Senin, 17 Agustus 2015

SPECIAL TOPIC : ERGONOMIC

Hazard Exposure of Wood Carvers 

INTRODUCTION

1.1  ERGONOMY
Ergonomics is derived from two Greek words: ergon and nomos: ergon meaning work, and nomos means rules, rules, or principles. Ergonomics is the science which studies human or rules as a component of a working system includes physical and non-physical characteristics, human limitations and capabilities in order to design a system that is effective, safe, healthy, comfortable, and efficient (Sutalaksana, 1979).
International Ergonomics Association (n.d.) said that , ergonomics (or human factors) is the scientific discipline concerned with understanding of the interactions among humans and other elements of a system, and the profession that applies theory, principles, data and method to design in order to optimize human well-being and overall system performance. Ergonomics is also called human factors. The goal of ergonomics is to provide a safe, healthy, comfortable and productive work environment. So, ergonomics approach is to make the workplace or environment to fit people, not the other way around (Dul Jan & Weerdmeester Bernhard, 2008).
Ergonomics has three domains of specialization, which are physical ergonomics, cognitive ergonomics, and organizational ergonomics. Physical ergonomics is concerned with anatomical, anthropometric, physiological and biomechanical characteristics of human in related to their physical activities. Cognitive ergonomics is concerned about mental processes as they affect interactions between humans and other elements of a system. Organizational ergonomics is concerned about how to optimize the sociotechnical systems, including the organizational structures, policies and processes (International Ergonomics Association, n.d).

1.2  TASK ASPECT
In our daily life, we need to carry out many tasks. Our body will react according to the given task. Specific postures and movements are needed to those tasks. Therefore, postures and movements are important in ergonomics which to help us optimise our work and prevent from getting musculoskeletal disorders, injury and stress.Types of postures are sitting, standing and walking whereas types of movements are bending, twisting, awkward and backward. When we are carrying out a movement or postures, force will be applied and our body’s muscles, ligaments and joints will react according to it.
The ergonomics of postures and movements are derived from three aspects which are anthropometrics, physiology and biomechanical. Anthropometry is the subject which deals with the measurements of the human external body dimensions in static and dynamic conditions. Anthropometric data is used for product and workplace design. In other words, the tools and products are designed to fit to human. In physiological aspect, it is the science of mechanical, physical and biochemical functions of humans in good health and how to apply that information in the evaluation and design of work. Our musculoskeletal system and energy expenditure are involved while doing the tasks. For biomechanical aspect, it is the study of the structure and function of biological systems by means of the methods of mechanics. It is the application of mechanical principles to biological systems of human being. Three factors are considered in this aspects which are force, joint and range of motion.

1.3 ORGANIZATION ASPECT

1.4 ENVIRONMENT ASPECT




DISCUSSION

2.1 OBSERVATION
On 15th July 2015, we did an observation to a woodcarving workshops which is located at Jalan Nangka 52, Denpasar. Our purpose is to evaluate the woodcarving workshops based on their ergonomics. We did an observation and also took a survey based on the attached questionnaire.
In our observation, we looking for some materials which could cause an injury. For example, injured feet from fallen heavy objects (woodcarving tools), electrocuted by tools, cuts and punctures caused by sharp edges of tools or woods.
We also observed about the work-time, the enviroment, and the noise level of the machinesin the woodcarving workshops. Beside that, we observed is there some chemicals which are toxic and also observed the affect psychology of workers in the woodcarving workshops.
Other than interview and observation, we have also conducted a reserach on journals that have been written about this topics. We did our research using mostly PubMed and also Google Scholar.

2.2 RESULTS AND DISCUSSION
Task Aspect
Movement
Movement means a change in place or position. In ergonomic, there are 4 types of movement including bending, twisting, awkward, and backward.
  • Bending
Wood carvers usually do a body bending or neck bending.Prolonged bending have a bad impact to the body. It can be lower back pain, neck pain or limb pain if it is done in the wrong body position. But the wood carver that we observed doesn’t feel any discomfort after doing his job.
  • Twisting
Twisting means to rotate or turn in another direction. When people do twisting in a wrong position or technique, it can cause lower back pain, wrist pain, waist pain, or sprain. (Davis et al, 2005)
  • Awkward
Awkward posture is the condition when joints are not in neutral positionslike squatting, kneeling, raising elbow above the shoulder, and so on. The wood carver that we observed usually does this awkward position. He usually does squatting while doing his job. Activities that requiring prolonged awkward postures as we mentioned before can be particularly stressful.
  • Backward
Backward means facing toward the back or rear. Wood carvers sometimes to do this movement, but should be considered, that backward should be avoided because if little wrong technique will be a problem in the back.

