Religion and Xenotransplantation (Raboan Discussion Forum)

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Wednesday, February 16, 2022, the Raboan Discussion Forum was again held by the Center of Bioethics and Medical Humanities (CBMH FK-KMK UGM) with the title Religions and Xenotransplantation. The title was presented by the speaker Prof. Syafaatun Almirzanah Ph.D from Prof. Syafaatun Almirzanah Ph.D., Center for Religion and Sciences Sunan Kalijaga State Islamic University. Meanwhile, the moderator was Dr. Nur Azid Mahardinata from CBMH FK-KMK UGM.

Prof. Syafaatun or who is usually called by the name of Prof. Shafa raised an issue that has recently been widely discussed, namely the transplantation of a pig heart into the body of a heart failure patient named David Bennet, who is 57 years old. The male patient was reported to be in a terminal condition so xenotransplantation had to be performed. Based on developments, it is known that David Bennet has improved after surgery. Prof. Shafa added that the procedure carried out on David Bennet had been authorized by the United States Food and Drug Administration (FDA).

“It says here that if he is transplanted with a human heart his condition is too sick, so the FDA there authorized him to be given a transplant from a genetically authored pig,” said Prof. Shafa
The practice of Xenotransplantation has been done decades ago. The most famous example is Baby Fae who received a liver transplant from a primate. Baby Fae reportedly lived for 12 days after surgery.
Several ethical and social implications overshadow the development of this biotechnology. Among them is the patient’s consent which will continue to be monitored for life. Another issue is fairness and equity regarding the allocation of organs. In addition, this practice has potential in terms of social and psychological impact.

Prof. Shafa then brought the discussion to the discussion of Xenotransplantation in religion. According to Prof. Shafa, most religions can accept this technology despite the debate. The issue that is quite crucial is the process of human creation. Xenotransplantation is considered to be able to obscure the uniqueness of human identity because humans have been created by God in a form that later becomes their self-esteem. Another opinion from the Catholic Religion says that Xenotransplantation can be done but is not allowed for human brain organs and also human genitals. This is because the two organs involve self-esteem as human beings.

Another issue that is also a concern is the fear of technology making humans too late to create a Frankenstein (undead) that can attack its creator. There are fears of manipulation of human cells that could make the creation too late and harm other humans.

Modern Paradigm in Medang Mataram Era (Raboan Discussion Forum)

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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.

Consumer Behaviour in Health Sector during Pandemic (Raboan Discussion Forum)

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Wednesday, February 2, 2022, the Center for Bioethics and Medical Humanities held a Raboan Discussion Forum with the theme Consumer Behavior in Health Industry. This theme was presented by Dr. Shine Pintor S. Patiro, S.T., M.M from the Faculty of Economics at the Open University. Meanwhile, the moderator was Puri Swastika GKD, S.E., M.Sc.

The Covid-19 pandemic has brought new dynamics to the Health industry players. This happens because there is a change in consumer behavior as a result of the increasing need for health goods and services. Dr. Pintor explained that during the pandemic, consumer behavior in the health industry became an issue that was widely discussed.

Consumers are customers or actors who use the goods and services offered by the company. Consumer behavior is an activity ranging from searching, choosing available alternatives, determining the final decision to buy goods or services, using or spending an item or service, to evaluating. Consumer behavior includes emotional and mental aspects because it involves the process of growing perceptions and attitudes.

Before delving deeper into consumer behavior, Dr. Pintor explained the importance of knowing the consumer market and marketing strategy. For this reason, several factors need to be considered, namely market size, changes in purchasing behavior and purchasing decisions, emphasis on market orientation, and designing an effective marketing strategy.

Dr. Pintor explained that two main factors influence Consumer Behavior, namely external factors, and internal factors. External factors are cultural and social. The factors included in the cultural factors are culture, sub-culture, and social class, while the factors included in the social factors include reference groups, family, roles, and status and roles in the buying process. Meanwhile, internal factors include personal and psychological. Factors that are included in personal factors include age, occupation, economic situation, and lifestyle. While the factors included in the psychological factors are motivation, perception, learning, belief, and attitudes.

