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Science and
technology progressChallenges
to diagnostic, mana
ged care, therapyEfforts
to sustain life for
emergency patients with adv
anced equipmentSide effects in the
field of medical
ethics & morality
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Diagnosis dead → not static, dependingon science and medical technology, the
tools of breath, a tool so that the
heart pacemaker and lungs are stillworking even though there has been
a clinical death.
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Government Regulation No 1!1"1 #rticle 1 verse
$"%&uman condition who is
believed by medical e'perts who authori(ed that brainfunction, breathing, and or heart rate of someone has died.
)atwa *+ D about Dead No.-/1!*+!#.0!2!1""verse 0 - # person declared dead when -3pontaneous respiratory and cardiac functions have
stopped for sure ! irreversible. f convicted of brain stem death has occurred.
+ritish 4edical 5ournal, 4#6 7, -Die is if the brain stem is not functioning
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#rticle 112 &ealth Regulation No /7 in
"
# person is declared as dead when no
function of the cardiovascular
system, circulatory andrespiratory systems have been proven
to be permanently stopped or if the brain
stem death has been proven.
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Kinds of Death (1) 3omatic death $clinically dead%
8ccurs due to interruption of the three sedentary life9support systems $circulatory system,respiratory system, nervoussystem%. :linical refle'es was not found, nopalpable pulse, heart rate did notsound, no breathing movements, inaudible breath
sounds.
3urvival of each organ is different, so that itsdeath not together. t is important for organ transplant.
3ome cells are still alive - +rain tissue - ; minutes
4uscle tissue - / hours:ornea, blood - 7 hours3perm - a few days in the vas deferens
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Kinds of Death (2)
#pparent death
8ccurs due to the third life
support systems drop until minimal
limit. <ith advanced medical
devices can still be proved thatthe three systems are still functioning.
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Kinds of Death (3)
:ellular death $molecular death%
=he death of an organ or
tissue that arise shortly after thedeath of somatic.
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Kinds of Death (4)
:erebral death
an irreversible damage
to both hemispheres, e'ceptthe brain
stem and cerebellum,whereas theother two systems are
still functioning with the aid.
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Kinds of Death(5)
+rain stem death<hen the damage has been done intothe entire contents of the center of the
brain within the skull whichis irreversible, including the brainstem and cerebellum.
<ith known brain stem dead, it>sstated that a person can not belived again
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3? *+ D No. /1!*+!#.0!2!"-
# person declared as dead when brain stem death
has occurred
loss of pupil refle' $pupillary refle'%
=he loss of the eye cornea refle' $corneal refle'%
@oss of response to pain
@oss of vomit refle', cough refle'.
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=o not make a mistake inclassifying the living as the dead
:reate a minimum error in
classifying the dead as people living *erform the determination of life or
death without unreasonable delay
t must be clear and verifiable
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Termination of TheEmergency Resuscitation
n each acute respiratory or circulatory distress,medical personnel should immediatelybegin resuscitation.
n every patient who can still be
saved, resuscitation efforts should be continueduntil spontaneous circulation recovers or thereare signs of irreversible cardiac arrest whichmarked by a flat line on the A:G at least
/ minutes. #s far as possible the decisionto terminate resuscitation is made by a team ofdoctors $neurologist, anaesthesiologist%.
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Transplant Denition
Removal of human tissue or
an organ from one place
to another on his own or on anotherpersonBs body with certain terms and
conditions.
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Transpantation from the
!ie"point of therecipient can #edistinguished$
1. Auto transplant , removal of tissues ! organs toother places in the body of oneBs own.
2. Homo transplant , removalof tissue ! organ from one body to anotherpersonBs body.
3. Hetero transplant, removalof tissue ! organs from onespecies into another species body.
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Ethical Aspectsof Transplantation =he transplanted tissue ! organ is closely
related to ethics whether the offer of a man
who is still alive is acceptable and when the
time of receipt of organ is acceptable.
8rgan transplants → may from a living
donor or death ! corpse donor
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Living Donor
+efore you decide to
become donors, you
must know and understand the risks- the
risk of medical, surgery, and the riskof later life.
=o become a donor, there should beno psychological pressure
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=ransplant failure
transplant successful
feeling guilty
Disappointed because the sacrifice in vain
Donors feel recipient
had a debt
of gratitude
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Corpse or Dead Donors
=he person in his lifetime has allowed inearnest to provide tissue ! organ of his body
when he died naturally.
<hen sick, to consider whether team doctorshave to treat it seriously.
=he bodies are used as the
donor must have permission from the familyBs
body to avoid charges of malpractice
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Donor and Recipient Family
=here should be a
good understanding between donor f amilies and recipients to avoidfamily
conflict of emotions.
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#rticle 70
Cerse - transplantation of organs and ! ortissue is done only for humanitarianpurposes and should notbe commerciali(ed
Cerse /- organs and ! or tissue areprohibited from sale by any prete't
&ealth Regulation No. /7 in "
TRANSLANT !N L"#ALAS"CTS
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$ealth Reg%lation No& '( in
)**+ #rticle 7;
Cerse 1- =he transplantation of organs and ! ortissue can only be done by health
personnel who have thee'pertise and authority to do so and bedone in certain healthcare facilities.
Cerse - organ retrieval and ! or tissue from a
donor must pay attention to health andconcerned donors and donor approval and ! ortheir heirs.
