Wednesday (23/03) Raboan Discussion Forum was again conducted by the Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM). The event, which was held online via Zoom and Youtube, raised the topic of Navigating end-of-life care: An Ethnography of Women with Reproductive and Breast Cancer in Jakarta, Indonesia. CBMH FK-KMK UGM invited speaker Hanum Atikasari, MPH, a PhD Candidate – Institute of Cultural Anthropology and Development Sociology, Leiden University. The discussion was also led by moderator Erlin Erlina, S.IP., M.A., Ph.D from CBMH FK-KMK UGM.

On that occasion, Hanum Atikasari explained his research plan on end-of-life care, especially palliative care for women with breast cancer and reproductive cancer which will be conducted in Jakarta, Indonesia. The research is part of the Globalizing Palliative Care project of Leiden University’s Institute of Cultural Anthropology and Development Sociology.

Hanum explained that he was interested in researching the problem because of several backgrounds. First, the problem of access to palliative care in Indonesia is still very limited even though the practice has been introduced since 1992. Second, discussions about the end of life are still considered taboo in society. Third, the number of patients with breast cancer and reproductive cancer is still high in Indonesia, where prevention efforts so that these diseases do not become terminal are still lacking. Then the last background is the stigma that still often afflicts breast cancer and reproductive cancer sufferers in Indonesia.

Some of the questions that Hanum would like to explore further include the forms of treatment that can be used and how these treatments are carried out for women with breast cancer and reproductive cancer at the end of their life. Another question to be explored is how gender and class affect the care of women with breast cancer and reproductive cancer. In addition, Hanum also explained that he wanted to know how the patient’s companion was involved in the decision-making process regarding end-of-life care and how the perception of the patient and the companion had towards good care.

The research conducted by Hanum uses the ethnographic method. It is hoped that this research can contribute to the study of the end-of-life and can provide information and recommendations to health program planners.

Wednesday (09/03) the virtual discussion forum Raboan Discussion Forum was again held by the Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM). On this occasion, CBMH FK-KMK UGM invited Prof. Dr.dr. Soenarto Sastrowijoto, SpTHT-KL(K) raised the topic with the title UGM, Pancasila, and Bioethics. The forum is also chaired by dr. Wika Hartanti MIH as moderator.

Prof. Soenarto started his presentation by explaining the origins of UGM’s establishment. Government of Indonesia, and Prof. Dr. Sardjito as President of UGM (1949-1964). The university, which is now a leading university in Indonesia, is here to carry out the task of improving the quality of the younger generation.

The efforts made for UGM to reach this position are not easy. It is necessary to fight for UGM to become a leading university in Indonesia and even the world. However, thanks to these efforts, in 2020, UGM received a mandate from UNESCO to become the 8th UNESCO Chair on Bioethics. This is a difficult task because UGM has to become a university that continues to develop bioethics science.

When discussing development, it never hurts to look back at the basics. Prof. Soenarto then continued his explanation referring to the basic ideology of the Indonesian nation, namely Pancasila. The five precepts contained in Pancasila are the perspectives used in the life of society, nation, and state in Indonesia. As the basis of all views of the Indonesian people, Pancasila can be the basis for developing the science of Bioethics, which is better known as New Bioethics (The New Sense of Bioethics).

According to Prof. Soenarto, The New Sense of Bioethics prioritizes the contribution of local wisdom. Pancasila, which puts forward the principle of gotong royong (cooperation), can be applied more broadly or globally in everyday life. The principle of the New Bioethics which always in the side of vulnerable groups, is in line with the principle of gotong royong in Pancasila.

To develop the principles of Pancasila in the New Bioethics (The New Sense of Bioethics), the role of the younger generation is needed to continue to strive for it. In this case, UGM as higher education has an important role to continue to promote and support these efforts.

 

Wednesday (23/02) the Center for Bioethics and Medical Humanities (CBMH FK-KMK) Universitas Gadjah Mada held a weekly Raboan Discussion Forum. On that occasion, the title that was raised was I Did Everything For My Patients Ethical Dilemmas of Specialist Doctors in the JKN Era. Present as speakers were dr. Sigid Kirana Lintang Bhima, Sp.FM(K), Secretary of the MKEK IDI Region of Central Java and Lecturer at the Faculty of Medicine, Diponegoro University. Meanwhile, the forum was chaired by dr. Nur Azid Mahadinata.

dr. Sigid highlighted a phenomenon that occurred to doctors in the era of the National Health Insurance (JKN) or also commonly known as BPJS. The existence of health insurance raises ethical dilemmas that are often experienced by doctors.

A doctor in carrying out his profession in providing health services has an obligation to follow three things, namely ethical legal discipline. These three things are contained in the Indonesian Doctor’s Code of Ethics (KODEKI), Laws and Regulations (UU 29 of 2004), as well as the Standard Operating Procedure (SOP) of each health facility.

In practice, as a decision-makers, doctors often experience dilemmas when faced with JKN patients. In the JKN era, doctors have a duty to consider patient funding as a factor in making decisions.

Based on the research of dr. Sigid in Semarang, this phenomenon turned out to be difficult for specialist doctors in making decisions regarding patient care. This is also coupled with the lack of socialization related to BPJS implementing regulations for specialist doctors. Often doctors feel they have to do trial and error when treating patients.

From dr. Sigid research can be concluded as an input for stakeholders, especially BPJS to improve the way of socializing the use of social insurance. Socialization needs to be carried out thoroughly and directly to doctors and patients so that there are no difficulties for all parties in the future.