Posture
·         Sitting
Sitting is a rest position supported in humans by the buttocks or thighs where the torso is more or less upright. Some research said that the amount of daily sitting time was positively associated with mortality rates from all causes, cardiovascular disease, and other causes but not from cancer in the combined sample of men and women. The results of this study suggest that greater daily time spent sitting in major activities is associated with elevated risks of mortality from all causes and from cardiovascular disease. These results remain significant after adjustment for potential confounders, including age, sex, smoking status, alcohol consumption, leisure time physical activitylevels,andthePAR-Q. (Katzmarzyk PT,2009)
In woodcarvers are also in risk of getting hazard from their position, sitting. Workers have sitting position in along time for more than 45 minutes. He can’t avoid and prolonged in sitting position. From the interview, the woodcarvers told us that he felt unccomfortable with his work position which make him sit for a long time. He admited experiencing low back pain because of their sitting position. In order to prevent prolonged sitting disadvantage we can give him education that sitting for long time is not good for his health
·         Standing
Standing is a human position in which the body is held in an upright and supported only by the feet. Some research said that there was a relationship between blood pressure regulation and standing balance. The associations between intermittent blood pressure measures and the ability to maintain standing balance adjusted for age and sex. And there were 2 position for standing with eyes open, intermittent blood pressure measures were not associated with the ability to maintain balance. In standing positions with eyes closed, intermittent blood pressure measures.( Pasma JH,2014)
In woodcarvers are also a risk of getting hazard from his position, standing. But on the woodcarvers standing is not prologed, and from the interview he is standing just for relax for the sitting that he was doing and there is no lementation.
·         Squatting
Squatting is a position where the weight of the body is on the feer (as with standing) but the knees are bent either fully (full of deep squat) or partially (partiaal, standing, half, semi, parallel or monkey squat). There is a research said that prolonged squatting for more than 30 minutes per hour can be the risk factors of ostheoarthritis (OR :1,51 95%CL 1,12-2,04)( Pasma JH,2014). And can causing low back pain.
We have to reduce long term of squatting in woodcarvers, for the interview the woodcarvers said that he do squatting for a long time to polish and sometimes shaping the detail of the carves. And from the interview he admitted that sometimes he got a back pain because of squatting that did’t realize he did that for long time cause he too serious of his work. And to prevent the hazard from squatting we can give them small chair or cushion for him.

