Deontology Aspect of P-Care Utilization in the First Healthcare Facility in Yogyakarta (Raboan Discussion Forum)

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Wednesday (24/11), Center For Bioethics and Medical Humanities held weekly Discussion Forum Raboan. CBMH UGM has brought a recent issue about ethics and health practice that is Deontology Aspect of P-Care Utilization in the First Healthcare Facility in Yogyakarta. This topic is presented by Zahwa Arsy Azzahra S.T., M.Sc. Also present as moderator is Puri Swastika GKD, SE, M.Sc.

According to Zahra, the use of Big Data in healthcare services has the potential to be misused. Based on Lenca’s research on Big Data, there is misuse potential in privacy and confidentiality, informed consent, Fairness, and Justice, etc.

 

Today, Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Indonesia) has using digital data to improve Healthcare Facility services. Thus, Zahra trying to find the ethical aspect especially the Deontology of BPJS system called P-Care (Primary Care) in Yogyakarta. Zahra said that finding the deontology aspect on the big data use is crucial because patient data is a private matter.

Based on Zahra’s findings there are three ethical issues on P-Care. The first is privacy and confidentiality. It is caused by the lack of ethical understanding of the respondents. Another issue found is a safety issue. Zahra’s respondents stated that BPJS as the system provider does not support a high-quality safety system. Another issue found is informed consent. This is caused by the involvement of third parties in P-Care data input.

 

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Ethical Disruption in Healthcare Digital Marketing Issues (Raboan Discussion Forum)

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Yogyakarta – Raboan Discussion Forum was again organized by the Center for Bioethics and Medical Humanity (CBMH UGM) on Wednesday (19/11). This weeks topic is  Ethical Issues in Healthcare Digital Marketing. CBMH UGM invited Dr. dr. Andreasta Meliala, DPH., M.Kes., MAS from the Center for Health Policy Management FK-KMK UGM. Meanwhile, the moderator  is Dr. Nur Azid Mahadinata.

In the past few years, the development of technology and the healthcare industry has grown very rapidly. This has resulted in new issues for health care providers one of them is Healthcare Marketing.

The Marketing practice in healthcare provider is becoming one of the topics that is increasingly being discussed by practitioners and researcher in the health and medical fields. Because, this challenges of industrialization and digitalization demand a balance between ethics and humanity.

 

Dr. dr. Andreasta explained that in the past advertising activities were unusual and unethical for a hospital. However, nowadays the term marketing is increasingly accepted and even becomes an important thing for the sustainability of the hospital. So that it brings disruption and also new challenges for the realization of the ethical principles that have been applied previously.

“Principles such as beneficence, fiduciary responsibility, respect for autonomy, non-maleficence have also disappeared, thus challenging the main ethical principle, namely human dignity,” said Dr. dr, Andreas.

One of the problems that often arise in Healthcare Marketing is the existence of excessive claims of a health product. Many health advertisements are found scattered among the public displaying research results that do not meet the rules of clinical research. For example, in advertisements targeting cancer patients.

“Because it is wrapped or used as a marketing strategy, the results have been blown up,” added Dr. Dr. Andreasta.

In his presentation, Dr. dr Andreasta also added some principles that can be applied by health care providers to promote a product. First, the information provided must be honest and balanced. Second, it is not allowed to exaggerate claims just for the sake of building perceptions. Third, providing data that can be accessed by all parties so that claims can be proven and accounted for. Fourth, ensure that the drugs given are appropriate for each group.

 

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Human Rights and Bioethics in the Quranic Perspective (Raboan Discussion Forum)

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Yogyakarta – Center for Bioethics and Medical Humanities (CBMH UGM) held the Raboan discussion forum on Wednesday (03/11). This regular discussion forum raised an interesting theme Human Rights and the Perspective of the Qur’an.

CBMH collaborated with  Center for Religious and Cross-cultural Studies (CRCS UIN Sunan Kalijaga) and invited Prof. Syafaatun Almirzanah Ph.D, a professor in the field of Islamic Studies and the head of CRCS UIN Sunan Kalijaga as a speaker. Meanwhile dr. Nur Azid Mahadinata acts as a moderator who guides the discussion.

Prof. Syafaatun who is also called Prof. Shafa started the discussion by explaining the values ​​of the Universal Declaration of Human Rights (UDHR) in the Quran. According to Prof. Safa, the Quran has accommodated UDHR values. As one of them is stated in the letter Al-Isra verse 70.

“Really, we have glorified every human being” said Prof. Safa quoted a verse from the Quran.

Prof. Shafa said that the implementation of human rights values ​​must be carried out with individual obligations. This notion is related to the science of Bioethics which is morally responsible for professionals.

The science of Bioethics was born out of a deep concern for human suffering. However, in reality, the science of Bioethics is still based on secular rational thinking. Thus according to Prof. Shafa’s Bioethics science becomes less responsive in dealing with suffering.

“We moved from thick bioethics to thin bioethics,” added Prof. Shafa.

 

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Digital Humanities, Ethics of Humanities and Ecology (Raboan Discussion Forum)

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Nowadays, humankind is facing what we often call digital reality, with the ever-increasing uses of digital technologies in almost all sectors of life. While these technologies promise convenience and practicality, the gaps in network availability and infrastructure, the differing capacity and maturity in using the technologies remain challenging, as do the ethical implications and threat of dehumanization due to the technological revolution and extensive emphasis and reliance on data (“big data”).

It is important that we find ways to harness the power of such technologies to endorse and uphold our endeavor in the cause of humanity, including but not limited to sustainability and ecology. It is also clear that a transdisciplinary approach will be much needed in navigating these issues.

