Webinar Raboan Center for Bioethics and Medical Humanities (CBMH) UGM: Family Decision Making

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RABOAN “Family Decision Making”

Center for Bioethics and Medical Humanities Universitas Gadjah Mada (CBMH UGM) held its regular Raboan event with the theme “Family Decision Making” on Wednesday, October 8, 2024. The event was hosted via Zoom and featured Lintang Sagoro, MD, a master’s student from Harvard Medical School, as the speaker. The webinar was attended by students, academics, and healthcare practitioners interested in medical ethics and policy issues.

Lintang Sagoro, MD, opened the discussion by highlighting the crucial role of the family in decision-making for the care of patients with serious illnesses. “Medical decisions are not just about the therapies to be administered, but also about how to maintain the quality of life of the patient, both physically and emotionally,” he explained. Lintang Sagoro, MD emphasized that honest and transparent communication between patients, families, and healthcare providers is essential for ensuring the well-being of the patient, especially in the context of palliative care.

In the first session, Lintang Sagoro, MD discussed the importance of bioethical principles in medical decision-making, grounded in the values of Pancasila. The concepts of respect, beneficence, and justice, which advocate for the respect of all forms of life, including humans, animals, and the environment, serve as the foundation that must be considered in every medical decision. “The principle of patient autonomy must be balanced with family responsibility, and we need to ensure that decisions reflect the noble values that underpin bioethics,” he said.

The discussion then moved to the topic of palliative care, which aims to improve the quality of life for patients with serious illnesses. Lintang Sagoro, MD explained that palliative care is not meant to replace curative treatment, but rather to complement it by focusing on the comfort of the patient, as well as providing emotional and spiritual support for both the patient and their family.

Communication challenges between families and patients were also a key point of focus in this webinar. Lintang Sagoro, MD revealed that families often face dilemmas in disclosing the health condition of patients with severe illnesses, as they try to protect the patient from stress that may arise from unpleasant information. “It is important for healthcare providers to help families deliver information carefully and empathetically, so the decision-making process can proceed smoothly,” he said.

The webinar also highlighted the cultural differences in medical decision-making between Indonesia and Western countries. In Indonesia, medical decisions tend to involve the extended family, whereas in countries like the United States, patient autonomy plays a more dominant role in determining their care. This difference underscores the importance of understanding cultural context in medical practice.

The discussion was relevant to SDG 3 on Good Health and Well-Being, which emphasizes the importance of quality and inclusive healthcare. Family-based decision-making and honest communication in the care of patients with serious illnesses support efforts to achieve better access to holistic palliative care. This also contributes to reducing healthcare inequities and enhancing the well-being of both patients and families facing difficult conditions.

At the conclusion of the event, Lintang Sagoro, MD encouraged participants to better understand the importance of emotional support for families caring for patients with serious illnesses, as well as the need to integrate palliative care into the healthcare system. “Support for caregivers is crucial, as they not only care for the physical needs of the patient, but also face significant emotional challenges,” he remarked.

For more information, please visit the official of CBMH UGM

E-mail             : cbmhfkugm@ugm.ac.id

Youtube          : CBMH UGM

Instagram        : cbmh_ugm

 

Reporter          : Alvira Rahmasari, S.H.G.

Editor              : Rafi Khairuna Wibisono, S.Kom.

Webinar RABOAN “Ethics and Moral Dilemma: Approaches For Solving Ethical Dilemmas”

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RABOAN “Ethics and Moral Dilemma: Approaches For Solving Ethical Dilemmas”

Yogyakarta, October 2, 2024 – The Center for Bioethics and Medical Humanities (CBMH) of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada (FKKMK UGM) hosted the RABOAN webinar titled “Ethics and Moral Dilemma: Approaches For Solving Ethical Dilemmas”. The event featured Dr. Johanes Haryatmoko, SJ., a social ethics expert, as the keynote speaker, with Prof. Syafaatun Almirzanah, M.A., M.Th., Ph.D., D.Min. serving as the moderator.

This webinar explored ethical approaches to addressing moral dilemmas, particularly in the healthcare field, using principles such as deontology, utilitarianism, proportionalism, and communitarianism. The discussion emphasized the importance of deep reflection in making ethical and fair decisions, aligning with the Sustainable Development Goals (SDGs) 3 on Good Health and Well-Being, and SDG 16 on Peace, Justice, and Strong Institutions.


Dr. Haryatmoko highlighted that “what is legal is not necessarily moral.” Ethical decisions, especially in the medical field, cannot be based solely on formal law but must also involve a deep analysis of social and cultural contexts. One example discussed was the case of a mother who refused an abortion despite significant pressure from her family. Dr. Haryatmoko emphasized the importance of respecting individual autonomy while considering collective values.

