The Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held a Raboan Discussion Forum on Leadership in Academic Medicine on Wednesday (06/09). The event, which was held online, invited speakers Prof Chandramani Thuraisingham and Dr Sasikala Amirthalingam. The discussion was led by moderator Prof. Dra. Yayi Suryo Prabandari, M.Si., Ph.D.

The presentation was divided into two sessions. The first session was by Prof. Chandramani titled Leadership as a Primary Care Physician. Prof. Chandramani emphasized that Leadership is important in medical school. Prof Chandramani explains that Leadership is not a talent anyone is born with. It is a skill one needs first to acquire and then hone further. 4 crucial points on ethical Leadership: 1) Ethical leaders have high standards for their team & set the same standards for themselves daily. 2) Ethical leaders would also do the job they ask someone to do. 3) Ethical Leaders hold equal respect for others & the team. 4) Ethical leaders are honest and straightforward in their communication.

The second session is by Dr. A Sasikala. Her presentation is titled Learning Leadership During Community Engagement Activities. She presented her community engagement project in Kampung Sebir. This project provided valuable experiential learning opportunities for the students, helping them develop essential Leadership and interpersonal skills such as communication skills, listening skills, delegating tasks and responsibilities, being transparent leader, creating a collaborative environment, teamwork, being empathetic, Having confidence, Firmly believing in their vision Developing mutual trust relationships, and openness to feedback.

Wednesday, (23/08) Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) held Raboan Discussion Forum. The routine webinar was held in collaboration with International Medical University Malaysia. The speaker was Dr. Renu Agarwal and the moderator was Erlin Erlina, PhD. The raised topic is Translational Value of Animal Models in Research: Ethical Viewpoint.

Understanding how the human body functions, identifying diseases that affect humans, and developing effective treatment options are pivotal endeavors in medical and scientific research. To advance these goals, animal testing has played a significant role in various fields, including research and development (R&D), fundamental research, quality control (QC), production, and toxicity testing. Commonly used animals for these purposes include mice, rats, ectotherms, rabbits, and birds.

One of the most poignant stories related to animal testing is that of Laika, the first dog in space. Laika was sent into orbit aboard the Soviet spacecraft Sputnik 2 to study the prolonged effects of weightlessness on a living being. Unfortunately, her mission ended tragically as she succumbed to stress and overheating. This story sparking a debate on the ethical considerations surrounding animal testing.

This debate can be distilled into two primary viewpoints: those in favor of animal testing (pro-animal testing) and those against it (kontra animal testing).

Proponents of Animal Testing (Pro):
– Argue that human life has greater intrinsic value than animal life and that medical research saves countless human lives.
– Emphasize that legislation is in place to protect lab animals from cruelty or mistreatment.
– Point out that many animals are euthanized before experiencing significant suffering, making their sacrifice more humane.
– Highlight the irony that millions of animals are killed every year for food, questioning whether their deaths for medical research are a more worthy cause.

Opponents of Animal Testing (Kontra):
– Contend that animals have as much right to live as humans and that their lives should not be sacrificed for research purposes.
– Argue that strict controls have not always prevented some animals from being abused, even if such instances are rare.
– Assert that death for research is unnecessary, and alternative methods should be explored to replace animal testing.
– Express concerns about the suffering experienced by animals while they are confined and question our ability to accurately gauge when they do or don’t feel pain.

Despite the ethical divide, international guidelines acknowledge the role of animal testing in advancing medical knowledge and ensuring the safety and efficacy of medicines, vaccines, and surgical techniques. These guidelines stipulate that such testing must involve two different species of mammals. While contentious, it is an unavoidable reality in the pursuit of scientific progress.

The guiding principles underscore the need to regulate animal testing rather than abolishing it and emphasize the humane treatment of animals involved in experiments.

For scientific integrity, researchers must address internal and external validity in animal testing. Key questions include considering the relevance of the chosen animal species, designing experiments to eliminate bias, and outlining plans for data collection and analysis.

In conclusion, the debate over animal testing is complex and multifaceted, touching on ethical, scientific, and regulatory considerations. Striking a balance between advancing medical knowledge and respecting the welfare of animals remains a challenging and ongoing endeavor in the field of research.

Wednesday (09/08), Center for Medical Bioethics and Humanities, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University held Raboan: International Collaboration in collaboration with International Medical University Malaysia. The boldly held event raised the topic of Student Empowerment: Professionalism & Ethical Responsiveness, which was presented by Dr. Serena In from IMU Malaysia. Meanwhile, the moderator who led the discussion was Dr. Wika Hartanti MIH from CBMH FK-KMK UGM.

Professionalism is an important thing to be mastered by students, especially medical students. Professionalism and Ethical Responsiveness emphasize the commitment of physicians and healthcare professionals to excellence, patient well-being, and the health needs of society. For students to have professionalism and ethical responsiveness, such as integrity, accountability, respect, and professional commitment, it is necessary to involve various stakeholders in medical education and patient care.

