Application of the Value of Altruism and Doctor’s Responsibility in Handling Patient Complaints at the Hospital [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 (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.

Humanist Education [Raboan Discussion Forum]

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Wednesday (23/11), the Center for Medical Bioethics and Humanities held the Raboan Discussion Forum. The topic raised was Humanist Education. The speaker for this discussion was dr. C.B. Mulyatno, Pr. and moderated by Noviyanti Fahdilla, S. Tr.Keb, MPH.

Experimental School is a school that focuses on human and experience. The core of the school built by YB Mangunwijaya is the development of the character of solidarity. The reason is because Indonesian society is plural, so it has religious riches such as respecting, celebrating, and giving meaning to life. So far, education in Indonesia has only prioritized by the value of rivalry through the ranking. That’s why, YB Mangunwijaya want to create a happy school and every student was involved in self-development.

Students were invited to make some agreement like classroom rules, so we let the children to contribute. Thus the class becomes an exploratory space. An integral aspect of the experimental school is children get the value from the activities that they do, so children can express it by understanding the meaning of sharing, empathy and friendship.

Mangunan experimental school is a school that has a basic education system by developing children’s creativity. The main goal of the experimental school is the ability to value and live life. According to YB Mangunwijaya, the meaning of school is convivium (learning community), which is a place to interact with teachers, students, parents, and the community. The experimental school didn’t use any fences because they thought that children can directly interact with the people around the school.

There are 7 basic modalities applied by experimental schools:

  1. Have good mental and spiritual character.
  2. Understanding the language so they can express themselves in a polite communication.
  3. Independent, honest, critical, and creative
  4. Able to understand and appreciate useful items in life.
  5. Like to help someone and doing good.
  6. Respect each other and work together to keep the environment in a good term.
  7. Physically and spiritually healthy

Predicting the Future of Telemedicine in Indonesia Post COVID-19 [Raboan Discussion Forum]

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Wednesday (16/11) Center for Bioethics and Medical Humanities Faculty of Medicine Public Health and Nursing held a Raboan Discussion Forum. The virtual forum raised the topic Measuring the Future of Telemedicine in Indonesia Post COVID-19, presented by dr. Dony Septriana Rosady MH.Kes MBA M.AP M.Sc. Meanwhile, the moderator for the discussion was Nathan Agwin Khenda, Ftr.

Telemedicine refers to remote healthcare services provided by healthcare professionals using information and communication technology. The Ministry of Health’s regulation on Telemedicine (Permenkes 20/2019) covers teleradiology, tele-electrocardiography, tele-ultrasonography, teleclinical consultations, and other telemedicine services as per advancements in science and technology. Research development with various public-private ownership characteristics, geographic locations, and service levels is necessary to strengthen telemedicine implementation. Regulatory guidance on clinical teleconsultation, the development of online PNPK (National Standardization of Health Facility), and strengthening health information management policies, including financing and digital literacy, are also necessary. Collaboration across academic, business, community, government, and media sectors is crucial for developing clinical teleconsultation.

During the COVID-19 pandemic, clinical teleconsultation has adhered to bioethical principles and ethical guidelines set by professional organizations. Respect for patient autonomy, non-maleficence, beneficence, and justice in providing easy access to all while ensuring the provision of face-to-face services for those in need have been maintained. The practice of teleconsultation during the pandemic is in line with existing regulations and does not violate medical ethics. Post-pandemic regulation review is necessary for the sustainable implementation of clinical teleconsultation.

 

The Ethical Perspective of Medical Personnel on the Crisis of Personal Protective Equipment at the Beginning of the COVID-19 Pandemic [Raboan Discussion Forum]

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Wednesday (09/11), the Center for Bioethics and Medical Humanities again held the Raboan Discussion Forum. The topic discussed at this event was the Ethical Perspective of Medical Personnel on the Crisis of Personal Protective Equipment at the Beginning of the COVID-19 Pandemic. Dr explained this topic. Paramita Sari M.Sc, Lecturer at the Faculty of Medicine, Nahdalatul Ulama University in Surabaya and also an Alumni of the UGM Bioethics Masters Study Program. Meanwhile, acting as moderator is Desy Putri Ratnasari, S.Si, M.Si.

The Covid-19 pandemic in Hubei, China, spread quickly and resulted in high morbidity and mortality rates. According to Dr. Paramita, this is a new challenge for medical personnel, especially at the forefront of health facilities. Health systems in various countries, including Indonesia, are not ready to face the Covid-19 Pandemic.