Prof. Syafaatun added that often, moral dilemmas arise from a lack of effective communication. “Before an issue becomes an ethical dilemma, the main problem is often poor communication,” she stated. She stressed the need for open and inclusive dialogue between healthcare providers and patients, which is in line with the SDGs’ efforts to promote peace and justice through effective communication.

The discussion also touched on ethical dilemmas in medical practice in Indonesia, such as preeclampsia procedures, abortion, and vasectomy, which often conflict with religious values. The webinar stressed the importance of adopting locally grounded ethical approaches to formulating humane solutions, in line with global efforts to ensure equitable and dignified healthcare access.

In conclusion, Dr. Haryatmoko reminded the participants that open discourse and deep reflection are key to navigating moral dilemmas. “Social ethics requires a bridge in the form of values and competencies to connect vision with action,” he stated.

The webinar was attended by participants from various sectors, including healthcare professionals, academics, and students, who actively asked questions regarding ethical dilemmas in medical practice. Dr. Haryatmoko’s book, which delves further into social ethics, also garnered significant attention from attendees.

 

For more information, please visit the official of CBMH UGM

E-mail             : cbmhfkugm@ugm.ac.id

Youtube          : CBMH UGM

Instagram        : cbmh_ugm

 

Reporter          : Rafi Khairuna Wibisono, S.Kom.

Editor              : Alvira Rahmasari, S.H.G.

Leadership Skill for Medical Student [Raboan Discussion Forum]

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The Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held a Raboan Discussion Forum on Leadership in Academic Medicine on Wednesday (06/09). The event, which was held online, invited speakers Prof Chandramani Thuraisingham and Dr Sasikala Amirthalingam. The discussion was led by moderator Prof. Dra. Yayi Suryo Prabandari, M.Si., Ph.D.

The presentation was divided into two sessions. The first session was by Prof. Chandramani titled Leadership as a Primary Care Physician. Prof. Chandramani emphasized that Leadership is important in medical school. Prof Chandramani explains that Leadership is not a talent anyone is born with. It is a skill one needs first to acquire and then hone further. 4 crucial points on ethical Leadership: 1) Ethical leaders have high standards for their team & set the same standards for themselves daily. 2) Ethical leaders would also do the job they ask someone to do. 3) Ethical Leaders hold equal respect for others & the team. 4) Ethical leaders are honest and straightforward in their communication.

The second session is by Dr. A Sasikala. Her presentation is titled Learning Leadership During Community Engagement Activities. She presented her community engagement project in Kampung Sebir. This project provided valuable experiential learning opportunities for the students, helping them develop essential Leadership and interpersonal skills such as communication skills, listening skills, delegating tasks and responsibilities, being transparent leader, creating a collaborative environment, teamwork, being empathetic, Having confidence, Firmly believing in their vision Developing mutual trust relationships, and openness to feedback.

Ethical Dilemma During Limited Resource in Covid-19 Pandemic and The Urgency of Bioethics Education [Raboan Discussion Forum]

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Wednesday (30/08) The Center for Bioethics and Medical Humanities held a regular Raboan Discussion Forum. The activity, which was held online, invited speakers, Dr. Ervin Dyah Ayu M. D., M.Sc, who is an alumnus of the UGM bioethics master’s study program and a lecturer at the University of Surabaya. The topic presented was The Urgency of Bioethics Education in Allocating Limited Resources. Acting as moderator is Noviyanti Fahdilla, S.Tr.Keb, MPH.

The COVID-19 pandemic has raised various ethical dilemmas in treating patients. In conditions where human resources (HR) and facilities are limited, doctors and medical personnel face demanding situations that result in services not being optimal and many patients needing to be treated.

It is also prone to misunderstandings and conflicts between doctors and patients. With limited resources, doctors are forced to choose which patients receive treatment first. A doctor’s decision needs to be understood by patients, and patients require an explanation from doctors and health workers.

Dr. Ervin explained that there is a guide to resource allocation when in limited condition. However, these guidelines need to be adapted to Indonesian culture. Thus, bioethics training or education with an Indonesian cultural background is essential for students, doctors, and health workers to improve their communication skills and cultural competence.

 

Translational Value of Animal Models in Research [Raboan Discussion Forum]

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Wednesday, (23/08) Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held Raboan Discussion Forum. The routine webinar was held in collaboration with International Medical University Malaysia. The speaker was Dr. Renu Agarwal and the moderator was Erlin Erlina, PhD. The raised topic is Translational Value of Animal Models in Research: Ethical Viewpoint.

Understanding how the human body functions, identifying diseases that affect humans, and developing effective treatment options are pivotal endeavors in medical and scientific research. To advance these goals, animal testing has played a significant role in various fields, including research and development (R&D), fundamental research, quality control (QC), production, and toxicity testing. Commonly used animals for these purposes include mice, rats, ectotherms, rabbits, and birds.

