Journal of Medical Ethics and History of Medicine

Ethics in complementary and alternative medicine

Hamid-Reza, Delaram

Nowadays, complementary and alternative medicine is considered as an important part of healthcare management. General population highly accepted it which signifies ethical issues as a challenge to all healthcare specialists.

Concerning the risk-benefit issues such as the severity and acuteness of illness; the curability of the disease by conventional treatment modalities; the degree of invasiveness, the linken toxicities, and the side effects of the conventional treatment; the accessibility and quality of evidence of usefulness and safety of the desired CAM (complementary and alternative medicine) treatment; the level of information about the risks and benefits of the CAM treatment combined with the patient's knowledge and voluntary acceptance of those risks; and the patient's persistence of intention to use CAM therapies; providers can delineate a plan that is clinically sound, ethically suitable, and aimed at the particular experience of individual patients. Physicians are proposed to remain committed in problem-solving with their patients and to try to reveal the patient's core values and opinions while guiding about CAM modalities.

In this article some of more obvious or practical ethical aspects of complementary and alternative medicine have been discussed.

Evaluating physicians points of view about terminally ill patients

Ali

In facing with terminally ill patients, many ethical issues emerges such as patient's information about the disease and getting patient's idea about supportive and curative measures, starting and stopping life saving treatments, and finally euthanasia. Considering different cultures, there are different ethical aspects which may affect decision making about terminally ill patients and needs to be further evaluated. According to the lack of study in this field in Iran, the aim of this study was to describe the attitude of Iranian specialists about ethical issues in the end of life care.

In this study we interviewed with 20 specialists in the fields of nephrology, hematology, anesthesiology, neurology, surgery, neurosurgery and oncology; who are facing with terminally ill patients more than the others.

Analysis revealed that declaring disease information to the patient and his decision are the most important factors affecting patient's family and the diagnosis and decision of the physician in sustaining life saving treatments are in the second order, although the definition of terminal illness was different between specialists and even in contrast with ethical resources. Considering western country model, while this is not in agreement with patient's autonomy, it is compatible with the eastern ethical model. It seems that in this approach beneficence, non malfeasance and legal issues are more important than patient's autonomy. By accepting this approach, there is no need for advanced care management.

Prophetic medicine and Western world

S. Mohammad, S. Mohammad Ali, Zahra

Modern medicine and advances in the health system is due to a great part of the instructions of the prophet of Islam. But, a great part of these accomplishments remained unknown. The great philosophers and physicians of Islam such as Ibn Sina, Razi and Birooni have caused great developments in the different medical fields. Prophetic medicine is a collection of medical orders which was used by the early Moslems as a replacement for Galen medicine. In fact the collectors of these orders were Moslems who used Quranic verses and the Sonah (prophet's lifestyle) as a model for these orders. Later on philosophers such as Adh-Dhahali tried to join the Arabic-Islamic medicine with the Roman medicine. These philosophers used Hippocratic and Galen medicine too. Some of the medical treatments which were used by the Islamic physicians such as Jalal Aldin Alsioti were based on medical knowledge of the prophet's time which was also based on the holy Quran, and the Sonah (life style of the prophet Mohammad (PBUH). With all the documentations regarding the role of early Moslem physicians in developing and raising the modern medicine, some western scientists have tried to deny the role of Islam regarding the medicine and health. Manfred Ullman in his book "Islamic Medicine" states that Islam did not bring any change in the medical conditions of the early medicine and in the holy Quran there is no mention of physician and medicine. In this article the role of prophetic medicine in the advancement of medicine and also the roots and causes of the attempts of the western world to downgrade this role has been analyzed.

The ethical and legal considerations in human cloning

Alireza, Hamideh, Amir

Cloning Technology persuaded humankind to hope for perpetual living. Subsequently arguments about the eligibility of this technology emerged.

This technology is discussed from various aspects such as: ethics, law, religion, etc. In each field scholars have made an attempt to find a proper answer; some of them condemned it seriously, some accepted it absolutely; while the others have chosen the middle road. So, different attitudes bring up different legislations.

This article evaluated different legal and ethical views about cloning and showed that violating human dignity and the adverse consequences of cloning are the most important legal and ethical points that cloning opponents considered.

Ethical indecency and fineness

Seyed Ahmad, Abbas

Ethical indecency and fineness have paramount importance in ethics. If it is denied, ethics will be considered relative. In this article, its definitions and aspects will be discussed using the Islamic sources.

The data have been collected from reliable Islamic sources and search engines such as Yahoo, Google, and Iran Medex using key words such as "innate goodness and badness", "ethical indecency and fineness" and "rational deductions".