 

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Ethical Dilemmas in Matched Unrelated Bone Marrow Transplant for Metachromatic Leukodystrophy (Raboan Discussion Forum)

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Raboan Discussion Forum on Wednesday, 13 October 2021 was presented by two excellent collaborator of Center for Bioethics and Medical Humanities UGM:  Prof. dr. Zabidi Hussin and Asocc. Prof. dr. Teguh Haryo Sasongko, Ph.D. Prof. Zabidi is a Pro-Vice Chancellor and Professor of Paediatrics at International Medical University, Malaysia. In this Raboan he told his own experiences on managing a patient with metachromatic leukodystrophy that has been written in a book titled perilous genes.  Asocc. Prof. dr. Teguh Haryo Sasongko, Ph.D,  Deputy Director of Center for Research Excellence, Perdana University later gave the medical explanation about the disease from the pathogenesis until the treatment options. This event was moderated by dr. Rusdy Ghazali Malueka, Sp.S(K), Ph.D from Neurology Department Sardjito General Hospital – FMPHN UGM.

Metachromatic leukodystrophy (MLD) is a complex genetic disease that leads to many complication resulting in its high mortality rate. There are limited options available to cure this disease, including bone marrow transplant. Short story, the patient of Prof Zabidi finally done the experimental treatment of matched  unrelated bone marrow transplant in Minessota USA with numerous drama including: finding the donor, treatment funding, sending the sample organ in secrecy and violating the existing rules. In his pledge, Prof. Zabidi convinced that the lying was unethical but can be justified as a right thing to do since his goal is to preserve human life.

Discussion was heated by question from the audiences, one of it was about the boundaries of white lie. The panelist agree that on justifying lie, flexibility is a must and it has to be examined one by one based on the case. This case was an example of law violation that can be justified by a good intention.

The discussion was closed by a comment from dr. Azid elaborating what Prof. Zabidi did was extremely inspiring and this was a living example of how virtue ethics had been applied since Prof. Zabidi was a virtuous person himself. Somehow to just use the four basic principle or principlism to analyze ethical dilemma isn’t enough, going deeper on the root of medicine to help the others will be the key meaning. (gdf/2021)

 

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Ethical Aspects in COVID-19 Vaccination (Raboan Discussion Forum)

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Raboan Online held by Center for Bioethics and Medical Humanity (CBMH) on Wednesday (6/10) was back with a topic very much relevant to the world situation this day, “Ethical Aspects in COVID-19 Vaccination”. The speaker on this afternoon was Dr. dr. Iqbal Mochtar, MPH, MKKK, DipiCard, DoccMed, Sp.Ok, who is based in Qatar and is the Head of Middle East Indonesian Doctors Association, who also oftentimes talks about ethical issues in medicine. All the while, dr. Nur Azid Mahardinata from CBMH tackled the role of moderator in this discussion.

Vaccination in COVID-19 pandemic to this day is known to be the biggest vaccination campaign in history and is an urgent modality on resolving said pandemic. Nevertheless, the reality in practice shows a huge disparity between high-income countries and developing countries in vaccine distribution. A quite shocking number was revealed by dr. Iqbal where 46% of world population have already received their vaccination dose, but developing countries donate only 2.3% of that number.

Vaccine nationalism phenomenon, where a country stocks vaccines in a great number  even three to eight times its population, that widely occurred at the beginning of the pandemic turns out to be ethically justifiable. Conflict between the country’s duty to protect its people and the moral obligation to human in general, that is to say conflict between local moral and universal moral could be seen here.

“As an individual, we’re not only living as the entity of our own self, but also as the core element of the society”, dr. Iqbal urged to see any ethical problems locally and universally during discussion.

No less interesting than previous discussions, a discourse then arose when talking about mandatory vaccine. Surely there is an ethical discord between individual values, especially autonomy principle, and the public goods, which is a common occurrence but much more prominent in a pandemic. Public goods is priority, but individual rights should not be infringed.

To this day, WHO doesn’t support mandatory vaccine during this COVID-19 pandemic. Widely seen policy are “no jab no pay”, or “no jab no play”, or making the state of being vaccinated as mandatory requirement to visit certain places or do certain activities. Then, could these policies be seen as half hearted effort of mandatory vaccine and country’s inability to bear the social politic consequences of making vaccine mandatory, one of the forum participant Prof. dr. Teguh Haryo Sasongko, Ph.D. bluntly asked.

Public health ethics and clinical ethics do not always have to go against each other, instead a meticulous consideration of time and urgency is needed, was how dr. Iqbal concluded his presentation.

 

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Medical Dispute Dynamics (Raboan Discussion Forum)

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Weekly discussion forum, Raboan Online, held by Center for Bioethics and Medical Humanity (CBMH) on Wednesday (14/07) invited Indonesia Vice Minister of Law and Human Rights, Prof. Dr. Edward O.S. Hiariej, S.H., M.Hum., as a speaker on a discussion about Medical Dispute Dynamics, with dr. Darwito, Sp.B(K)-Onk, S.H., accompanying as moderator.

Medical dispute is a dispute between two or more parties about a law incident that is happening on a medical setting, one example being a malpractice.

According to the speaker who is familiarly known as Prof. Eddy, malpractice from the eyes of a law expert could be different from the medical perspective, where there are elements that should be fulfilled for a case to be judged as a malpractice. Prof. Eddy proceeded to emphasize that even then, a jurist can not decide the occurrence of a malpractice without the help of internal investigation by professional organizations of doctors themselves.

A few theories were explained further by Prof. Eddy regarding the elements of malpractice before he then got to the focus of his presentation, which was “why in medical dispute it has to be restorative justice?”

That in the practice of restorative justice, an investigation of malpractice is held with the intention not to punish a doctor or a medical personnel, but to prevent similar incidents to happen in the future, was one of the point that was highlighted by Prof. Eddy.