One of the most poignant stories related to animal testing is that of Laika, the first dog in space. Laika was sent into orbit aboard the Soviet spacecraft Sputnik 2 to study the prolonged effects of weightlessness on a living being. Unfortunately, her mission ended tragically as she succumbed to stress and overheating. This story sparking a debate on the ethical considerations surrounding animal testing.

This debate can be distilled into two primary viewpoints: those in favor of animal testing (pro-animal testing) and those against it (kontra animal testing).

Proponents of Animal Testing (Pro):
– Argue that human life has greater intrinsic value than animal life and that medical research saves countless human lives.
– Emphasize that legislation is in place to protect lab animals from cruelty or mistreatment.
– Point out that many animals are euthanized before experiencing significant suffering, making their sacrifice more humane.
– Highlight the irony that millions of animals are killed every year for food, questioning whether their deaths for medical research are a more worthy cause.

Opponents of Animal Testing (Kontra):
– Contend that animals have as much right to live as humans and that their lives should not be sacrificed for research purposes.
– Argue that strict controls have not always prevented some animals from being abused, even if such instances are rare.
– Assert that death for research is unnecessary, and alternative methods should be explored to replace animal testing.
– Express concerns about the suffering experienced by animals while they are confined and question our ability to accurately gauge when they do or don’t feel pain.

Despite the ethical divide, international guidelines acknowledge the role of animal testing in advancing medical knowledge and ensuring the safety and efficacy of medicines, vaccines, and surgical techniques. These guidelines stipulate that such testing must involve two different species of mammals. While contentious, it is an unavoidable reality in the pursuit of scientific progress.

The guiding principles underscore the need to regulate animal testing rather than abolishing it and emphasize the humane treatment of animals involved in experiments.

For scientific integrity, researchers must address internal and external validity in animal testing. Key questions include considering the relevance of the chosen animal species, designing experiments to eliminate bias, and outlining plans for data collection and analysis.

In conclusion, the debate over animal testing is complex and multifaceted, touching on ethical, scientific, and regulatory considerations. Striking a balance between advancing medical knowledge and respecting the welfare of animals remains a challenging and ongoing endeavor in the field of research.

Islamic Perspective on the Use of Tube Feeding [Raboan Discussion Forum]

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Wednesday (16/08), Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health, and Nursing held a Raboan Discussion Forum titled “Tube Feeding in Dementia at the End of Life from an Islamic Perspective.” The event, which was held online, invited speakers, Dr. Hadil Lababidi from Erlangen University, Germany. Meanwhile, the discussion was led by Ns. Wahyu Dewi Sulistyarini, M.SN.

Dementia is an umbrella term for a disease of decreased cognitive ability. One type of disease in dementia is Alzheimer’s. People living with acute dementia will experience severe symptoms such as being confined to bed, wetting the bed, and having difficulty swallowing food.

Artificial Nutrition and Hydration (ANH) was created to help people living with dementia get food intake. ANH will be given through a gastronomic tube or nasogastric tube, so this process is often called Tube Feeding. ANH can cause several side effects, such as nausea, vomiting, diarrhea, and infection. Apart from that, it can also make patients stressed and uncomfortable and increase social isolation.

From an Islamic point of view, hunger and lack of nutrition is something that is opposed. However, continuous use of ANH should be avoided. Islam teaches that close relatives who care for dementia patients must respect the patient’s dignity and prevent the side effects of ANH.
There are several alternatives that can be used besides tube feeding, including Assisted Hand Feeding (AHF), Feeding Positions and Skills, and Modification of Food Texture.

Professionalism and Ethical Responsiveness for Medical Student [Raboan Discussion Forum]

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Wednesday (09/08), Center for Medical Bioethics and Humanities, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University held Raboan: International Collaboration in collaboration with International Medical University Malaysia. The boldly held event raised the topic of Student Empowerment: Professionalism & Ethical Responsiveness, which was presented by Dr. Serena In from IMU Malaysia. Meanwhile, the moderator who led the discussion was Dr. Wika Hartanti MIH from CBMH FK-KMK UGM.

Professionalism is an important thing to be mastered by students, especially medical students. Professionalism and Ethical Responsiveness emphasize the commitment of physicians and healthcare professionals to excellence, patient well-being, and the health needs of society. For students to have professionalism and ethical responsiveness, such as integrity, accountability, respect, and professional commitment, it is necessary to involve various stakeholders in medical education and patient care.

