Learning Professionalism Through Role Modelling [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities just held the Raboan Discussion Forum on (13/07). On that occasion, the title raised was Learning Professionalism Through Role Modeling. The material was presented by the speaker: Prof. dr. Gandes Retno Rahayu, M.Med.Ed., Ph.D. Meanwhile, the moderator is dr. Wika Hartanti MIH.

In the rapid development of medical science, there are still many teachers who do not have the sensitivity to be professional. This is the impact of the old view which assumes that professionalism is obtained during the learning process. Prof Gandes explained that nowadays professional attitude of a doctor is an aspect that needs to be taught and taught as a specific topic and taught explicitly.

To teach professionalism Prof. Gandes the importance of understanding the right learning method for medical students. One of the effective methods to develop professionalism is role modeling. Prof. Gandes revealed the four processes that occur in the role modeling method. The first is to inspire, then to learn, to follow professionally, and the last is to portray oneself.

Prof. Gandes explained that there are three characteristics of a role model. The first is to have superior competence. Both have humanistic personalities such as interpersonal skills, positive outlook, commitment to growth, and leadership. The third is effective teaching skills.

At the end of his presentation, Prof Gandes revealed that role modeling is one of the important teaching tools to teach professionalism in the field of medicine and health professional education.

“Teachers must be aware of being role models and the impact of what they emulate” Said Prof. Gandes.

 

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Minority Group Spiritual Reflection [Raboan Discussion Forum]

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The Center for Bioethics and Medical Humanities again held the Raboan Discussion Forum on Wednesday (6/7). The topic raised on the occasion was entitled Reflection on the Spirituality of Gender Minority Groups. The topic was presented by the speaker Desy Putri Ratnasari, S.Si., M.Sc. Meanwhile, the role of the moderator is dr. Galuh Dyah Fatmala.

Desy’s background in conducting research with the theme of Gender Minority is that there is still a negative stigma given to this group. Data obtained by Desy from LBH shows that gender minorities are often seen as a threat to the nation, sexual crimes deviant behavior, and so on. Not only stigma, but discriminatory actions are also often found by gender minority groups in various institutions. According to data from LBH, religious institutions are the institutions that often discriminate.

As a researcher, Desy feels the need to explore more about the spiritual aspect of an individual belonging to a gender minority group. In the literature, it is said that spirituality is different from religion. Spirituality is defined as something that is beyond religious and deep in individual people. Spirituality is an attitude of seeking a meaningful connection with something than yourself which can result in positive emotions such as peace, awe contentment, gratitude, and acceptance.

In this study, Desy used the SOGIESC (Sexual Orientation, Gender Identity and Expression, Sexual characteristic) approach. The SOGIESC approach is a concept regarding the need for sexual orientation and gender which is created to open the public’s mind more broadly about the diversity of sexual orientation and gender. This approach seeks to capture and at the same time show gender and sexuality, including their complexity.

From research conducted on gender minority individuals and communities in Yogyakarta, Desy concluded three things, namely:
1. they can find their identity even though they get negative stigma and discriminatory treatment from society, they can make peace with themselves and can even actualize themselves
2. they can forgive and help people who have treated them badly by continuing to do good deeds
3. they can express spirituality and live it through their ways and ways of doing this because they believe that the relationship with the Creator is the most important and important thing in life.

 

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Prima Facie Duty for Healthcare Workers [Raboan Discussion Forum]

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The Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) again held a Raboan Discussion Forum on Wednesday (29/06). The event, which was held online, was presented Dr. CB Kusmaryanto, SCJ who is a lecturer in Bioethics from Sanata Dharma University and a consultant to hospitals throughout Indonesia. Father Kus, Dr. CB Kusmaryanto, SCJ, presented the material with the title Efforts to Achieve Restorative Justice: Strategies in Facing Medical Disputes. Acting as moderator is Desy Putri Ratnasari, S.Si., M.Sc. Desy is an alumnus of the Bioethics Masters Study Program and a Researcher at CBMH FK-KMK UGM.

The term Prima Facie was popularized by a philosopher from England named David Ross. The definition of Prima Facie when viewed from the term means the first appearance. In Latin, Prima means first while Facie means face. Prima Facie is then interpreted as truth or obligation that first appears.

According to David Ross, Prima Facie can be recognized by intuition. Ross says that through intuition a person realizes that he has several obligations to do good. According to Ross, there are seven Prima Facie duties, including Duty of Fidelity (promise keeping), Duty of Reparation (making up for prior wrongful acts), Duty of gratitude (being grateful for others acts of kindness), Duty of justice (being fair). , Duty of beneficence (benefiting or helping others), Duty of self-improvement (education or practice), and Duty of non-maleficence (not harming others).

Ross points out that the Prima Facie appears to be an obligation. The Prima Facie principle can turn into an obligation which is then called the actual duty. According to Ross, the Prima Facie principle can become an actual duty when there is no conflict with other principles. As already explained, there are seven prima facie principles and four of them are included in the basic principles of Bioethics.

