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.

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.

Center for Bioethics and Medical Humanities just held the Raboan Discussion Forum on Wednesday, (31/08). The title of this discussion is Determination of  Death and End of Life Care. The material was presented by the speaker: Prof. Dr. dr. Dedi Afandi, DFM, Sp.FM(K) the moderator is dr. Galuh Dyah Fatmala.

The beginning of life and the end of life are a dilemma that existed long ago. The dilemma also exists in the financing of patient care using whether or not his life aids are still being given. Karen Ann quinlan is one example of when the ventilator she was unplugged turned out to be able to breathe spontaneously, this caused concern for patients in end-of-life care.

There is a confusion in clinicians in determining death, according to article 117 of the Health Law and Permenkes No. 37 of 2004 a person is declared dead if the function of the heart and breathing has stopped and there is death in the brainstem. Indonesia adheres to the death of the brainstem because if there is a malfunction in the brainstem, the respiratory and cardiac functions cannot function.

The determination of death can be made by a health care facility or outside a health care facility. The determination of death in health care facilities must be carried out by doctors, nurses or midwives. The determination of the patient’s death is written when there has been a death of the brainstem instead of the cessation of the work of the heart and breathing. The determination of the death of the brainstem can only be done by 3 competent doctors consisting of a neurologist and an anesthesiologist.

Ethical and medical legal studies are needed in determining brain death. The earlier in the determination of mortality increases the effectiveness in organ donors. The problem that needs to be considered is that brain damage still allows a person to survive using life aids and the difficulty of definitively determining that the patient’s cerebral lesions are permanent.

Indonesia prohibits health care from deliberately killing someone for life, one example of which is euthanasia. Requests for Do Not Rescucitate are the right of patients whether they are willing or not, but rarely patients in Indonesia want dnr. The decision of the DNR is not only made by the party concerned but there must also be a team of doctors who discuss the right with the family. There needs to be informed consent regarding the provision of life support therapy.

Center for Bioethics and Medical Humanities just held the Raboan Discussion Forum on (10/09). The title of this discussion is What do patients value regarding primary health care? A Sysmetic Review evidence. The material was presented by the speaker: drg. Agnes B Pratiwi, MPH the moderator is dr. Galuh Dyah Fatmala.

Many countries are focused on achieving universal health couferage, therefore requiring efficient resources, sustainable health financing, and strong primary care. Primary health care is very important and must be improved because it is closest to the community. Primary care is available but patients are sometimes uninterested regarding the service.

The value of patients is very important in primary care. In this study, the point of view was seen from the patient’s side. Articles used started from 2009 – 2010. For critical appraisal use JBI aprraisal chechk list. 18 relevant articles in this study 9 qualitative 9 quantitative.

The results of this study show that there is some value from the point of view of patients, doctors, interactions between doctors and patients and primary health care. The values of the patient include autonomy and privacy. Values from the doctor’s point of view include patient individuality, Apropriate communication, competence. Virtous characteristic. The interaction between doctors and patients includes, shared decision making, empowerment. The values of primary health care include accessibility, time, continuity of care and adequate.

Primary care is make patients have very high expectations of good interpersonal skills of it. Therefore, primary care provides services that pay attention to the  needs of patients. In this study, no one predicted the views of children or parents as proxy. It is also important that this primary care moves to patient-centered care.