Dr. Serena highlighted the competencies of good ethical education, including the ability to identify ethical issues, knowledge of aspects, self-reflection, and making ethical decisions in critical situations. Methods that can be taken include conducting open dialogues, simulations, case studies, and workshops in order to develop skills and understanding of complex ethical issues. So students can explore their attitudes, manage emotions, and engage with different perspectives.
Dr. Serena suggested that lecturers can encourage students to be aware of how ethical issues can be resolved in clinical practice. She also encourages students to dialogue and interact with others to determine whether students have ethical abilities in clinical practice.

The Center for Bioethics and Medical Humanities (CBMH FK-KMK UGM) again held the Raboan Discussion Forum on Wednesday (26/07). The weekly forum raised the topic Bioethical Problems in Child Marriage. On this occasion, the speaker was Dr. Pinky Saptandari, Dra., M.A. Meanwhile, the moderator of the discussion was dr. Tiea Khatija.

The problem of child marriage is an issue of violation of the rights of children and women, both from a legal, political, health, and social perspective. This issue involves many scientific disciplines, such as law, medicine, psychology, anthropology, and social affairs. Child marriage contributes to stunting, maternal mortality, and educational problems. Even though there is a legal umbrella, such as laws and international conventions, marriage dispensation is still easy to obtain. Culture, tradition, and religious interpretations also influence this issue.

Addressing child marriage through a comprehensive approach, integrating related government programs, and involving cross-sectoral and cross-disciplines is essential. The world of education must play a role in overcoming this problem by involving students, conducting research, outreach, and providing education. Integrating human rights issues into the curriculum and developing and applying wise bioethics is also necessary.

All parties, including the government, education, media, and society, must collaborate to reduce the number of child marriages, which will ultimately contribute to the progress of the nation and state.

Wednesday (21/6), the Center for Medical Bioethics and Humanities held the Raboan Discussion Forum. The topic that we raised was Patient Preference VS Family Preference in Palliative Care. The speaker for this discussion was Dr. Christantie Effendy, S.Kp., M.Kes. and moderated by dr. Galuh Dyah Fatmala.

The family in Indonesia is consists of extended family, so making decisions cannot be based on personal preferences. Elderly people in Indonesia are often not the important to have the opportunity to express their opinions, as they are perceived as lacking competence in decision-making.

Patient is a person who is waiting for or undergoing medical treatment and care. The word patient comes from a Latin word meaning to suffer or to bear. Traditionally, the person receiving health care has been called a patient. A client is a person who engages the advice or services of another who is qualified to provide this service. The term client presents the receivers of health care as collaborators in the care, that is, as people who are also responsible for their own health.

Promoting Patient centred care from diagnosis to end of life requires a better understanding of physical, psychological, social, and spiritual coping factors in advanced cancer. PCC makes the client and his or her family an integral part of the care team, and as such they collaborate with health-care professionals in the decisions that impact on the care that they receive.

8 dimensions of patient centered care:

• Patient preferences: There is a need to be honest about the patient’s illness and educate them so they can actively participate in deciding the best solution for their disease.
• The Role of Healthcare Workers
• The concept of family caregivers: Sometimes because they really love patient, many relatives does not ask about the patient’s opinion, assuming that the best decisions should come from the family.
• The concept of decision-making autonomy: In challenging disease situations where a cure is difficult to do, the patient should be given the opportunity to express their desires and make decisions together.
• Ethical Dilemma
• Advance Care Planning

The communication gap can make patients more stressed because they don’t know what illness they have or how long the treatment will take. Proper communication with patients must be carried out so that we understand the patient’s wishes and level of understanding. There are still difficulties for healthcare workers to convey bad news to patients about their health condition. The COVID-19 phenomenon has caused a change in attitude towards sharing sad news, so the patient’s family no longer considers painful facts about the patient as taboo.The phases of the palliative care pathway :

• The first phase : when diagnosed
• The middle phase : constituted the time between the early phase and the terminal phase
• The terminal phase : comprised the last weeks and days before death

Palliative home-based care is a good choice for patients because the best indicator of the end of life is when they pass away peacefully at home. But healthcare workers still need to monitor the progress of the condition of patients being treated at home.

Five levels of involvement:

• Contributing to action sequences
• Influencing the problem definition
• Sharing the reasoning process
• Influencing decision making
• Experiencing emotional reciprocity

4 boxes method – Facilitating ethical and legal practice:

• Clinical indications: Sort out which therapies are still effective and which are no longer effective.
• Patient preferences: Involve the patient in deciding something related to their life.
• Quality of life: The patient’s wishes for food/activity need to be aware because it can help patient to be more enthusiastic about maintaining good health (provided it is monitored).
• Contextual features: Are there any external factors that affect the patient’s mental well-being?

A Seven Step Model

• Determine the facts.
• Define the precise ethical issue.
• Identify the major principles, rules, and values.
• Specify the alternatives.
• Compare values and alternatives.
• Assess the consequences.
• Make a decision.