Material
·         Paint
Paint countain much anorganic material such us formaldehide and lead. The paint and coating can be used in spray application. The woodwoker said he never have health problem caused by exposure of paint .The woodworks use double surgerical mask when he work to minimize inhaling by paint. Paint is cheamical material, double surgerical mask not good enough for woodwokers when he use paint. The wood warker also use tools for protect his eyes.but its not a standar safety for this occupation. The possible health effects of overexposure to these products can vary depending on the chemicals they contain (1.    National Cancer Institute. Formaldehyde and Cancer Risk . 2015) Formaldehyde is a colorless, strong-smelling gas. It is used to make building materials and household products. Exposure occurs primarily by inhaling formaldehyde gas or vapor from the air or by absorbing liquids containing formaldehyde through the skin. Some individuals may experience adverse effects such as watery eyes, burning sensations in the eyes, nose, and throat, coughing,  wheezing, nausea, and skin irritation. Some people are very sensitive to formaldehyde, whereas others have no reaction to the same level of exposure. The long term effect is cancer as stated by The International Agency for Research on Cancer (IARC) that classifies formaldehyde as a human carcinogen(CDC,2014)
            LEAD is a naturally occurring metal found deep within the ground. It occurs in small amounts in ore, along with other elements such as silver, zinc or copper. Chronic lead exposure in adults can decrease kidney function, increased blood pressure, decreased fertility, cataracts, nerve disorders for example increased incidence of essential tremor, muscle and joint pain, memory or concentration problems(Niehs.nih.gov.Lead.2015)
·         Lacquer
Lacquer is a clear or colored coating (called varnish) that is often used to give wooden surfaces a glossy look. Same with paint, the woodworkers use double mask to prevent the bad inhaling causeing by lacquer, Also the woodworker said never have health problem when using tehe lacquer. Most of the health effect caused by lacquers is from the solvents. Some of the common solvents are toluene, xylene, ketones, esters and alcohols. The bad effects in workers that use unregulary and repeated exposure is breathing difficulty (from inhalation), dizziness, nausea, severe pain or burning in nose, eyes, lips, skin accompanied with irritation, vision loss, chronic respiratory disease, kidney failure and brain demage(Jacob L,2014)
·         Thinner
Thinner is a chemical mixtures used as industrial solvents. The woodworker use thinner too. The woodworker never have health problem with thinner, even He poured thinner on his hand and feel his hand is cool. Humans can come into contact with thinner by occupational exposure or by intentional inhalation . Toluene and acetone are the most abundant compounds in commercial thinner. Thinner inhalation induces oxidative stress and  activation of free radical processes. Free radicals induce the cross linking between, DNA and proteins,damage between deoxyribose and the phosphate skeleton, and specific modifications between the purine and pyrimidine bases resulting in mutation of DNA(Martinez, 2011). The process can also  give bad effects on organs like brain, lung, kidney and blood ( Konuk, 2014)
·         Wood
The place the woodworker work is very dusty. The woodworker use single surgerical mask to prevent the effect and he claimed that he doesnt have health problem with the dust(no effect irritation and bad effect of inhaling the dust) . In the working place there’s no one ventilation and that can make bad air circulation when he work.The effects of wood consist by two , Organic and Anorganic
a.      Organic dust
Organic dust consists of particulate matter from microbial,  plant or animal origin.  Its specific agents include viruses, bacteria, fungi and etc. The main effect is irritation that can be caused by skin contact with wood, it sap and it dust. Symptoms usually only persist as long as the affected skin site remains in contact with the source of irritation such as the wood dust or sap etc (HSE,2014)
b.      Anorganic Dust
 In addition to causing several infectious diseases, exposure to organic dust at the workplace is known to lead to an increased frequency of cough,sneezing that can increase risk of occupational respiratory diseases, such as chronic obstructive pulmonary disease (COPD), asthma, hypersensitivity pneumonitis ,organic dust toxicsyndrome and lung cancer     
  • Sandpaper and Electric Sandpaper
Sandpaper  are generic names used for a type of coated abrasive that consists of a heavy paper with abrasive material attached to its surface. andpaper is produced in different grit sizes and is used to remove small amounts of material from surfaces, either to make them smoother (for example, in painting and wood finishing), to remove a layer of material (such as oldpaint), or sometimes to make the surface rougher. Not only produce the dust , The electric sandpaper also produce noise. The woodworker use the tool without ear plug or something alse that can help to reduce bad effect of noise. The tools (electric Sandpaper) also quite heavy , so if the woodwork holding it the wrong way ,the bad effects can happen like injoury and wound (Osha,2015)
·         Spiritus
Methanol, also known as wood alcohol, is a clear colorless liquid with a faint alcoholic odor. As a solvent, it is present in cleaning solutions, printing and duplicating solutions, adhesives, enamels, stains, dyes, varnishes, and paint removers. The woodworker use cheamical material without adequate personal protective equipment,he said doesnt have health problem with this material.  Bad effect may be happen to the woodworkers ,exposure to methanol (by inhaling or touching directly) will cause toxic metabolites, which present symptoms such as manifesting a mild euphoria inebriation, and drowsiness in early stages, whereas in long-term exposure, methanol will cause headache, vertigo, lethargy, masked face, and mild dementia. A study about methanol in rat shows that exposure to methanol dilution will cause hypotension with high heart rate (Jammalamadaka,2010)
·         Saw/ Cutting Tools
In woodworking, hand saws, are used to cut pieces of wood into different shapes. This is usually done in order to join the pieces together and carve a wooden object. They usually operate by having a series of sharp points of some substance that is harder than the wood being cut.The monotounes movement can effect his hand become tired quickly . Inspect the wood stock for nails, knots, or imperfections in the wood that could damage the hand saw.(13) The woodworker also use  the Electric circular saw is The side drive saw is usually less expensive and is the most common type for general work. The size of the saw is determined by the maximum size of blade that can be used. One of the disadvantages of the side drive saw is that the handles are offset from the blade and the saw tends to twist to the side as it is being pushed through the cut. This makes it much harder to follow a line and the constant torque that must be applied to the saw handles can cause the arm and wrist to become tired quickly The common practice of resting the weight of the saw on the guard will damage the moveable guard, but they are more likely damaged by the saw being dropped (Portable Circular Saw, 2015)
·         Air Compressor
               Air compressor appliance producers  High pressure air blower used to clean dirty material and can reduce attachment of dust. The air compressor can produce noise . where the woodworker can feel unconfertable when he work and can effect of hearing system (Trocchi M,2015)

Organization Aspect
·         Working hour and resting time
According to the interview with wood carver worker, every day the workers will start their work at 8 o’clock in the morning and finish their work at 5 o’clock in the evening where the work approximately 9 hours daily. Within the 9 hours daily of the work, the worker will rest 90 minutes daily for their lunch and they can go home for a while if they want it. In this workshop the workers work in daily hours and there is no shift work and also there is late night shift emphasized in the workshop.
·         Day off
In this workshop, each worker has to work from Monday until Saturday, leaving Sunday as their only day off for every week. According to the interview every workers are given permission to take day of holiday by the owner of the workshop, if they have religion ceremony at home or sometimes they get sick. There is no limitation for they permission for holiday each month, because based on interview the workers rare to take a long holiday so there is no problem with the owner of the workshop. But sometimes when the workers take long holiday in the workshop, the owners will replace it with another worker until they back again.
Environment Aspect
Physical
1.      Noise
Wood carver are exposed to load noise in their daily work. The noises are come from their equipmenst like  electric saws, sanders, drills, and other woodworking machines. Woodworking machines are often very noisy, with noise levels ranging as high as 115 dB.This can cause permanent  hearing loss with long-term exposure.  The generally accepted standard to minimize hearing risk is based on an exposure to 85 dBA for a maximum limit of eight hours per day, followed by at least ten hours of recovery time at 70 dBA.  (http://www.noisehelp.com/noise-dose.html). The noise is often increased with old machinery with worn parts and poor maintenance.
From our interview and observation, Mr. Ketut Suyatra use electric saws, drills and compressor  in doing his job. He change the equipment every 5 years.He never wear ear protection when he use wood working machines. He had been working as wood carver for 24 years. While now he doesn’t complain about hearing problem, long-term exposure of noise in his job can cause hearing loss in the future.
For prevent the harm effect of noise the wood carver can shield noisy machines and replace it whenever possible and use hearing protection such as ear plug or ear muffs.
2.      Vibration
Wood carver are also exposed to vibration. Vibrating tools, for example chain saws, can cause "whitefingers" (Raynaud's phenomenon) involving numbness of the finger and hands.  This can lead to permanent damage. Mr. Ketut Suyatra doesn’t have problem with the vibration from the equipment. For prevent the harm effect of vibration the wood carver canmount the machinert with vibration isolators (like shock absorbers).
3.      Electrical shock and fire
            Woodworking machinery and tools also present physical hazards from accidents.  Machinery accidents are often due to missing machine guards, faulty equipment, or using the wrong type of machine for a particular operation.  Tool accidents are often caused by dull tools or improper use.   The accident causes by electrical equipment can present electrical shock andfire hazards from faulty or inadequate wiring. Sawdust and wood are fire hazards.  In addition, fine sawdust is an explosion hazard if enclosed. Mr Ketut Suyatra often changed his equipment to make sure that they are in good condition. All wood carver must keep all electrical equipment and wiring in good condition and avoid extension cord to avoid electrical shock and fire