The five found definitions are " compatibility and incompatibility with habitude"," aims agreement"," perfection and imperfection", "admiration and criticism" and "innate tendencies". Human humors can be defined as brutal humor and spiritual humor. The first definition doesn't give us a scale to differentiate ethical from unethical issues and the second one can't prove spiritual deeds comprehensively; unless its correctness has been accepted. The aims have three types: individual aims, common aims and favorable aims. Individual aims lead to ethical chaos but common aims can support ethics. Common aims neither clarify the essence of an action nor concern innate "goodness and badness". They are really the explanations for reasonable indecency or fineness". Favorable aims seek God's satisfaction and need good intends. Perfection and imperfection is actually another expression for "compatibility with humor". "Admiration and criticism" is the only definition of optional conducts. It is defined as "appropriateness of admiration and criticism", " order of admiration and criticism"," having capability to be admired or criticized" , "admiration and criticism by themselves "and " the wise opinions for admiration or criticism". "Innate tendencies" are another explanation for "compatibility with humor".

In defining "ethical indecency and fineness", we should consider standards with ethical applications like compatibility with celestial humor, perfection and imperfection, innate tendencies and common aims.

Euthanasia and "right to-self" a challenge in the nature of human rights

Amir

In the international documents "voluntary euthanasia" refers to the "right to cure" and the "right to life". The question is whether or not these rights can be rejected by the right holder himself/herself? It needs an argue in the nature of human rights. There is no international permission on "Voluntary Euthanasia". However, one may ask a question "Is the right to life against the right to death?" Also when states must protect fundamental human rights, we can't easily accept human's right to die by himself.

The European Court of Human Rights respects the idea that the mentioned prohibitions on right to life in the second article of the European Convention of Human Rights actually exist in relations between mankind, but the question which still remains unanswered is whether the right holder can nullify his right?!

Because of the positive obligation of states on human rights, they can't rely on rights nullifying. In fact the rules of human rights are imperative. For example, the article 959 of Iranian Civil Code, says no one can take out his civil rights. Also suicide is extensively prohibited in Islam and another religions. According to the imperative nature of human rights and logical idea of cure and the necessity of considering human abilities, we can say that has been banned. Therefore, there is no legal or real meaning of right to-self as the third generation of human rights; especially in situations which using and enjoying fundamental rights depend on right to life. But the new question is "what the relation between human rights (right to life) and freedom of action is".

The theory of derivation of ethics from religion

Seyed Ahmad

The relationship between "ethics" and "religion" is an important issue especially when facing with different ethical and religious perspectives. Separating religion from ethics, new concepts such as secular ethics emerges. In this field, special attention has paid to the commentary of derivation of ethics from religion which we are going to discuss about that.

Our data have been collected from reliable Islamic sources from the library of the National Museum of Medical Sciences History. We also did search in the Yahoo and Google using key words such as"ethics and religion", "divine command theory" and "Islam".

Taking a look at the human history shows us that in many societies religious and ethical claims have a close relationship. Controversy among Ashaere and Motazele shows the long history of the issue among Muslims. The relationship between ethics and religion can be fundamental or structural. Fundamentally, the common aims between religion and ethics and the requirement of ethics to the religion can be mentioned. In fact, both of them seek human perfection; however, human's intellect has intrinsic deficiencies. Religion compensates it by offering divine commands. In addition, regarding the wide spectrum of religious claims, religion will have an organic relationship with ethics like a tree with its trunk. For acting morally and preventing unethical actions, human beings need to be encouraged or punished. Religious comments can support and clarify ethical commands. On the other hand, with the promise of heaven and the threat of hell, people would behave morally.

From theoretical point of view, there is controversy among Muslims. Ashaere don't believe in reasonable deductions and regard the religion as the only source for ethical commands. However, Moetazelis accept "rational deductions" as a source for ethical claims.

Therefore the "Theory of derivation of ethics from religion", can be evaluated from different aspects. The common aims have supportive effect on these two aspects. The ethics based on wisdom, requires religious guidance in order to compensate its limitations. The religious confirmation on the definitions of common ethics guaranties the social behavior. From theoretic point of view, there is controversy among Muslims (Ashaere and Moetazelis) as well.