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$ealth Reg%lation No& '( in
)**+ #rticle 72
Cerse 1- retrieval and delivery
of specimens or parts of organs can onlybe done by health personnel who have
the e'pertise and authority as well
as performed at certain health carefacilities.
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,L--D TRANSF.S!-N
&ealth Regulation No. /7 in "
#rticle 7
Cerse 1- =he blood service is an effort of health care that
utili(es human blood as a base material with humanitarianpurposes and not for commercial purposes.
Cerse - +lood obtained from healthy voluntary donors anddonor selection criteria to prioriti(e health donors.
Cerse /- +lood of blood donors before used for service mustbe carried out for laboratory tests to prevent transmission ofdisease
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$ealth Reg%lation No& '( in
)**+ #rticle 2
Cerse 1- =he implementation of donor bloodand blood processing performed by the+lood =ransfusion nit.
Cerse - nit of +lood =ransfusion held by thegovernment, or social organi(ation duties and
functions in the area of the Red :ross.
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$ealth Reg%lation No& '( in
)**+ #rticle
Cerse - mplementation of a bloodtransfusion is done by maintaining thesafety and healthof blood recipients and healthworkers from diseasetransmission through blood transfusion.
#rticle "Cerse /- +lood on the prete'tof any commercial use is prohibited.
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$ealth Reg%lation No& '( in
)**+ #rticle 1" #ny person who knowingly tradein organs or tissues by any prete't sentencedto a ma'imum of 1 years imprisonment and a
ma'imum fine of one billion rupiahs.
#rticle 1";any person who knowingly trade in blood on
the prete't whatever shall be sentenced up tofive years imprisonment and a ma'imum fineof five hundred million rupiahs.
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a clone of an organism that genetically isidentical to another.
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=he development of science and technology.
# techniEue to produce a duplicate that
genetically same from an organism by replacing
the nucleus of cells that have notbeen fertili(ed egg with the nucleus of
the organismBs body.
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:loning is a serious problem in
ethics, much opposed by the religious
+uddhism =he birth of
human cloning incompatible with the teachings
of +uddhism.
slam &uman beings are distinguished onthe side of God, which was created by God.
Religion :loning is an effort to violate
the nature of God.
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?inds of :loning-
1. Reproductive :loning all religions do
not agree.. =herapeutic cloning for treatment.
;th <orld &ealth #ssembly in Geneva,4ay 10th 1""2 the use of cloning forthe replication ofhuman individuals is ethically unacceptab
le and contrary to human integrityand morality.
F =he nternasional +ioethics :omitteeNA3:8F
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Guidelines for Athics in8bstetrics and Gynecology$/%
#rticle 1-
:ommercialpurposes and cloningfor reproduction is prohibited
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!n /itro Fertili0ation 1!/F2
=he first test9tube baby was born 1"2in Angland
n ndonesia
5akarta, +andung, 3urabaya and otherbig cities in ndonesia
:onditions 9 in women who havemarried and can not get pregnant in the
natural way, ovum from the woman withsperm from the husbandBs own $&ealthRegulation No./7 in " article 12%
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Legal !ss%es of !n /itroFertili0ation1. *re9embryos may be discarded if not used
Angland 9 prohibit
Netherlands 9 should be discarded because
it has not been considered as an embryo $asyet nidation in
the uterus% H have approval from the relevant
ndonesia I Netherlands
#ustralia 9 all pre9embryos implanted in the
motherBs womb
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. s pre9embryos may be used for research -
9 allowed $must be approved%
9 prohibited
/. :an pre9embryos be fro(en -
#llowed but there should be that personBs
consent0. )ro(en pre9embryos, may be donated to other
couples unethical
;. *re9e'isting embryos that already nidation may
be discarded ! reduced prohibited becauseit>s considered as abortion
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S%rrogate 3other
a woman who bindthemselves through an agreement with another party $husband ! wife%to become pregnant and deliver an unborn
child after birth to anotherparty $the husband !wife%.
n ndonesia is prohibited contraryto #rticle 1/ :ivil :ode
1. #greements. # particular case
/. )or the kosher
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".T$ANAS!A
8riginally from the Greek word-
eu J Good without suffering, thanatos J death
Authanasia-
+y deliberately not doing anything to prolong
the life of a patient or intentionally do
anything to shorten or terminate the life ofa patient. #ll this is done specifically for the
benefit of the patientBs own.
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Kinds of "%thanasia
*assive euthanasia $on
reEuest or without reEuest%
#ctive euthanasia $on
reEuest or without reEuest% #uto9euthanasia- a firm with
a conscious patient
refuses to receive medical care and heknows this will shorten or end life. =he
patient made a statement of reKection.
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assive "%thanasia
*hysician or other health
professionals are no
longer intentionally provide medical
assistance to patientswho can prolong his life.
*assive euthanasia at the
reEuest J auto9euthanasia
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Active "%thanasia
*hysician or other health
workers deliberately taking action
to shorten patients lives or end the life of
the patient.
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Legal Aspects
of "%thanasia +oth active and passive euthanasia is
prohibited under e'isting criminal
law in ndonesia.
#rticle /00 of the :riminal :ode-
<hoever removes another soul at the
reEuest of the man
himself who mentioned the real andtruly put to Kail for ever 1 years.
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se%do "%thanasia
=ermination of patient care because
of symptoms of Lbrain stem deadM
=ermination of a personBs life due to an
emergency Dismiss a medical treatment that is
not useful anymore
Refusing medical treatment