Iranian Journal of Medical Ethics and History of Medicine

Examination and analysis of laws and regulations related to organ transplantation in Iran

Shahla Moazami

With the progress of science, organ transplantation emerged as one of the modern innovations of the medical science. Like other innovations, organ transplantation brings individuals in the society some disadvantages alongside numerous advantages. Legislators have therefore adopted rules and regulations for the mutual support of society members and their rights.In this article the researchers will examine the current regulations on organ transplantation in Iran. Legal sources in Iran, especially the constitution, Islamic criminal law, health and sanitary regulations, moral codes and so on will be referred to in this respect.In the constitution (as epigraph of all laws and regulations within the country), articles 14, 29, 43, 167 will be examined, and in Islamic criminal law articles 159, 372, 495, 497 and 724 will be discussed as the most significant existing articles on organ transplantation. In relation to the moral codes and medical and sanitary regulations we studied the following: Organ transplantation act of April 5, 2000 about the deceased or patients whose brain death has been confirmed the protocol on confirmation of brain death, established 2000 executive regulations for transplant from the deceased or patients whose brain death has been confirmed, adopted May 15, 2002 act of renal transplantation and donation from living donors passed on October 20, 2008 executive regulation 13101 approved on April 29, 2006 about living donors (with the exception of transplantation from a living donor to a foreign citizen) and the charter of patient’s rights ratified in 2009. Lastly, it should be mentioned that transplantation laws and regulations that presently exist in Iran appear to be inadequate for the purpose of resolving the current challenges and problems.

A legal analysis of euthanasia in the Islamic criminal code of 2011

Ensieh Salimi

Euthanasia or mercy killing is a new and challenging topic in medical law. This article examines all types of euthanasia based on the Islamic criminal code of 2011, and demonstrates that active and involuntary euthanasia is murder if conditions exist the basis for active and voluntary euthanasia, however, is the victim’s consent, so the penalty is less. As the physical element of inactive euthanasia is omission, clause 296 of the criminal code and clause 2 of the penal code on refusing to help the wounded apply. Lastly, it is suggested that legislators criminalize euthanasia with a new approach and independent title, and consider principles of justice to determine less punishment for this type of killing compared to murder with malice aforethought.

A legal research on the responsibility of surrogate mother in custody of child in the laws of Iran

Abbas Yadollahi Baghlooei

Surrogacy is an infertility treatment in which the sperm and egg of couples are mixed in vitro and then transferred to the womb of other woman to grow until the end of pregnancy, and this woman is called the surrogate mother. According to article 1168 of the Iranian civil law, children conceived through surrogacy must remain in custody of their parents like other children, and it is the right and responsibility of the parents to maintain their children. Now what will happen if the surrogate mother refuses to release the baby to his/her parents? Based on the various provisions of the civil law, criminal law and the civil liability act, on the one hand, the surrogate mother is obligated to deliver the baby to the couple, and on the other hand, she will be held liable for any damage or injury to the child should she choose to take custody of the child.

Inter-professional ethics education in team-based approach: values and ethics development in inter-professional collaboration

Fatemeh Keshmiri

In order to achieve teamwork-based and integrated care, one of the issues in health care is the implementation of ethics and values in teamwork. The aim of this study is to develop the interprofessional collaborative ethics framework.This cross sectional study was conducted in two phases. In phase one, core competencies of the interprofessional collaborative ethics were determined by literature review. In phase two, Delphi rounds of experts were undertaken to validate the competencies and calculate content validity indexes through Content Validity Ratio (CVR) and Content Validity Index (CVI).The interviews and Delphi rounds identified 12 competencies categorized in three core themes including patient-centered values, interprofessional collaborative ethics, and team-based values. In phase two, based on the mean scores of importance, utility, and clarity, patient center value (4.9), interprofessional ethics competencies (4.6), and team-based values (4.5) were determined as essential themes.In conclusion, the validation of the inter-professional ethics framework was found to be acceptable in the Iranian context. Therefore, the framework for teaching and evaluating inter-professional ethical competencies is an applicable tool in the Iranian context.

The attitudes of health care providers toward breaking bad news in neonatal intensive care units and labor wards

Manijeh Seresht

Breaking bad news emotionally affects both health professionals and patients. Breaking bad news is a sensitive issue for both health care providers and patients. It is generally believed that the patient’s adjustment can be affected by either a positive or a negative experience in this respect. This study aims to determine health care providers’ attitudes toward breaking bad news to parents in NICU and labor wards.This cross-sectional study was conducted in Shahrecord in 2011 with a study sample of 70 health care providers drawn from neonatal intensive care units and labor wards and the department of nursing and midwifery who had had at least one year’s clinical experience. The sampling method was census. Data were collected through a self-administered questionnaire in two sections: demographic information and health care providers’ attitudes toward breaking bad news. Data were analyzed by SPSS software with descriptive and Chi-square and T-student test statistics. Most participants (63.2%) had a positive attitude toward disclosing bad news to parents. 77.6% of caregivers faced difficulties in delivering bad news to parents, 92.6% of them believed that training workshops in this field are necessary. There was a significant statistical relationship between the attitudes of the health care providers and their education level and work place (P < 0.0001). Health professionals with higher education levels and nursing and midwifery staff had more positive attitudes.There was no significant statistical relationship between the attitudes of the health care providers and their history of difficulties in transferring bad news, workshop trainings, work experience, gender, age and marital status (P > 0.05). The majority of health professionals had a negative attitude toward immediate disclosure of bad news to parents, mothers holding and seeing their deceased babies, dedicating a special room to perinatal loss mothers with similar problems, and preventing other patients and their families from contacting them.Based on the findings of this study, teaching bad news communication skills to personnel of NICU and labor wards should receive prioritization in future continuing medical education programs in order to best prepare the staff for disclosure of bad news to parents.