Chemical
            Chemical
Wood carvers have a high risk to be exposed to chemical in two forms : liquids and dusts. The liquids form, including paint and thinner, and also the dusts can have a bad impact for the workers.
•           Liquids
The major component of thinner is toluene, which is known as a neurotoxic agent. Acute and chronic effects of toluene on neurons have been well documented. Thinner inhalation induces oxidative stress in some organs, such as brain, lung, kidney, and blood (http://www.ehow.com/info_8249573_dangers-paint-thinner.html) The other hazardous substances contained in thinner is benzene, which is lately classified as a genotoxic. This indicates that more thinner inhaled by the workers, the greater risk they have to suffer from disease. Moreover, the use of this substance should always be handled carefully. Based on the place we observed, we can assume that the workshop hasn’t reached a good standard of safety for the workers. They don’t use any equipment when they put the paint and the thinner. There has never been accident connected to this, but paint and thinner have some chemical composition that can be harmful, some effects may occur in some future time. Too much direct contact with paint thinner can cause allergic, irritation, and respiratory problems.
•           Dusts
Wood carvers are likely to be exposed to wood dust all the time. Numerous recent studies have shown that exposure to wood dust can cause some health problems. Woods contain some chemicals that is toxic which can result headaches, giddiness, weight loss, breathlessness, cramps, and irregular heart beat. Furthermore, wood dust can also irritate eyes, nose, and throat, cause dermatitis condition in the skin, cause some respiratory system problems such as decreased lung capacity and allergic reaction in the lungs, and the most harmful effect that can appear in the future is cancer. However, we found that the workers at the observational place have already use masks in their work. This is a good precaution to protect themselves from dust hazards (Work Safe Alberta, 2004)

Mental psychology




CONCLUSION

3.1 CONCLUSION
            There are so many exposure that can hazard the health of wood carvers. Posture is common problem with them, they are getting hazard from their position, especially sitting. Workers have sitting position in along time for more than 45 minutes. He can’t avoid and prolonged in sitting position and  this can be result as low back pain. Furthermore, wood dust as a residual in their work can also irritate eyes, nose, and throat, cause dermatitis condition in the skin, cause some respiratory system problems such as decreased lung capacity and allergic reaction in the lungs, and the most harmful effect that can appear in the future is cancer. The hazardous substances contained in thinner is benzene, which is lately classified as a genotoxic also frequently exposure the wood carvers. Too much direct contact with paint thinner can cause allergic, irritation, and respiratory problems. Wood carver are also exposed to load noise in their daily work. The noises are come from their equipment like  electric saws, sanders, drills, and other woodworking machines. Woodworking machines are often very noisy, with noise levels ranging as high as 115 dB. This can cause permanent  hearing loss with long-term exposure.

3.2 RECOMMENDATION
During our interview we realize posture from wordcarvers which monoton and long time can affect many healt problem, frequent short break is recommended while prolonged duty can’t avoidable. Wood carver also have no protect device in contact with chemical substance like tinner so we suggest to use slope so risk factor for irritation can be reduced.



