Aminuddin Prahatama Putra1), Huldani2), Bayu Indra Sukmana3), Fauziah4), Harun Achmad5)

A DILEMMA OF MORALITY IN EUTHANASIA PROBLEM

1) Biology Education Department, Faculty of Teacher Training and Education, Lambung Mangkurat University, Banjarmasin 2) Medical Sciences Department, Medical Faculty of Lambung Mangkurat University, Banjarmasin 3) Dentistry Department, Dentistry Medical Faculty of Lambung Mangkurat University, Banjarmasin 4) Co-Assistant Doctor, Medical Faculty of Lambung Mangkurat University, Banjarmasin 5Departement of pediatric dentistry, Hasanuddin University, Makassar, South Sulawesi, Indonesia

Abstract

Euthanasia (eu means good and thanatos means dead) which literally means death well without suffering. Euthanasia brings many pros and cons from various aspects, both medical, social, cultural and religious. Design: The first part is formulating the initial theory (draft stage of the moral development of the problem of euthanasia) hereinafter abbreviated as PMDEP. The second part is designing data collection instruments and product testing (instruments). Results: The results of this assessment indicate that written theories and assignments that are arranged theoretically are very valid, meaning the written stages and assignments are in accordance with the theory revealed, and the researchers' mindset to construct that stage is acceptable. This means that the content validity and construct of the theory is sufficient, so that it can be implemented and verified in the field Conclusion: 1. Content validity and hypothetical construct theory Phase of Moral Development of Euthanasia Problems already fulfilled and can be verified in the field, 2. Validation test of 4.81 with a very valid category and reliability of 98.13% shows written assignments arranged theoretically are very valid it means they can be implemented and verified in the field.

Keywords: Morality, Dilemma, Euthanasia

INTRODUCTION Phase of Moral Development of Euthanasia Problems Current development produces various thoughts and technology inventions which had an impact on shifting perspectives, social and cultural values. In 1945 Constitution of the Republic Indonesia written that health is one of the fundamental rights of every human being.2 So many people who suffer from serious illness, undergo long-term treatments and conditions with morbidity and high mortality are at risk for depression and hopeless thought that pain will ended by death. Based on that thought, people finally found a new way of death, in Greek term known as euthanasia (eu means good and thanatos means dead) which literally means death well without suffering. According to Sutarno, euthanasia is the act of killing a patient or letting the patient die naturally, where the patient suffers from an incurable disease according to medical science, with the aim of shortening the patients suffering.3 Euthanasia brings many pros and cons from various aspects, both medical, social, cultural and religious. In terms of religion, in Indonesia it has been regulated in the MUI fatwa that euthanasia is murder based on media considerations for people with diseases that are no longer possible to be cured. However, the essence of life is entrusted by the Almighty God so that it

1 must not be ignored. The law of killing in the Qur'an is very clear forbidden, as in surah Al- An'am verse 151 which means "And do not kill a soul that is forbidden by Allah (to kill it) but with a right cause." Killing in this verse is all forms and types of murder including euthanasia especially active euthanasia, while what is meant by the right cause is for example in the war against infidels. Whereas the prohibition to do passive euthanasia is one of them in surah An- Nisa verse 29 which means "And do not kill yourself, verily Allah is Merciful to you." Even in the conditions of infectious diseases, euthanasia is avoided as much as possible. For example for sufferers of AIDS, isolation action on sufferers is seen as a better solution than eliminated his life (euthanasia).7 The issue of euthanasia when viewed from the aspect of criminal law and human rights in Indonesia is still caused the endless debate between the provision of human rights and the contradiction of national law, especially the Criminal Code which is applied in Indonesia. Basically, euthanasia is still prohibited in the criminal law system or health law in Indonesia, no matter whatever the reason is and whoever request it individually for their own selves or those who request euthanasia for their families are all still forbidden.12 Every efforts that have been made of course lead to pros and cons, moreover South Kalimantan has been known as "religious regions and have many theologians". Moreover, it will give an impact to the community especially "students" who have family members who suffer from chronic illness while there is a desire of family members to choose euthanasia as the way out of pain. According to it has become an axiom in education that education will achieve the most Dewey said that morality is related to moral is things that are related to prohibitions and actions that speak incorrectly or correctly.2,9,14 Martin Hoffman complements of Piaget and Kohlberg’s work by paying the attention to the role of cognitive abilities and reasoning skills in explaining moral behavior. Hoffman argues that empathy for the suffering of others or called emphatic distress. Cognitive abilities determine the types of emphatic distress that a person can experience and as a consequence, empathic abilities develop in a pattern resembling levels.15 Thus all stages of moral development proposed by Piaget and Kohlberg can be predicted, taught and identified in students.10,18,19,21 Based on above description, research studies on moral development have not been carried out in Biology science learning field. Meanwhile, in biology we cannot be separated from things that related to God's power and good morals towards disease and its treatments.22,23 Biology teaches how to behave towards ourselves and others. Biology instills these values without patronizing, obtained consciously by students through a process, so that it can increase the power to receive/store that information. This problem has never been examined before, therefore moral dilemma research in the issue of euthanasia is expected to produce a moral representation of students about euthanasia. This also will contribute to biology study in Junior High School level in psychotherapy substance uses, treatment aspect assessments, law and human rights aspects. The purpose of this study was to produce an overview of the moral development of Junior High School students in the problem of euthanasia through problem solving.

