Wednesday (8/2), the Center for Medical Bioethics and Humanities held the Raboan Discussion Forum. The topic that we raised was Bioethical Problems in Women’s Surgical Methods of Contraception. The speaker for this discussion was Dr. Annisa Ullya Rasyida, dr., M.Si. and moderated by dr. Tiea Khatija.

Women’s Surgical Methods of Contraception (MOW) or female tubectomy or sterilization to close the fallopian tubes, to preventing the pregnancy, because the ovum can’t meet sperm cells. Contraception can be done if there are indications and/or the couple doesn’t want to have more children (BKKBN, 2011). One of the indications for someone that use the MOW contraception is the presence of psychological/physical disturbances when the woman is pregnant again. Only 44.5% of MOW acceptors knew about the side effects of using that contraception. MOW contraceptive users can only give birth with caesarean section method is maximum of 3 times. The use of MOW contraception is recommended for mothers who have heart defects that are quite serious.

New Sense of Bioethics:

1. Belief in God or Faith: doctors being an intermediator to help patients, but God determines the outcome. Patient like to stubborn, because they feel that death is in God’s hand, so they still want to try.
2. Respect for others: doctors respect the wishes of patients and do not force patients to sign informed consent. The patient has been explained the action procedure, but when the formula Is not clearly written and there is a risk, the patient blames the doctor.
3. Beneficence: doctor tries to help patient, in this case the patient feels loss in the future because she can’t get pregnant again
4. Non maleficence: the doctor tries to save the patient’s life. In this case the patient was saved by being advised to be sterile because he had a history of the disease. But, turns out patient wants to get pregnant again and she knows that she can’t, the patient feels aggrieved.
5. Social justice for all: doctors help patients regardless of status.

The absence of the word “permanent sterile” on the informed consent sheet make an opportunity to bring the matter into the realm of law. The response: verbal consent is sufficient, so written informed consent is only a confirmation of what has been previously agreed upon. However, it would be better if the informed consent was written in full of the purpose, benefits and risks of an action/operation. Then effective communication builds trust between doctors and patients.

Center for Bioethics and Medical Humanities held Raboan Discussion Forum on Wednesday (25/01). The weekly discussion forum raised topic Digital Health Transformation Impact on Health and Inclusion: Some Moral Considerations. The topic was presented by Abdul Rohman, PhD. and lead by moderator Erlin Erlina, PhD.

People with disabilities (PwD) have faced challenges accessing information related to the pandemic, including vaccination programs, indicating an inconsistent implementation of social inclusion principles in the pandemic response plans. In response, three organizations of PwD in Vietnam organized five online information sessions between late 2021 and early 2022 when major cities in Vietnam were on lockdown. During each session, medical experts shared pandemic and vaccination-related information with 209 participants. After the session, participants were asked to rate their confidence in COVID-19 vaccines, share what information they needed, what information sources they used, and how to improve the inclusiveness of vaccination programs. The study found that PwD in Vietnam are willing to take vaccines, but making a range of information sources accessible to them can help communicate the side effects of the vaccines to their specific health conditions. It is important to consistently implement disability rights in vaccination programs as part of the pandemic response plans to become more inclusive. The study recommends strengthening the capacity of organizations of PwD to produce accessible information independently to better protect them in future pandemics.

Center for Bioethics and Medical Humanities held Raboan Discussion Forum on Wednesday (11/01). The weekly discussion forum raised topic Ethical Issue in Assesment. The topic was presented by dr. Yoyo Suhoyo, M.Med.Ed, PhD. and lead by moderator dr. Galuh Dyah Fatmala.

Ethical behavior in assessment requires individuals to act based on their obligation to protect the rights of those affected by the evaluation, treat them with respect, and incorporate principles of fairness. The first principle of assessment is to do no harm, meaning that assessments should accurately reflect mastery of content, be administered fairly, and treated confidentially to avoid score pollution. Score pollution is any practice that artificially improves test performance without increasing actual mastery of content, resulting in scores that do not represent actual student achievement.

Assessment principles include validity, which ensures that the assessment measures what it is intended to measure, reproducibility, which ensures consistency in measurement, equivalence, which ensures that different forms of the assessment measure the same construct, feasibility, which ensures that the assessment can be practically administered, educational effect, which considers the impact of assessment on learning, and catalytic effect, which considers the impact of assessment on instruction. Acceptability, which considers the stakeholders’ perceptions of the assessment, is also a crucial principle.

In summary, ethical behavior in assessment requires individuals to protect the rights of those affected by the evaluation, avoid score pollution, and incorporate principles of fairness. Assessment principles such as validity, reproducibility, equivalence, feasibility, educational effect, catalytic effect, and acceptability ensure that assessments accurately measure what they intend to measure, are administered consistently and fairly, and have a positive impact on learning and instruction.

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.

2. 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.

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.