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MEDICAL PROFESIONALISM


ABORTION 


BAB I
PENDAHULUAN

1.1  Latar Belakang Masalah
Dalam dunia medis, profesionalisme seorang dokter tentulah harus dijunjung tinggi, karena profesionalisme ini memegang peranan yang sangat penting dalam praktek kedokteran dan merupakan wujud tanggung jawab seorang dokter dalam menjalankan profesinya. Profesionalisme seorang dokter dapat dilihat dari caranya berkomunikasi dan berinteraksi dengan pasien maupun praktisi medis lainnya, berperilaku, juga dalam menghadapi sebuah kasus yang dapat dikatakan kontroversial.
Salah satu kasus yang sedang hangat diperbincangkan saat ini dalam praktik kedokteran adalah mengenai aborsi. Permasalahan ini masih menjadi pro dan kontra sampai sekarang. Banyak orang beranggapan bahwa aborsi adalah tindakan yang tidak manusiawi karena tindakan ini dianggap melakukan pembunuhan. Tidak hanya masyarakat awam, orang-orang dengan latar belakang kesehatan pun masih banyak yang menentang tindakan aborsi ini.
Namun, karena beberapa alasan medis aborsi telah dilegalkan di berbagai negara di dunia, sebut saja Australia, Belanda, Kanada, Jerman, dan Amerika Serikat. Begitu pula di Indonesia, tindakan aborsi juga telah dilegalkan sejak beberapa tahun yang lalu, tentunya dengan kondisi-kondisi dan alasan-alasan tertentu. Legalnya tindakan aborsi ini secara khusus dilatarbelakangi oleh pendapat para tenaga kesehatan yang merasa bahwa tindakan aborsi memang wajar untuk dilakukan, apabila memang keadaannya tidak memungkinkan sang janin untuk dilahirkan. Kelaianan kongenital pada bayi merupakan salah satu penyebab mengapa seorang wanita ingin menggugurkan  kadungannya
Di Indonesia sendiri, aborsi merupakan salah satu masalah yang sering terjadi. Kegiatan aborsi ini juga mengundang pro dan kontra dari opini masyarakat. Sehingga timbul rasa kebingungan mengenai legal atau tidaknya tindakan ini jika dilakukan oleh  seseorang. Padahal, aborsi sendiri dapat dikatakan legal apabila kehamilan tersebut dapat mengancam  nyawa ibu dan atau janin itu sendiri. Ancaman dapat berupa penyakit genetika berat atau cacat bawaan yang menyulitkan bayi untuk hidup di luar kandungan
Pada kasus yang kami dapatkan, diketahui seorang ibu dan suaminya yang sedang melakukan konseling kehamilannya, didapatkan bahwa janinnya kelak akan mengalami Down Syndrome yang merupakan penyakit genetik disertai kelainan jantung bawaan yaitu atrioventrikular septal defect (AVSD). Penyakit ini merupakan penyakit yang genetic yang sangat berat, dimana janin akan mengalami penderitaan selama hidupnya. Oleh sebab itu dalam makalah ini, kami akan membahas mengenai alasan mengapa aborsi dibenarkan pada kasus ini dari segala aspek.
1.2     Dasar Teori
1.2.1  Medical Professionalism
Medical Profesionalism merupakan tanggung jawab dari profesi tenaga medis dalam hal berkomunikasi dan berinteraksi dengan pasien dan masyarakat. Dalam artian singkatnya, merupakan prosionalisme medis seorang dokter dalam berperilaku. Pada Medical professionalism terdapat tiga pilar utama, yaitu Personal Attributes, yang mengatur mengenai kepribadian yang wajib dimiliki seorang dokter meliputi empati, jujur, dan tanggung jawab, Medical Ethic, yang merupakan pedoman-pedoman bagi seorang dokter dalam penerapan etika terhadap situasi praktik, dan Medical Law, yang mengandung aspek-aspek hukum yang mengatur mengenai pelayanan kesehatan dan hubungan dokter-pasien.

1.2.2  Aborsi
Aborsi biasanya dikenal oleh masyarakat awam dengan menggugurkan kandungan. Namun dalam dunia kedokteran, aborsi berarti pengeluaran hasil konsepsi (pertemuan sel telur dan sel sperma) sebelum janin dapat hidup di luar kandungan. Istilah lain yang secara resmi dipakai dalam kalangan kedokteran dan hukum ialah Aborsi provocatus. Ada cukup banyak pengartian mengenai aborsi di dalam dunia kesehatan. Menurut Fact Abortion, Info Kit on Women’s Health oleh Institute for Social, Studies, and Action, Maret 1991, aborsi didefinisikan sebagai penghentian kehamilan setelah tertanamnya ovum yang telah dibuahi di rahim, sebelum janin (fetus) mencapai 20 minggu. Sedangkan oleh Js. Badudu dan Sultan Mohamad Zair (1996) aborsi didefinisikan sebagai terjadinya keguguran janin, diana melakukan aborsi berarti melakukan pengguguran dengan sengaja karena tidak menginginkan bakal bayi yang dikandung itu.
Tindakan aborsi ini bukanlah hal yang baru di dunia kesehatan dunia maupun di Indonesia. Sudah sejak lama pula aborsi telah menjadi perdebatan dan memunculkan kontroversi di tengah-tengah ahli kesehatan Indonesia. Permasalahan ini masih terus menjadi pro dan kontra hingga saat ini.