METHODS This research is a type of research and development. The aims to develop research instruments about the stages of students' moral development for each stage through solving the problem of euthanasia.

2 a. Design This study uses a model of ASSURE development which developed by Heinich, Molenda, Russell and Smaldino.3 Broadly speaking this research was carried out in two parts of the series of instrument development activities. The first part is formulating the initial theory (draft stage of the moral development of the problem of euthanasia) hereinafter abbreviated as Phase of Moral Development of Euthanasia Problems (PMDEP). The second part is designing data collection instruments and product testing (instruments), followed by expert validation and readability tests for students. b. Developed Instruments The developing instruments include Defining Issue Test (DIT) which adapted from Rest (1999), this used to measure the stage of student moral development. DIT was modified by using a moral dilemma discourse on the problem of euthanasia. Discourse related to science- biology learning material that has been taught by the teacher is Addictive and Psychotropic Substances. c. Research Subjects The subjects of the study consisted of learning experts and educational practitioners as validators of the research instruments which amounted 5 (five) persons. While the research subjects for readability test came from VIIIth grade students of junior high school. Determination of research subjects came from class 8th junior high school with considerations: a) subjects were at a formal level who were able to think more abstractly, b) moral development of subjects tended to be more rigid in looking at right and wrong than older children, c) material about Various Organ Systems in humans, chemicals in the fields of industry and health, as well as chemicals in foodstuffs have been studied by students on grade 7th in the previous material.

Fig 1. Readability Test d. Data analysis technique Analysis of data from DIT validation, written assignments, and interview guidelines was carried out based on Table 2. The results of validation from the validator or expert if the research instrument was declared valid, then the research instrument was feasible to use based on the validator's suggestion. Readability test, analysis activities carried out by identifying research instruments that are not well understood by students, then make revisions based on the results of the identification.

Table 1. Assessment criteria7

Validity No. Validity Level Criteria 1. 4 ≤ P  5 Very worthy/Valid 2. 3 ≤ P  4 Decent / Valid 3. 2 ≤ P  3 Middle 4. 1 ≤ P  2 Less

Calculation of the reliability of device assessment instruments uses the following formula: A R  x 100% D  A Explanation: R = Instrument Reliability (persentage of agreement) A = Frequency of match between the two assessors (agree) D = Frequency of discrepancy between the two assessors (disagree) Device assessment instruments are said to be reliable, if the reliability is  75% 5

RESULTS AND DISCUSSION a. Results of Hypothetical Theory Validation PMDEP Validation of the draft stage of moral development the problem of euthanasia to experts to find out the validity of the content and the theoretical constructs developed. Content and construct validity is obtained through the assessment of 3 experts. Assessment is given through a validation sheet with a suggestion / comment column. The results obtained and the summary are presented in Figure 2 and Tabel 3.

