Forum on Wednesday, (31/08). The title of this discussion is Determination of  Death and End of Life Care. The material was presented by the speaker: Prof. Dr. dr. Dedi Afandi, DFM, Sp.FM(K) the moderator is dr. Galuh Dyah Fatmala.

The beginning of life and the end of life are a dilemma that existed long ago. The dilemma also exists in the financing of patient care using whether or not his life aids are still being given. Karen Ann quinlan is one example of when the ventilator she was unplugged turned out to be able to breathe spontaneously, this caused concern for patients in end-of-life care.

There is a confusion in clinicians in determining death, according to article 117 of the Health Law and Permenkes No. 37 of 2004 a person is declared dead if the function of the heart and breathing has stopped and there is death in the brainstem. Indonesia adheres to the death of the brainstem because if there is a malfunction in the brainstem, the respiratory and cardiac functions cannot function.

The determination of death can be made by a health care facility or outside a health care facility. The determination of death in health care facilities must be carried out by doctors, nurses or midwives. The determination of the patient’s death is written when there has been a death of the brainstem instead of the cessation of the work of the heart and breathing. The determination of the death of the brainstem can only be done by 3 competent doctors consisting of a neurologist and an anesthesiologist.

Ethical and medical legal studies are needed in determining brain death. The earlier in the determination of mortality increases the effectiveness in organ donors. The problem that needs to be considered is that brain damage still allows a person to survive using life aids and the difficulty of definitively determining that the patient’s cerebral lesions are permanent.

Indonesia prohibits health care from deliberately killing someone for life, one example of which is euthanasia. Requests for Do Not Rescucitate are the right of patients whether they are willing or not, but rarely patients in Indonesia want dnr. The decision of the DNR is not only made by the party concerned but there must also be a team of doctors who discuss the right with the family. There needs to be informed consent regarding the provision of life support therapy.

WHOLE-BRAIN EMULATOR: Going Beyond Death and Considerations Against It [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities just held the Raboan Discussion Forum on (24/08). The title was Whole-brain Emulation: Efforts to pass the death and consideration against it. The material was presented by the speaker: Fajar Nurcahyo, S.Fil., M.Sc and moderator was Dessy Putri Ratnasari, S.Si., M.Sc.

Death is an extraordinary thing that happens to every living human being. It is undeniable that this death often creates anxiety in life which then makes people try everything to deal with it. Death is something that able shows the helplessness and fear of humans for something that is uncertain. What if all that anxiety could completely fight by humans or even lead humans to truly achieve independence for their lives from the shadow of death?

Whole-brain emulation is one of the answers to all human anxiety related to death. WBE tries to combine several scientific studies that try to study parts of the brain and its parts and able to help humans fight various physical and mental illnesses. WBE tries to answer the problem from two different aspects: the mind and the body which are then able to interfere with the quality of human life. These aspects are then finally transferred in the computer system.

What do Patients Value Regarding Primary Health Care? A Systematic Review of Evidence [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities just held the Raboan Discussion Forum on (10/09). The title of this discussion is What do patients value regarding primary health care? A Sysmetic Review evidence. The material was presented by the speaker: drg. Agnes B Pratiwi, MPH the moderator is dr. Galuh Dyah Fatmala.

Many countries are focused on achieving universal health couferage, therefore requiring efficient resources, sustainable health financing, and strong primary care. Primary health care is very important and must be improved because it is closest to the community. Primary care is available but patients are sometimes uninterested regarding the service.

The value of patients is very important in primary care. In this study, the point of view was seen from the patient’s side. Articles used started from 2009 – 2010. For critical appraisal use JBI aprraisal chechk list. 18 relevant articles in this study 9 qualitative 9 quantitative.

The results of this study show that there is some value from the point of view of patients, doctors, interactions between doctors and patients and primary health care. The values of the patient include autonomy and privacy. Values from the doctor’s point of view include patient individuality, Apropriate communication, competence. Virtous characteristic. The interaction between doctors and patients includes, shared decision making, empowerment. The values of primary health care include accessibility, time, continuity of care and adequate.

Primary care is make patients have very high expectations of good interpersonal skills of it. Therefore, primary care provides services that pay attention to the  needs of patients. In this study, no one predicted the views of children or parents as proxy. It is also important that this primary care moves to patient-centered care.

Moral Dilemma Discussion: A Model Study for Medical Student [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities just held the Raboan Discussion Forum on (27/07).The title of this discussion is Ethics learning system model in medical doctors student. The material was presented by the speaker: Dr. B. Triagung Ruddy Prabantoro, dr.,SpOG(K) the moderator is dr. Nur Azid Mahardinata.

Doctors are a precious profession because they accompany humans from birth to death. Bioethics and humanities are very important in supporting medical education. Ethics is very imporatant because it can made trust between medical doctor and patients. If there is no trust between medical doctor and patients, it can makes the effectiveness of healthcare low. Medical doctors must have ability to change behavior of patient better than before, because bad behavior of patients make the disesase worst.

Moral dilemma discussion goals is students have  higher moral reasoning. The discussion  between students and lecture as facilitator. Facilitators must give students opportunity to grow and awereness to help students study. Every student has unique method to learn something, therefore student base learning is important. The facilitators make sure that students understand about the discussion.

The main goals of ethics model learning is create medical doctors that understand about human values and environment values. Because health care not only about human but also about environments that support it.

Human Rights Perspective on Abortion for Rape Victim [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities just held the Raboan Discussion Forum on Wdnesday (20/06). On that occasion, the title raised was Human Rights Perspective on Abortion for Rape Victims. The material was presented by the speaker: dr. Wika Hartanti MIH. Meanwhile, the moderator is dr. Tiea Khatija.

Framing the problem: rape victim were criminalized for conducting an unsafe abortion, and rape victim was denied access to legal abortion. Expert group meeting report 2020, stated that rape is a systematic violation of human rights which is very sad and very serious, because often many cases are not processed and not resolved, and victims do not get their rights as victims. So it is hoped that there will be a better system of regulation in the handling of rape victims and that the victims get their rights.

There are cases of minors who are victims of rape. In these 2 cases, one of the victims (15 years old) had an abortion with her mother when she was 6 months pregnant, while the second victim (12 years old) applied for an abortion, but was rejected by the police and the court because she was already 2 months pregnant. The obstacle that is always faced by victims is proof that they are victims.

HR recommendation on abortion in Indonesia from SR on Health (UN GA 2018):
• Respect, protect and fulfill the right to health of women and girls by removing barriers to their sexual and reproductive rights
• Ending the criminalization of abortion and ensuring access to abortion services
• Providing sexual and reproductive health information, service, and goods, particularly comprehensive age-sensitive and inclusive sexual education in secondary schools.

The state’s obligation to provide access to safe abortion must consider the complex nature of rape cases, and regulation must be oriented towards facilitating, and not hindering, the safety and well-being of rape victims. Further studies and discussions/dialogues are critical to foster a better understanding of our society’s context, perspective, and needs, which can inform the policy and regulation of reproductive health services in Indonesia.