Rhazes's views on medical ethics

S. Mahmoud

There are some important remarks on medical ethics by Muslim physicians such as Mohammad Ibn Zakariay-e- Razi (Rhazes). This paper elaborates Rhazes's views on some ethical issues in medicine in three major points:
1- Health Professionals and observing ethical issues: Rhazes has emphasized on some personality characters that physicians should acquire to perform medical education. For example he believes that a good physician should have some characteristics such as: sound behavior, confidentiality, self-confidence, and also it is necessary to study hard, not to waste time, not to consider medicine as a business, and to respect patients.
2- Ethical issues in research: One of the characteristics which make Rhazes different from other physicians of his time even from Avecina is observing ethical issues in research. Rhazes was stating the reference of each sentence and quotation. In case of giving information without a reference, he used to emphasize the unknown identity of the reference. He criticized plagiarism by physicians. He believed that plagiarism is an inappropriate behavior for a physician.
3- Ethical issues in treatment: In providing healthcare, Rhazes obliged himself to observe ethical norms, trust and commitment to his patients. For example he emphasized that firstly a physician should find out the cause of pain, and then prescribe pain killer.
For instance he rejected prescribing opium as an eye pain killer which may cause blindness. Also he believed that polypharmacy may cause harm to patients and he warned us about giving several drugs to a patient.

Ethical assessment of confidentiality in gamete and embryo donation

Kiarash

Confidentiality is anonymity of gamete or embryo donors to the recipients and resulted children and Vice Versa. In this article, I formulated the question about confidentiality through two main questions: 1- Ethically speaking, should the information about the characteristics and identity of donors be kept in specific organizations to be accessible for who considered having the right of access in the future? 2- Are receivers ethically obliged to inform their children about their biological origin? In this article, I assess the subject from Deontological, Utilitarianistic and Principalistic approaches and conclude that it is the right of such children to be informed about their biological origin. Of course in Iran, such ethical obligation should be suspended until the problems relating the heritage are solved.

The pathology of pharmacy ethics

Hassan

Pharmacy, from the earliest time has been closely related to health and well-being of the people and its own code of ethics. In recent decades there has been a shift in the pharmacist role from traditionally dispensing to patient oriented health care management. Nowadays, the philosophy of pharmacy practice is that a pharmacist is an individual who provide his knowledge and skills in patient counseling regarding ethical principles.

Recent advances in the science and technology and emerging new horizons of medical therapy, drug delivery and pharmacy practice put forth new concepts such as professionalism and professional code of ethics for health care providers. In this respect, rights of patient, patient autonomy and consent, consumerism, and commercialism put forth the importance of the study of pharmacy practice pathology and implementation of the code of ethics. These constrain has not put into consideration in Iran, it seems necessary to study how effective are code of ethics with these factors as well as others such as lack of knowledge and skills, economical, cultural, and socio-cultural constrains.

Medical ethics challenges in the information societies

Farzaneh

Information is the symbol of the present age due to the significant development in accessing, processing, storage and transferring information. Information societies have been formed by the widespread utilization of information and communication technologies in human social life and generally focus on the computer systems and information networks. Nowadays, various technologies of medical informatics comprise an important component of the management infrastructures of health care systems. Medical informatics is the development and assessment of specific methods and systems for acquisition, processing and analyzing patients' data with the help of knowledge and information from scientific researches. Moreover, it intends to increase access, improve quality and decrease the costs of care through decreasing chronological and geographical limitations. On the other hand, ethics have been always considered as a basic component of these systems. The increasing development of digital technologies and their application in health information management provides numerous benefits; however, it encounters health care managers with new challenges in the information societies. These challenges may has been mainly caused by the conflicts among ethical principles by themselves or disregarding them in the field of medical informatics. Therefore, careful consideration of info ethics as well as beneficence, autonomy, fidelity and justice is essential to overcome those conflicts in the information societies.

Assessing the ethical climate of Kerman teaching hospitals

Nouzar, Mina, Sareh

Background: The ethical climate (organizational culture) of an organization as perceived by a group of its workers is believed to affect ethical practices, job satisfaction and quality of care.

Objectives: To assess the ethical climate of teaching hospitals of Kerman city according to nursing staffs' views.

Methods: A 26-items questionnaire was translated to Persian which its content validity was acceptable according to the literature review. Its reliability was in an acceptable range according to Cronbach's alpha (0.92). It was distributed between a convenient sample of 350 nursing staff who worked in the four teaching hospitals of Kerman city. Three hundred and two subjects completed the inventory. All questionnaires were anonymous.

Results: The majority of them (76%) were female. The mean (±SD) age of the individuals were 32.4 (± 8.5). Subscription to the expression "always" was mostly seen for the item "my manager is someone I respect" and it was seldom observed for the item "nurses are supported and respected in this hospital". There was no significant difference in the total score of the inventory according to background variables (i.e. age, sex, educational level, employment status and hospitals).