4.7 4.67 4.67 4.65 4.6 4.55 4.5 4.5 4.45 4.4 level fill in language

Fig 2. Graph of Validation Results PMDEP by Experts

The results of the validation carried out by the expert, obtained an average score for the stage assessment aspects as much as 4.50(very valid), for the content aspect getting a score 4.67(very valid), and language assessment aspects getting score 4.67(very valid). The overall average results obtained for PMDEP based on the expert validation test amounted to 4.61 with a very valid category. Based on the results of the validation carried out by the expert, the average score for the stage assessment aspect was 4.50(very valid), the content aspect got a score of 4.67(very valid), and the language assessment aspect got a score of 4.67(very valid). The overall average results obtained from this PMDEP based on the expert validation test amounted to 4.61 with a very valid category, while for reliability obtained 96.31%. The results of this assessment indicate that PMDEP and the theories compiled theoretically are very valid, it means that the stages and theories are in accordance with what was revealed, and the researchers' mindset to construct that stage is acceptable. This is consistent with the

4 opinion of Rest13 that some researchers have tried to develop new methods to identify someone’s moral development. The moral that is held and believed by a person does not run stagnant, but experiences the stages of moral development1,10 found four prominent moral developments in one's development based on spiritual life factors, moral awareness, moral emotion, and post-conventional morality. Thus the content validity and construct of the theory is sufficiently fulfilling, so it can be implemented and verified in the field. The results of this assessment indicate that written theories and assignments that are arranged theoretically are very valid, meaning the written stages and assignments are in accordance with the theory revealed, and the researchers' mindset to construct that stage is acceptable. This means that the content validity and construct of the theory is sufficient, so that it can be implemented and verified in the field. b. Written Validation Results Validation of written assignments of discourse moral dilemma to experts to find out whether this moral dilemma discourse is appropriate and feasible to be used as a written task with the problem of euthanasia in junior high school. Assessment is given through a validation sheet and a suggestion/comment column. The results obtained are presented in Figure 3. 5.1 5 5 5 4.9 4.83 4.8 4.67 4.7 4.6 4.5

Fig 3. Graph of Task Validation Results Written by Experts

Based on the results of the validation carried out by the expert, obtained an average score for the aspect assessment which is 5.00 (very valid), for the construction assessment gets a score of 4.83 (very valid), and the material assessment gets a score of 4.67 (very valid) , and language assessment 5,00 (very valid). The overall results obtained from this written assignment based on the expert validation test is 4.88 with a very valid category. Scores obtained from three validators, which t elah charge sheet validation. In addition to rating, third validator also recommendations, namely that each task fit for use with repairs. The draft written assignment was then validated to two teachers as presented in Table 2 and tested on 3 students in each school. The results of the revision of draft 2 are the final instruments that will be used in the next research. Task validity is known from the results of content and construct validation by lecturers/experts, teachers and students.

Table 2. Results of Validation of Written Tasks by the teacher

Problem Validator 1 Validator 2

Good Worth using Worth using medical with small (without action for revisions revision) patients Euthanasia Worth Worth using reduces using with small the (without revisions suffering revision) of patients Euthanasia Worth using Worth using deserves (without (without punishment revision) revision)

The first written assignments using the discourse of skin disease related to the concept of Negative Impact Use of Psychotropic Substances that are made in the discourse of the first task is authentic problems that often occur among people, thus providing problem solving alternatives for students. The format is quite simple and is expected to help students make solutions according to their stages. The scores obtained only come from two validators, because there are validators who do not fill in the validation sheet. However, the non-writing validator continued to write the recommendations in writing, ie the assignments were each suitable to be used with repairs and then validated by two teachers. Based on the results of the validation carried out by the experts, the average score for the aspect assessment was 4.75(very valid), the assessment of construction got a score of 4.81 (very valid) and the assessment of the material got a score of 4.86 (very valid), as well as language assessment 4.83 (very valid). The overall average results obtained from this written assignment based on the expert validation test are 4.81 with a very valid category and 98.13% reliability. The results of this assessment indicate that written assignments arranged theoretically are very valid, meaning that the written assignments are in accordance with the mindset of the researcher to construct written assignments that are acceptable. Thus the content validity and construct of the theory is sufficiently fulfilling, so it can be implemented and verified in the field.

CONCLUSION a. Content validity and hypothetical construct theory Phase of Moral Development of Euthanasia Problems already fulfilled and can be verified in the field . b. Validation test of 4.81 with a very valid category and reliability of 98.13% shows written assignments arranged theoretically are very valid it means they can be implemented and verified in the field.

SOURCE OF FUNDING Domestic government

CONFLICT OF INTEREST There is no conflict of interest in this study.