BAB II
PEMBAHASAN

2.1     Aborsi Menurut Hukum di Indonesia
Aborsi memang merupakan polemik yang tak asing diseluruh dunia, termasuk Indonesia. Berbagai pendapatpun berkembang dimasyarakat, Berbagai pendapat dilontarkan untuk menyatakan pro maupun kontra terhadap tindakan tersebut. Namun, permasalahan ini telah memperoleh jawaban secara hukum pada tanggal 6 Oktober 2005 dengan dikeluarkannya Undang-Undang 39 tahun 2004 tentang Kesehatan

Pasal 75
(1)          Setiap orang dilarang melakukan aborsi.
(2)          Larangan sebagaimana dimaksud pada ayat (1) dapat dikecualikan berdasarkan:
a.      indikasi kedaruratan medis yang dideteksi sejak usia dini kehamilan, baik yang mengancam nyawa ibu dan/atau janin, yang menderita penyakit genetik berat dan/atau cacat bawaan, maupun yang tidak dapat diperbaiki sehingga menyulitkan bayi tersebut hidup di luar kandungan; atau
b.      kehamilan akibat perkosaan yang dapat menyebabkan trauma psikologis bagi korban perkosaan.
(3)          Tindakan sebagaimana dimaksud pada ayat (2) hanya dapat dilakukan setelah melalui konseling dan/atau penasehatan pra tindakan dan diakhiri dengan konseling pasca tindakan yang dilakukan oleh konselor yang kompeten dan berwenang.
(4)          Ketentuan lebih lanjut mengenai indikasi kedaruratan medis dan perkosaan, sebagaimana dimaksud pada ayat (2) dan ayat (3) diatur dengan Peraturan Pemerintah.
Pasal 76
Aborsi sebagaimana dimaksud dalam Pasal 75 hanya dapat dilakukan:
a.      sebelum kehamilan berumur 6 (enam) minggu dihitung dari hari pertama haid terakhir, kecuali dalam hal kedaruratan medis;
b.      oleh tenaga kesehatan yang memiliki keterampilan dan kewenangan yang memiliki sertifikat yang ditetapkan oleh menteri;
c.       dengan persetujuan ibu hamil yang bersangkutan;
d.      dengan izin suami, kecuali korban perkosaan; dan
e.       penyedia layanan kesehatan yang memenuhi syarat yang ditetapkan oleh Menteri.
Pasal 77
Pemerintah wajib melindungi dan mencegah perempuan dari aborsi sebagaimana dimaksud dalam Pasal 75 ayat (2) dan ayat (3) yang tidak bermutu, tidak aman, dan tidak bertanggung jawab serta bertentangan dengan norma agama dan ketentuan peraturan perundang- undangan.

Selain itu, tindakan aborsi legal juga dipertegas dengan dibuatnya Peraturan Pemerintah No. 62 tahun 2004 tentang Kesehatan Reproduksi sebagai dasar penegakan hukum.

Pasal 31 ayat (1) tersebut menyatakan bahwa :
“Tindakan aborsi hanya dapat dilakukan berdasarkan:
 a.  indikasi kedaruratan medis; atau
 b. kehamilan akibat perkosaan.”
Pasal 31 ayat (2)
“Tindakan aborsi akibat perkosaan sebagaimana dimaksud pada ayat (1) huruf b hanya dapat dilakukan apabila usia kehamilan paling lama berusia 40 (empat puluh) hari dihitung sejak hari pertama haid terakhir.”
Pernyataan Pasal 31 ayat (1) dan ayat (2) kemudian dijelaskan lebih rinci pada pasal 32 ayat (1) dan (2) yang menyatakan bahwa
(1) Indikasi kedaruratan medis sebagaimana dimaksud dalam Pasal 31 ayat (1) huruf a dan b yang meliputi:
a.   kehamilan yang mengancam nyawa dan kesehatan ibu; dan/atau
b. kehamilan yang mengancam nyawa dan kesehatan janin, termasuk yang menderita penyakit genetik berat dan/atau cacat bawaan, maupun yang tidak dapat diperbaiki sehingga menyulitkan bayi tersebut hidup di luar kandungan.
(2) Penanganan indikasi kedaruratan medis sebagaimana dimaksud pada ayat (1) dilaksanakan sesuai dengan standar.