Patient’s viewpoints about how to break bad news

Sayyed Esmaeil Managheb

Breaking bad news is an unavoidable part of the medical profession, and doctors and patients stand at the two sides of this function. There are different views about how to break bad news in different cultures and societies. In this study we assessed the viewpoints of hospitalized patients on how to break bad news. This cross sectional study was performed in 2011 at the Jahrom University of Medical Sciences. Sample size of 110 patients was calculated and the method of sampling was simple random sampling. Target population was the hospitalized patients of Peymanyeh and Motahari hospitals in Jahrom. Entry criteria consisted of being admitted to the above hospitals, and exclusion criteria included severely ill patients and patients with mental disorders. A reliable self-administered questionnaire was designed and validated. The questionnaires were completed and returned by 110 patients. Data were analyzed using the SPSS16 software through descriptive analysis. One hundred and ten patients were included in this study. The factor analysis showed three elements: methods of breaking bad news, the people involved in the breaking bad news process, and timing and location. Of participants 78% wanted to be told the bad news while their relatives were present, 63.2% wanted to be told the bad news in a private and quiet room. Almost all respondents emphasized the need for religious advisors and psychological counselors (77.2% and 62.5% respectively). Most of participants (91.5%) wished to receive all the information about the etiology of their disease, and 74.8% of them wanted to be told whether their illness was cancer.This study showed that there are different views on how to break bad news in different cultures and societies. Social and cultural differences must be considered in breaking bad news. In our country, patients’ families could have a prominent supporting role in the delivery of bad news to patients.

Moral distress in nurses working in educational hospitals of Northwest Medical Universities of Iran

Arezo Azarm

One of the most important issues in nursing ethics is moral distress, which is a severe psychological problem among nurses. The purpose of this study was to determine the nurses’ moral distress in the hospitals of the northwest of Iran.This was a cross-sectional study in which 418 nurses were selected by randomized multistep sampling method in the northwest of Iran in 2012. Data collection was done using the moral distress standard scale with high reliability and validity. In order to analyze data, descriptive (mean, standard deviation, frequency and percent) and inferential statistics (independent t-test and one way ANOVA) were used.The mean score of nurses’ moral distress was 148.49 ± 32.93, and 222 nurses (53%) suffered from severe moral distress. Of the three provinces under study, Zanjan (152.46 ± 35.88) and intensive care units (152.72 ± 33.36) had the highest moral distress scores. Among the respondents’ demographic characteristics, province (P < 0.01), education (P < 0.05), type of shift (P < 0.05) and job status (P < 0.05) were significantly related to the level of moral distress experienced by the nurses.Due to the high level of moral distress in the nursing profession, dealing with it requires a lot of attention. Studies on casual and predictive factors in different wards and teaching coping strategies to nurses appear to be necessary in order to address this issue.

Assessment of knowledge and viewpoint of midwifery students of Tabriz Azad Islamic University and Tabriz University of Medical Sciences toward abortion in 2012

Somayyeh Naghizadeh

Lack of knowledge of the medical team about the regulations and laws of abortion can endanger mother’s health and also faces the medical community with serious problems. The aim of this study was assessment of knowledge and viewpoint of midwifery students in Tabriz Azad Islamic University and Tabriz University of Medical Sciences toward abortion. This study is a descriptive study which was conducted in 2013 on 300 midwifery students in Tabriz Islamic Azad University and Faculty of Nursing & Midwifery at Tabriz University of Medical Sciences. A four-part questionnaire was used for gathering data parts 1 to 4 included the personal, social, educational particulars of midwifery students and studying the students’ knowledge about the I. R. Iran’s regulations and laws regarding abortion, studying the students’ viewpoints toward legal and illegal abortion. Our study showed that 26.7% of midwifery students have proper knowledge about abortion, the knowledge of 53.7% of them was in the medium level and 19.7% of students have weak knowledge toward it. The positive viewpoint toward legal abortion was observed in 89.3% of the students and 10.7% of students had negative viewpoint. Our analysis showed that there is no statistically significant difference between students’ knowledge about abortion (P≤0.76), students’ viewpoint toward legal abortion (P≤0.44) and students’ viewpoint toward illegal abortion (P≤0.081). Although in our study midwifery students’ knowledge about abortion regulations was not sufficient, there is the high probability of their encountering with judicial problems. Therefore, it is recommended to raise the midwifery students’ level of knowledge about the authorized cases of abortion and regulations which may decrease the fines of criminal abortions in the future.