At the beginning of the spread of Covid-19, medical workers faced the problem of a shortage of logistics for personal protective equipment (PPE) even though tools such as masks, gloves, hand sanitizers, and so on are urgently needed so that health workers are not infected with Covid-19.

“Covid-19 spreads rapidly with high morbidity and mortality rates, while the readiness of personal protective equipment at the start of the pandemic was not close and is said to be in a crisis condition.” Dr. Paramita said.

Many ethical dilemmas were faced by medical personnel at that time. Medical personnel should save patients during a crisis for personal protective equipment. Limited personal protective equipment makes the risk of contracting Covid-19 even higher.

Even though the principle is that medical personnel must save themselves before helping others. Before meeting the patient, personal protective equipment is a mandatory requirement to help patients who need help and care.

 

Application of Virtue Ethics in Health Service For Persons With Disabilities of Medula Spinalis Injury [Raboan Discussion Forum]

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Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada (CBMH FK-KMK UGM) again held a Raboan Discussion Forum on Wednesday (2/11). The event which was held virtually raised the topic of Application of Virtue Ethics in Health Services for Persons with Disabilities Spinal Cord Injury, which was presented by Dr. dr. Maria Regina Rachmawati, Sp.KFR, M.Sc. Meanwhile, acting as a moderator is dr. Tiea Khatija.

At the beginning of her presentation, Dr. Maria explained that disability is a decline in the function of the human body which can be categorized into three, namely mild, moderate and severe. Spinal cord injuries are included in the category of severe disability. Patients with spinal cord injuries are unable to carry out activities of daily living. They experience loss of sensory and autonomic motor function, resulting in dependence on other people or medical devices. In her research, Dr. Maria tries to find out the application of virtue ethical principles by doctors in health services to sufferers of spinal cord injuries. dr. Maria also saw whether the doctor’s virtue character and service to Specialist Medula Injury patients followed the egalitarian concept. To find out this, Dr. Maria distributed questionnaires and interviewed doctors in the Jakarta, Bogor, Depok, Tangerang, Bekasi, and Banten areas.

The results of the study show that there are good virtue characteristics that are adhered to by doctors in serving people with spinal cord injuries, namely: love, gratitude, spiritualism, passion, justice, and kindness. However, these characters do not fulfill the egalitarian concept of justice and objectivity. Meanwhile, for patients with spinal cord injuries, three virtue characteristics are expected from doctors: prioritizing the patient’s interests over personal interests, compassion and loyalty, and being trusted. This view needs to fulfill the egalitarian concept that patients are expected to be active, logical, and wise.

Based on the results of Dr. Maria’s research, she recommended that there should be an increase in doctors’ understanding of virtue character, which supports an egalitarian concept. Not only doctors, but patients with spinal cord injuries also need to receive education to support an egalitarian concept, namely being active, logical, and wise patients in long-term health services.

Humanitarian Forensic Action [Raboan Discussion Forum]

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Wednesday (26/10) the Center for Bioethics and Medical Humanities again held a Raboan Discussion Forum with the topic ICRC and Humanitarian Forensic Action. The event, which was held virtually, invited the speaker, dr. Tjiang Sari Lestari, Sp.FM from the International Committee of the Red Cross (ICRC) Regional Delegation to Indonesia and Timor Leste. Meanwhile, the moderator was Desy Putri Ratnasari S.Si M.Sc.

The International Committee of the Red Cross (ICRC) is a humanitarian organization born out of concern for the fate of war victims. In Indonesia, the ICRC was established in 1987.
dr. Tjiang Sari Lestari explained that the ICRC is engaged in four focus activities, namely Protection, Assistance, Prevention, and Cooperation.

One of the focuses of activities carried out by the ICRC is conducting Humanitarian Forensic Action. This activity aims to ensure that the victims’ bodies can be treated with respect and dignity. Referring to International Humanitarian Law, improper handling of corpses can result in the bodies being unrecognized, or incorrectly identified. Bodies whose status is not identified will be recorded as missing persons so they cannot be returned to their families for proper and proper burial.

dr. Tjiang Sari Lestari explained that the ICRC already has a guide used by volunteers with the title Management of The Dead after Disaster (MotD). The guidelines cover the process that must be followed to handle the bodies of victims of natural disasters or war, from the time the bodies are found until they are returned to their families. The process is divided into four which is: the discovery of the body by the first responder team, information collection, data management and forensic identification, and last is returning the body to the family.

Genetics and Ethics [Raboan Discussion Forum]

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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.