2.2     Aborsi menurut Deklarasi Oslo (1970)
Dalam deklarasi Oslo (1970) tentang pengguguran kandungan atas indikasi medik, disebutkan bahwa moral dasar yang dijiwai seorang dokter adalah butir Lafal Sumpah Dokter yang berbunyi : ”Saya akan menghormati hidup insani sejak saat pembuahan : oleh karena itu Abortus buatan dengan indikasi medik, hanya dapat dilakukan dengan syarat-syarat berikut”:
1.      Pengguguran hanya dilakukan sebagai suatu tindakan terapeutik
2.      Suatu keputusan untuk menghentikan kehamilan, sedapat mungkin disetujui secara tertulis oleh dua orang dokter yang dipilih berkat kompetensi profesional mereka.
3.      Prosedur itu hendaklah dilakukan seorang dokter yang kompeten di instalasi yang diakui oleh suatu otoritas yang sah.
4.      Jika  dokter  itu  merasa  bahwa  hati  nuraninya  tidak  memberanikan  ia melakukan pengguguran tersebut, maka ia hendak mengundurkan diri dan menyerahkan pelaksanaan tindakan medik itu kepada sejawatnya yang lain yang kompeten.
5.      Selain memahami dan menghayati sumpah profesi dan kode etik, para tenaga kesehatan perlu  pula  meningkatkan pemahaman agama  yang  dianutnya. Melalui pemahaman agama yang benar, diharapkan para tenaga kesehatan dalam menjalankan profesinya selalu mendasarkan tindakannya kepada tuntunan agama.           
2.3    Aborsi di Dunia
Di Inggris, ini terdapat hukum yang membenarkan penghentian kehamilan dengan beberapa ketentuan seperti yang dituangkan dalam pasal-pasal pada Undang-Undang di Inggris seperti ini,
 Berdasarkan ketentuan dari bagian ini, seseorang tidak akan bersalah karena melakukan kejahatan di bawah hukum yang berkaitan dengan aborsi saat kehamilan diakhiri oleh seorang praktisi medis yang terdaftar jika dua praktisi medis yang terdaftar berpendapat, dibentuk dengan itikad baik -
(a) bahwa kehamilan tidak melebihi minggu kedua puluh empat dan bahwa kelanjutan kehamilan akan melibatkan risiko, lebih besar daripada jika kehamilan dihentikan, cedera pada kesehatan fisik atau mental wanita hamil atau ada anak keluarganya; atau
(b) bahwa penghentian diperlukan untuk mencegah cedera permanen besar bagi kesehatan fisik atau mental ibu hamil; atau
(c) bahwa kelanjutan kehamilan akan melibatkan resiko bagi kehidupan wanita hamil, lebih besar daripada jika kehamilan dihentikan; atau
(d) bahwa ada risiko besar bahwa jika anak lahir akan menderita kelainan fisik atau mental seperti menjadi cacat serius.
Menurut PBB, 98 dari 176 negara di PBB menyetujui penghentian kehamilan dengan gangguan janin. Hal ini berlaku untuk kasus kami, di mana anak memiliki Down Syndrome, kelainan jantung termasuk cacat atrioventrikular-septal. Selain itu, yang mana merupakan penyakit genetik yang sangat berat dalam hidupnya.
Berikut adalah tabel yang menunjukan hukum aborsi dibeberapa Negara di Eropa berdasarkan penelitian BBC dan Internasional Planned Parenthood Federation Summary
Negara
Batas Gestational untuk permintaan Aborsi
Rincian Ketentuan
Kanada
Kehamilan penuh
Tidak ada pembatasan
Austria
3 bulan
Harus memiliki kondisi medis
Republik Ceko
12 minggu
Aborsi harus disetujui oleh komisi medis dan dilakukan di rumah sakit. Sebuah aborsi kedua tidak diizinkan dalam waktu enam bulan.
Denmark
12 minggu
Setelah 12 minggu, aborsi harus disetujui oleh komite.
Finlandia
0 minggu, dengan banyak pengecualian
12 minggu untuk menyelamatkan nyawa wanita, kesehatan mental, pemerkosaan dan inses. 20 minggu jika risiko terhadap kesehatan fisik. 24 minggu jika risiko "malformasi janin"
Perancis
12 minggu
Harus dalam "keadaan tertekan." Beberapa pengecualian setelah 12 minggu.
Jerman
12 minggu
Konseling diperlukan setidaknya 3 hari sebelum aborsi. Konseling harus mencoba meyakinkan wanita untuk melanjutkan kehamilan.
Yunani
12 minggu
Beberapa pengecualian setelah 12 minggu.
Irlandia
0 minggu
Perkecualian jika kehidupan ibu beresiko.
Italia
12-13 minggu, tapi tidak pada permintaan
Persyaratan longgar diperlukan.
Belanda
13 minggu, tetapi sampai viabilitas jika dalam keadaan tertekan
Masa tunggu 5 hari yang diperlukan.
Polandia
0 minggu
Diizinkan sampai 12 minggu untuk menyimpan wanita hidup, kesehatan atau dalam kasus pemerkosaan, inses ataugangguan janin.
Swedia
18 minggu
"Alasan kuat" yang dibutuhkan untuk aborsi hingga 22 minggu.
Inggris
24 minggu, tapi tidak pada permintaan
Hanya jika dilakukan seumur hidup, kesehatan, alasan ekonomi dan sosial dan jika dilakukan dengan persetujuan dari dua praktisi medis di tempat yang disetujui.