Dr. Serena highlighted the competencies of good ethical education, including the ability to identify ethical issues, knowledge of aspects, self-reflection, and making ethical decisions in critical situations. Methods that can be taken include conducting open dialogues, simulations, case studies, and workshops in order to develop skills and understanding of complex ethical issues. So students can explore their attitudes, manage emotions, and engage with different perspectives.
Dr. Serena suggested that lecturers can encourage students to be aware of how ethical issues can be resolved in clinical practice. She also encourages students to dialogue and interact with others to determine whether students have ethical abilities in clinical practice.

Cultural Influence on Clinical Ethics [Raboan Discussion Forum]

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Wednesday (02/08) Center for Bioethics and Medical Humanities held the Raboan Discussion Forum again. The webinar, which was held online, raised the topic of Cultural Influence on Clinical Ethics. The speaker was Peter Johannes Manoppo Bioethicist, General Surgeon. Meanwhile, the role of the moderator was Nathan Agwin Khenda, Ftr.

Culture influence is the influence of culture or tradition in clinical practice. The challenges that arise in the doctor-patient relationship occur because of differences in culture and language. One of the cultural influences of paternalism is when doctors make decisions without considering patient autonomy.

In applying clinical ethics, cultural context, relationships between groups, and medical ethical codes must be considered. Culture and tradition influence arguments, medical indications, and patient wishes.

The solution to overcoming cultural differences is forming bridging groups, such as nurses or patient families, who can help bridge the communication between doctors and patients. This can improve patient comfort, doctor’s analytical ability, and benefit both parties.

It is very important for doctors to have soft skills such as the ability to communicate and understand cultural differences. This can provide benefits for improving interaction and collaboration with local communities in efforts to improve health services in various contexts.

Bioethical Problems in Child Marriage [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 (26/07). The weekly forum raised the topic Bioethical Problems in Child Marriage. On this occasion, the speaker was Dr. Pinky Saptandari, Dra., M.A. Meanwhile, the moderator of the discussion was dr. Tiea Khatija.

The problem of child marriage is an issue of violation of the rights of children and women, both from a legal, political, health, and social perspective. This issue involves many scientific disciplines, such as law, medicine, psychology, anthropology, and social affairs. Child marriage contributes to stunting, maternal mortality, and educational problems. Even though there is a legal umbrella, such as laws and international conventions, marriage dispensation is still easy to obtain. Culture, tradition, and religious interpretations also influence this issue.

Addressing child marriage through a comprehensive approach, integrating related government programs, and involving cross-sectoral and cross-disciplines is essential. The world of education must play a role in overcoming this problem by involving students, conducting research, outreach, and providing education. Integrating human rights issues into the curriculum and developing and applying wise bioethics is also necessary.

All parties, including the government, education, media, and society, must collaborate to reduce the number of child marriages, which will ultimately contribute to the progress of the nation and state.

Knowledge Level of Residents on Bioethical Principles [Raboan Discussion Forum]

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The Center for Medical Bioethics and Humanities (CBMH FK-KMK UGM) held the Raboan Discussion Forum last Wednesday (12/7). The topic discussed in the forum was “Knowledge Level of Residents on Bioethical Principles.” The speaker for the forum was dr. Narumi Hayakawa while the moderator was Noviyanti Fahdilla, S.Tr.Keb, MPH.

Research conducted by Narumi shows that the level of knowledge of bioethics among the Indonesian population still needs to be improved. The study illustrates that most of the residents have a moderate level of knowledge of bioethics, indicating a challenge in dealing with ethical issues in medical practice.

Bioethics is a science that discusses ethical principles relevant to medicine and health. These principles include “Respect for Autonomy,” “Beneficence,” “Non-Maleficence,” and “Justice.” Bioethics is essential for residents because they not only have to face education and training in the medical field but are also obliged to conduct research and medical services.

According to the study results, most residents claimed to have experienced bioethics while studying at the undergraduate level. Nonetheless, the lack of understanding of the principle of “Justice” is one of the highlights, and only the “Respect for Autonomy” principle is most familiar to the population. This indicates the need for more understanding of bioethical principles to improve the quality of medical services.

Research also shows that many residents are reluctant to discuss ethical dilemmas and prefer to consult with colleagues. This is due to the strong hierarchical arrangements in educational institutions and medical practice. The important role of the center or resources that can help residents in solving bioethical problems is also enlightenment in this research.

To increase the understanding of bioethics in the population, recommendations have been put forward. Among them are deepening the understanding of bioethical principles, conducting regular discussions regarding ethical issues in medical services, and providing centers or resources that can assist residents in dealing with ethical dilemmas.

Through increasing understanding of bioethics, it is hoped that residents will be better prepared to face complex ethical issues in medical practice. Improvements in the knowledge of bioethics are also expected to positively impact medical services and adherence to professional ethics in the medical profession in Indonesia.