 

Wednesday, February 9, 2022, the Center for Bioethics and Medical Humanities (CBMH FKKMK UGM) again held the Raboan Discussion Forum. On that occasion, the theme raised was Modern Paradigm in the Field of Science and Technology, Government and Social Life System that Has Been Implemented in the Classical Javanese Era Medang I Bhumi Mataram. The theme was presented by the speaker: Ki Dr. Budiono Santoso Setradjaja, PhD., Sp.FK. The virtual discussion forum is led by Moderator: dr. Nur Azid Mahadinata.

Dr. Budiono thought that in recent society there were misconceptions about the quality of human technology during the Medang Mataram kingdom which had spread systematically and from generation to generation. An example is the story of the construction of a temple that was built mystically with an unexplainable logical framework. According to Dr. Budiono, this could result in the erosion of the current generation’s confidence in the abilities and capacities of their ancestors in terms of knowledge and technology. Even though the ancestors during the Medang Mataram kingdom had abilities in the fields of technology, science, and governance that were no less than the modern era. So it is very important to straighten out these myths and spread the truth about what happened to preserve and protect material and intangible relics of the Medang Mataram kingdom.

The Medang Mataram Kingdom is famous for its material heritage which can still be seen today. Among them are Borobudur Temple (Bhumi Sambara Budhara) & Prambanan Temple (Ciwagraha). The two temples have been recognized by UNESCO as World Cultural Heritage since 1991. From the construction of the Borobudur temple, three important lessons can be learned, namely the leap in the mastery of technology, consistency of policies across generations, and consistency and precision of technology.

“Medang leaders have a far-sighted vision. Approximately 70 years ago, Medang leaders decided to build a colossal architecture that could last thousands of years,” said Dr. Budiono.

Based on the research of Ir. Hadiwaratama, MSc. E revealed that the architecture of the temple was designed with the scientific principles of binary-coded mathematics so that it is always symmetrical. Binary numbers are also like those that appear in literature and batik works.

Not only building technology, during the Medang Mataram era, the people also had marine transportation technology in the form of outrigger boats. Based on the findings of Prof. Dr. Umar Anggara Jenie, Apt, Msc, the sailors’ outrigger boats were able to reach mainland Southeast Asia, Africa, and the Pacific. At that time Medang was a rich maritime and agrarian kingdom that had trading commodities of cinnamon, cardamom, rice, spices.

In the field of governance, the Medang Mataram kingdom runs a unitary state power system. This is like a democratic system originating from western countries which are now used in the modern era. In the era of Medang Mataram, various levels of government were found that were autonomous and decentralized.

During the Medang Kingdom, the concept of gender equality was also known. This can be seen from the election of female leaders such as Ratu Shima from Kalingga, Pramodhawardhani from Medang, Sri Isyana Tunggawijaya from Medang and Tribhuana Tungga Dewi who was the political architect of Majapahit.

According to Dr. Budiono, several steps need to be taken so that the conservation and protection of the Medang Mataram heritage can continue to be carried out. Among them are by conducting studies and publications on the classical Javanese Medang era, commemorating the history of the founding of the Medang Mataram kingdom on October 6, Proposing the commemoration of Archipelago Culture Day every October 6, holding the Pramodawardani & Raka I Pikatan Ballet performances, making book publications about the Characters Women of the Classical Javanese or Nusantara Era.

Wednesday (26/01), the Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held a routine Raboan Discussion Forum program with the theme Ethical Decision Making in Obstetrics and Gynecology. The theme was presented by the speaker, dr. Azharul Yusri Sp.OG, Chair of Dewan Kehormatan Etik Kedokteran Riau Ikatan Dokter Indonesia. Meanwhile, the moderator is Dr. dr. B. Triagung Ruddy Prabantoro, Sp.OG(K) student at Master of Bioethics Program Universitas Gadjah Mada and Lecturer at Universitas Kristen Widya Mandala.

At the beginning of his presentation, dr. Azharul explained the basis for the emergence of ethical biomedical practices in the medical field. The practice of biomedical ethics has been around for 2500 years. The practice is based on the Hippocratic tradition which is a virtue as a guide for a doctor.

Biomedical ethics is becoming increasingly complex as technology advances in obstetrics and gynecology. This requires doctors to posses skills in making decisions quickly because it will greatly affect the condition of the baby and mother.

“Not to mention that a female patient is very vulnerable, and we also often make decisions during a terminal state,” said dr. Azharul.

Dr. Azharul then explained the ethical framework that can be used as a basis for analyzing ethical problems faced by ob-gyn doctors. The basic principles that can be used are the 4 basic principles of Bioethics by Beauchamp and Childress (2019) which consist of Respect for Autonomy, Nonmaleficence, Beneficence, and Justice.

Four basic principles of Bioethics are indispensable when facing ethical dilemmas. In obstetrics, doctors must consider the conditions of two patients, the baby and the mother, so that conflicts often occur which leads to ethical dilemmas. To deal with this ethical dilemma, doctors must establish a prima facie principle. Prima Facie is a condition when doctors are faced with a difficult choice because it occurs between two basic principles of bioethics.

Dr. Azharul is an example of a prima facie condition, namely providing a complementary diagnosis to pregnant women. Examinations such as radiography, CT scan, and MRIs are very useful for mothers to see their health condition. However, this examination can affect the fetus

“It can interfere with organogenesis which can lead to the induction of malformations, IUGR babies, and others when given a dose of more than 100 mg,” said dr. Azharul.

In order to ob-gyn specialists can train their ethical framework skills, dr. Azharul provides one method that can be used, namely the four-box method. The method is applied by analyzing Medical Indications, Patient References, Quality of Life, Contextual Features. The doctor will identify the facts based on these four things, then the doctor will determine the conflicting ethical principles and explore options. At the end, the doctor will take action by deciding an action and the result.

 

Download the material here

 

Watch the full video here