Father Kus explained that the Prima Facie principle is very important for a health care provider to understand. Health care providers often assume that the four basic principles of Bioethics are absolute principles that must be implemented. However, it is not uncommon for conflicts to occur between one principle and another.

For example, when someone proposes to perform Euthanasia, the doctor should oppose it. In this case, there are two conflicting principles, namely autonomy and respect for human life. A doctor should apply the principle of respect for human life above all else.

In addition to respect for human life, other principles that must also be prioritized are Respect for human dignity and Respect for human integrity. According to Romo Kus, these three principles must be well understood by health service providers to produce the best decisions for all parties.

 

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. Tia 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.

 

Medical Disputes and Restorative Justice [Raboan Discussion Forum]

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Wednesday (15/06) Center for Bioethics and Medical Humanities again held a virtual discussion forum entitled Raboan Discussion Forum. On that occasion, the topic was entitled Efforts to Achieve Restorative Justice: Strategies in Facing Medical Disputes. The title was presented by the speaker, dr. Gregorius Yoga Panji Asmara, S.Ked., S.H., M.H., C.L.A. Meanwhile, the moderator was dr. Galuh Dyah Fatmala.

Neither doctors nor patients want a medical dispute to occur. However, a doctor has rights and obligations that must be carried out. Likewise, with patients, they have the right to get maximum health services from doctors. A patient has the right to file a criminal complaint when he feels he has received inappropriate services. So legal disputes between doctors and patients are things that can happen in the practice of health services.

According to dr. Gregorius said that current law in Indonesia still tends to use the retributive paradigm. The retributive paradigm is one of the legal paradigms that emphasizes providing a deterrent effect to perpetrators. Whereas the retributive paradigm has been criticized by legal experts abroad because it is considered to ignore the long-term aspects of a sentence.

Gregorius said that abroad there has been a paradigm shift from retributive to restorative. The restorative justice paradigm puts forward alternative solutions in a legal case. Restorative justice encourages the process of conciliation between patients and doctors. The parties involved will be asked to gather and consult to resolve the problem collectively to prevent negative consequences in the future.

“Encouraging efforts to heal rather than punish,” said dr. Gregorius

Article 29 of Law Number 36 of 2009 concerning Health reads “If a health worker is suspected of negligence in carrying out his profession, the negligence must be resolved first through mediation”. The article indicates that the resolution of health disputes in Indonesia seeks a deliberation process carried out by both parties before the dispute is brought to court. In addition to mediation, there are several other non-litigation Alternative Dispute Resolutions such as negotiation and arbitration.

Gregorius hopes that restorative justice can become a modern legal paradigm that is developing in Indonesian society. “Medical disputes in the form of alleged ethical, disciplinary, and legal issues have their respective enforcement/handling procedures. “Justice” can be fought for until the end, by fully understanding the process taken,” said dr. Gregorius.

 

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Indonesia Physician and Legal Perception on Human Enhancement Technology [Raboan Discussion Forum]

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Wednesday (08/06), the Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held the Raboan Discussion Forum again. The first Raboan after the Eid holiday featured a sharing ideas segment about a research project by CBMH FK-KMK UGM titled Sharing Ideas: Exploring Perceptions of Indonesian Doctors and Legal Experts on Human Enhancement Technology (HET). The virtual forum presented speakers Nabila Puspakesuma S.Psi M.Sc and moderator dr. Wika Hartanti, MIH.

Nabila explained that the phenomenon that became the background of HET’s research was integrating technology into everyday life, which is now widely used. Especially in this research is in the medical field. The presence of technology is actually used for healing patients, but along with the times, technology is also used to improve the human condition, including athletics, aesthetics, and cognitive performance. This phenomenon has the potential to create potential and is also legal. The presence of HET can be a challenge for the sustainability of implementing ethics and laws that have been applied so far. So there needs to be initial research that discusses the public’s view of this technology.
“This technology will challenge the legal concept of responsibility and requires a new approach to regulation,” said Nabila.

The research by CBMH FK-KMK UGM will be carried out on a population of doctors and legal experts in Indonesia. According to Nabila, it is essential to know because doctors and legal experts have a responsibility as gatekeepers for implementing the latest technology. Doctors and legal experts can guard against anything that could interfere with the continuity of public ethics and law.

The definition of HET, according to the SIENNA Foundation, is the process of improving human abilities in a positive direction, permanently or temporarily. HET is used to enhance, modify, and/or add traits or abilities that a person has had since birth. The categories of HET include cognitive, affective, moral, physical, cosmetic, and longevity.

Previously, research related to HET was mostly carried out in developed countries such as countries in the Americas and Europe. Whereas in Indonesia, the application of HET technology has begun to be widely carried out while the research is relatively small. This also prompted Nabila and the CBMH FK-KMK UGM team to carry out this research.

 

 

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.