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.

End-of-life Care for Breast and Reproductive Cancer Patients in Jakarta, Indonesia (Raboan Discussion Forum)

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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.

Ancient Java Tradition on Sex Education [Raboan Discussion Forum]

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Raboan Discussion Forum was again held by the Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) on (16/03). On that occasion, the theme raised was Javanese Ancestor Sex Education: An Ethical Perspective. The event which was held virtually invited speaker Chandra Halim, M.A who is a lecturer in the History Study Program at Sanata Dharma University, Yogyakarta. Meanwhile, the moderator is dr. Galuh Dyah Fatmala.

Chandra Halim’s presentation was motivated by a recent phenomenon, namely the many problems of sexual violence experienced by young people in Indonesia. According to Chandra Halim, this is one of the effects of sex education in Indonesia, which is still often considered taboo to talk about. So often the discussion of sex education is something that society avoids.

Based on a search conducted by Chandra Halim through historical evidence, found that in the past the Javanese ancestors gave sex education to young people. Sex education that was carried out at that time was not only knowledge about intercourse but also lessons about how to behave ethically between husband and wife.

In the past, Javanese ancestors in the Banjoemas district had known a tradition called Gowokan. This tradition is one of the traditions that teach ethics in married life, especially in sex education. The Gowokan tradition is carried out by a Gowok who has the duty of being a teacher to test how ready a young man is to be married.

A Gowok is often identified with a prostitute, even though according to Chandra Halim this is not the case. A Gowok is not a prostitute who just peddles the game of intercourse. But it is more obvious that Gowok teaches men to be men who are able to complete a woman and treat women well (lelaning jagad).

Besides Gowokan, another tradition that was also a practice of sex education in the past was Ngenger. The Ngenger tradition is a practice where the groom-to-be has to surrender to the prospective in-laws. He is allowed to sleep at the prospective in-laws’ house together with the bride-to-be. The tradition is carried out after the process of dowry. The practice of Ngenger is carried out so that the prospective groom familiarizes himself with the prospective bride’s family and the community around the prospective bride’s residence.

Not only in the form of tradition but the practice of sex education of Javanese ancestors is also found in ancient texts such as Serat Centhini, Serat Nitimani, and Serat Gatho loco. In the text, it was found that there were many things related to sex and women’s education. The Serat Panitisastra which is a legacy from the Pakubuwana V era also talks about many things related to women’s problems.

Pancasila in The New Sense of Bioethics and The UGM’s Duty [Raboan Discussion Forum]

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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.