Dari sekian fakta kami dapatkan tentang aborsi di dunia, ini telah menunjukan bahwa aborsi dengan indikasi-indikasi tertentu yang dapat membahayakan ibu atau janin yang akan lahir, membuat sebagian besar Negara-negara di dunia memperbolehkan untuk melakukan aborsi
2.4    Kasus Janin dengan Down Syndrome dan Kelainan Jantung Bawaan (AVSD)
Dari kasus yang kami dapatkan, diketahui bahwa janin mengalami Down Syndrome dan mengalami kelainan jantung bawaan yaitu atrioventrikular septal defect (AVDS). Setelah kami mengkajinya, penyakit-penyakit tersebut memang  akan sangat memberatkan hidupnya kelak. Anak-anak dengan Down Syndrome memerlukan beberapa terapi khusus untuk mengembangkan tubuhnya. Stimulasi dini diperlukan untuk mengembangkan kemampuan bicaranya, olah tubuh dan mengembangkan otot-ototnya yang cenderung lemah. Fisioterapi perlu dilakukan pada tahap perkembangan otot kasar, agar anak dapat menggerakkan tubuhnya secara benar. Anak dengan Down Syndrome juga mempunyai peluang yang lebih tinggi terlahir dengan kelainan jantung bawaan dengan kejadian mencapai 40-60%. Salah satu kelainan jantung bawaan yang sering diderita anak yang terlahir dengan down syndrome adalah atrioventrikular septal defect (AVSD) yang telah dipastikan akan diderita janin pada kasus ini. AVSDs diartikan sebagai adanya lubang di dinding antara atrium dan ventrikel akibat kegagalan pembentukan jaringan selama fase embrionik.
Untuk penanganan yang harus dilakukan adalah berupa pemberian obat diuretik untuk mengurangi penumpukan cairan di tubuh dan mengatur sirkulasi darah agar kerja jantung tidak berat. Penurunan berat badan sering terjadi adanya masalah pada penyerapan kalori selain itu bayipun sering kehilangan nafsu makan. Untuk itu diperlukan formula dengan kalori tinggi dan untuk administrasinya bisa melalui nasogastric tube.
Didapatkan data 44 % syndrom down hidup sampai 60 tahun dan hanya 14 % hidup sampai 68 tahun. Tingginya angka kejadian penyakit jantung bawaan pada penderita ini yang mengakibatkan 80 % kematian. Meningkatnya resiko terkena leukimia pada syndrom down adalah 15 kali dari populasi normal. Penyakit Alzheimer yang lebih dini akan menurunkan harapan hidup setelah umur 44 tahun.
Sebagian besar kasus AVSDs memerlukan operasi yang biasanya dilakukan pada usia 6 bulan pertama, namun demikian terkadang masih ada kelainan yang tersisa seperti katup yang tidak sempurna pada AVSDs.
Jadi dapat kita lihat bahwa janin yang mengalami penyakit-penyakit tersebut jika dibiarkan hidup, dia akan mengalami berbagai penderitaan. Harus mengikuti berbagai pengobatan yang kompleks, harus bergantung pada orang lain selama hidupnya, belum lagi masalah sosial yang akan dihadapi. Oleh sebab itu, keputusan aborsi sangat beralasan karena mempertimbangkan kehidupan janin kelak.





BAB III
                                             PENUTUP
3.1     Simpulan
Berdasarkan aspek hukum di Indonesia, aborsi dapat dilakukan jika ada indikasi kegawatdaruratan medis, seperti menyelamatkan nyawa ibu, atau karena janin dalam kandungan mengalami penyakit genetik berat dan cacat bawaan sehingga akan mempersulit hidupnya kelak. Permasalahan ini telah memperoleh jawaban secara hukum dengan adanya pasal 75 ayat (1),pasal 76, pasal 77 pada Undang-undang No. 36 Tahun 2004 tentang Kesehatan.  Begitu pula di berbagai negara di luar negeri, memperbolehkan untuk aborsi jika ada indikasi kegawatdaruratan medis, seperti di Inggris dan negara lainnya di Eropa.
Jadi dapat disimpulkan, bahwa kasus yang kami kaji, yaitu janin yang mengalami Down Syndrome dan kelainan janyung bawaan ( AVSD ) memiliki banyak alasan yang tepat dan masuk akal untuk diaborsi karena mempertimbangkan kehidupannya kelak
3.2     Saran
1.      Sebaiknya pemerintah lebih menyebarluaskan mengenai peraturan yang ada mengenai aborsi agar tidak disalahgunakan oleh pihak yang tidak berwenang
2.      Pemerintah juga harus tegas dalam mengaplikasikan peraturan ini di masyarakat, sehingga masyarakat akan mengerti perbedaan tindakan aborsi mana yang memang patut dilakukan demi keselamatan seseorang, dan aborsi yang tidak bertanggung jawab.


DAFTAR PUSTAKA

http://downsyndrome.nacd.org/heart_disease.php
http://klinikanakonline.com/2010/10/24/down-syndrome-deteksi-dini-pencegahan-dan-penatalaksanaan-sindrom-down/
http://www.un.org/en/development/desa/population/publications/pdf/policy/WorldAbortionPolicies2013/WorldAbortionPolicies2013_WallChart.xls
PP RI no. 62 tahun 2004 tentang Kesehatan Reproduksi
Roizen NJ. Down syndrome: progress in research. Ment Retard Dev Disabil Res Rev. 2001;7(1):38-44. [Medline].

UU RI no 36 tahun 2009 tentang Kesehatan