ETHICAL CLEARANCE

This study obtained a label of ethics escaped by the number:780/KEPK- FKUNLAM/EC/VIII/2018 on August 10, 2018

REFERENCE 1. Azagra, P. L. Structures of Cognitive Moral and Religious Development. Downloaded 12 Dec 2012 from, http://www.crvp.org/book/series05/v-4 /note_to_chapter_xiii.htm. 2002. 2. Budiningsih, C. A. Moral Learning. Building on the Characteristics of Students and Culture. Jakarta. PT. Rineka Cipta. 2008 3. Clymer, E. W. 2007. The ASSURE Model of Instructional Design (A presentation to HEAD & KNU NTID Student Development Center) http://www.pen.ntid.rit.edu. 2007. 4. Franken, R. E. What is Crativity? (from Human Motivation, 3rd ed). California State University,Northridge. Downloaded April 7, 2013 from, http://www.csun.edu/~vcpsy00h/creativity/define.htm. 2013 5. Ibrahim, M. Sustainable Assessment. Surabaya: Unipres Unesa.2005. 6. Ministry of Education and Culture. 2013 Curriculum. Basic Competencies for Middle School (SMP) / Madrasah Tsanawiyah (MTs).2013 7. Khabibah, S. Development of Mathematics Learning Models with Open Questions to Improve Primary School Student Creativity.Dissertation of unpublished Education Doctoral Program: Unesa Postgraduate Program. 2006. 8. Ma-Kellams C, Blascovich J. "Does Science Make You Moral? The Effects of Priming Science on Moral Judgments and Behavior". PLoS ONE 8(3):2013 9. Olson, C. "The Deep Roots of the Fairness Committee in Kohlberg's Moral Development Theory". Chicago Journal.8(1): 2011 10. Piaget, J. & Inhelder, B. The Psychology of the Child. Basic Books. New York.2010 11. Polya, G. How To Solve It. A New Aspect of Mathematical Method. (Second Edition). Stanford University. Princeton University Press. Princeton, New Jersey.1973. 12. Pradjonggo, T Sridjaja. "Dead Injection (Euthanasia) Judging from the Aspects of Criminal Law and Human Rights in Indonesia”. PPKn Scientific Journal, Th.1. No.1, June 2016.2016. 13. Rest, J and Narvaez, D. "DIT2: Devising and Testing a Revised Instrument of Moral Judgment". Journal of Educational Psychology.91(4):1999; 644-659. 14. Santrock, J. W. Child Development. Eleventh Edition. The McGraw-Hill Companies, Inc. 2007 15. Slavin, R. E. Educational Phsychology: Theory and Practice. Ninth Edition. Pearson Education, Inc. Upper Saddler River. New Jersey 07458. 2009. 16. Sulhan, N. Character Based Education (Synergy between School and Home in Establishing Children's Character). Surabaya: PT. JePe Press Media Main. 2010 17. Vessel, G. and Huitts, W. Moral and Character Development. Presented at the National Youth at Risk Conference, Savannah, GA, March 8-10. Downloaded February 7, 2013 from, http://chiron.valdosta.edu/whuitt/brilstar/chapter/chardev.doc. 2005 18. Welch, P. 2011."Moral Psychology and the Problem of Moral Criteria". Journal of Moral Education.40(4);2011;513-526. 19. Widodo, M. & Jatiningsih, O. "Single Mother's Role in Developing Child Morality in Wonokromo Village, Wonokromo District, Surabaya". E-Journal of Moral and Citizenship Studies.1(1);2013: 2337-473X. 20. Zubaedi. Character Education Design: Conception and Application in Educational Institutions.Jakarta: Kencana Prenada Media Group. 2011 21. Achmad H, Singgih MF, Andries S, Ramadhany S, Handayani H, Sumintarti. Analysis of ascorbic acid in gingival handling of children's mouth cavity.IJPHRD. 2019;10(5)

22. Zuriah, N. Moral & Character Education in a Change Perspective. Initiating a Constitutional and Futuristic Characteristics Education Platform. Jakarta: PT.Earth Literacy.2011 23. Achmad H, Suriamiharja MA, Mudjari S, Tandiarrang GW. Influence Of Length And Frequency Of Paan With The Occurence Of Gingivitis Of Community In Toraja Regency.IJPHRD. 2019;10(5)