During the COVID-19 pandemic, consumer behavior changed. According to Dr. Pintor during the covid pandemic, consumers tend to focus on things that are essential and have value. In addition, due to reduced physical activity outside the home, industry adoption towards a digital direction is very important.

“Consumers also need fast, efficient, and contact-free service,” said Dr. Pintor

Making Ethical Decisions in Obstetrics and Gynecology (Raboan Discussion Forum)

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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.

 

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Human Rights and Fundamental Human Rights in Bioethics (Raboan Discussion Forum)

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Improvement of Human Rights terminology which is often translated into Indonesian ‘Hak Asasi’ is very much needed. It is as said by Dr. CB Kusmaryanto SCJ, a Bioethics expert and lecturer in the Sanata Dharma University School of philosophy at the Raboan Discussion Forum organized by the Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM), Wednesday (19/01). The weekly forum, which is held virtually, takes the theme of Human Rights and Human Rights Fundamentals in Bioethics. The forum is led by dr. Ouve Rahadiani Permana, M.H.Kes., M.Sc, alumni of the Bioethics Masters Study Program as moderator.

Romo Kus, Dr. CB Kusmaryanto SCJ often called, said that there is a discrepancy in the translation of Human Rights terminology commonly used in Indonesia. Generally, the terminology is translated with the phrase ‘Hak Asasi’. In fact, according to Romo Kus, the correct English word for ‘Hak Asasi’ must be Fundamental Human Rights. Romo Kus also explained that the phrase Human Rights is more accurately translated into the phrase Hak Manusiawi.

According to Romo Kus, from a grammatical point of view, the word human can be a noun or an adjective. When the word is placed in front of the word rights which is a noun, then the word human functions as an adjective.

“So, the translation of Human Rights in Indonesian should be Human Rights, while the translation of Human Rights is Fundamental Human Rights,” said Romo Kus.

Father Kus then explained the difference between the two phrases. According to Romo Kus, human rights are only a small part of fundamental human rights. Human rights are the most basic rights for humans. In this case, Romo Kus explained that the most basic right for humans is the right to life. Meanwhile, human rights are very diverse.

In the second application in the field of Bioethics, according to Romo Kus, a person’s fundamental human rights should be prioritized over his or her human rights. Violations of Human Rights become legal if they are carried out in order to defend Fundamental Human Rights, which is the right to life. Romo Kus added that respect for Fundamental Human Rights is a prima facie, meaning that if it does not conflict with Human Rights, it must be respected. But if it collides with Fundamental Human Rights, then Fundamental Human Rights must be respected.

 

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Ethical Issues in the Use of Social Media in the Health Sector (Raboan Disussion Forum)

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The Center for Bioethics and Medical Humanities (CBMH UGM) on Wednesday (16/11) held a Raboan Discussion Forum with the theme of Ethics Problems in the Use of Social Media related to Health. The theme was delivered by the speaker Prof. Dra. Yayi Surya Prabandari Ph.D. Meanwhile, the discussion forum was led by dr. Wika Hartini MIH as moderator.

Prof. Yayi sees that social media is now increasingly being used by practitioners in the health sector. The use of social media is very diverse but in general social media is a platform so that users can connect and share with each other. Some examples of the use of social media include Blogs, Networking Sites, Media Sharing Sites, Wikis, and so on.

Social media has both positive and negative sides. A positive example of the use of social media in the health sector is to be able to disseminate health education. On the other hand, social media also has a negative side that has the potential to violate ethical principles.

According to Prof. Yayi, the use of social media needs to be based on careful consideration. The use of social media creates the potential for misuse of data by irresponsible third parties. Personally owned data that is distributed through social media is prone to be used by third parties without the permission of the data owner.

“When we have an account there are some things we share that can be used without permission. For example, for marketing activities,” said Prof. Yayi.

This can be overcome by reading in detail the terms and conditions when creating a social media account. So that users can understand social media policies in protecting user privacy.

Apart from privacy concerns, Prof. Yayi also presented ethical issues by professional health practitioners. With social media, doctors also have the opportunity to spread health education to the public. Prof. Yayi gave an example of a doctor on Instagram who made a post about the condition of his patient’s illness. According to Prof. Yes, these activities are allowed when they are intended for educational purposes. However, doctors must be aware that there are ethical guidelines that need to be observed because they involve the patient’s personal data.