Conclusion: According to the great impact of organizational culture on nurses' practices it seems that some aspects of organizational culture of teaching hospital especially the aspects that are related to physicians and top level managers need to be improved.

A philosophical assessment of the implications of the issue of human dignity for medical researches

Ali

Philosophers of ethics and those who are involved in the debates concerning Medical Ethics have discussed the issue of human dignity and its cluster of meaning from different angles and have suggested many interesting points in this respect. However, a cursory glance at the published works in this field reveals that most of those writers who have contributed to this issue have either based their arguments on notions such as rights or justice, or have used theological doctrines, or have conducted their debates within the frameworks of pragmatic or particularistic ethics. In the present paper, I shall approach the issue from a new viewpoint which is mostly inspired and informed by the ideas of some analytic philosophers.

The main argument of the paper revolves around the pivotal notion of "value of life". All those who take positions vis-à-vis stem-cell researches and the morality or otherwise of using embryos for such investigations, or those who form opinions concerning the ethicality or otherwise of abortion, or those who try to find satisfactory solutions for the vexing issue of the allocation of limited medical resources, maintain, at least in an intuitive way, that the life of a human organism, in whatever shape or form, has intrinsic value. The life of such an organism whether it is a newly conceived egg or an embryo ready to be implanted in the womb or a foetus whose neurological system has just emerged, or a morally fallen adult, is intrinsically valuable.

The idea that some things or events are valuable in themselves, namely, we respect them not because they serve our interests but because they are intrinsically valuable, is a familiar intuition. We have developed this ‘intuition' through our long existential experiences. Now if we reflect upon this very intuition we will be able to discover further layers of meaning in it. For example, we realize that from the belief that ‘human's life is intrinsically valuable' one cannot conclude that one should multiply human life as much as possible. On the contrary, some of our other intuitions would inform us that at least some parts of the world would be better off if less populated than crowded. Thus the question arises that if the intrinsic value of human life does not mean its multiplication, then how the continuation of human life, once it has appeared, can have intrinsic value? In the present paper I shall try to use the apparatus of analytic philosophy to explore the ways of reconciliation between the two seemingly contradictory notions of ‘the intrinsic value of life' and ‘the morality of sacrificing life under particular circumstances'.

Legal and ethical critisim to lobotomy

Alireza, Amir

Background: The first experimental lobotomy was performed in psychiatric patients at 1930. At the beginning, the purpose of such experiments was the treatment of certain patients such as psychotics, sexual offenders and schizophernics, but during the years, the unpredictable results and harms appeared. Nowadays the treatment is limited to medical treatment and psychosurgery which includes two new forms of lobotomy named cingulotomy and capsulotomy. Previously physicians were performing dangerous surgery on a wide rage of patients irrespective of their consent and objections. In fact they treated them in the favor of "patients' and public (social) interests" and some claims have risen against it. In this regard some legislators such as Canadian legislator enacted or amended their regulations and these regulations criticized.

Method: We selected the most related articles and books among the related resources. For completing this article, we searched by the keywords of Lobotomy, enforced offender to treatment, ethics.

Results & Conclusion: Studying some known cases demonstrated harmful effects of this special surgery and regarding to the ethical and legal points of view, operating patients only for the interest of patients or public, irrespective of their consent is not legitimate.

Executive management of bioethics in medical researches: The results of a workshop

Mostafa, Seyed Hassan, Seyed Hassan, Alireza, Fatemeh, Amin Mahmood, Alireza

Backgrounds: Nowadays one of the major problems in research ethics, especially in medical researches, is how to make bioethics codes practical and how to oblige researchers to perform them. In this essay, we have tried to suggest all detailed activities of different management sides which have a role in different phases of performing a research project, to make codes more practical.

Materials and Methods: In order to provide a practical guideline in medial research ethics issue from different points of view, a workshop was held by the presence of some representatives from type1 medical universities, 9 research centers, Pasteur Institute, molecular research and stem cells networks, and members of national research ethics committee.

Results: Participants were divided into 5 groups based on their proficiency and management scopes and edited the task's descriptions. These groups included: 1) task's description for ethics committee of universities; 2) task's description for research executive managers and research deputies of universities and research centers; 3) task's description for professors, executors, managers, research deputies of departments and research council's department; 4) task's description for international relationship committees of universities; 5) task's description for publishing committees. These 5 groups were chosen deliberatively.

Conclusion: Considering importance of bioethics, interference of environmental and sociological factors, local area culture and existence of executive facilities, providing practical codes of ethics needs group assistance and researchers' national impetus, research affairs accomplishment and massive country management.