Prof. Yayi explained that there need to be standards that doctors and health care providers can adhere to in the use of social media so that there are no violations in maintaining the confidentiality and privacy of patient data.

 

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Informed Consent Implementation on Complementary Alternative Medicine (CAM) Homeophaty (Raboan Discussion Forum)

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Wednesday (05/02),  Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held the weekly routine program Raboan Discussion Forum for the first week of January 2022. The theme on the occasion was Implementation of Informed Consent on Complementary & Alternative Medicine (CAM) and Homeopathic Services. The virtual discussion forum presented by speakers Desy Putri Ratnasari, M.Sc., Bioethics Masters Study Program Alumni and UGM CBMH Research Assistant. Meanwhile, the moderator is dr. Nur Aziz Mahadinata.

Based on Desy’s  finding in Indonesia there is a fairly high demand for Complementary Alternative Medicine (CAM). One type of CAM that is quite large in demand is Homeopathic medicine. Although this treatment has been widely found in the community, research on the ethical aspects of this practice has not been done much. This prompted Desy to research aspects of patient autonomy in the form of  Informed Consent.

Homeopathy is a treatment that relies on herbal medicines that work together with the immune system to fight disease. In Indonesia, the most popular practice of Homeopathic medicine is the Homeopathy of the Ahmadiyya Community. The Ahmadiyya Homeopathy practitioners are under the auspices of the  Departemen Homeopati Nasional (DHN). Homeopathic Medicine is in demanded by both Ahmadiyya congregants and non-congregants. Because, this treatment is considered to have low side effects.

Desy’s research results show that the implementation of Informed Consent is also used in Homeopathy CAM treatment. The practice is in accordance with Peraturan Kementrian Kesehatan No. 290/MENKES/PER/III/2008 concerning informed consent, which includes the diagnosis of the disease, the purpose of the action, other alternative actions, risks or complications that may occur, the prognosis for the action and the estimated cost. From the results of interviews with Homeopathic Practitioners, Patients, and DHN administrators, it was found that the use of informed consent was carried out to anticipate undesirable things in the future. Informed consent in the practice of Homeopathy is done in two forms, oral and written (form). The written Informed consent is generally used for homeopathic patients outside the Ahmadiyya Community.

 

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Patients Perspective on Hemodialysis Therapy (Raboan Discussion Forum)

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Wednesday (15/12), Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held the weekly Raboan Discussion Forum. The topic raised this week is the Perspective of End-Stage Chronic Renal Failure Patients on Joint Decision Making When Starting Hemodialysis Therapy. The topic was delivered by dr. Ouve Rahadiani Permana, M.H.Kes., M.Sc. dr. Ouve is lecturer of the Faculty of Medicine, Universitas Swadaya Sunan Gunung Jati (UGJ) and Masters in Bioethics UGM alumni. Meanwhile, the moderator was dr. Nurul Aida Fathya, Sp.FM, M.Sc. She is lecturer of the Faculty of Medicine at Universitas Jendral Soedirman and Masters in Bioethics UGM alumni.

Hemodialysis therapy or also commonly known as dialysis has a significant impact on patients. Kidney failure patients who take this therapy are required to limit the consumption of food and fluids. In addition, patients also have less ability to perform a physical activity such as working. Patients also have an emotional impact during the therapy. This attracted the interest of dr. Ouve to do further study, considering the prevalence of patients with kidney failure is increasing every year.

Doctors have a role to provide a complete explanation of the patient’s disease and treatment options. This is also an important aspect of bioethics because it is a form of respect for patient autonomy. But in reality, there are still many patients who do not get complete information from doctors. Based on previous research, it was found that 70% of patients with chronic kidney failure still do not know well their disease.

In addition to doctors, the patient’s family also has an equally important role to support the patient’s treatment therapy. So that a joint decision between patients, families, and doctors becomes an alternative that can be done in determining the treatment that respects patient autonomy.

“Shared decision making can optimize patients and families to make choices.” said dr. Ouve.

Based on dr. Ouve findings, chronic kidney failure patients are having deficient information about their treatment choices. It caused patients for not having well understanding of their hemodialysis therapy. In her conclusion, dr. Ouve recommended better communication for doctors and chronic kidney failure patients because complete information is the basis for patient autonomy.

 

The full video can be accessed here

Data Privacy in Healthcare (Raboan Discussion Forum)

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The Raboan Discussion Forum was again held by the Center for Bioethics and Medical Humanities on Wednesday (08/12). This raboan theme continues the previous discussion regarding Health Law, namely Data Privacy in Health Services which was presented by Dr. Abdul Rasyid Thalib, S.H., M.Hum as chairman of the Indonesian Health Law Society, Central Sulawesi. Meanwhile, the moderator of the discussion forum is dr. Nur Azid Mahadinata.

Technological developments bring challenges to Health data protection. This makes the regulation of personal data protection an urgent matter today.

The demands of Industry 4.0 and Society 5.0 make Health services now use more big data and the internet of things to help sustain it. However, the regulation of personal data protection is still considered weak. So it is very necessary to review the draft to produce a strong and comprehensive legal umbrella.

“Because personal data is confidential and must be protected, everyone must keep it safe, for example by using social media wisely because it could be spread through social media,” said Dr. Abdul Rashid Talib.

 

Dr. Abdul Rasyid Thalib explained that the Data Protection Bill distinguishes between personal and privacy terms. Personal data is defined as general data that can change from time to time. Personal data include Full Name, Gender, and Nationality which are generally listed in the Identity Card (KTP). Personal data will form your identity as a nation and a citizen.

Personal data is different from privacy data. Privacy data is defined as special data that is fixed and cannot change. Personal data includes health data and information, biometric data, genetic data, sexual orientation data, political views data, criminal records data, personal financial data, and other data by the legislation. Personal data is also known as Geometric Data. Privacy data is personal data that will shape a person’s character or identity.

In the practice of healthcare and medicine, there is often confusion about the difference between personal data and privacy. Personal data and privacy data are very important to be protected because the data contains the individual’s right to determine whether the data will be communicated or not. Because information about personal data and privacy data has the potential to be misused so that it can cause harm to the data owner. This makes the urgency of the ratification of the Personal Data Protection Bill that needs to be ratified immediately

 

Full video and power point can be accessed here.

Bioethics and Health Law (Raboan Discussion Forum)

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Center For Bioethics and Medical Humanities (CBMH UGM) held the annual Raboan Discussion Forum.  This week, Wednesday (01/12) the discussed topic is  Health Law Literacy. The topic was presented by Dr. dr. Muji Iswanty, S.H., M,H., Sp.KK.,M.Kes from Universitas Hassanudin. She is also the head Masyarakat Hukum Kesehatan Indonesia Sulawesi Selatan. The discussion was conducted by dr. Nasrun S.H., M.Sc as moderator.

Dr. Muji revealed that nowadays some doctors and health service provider doesn’t follow the four bioethics principal which is beneficience, non maleficience, autonomy, and justice. This occurences often led to legal dispute between patients and doctors or health care providers.

According to dr. Muji, doctors and patient should build a terapeutic relationship which is very important for both parties. To build healthy relationship between doctors and patient there should be a mutual understanding about both rights and obligations. Patients rights according to dr. Muji are healthcare services, rights for information, second opinion, privacy, and medical treatment consent. Meanwhile, patients ablogation are good intentions, giving information to doctor, to implement doctors advices and to be cooperative.

In another side, doctors and healtcare provides also had their rights and obligation. The obligation for doctors and healthcare are written in doctor’s oath and standard operating procedure. Meanwhile doctors and healthcare providers rights are the freedom to work, self privacy, and reward.

Bioethics principal and Health Policy thus can be concluded as very related. According to dr. Muji Health Law is part of the general law that regulates the behavior of every member of the community related to health services and is responsible for everything that can cause harm/death.

Laws related to health in Indonesia included Undang-Undang Praktik Kesehatan (UU Republik Indonesia No 29 tahun 2004), Undang-Undang Tenaga Kesehatan (UU Republik Indonesia No 36 tahun 2014), and Undang-Undang Rumah Sakit (UU Republik Indonesia No. 44 Tahun 2009).

It is very important for doctors and healthcare providers to understand this regulation because it is related to patient safety.

“This is our guideline that we need to know until we stop practicing,” said dr. Muji.

 

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