Iranian Journal of Medical Ethics and History of Medicine

Responsibility of the physician in the Islamic Penal Code of 2013

Nazafarin Ghasemzadeh

Recent provisions to the Islamic Penal Code have provided favorable regulations that absolve the skilled physician from absolute liability and adjust liability according to fault. The revised code adopts a new approach by allowing physicians more freedom while providing added protection, which is consistent with ethical standards and Jurisprudential principles. The present paper aimed to investigate the development process of statutory laws in Iran regarding medical liability and at the same time analyze articles of the Islamic Penal Code of 2013 on the subject. Some articles have been found to contain ambiguities that need to be modified. As an instance there seems to be a conflict between Article 492 and Clause 1 of Article 496 that should be resolved as it pertains to a case of the cause and the perpetrator (physician and nurse). In these situations the doctor orders and the nurse acts, and it is therefore necessary and proper that physicians not be absolved from liability.

Ethical and practical considerations on refusal of medical treatment

Mansoureh Madani

Refusal of medical treatment is among the most important rights of patients and a natural consequence of informed consent, although it can result in harm to patients or others and even the health care system. Treatment refusal may have various clinical manifestations whose recognition and proper understanding is essential to their management. In some cases the legal aspect is primarily dominant, such as when there is the possibility of harm to a third party. In other cases, for instance in absence of patient capacity, there are clear guidelines for decision-making. Major ethical challenges in the field of treatment refusal frequently pertain to capable patients, and this paper is mainly about the practical issues related to this group. The problems that these patients face are mostly due to improper physician-patient relationship or fleeting emotions. Caregivers should be prepared to deal with these issues and try their best to overcome obstacles and achieve patient satisfaction, with the exception of critical emergencies where treatment is carried out without consent. If all measures fail, patients’ refusal must be documented and other therapeutic interventions should be offered.

An outlook on the position of disabled fetus in the universe from Mulla Sadra’s philosophical view

Farzaneh Zahedi Anaraki

Abortion of the disabled fetus is among the challenges of medical ethics, and decision-making in this respect is subject to a major controversy between Islam and Western philosophies. One reason is skepticism about the continued existence and evolution of the human soul after death, which has resulted in legitimacy of abortion of disabled fetuses in the West. Islam and Islamic philosophers, however, attribute great importance to the soul and its evolution, and therefore in decisions related to such embryos all aspects of the body and soul are considered, with more emphasis on the latter. Some issues that are raised in the Islamic worldview include: What is the reason behind embryonic defects? And does a disabled fetus also suffer from a defect in the soul?The present paper is a descriptive-analytical non-systematic review that uses a data collection approach. Regardless of the issue of ensoulment, the study intends to examine the evolution of the spirit (nafs) in the fetus during various stages of life (vegetative, animal and human) based on Mulla Sadra and Imam Khomeini's perspectives. It also aims to conduct a philosophical investigation into defects in creation and to find the answer to the important question of whether the soul of a disabled fetus is also imperfect. Findings of this study show that based on Mulla Sadra’s views, all living things have been created in the best and most perfect form. The disabled fetus is not an exception and therefore has a perfect soul, but the appearance of the soul in a malformed body is defective. The imperfection may have two causes: first, a wrong choice made by the soul of the disabled fetus in the world before this one, i.e. the Zar world, although the concept is among the unfolded mysteries of creation unfathomable by human knowledge second, effect of the genes and/or the environment, regardless of the choice made by the soul of the disabled fetus in the world of Zar.However, since decision making regarding abortion of disabled fetuses is still a matter of controversy in medical ethics, further studies from the perspective of Islamic philosophy seem necessary to help resolve the issue and provide ethical guidelines based on Islamic principles.

Nursing advocacy models: A review of nurses’ protective role

Hadi Jafareimanesh

A model is a summarized representation of facts. Health-related models show values, perceptions and various understandings of health care. This study investigated the nursing advocacy models and the nurses’ protective role. In this review article, related literature and documents were searched in PubMed, Science Direct, Proquest, Google Scholar, Magiran, Iran Medex, and Scientific Information Database, using the general search engine Google. The search was performed by keywords “advocacy” and “nursing advocacy model”. In this stage, 89 sources including books, articles and dissertations on the subject of nursing advocacy written between 1991 and 2014 were collected. In the next stage, 43 sources were chosen for the review article. Finally, 8 models that were more consistent with the topic and objectives of the study were extracted. Considering the findings of this study and the benefits of nursing advocacy, we propose to design a model in order to promote the advocacy role of nurses in Iran. In this model, legal constraints, social factors and values, organizational culture, position of the nurse in the health care system and political and economic considerations should be taken into account.

Empathy with patients among dentistry students in Tehran

Nahid Rejeh

Empathy and communication between dentists and patients are among the major concerns of dental health educators. The present study aimed to evaluate the empathy levels of dentistry students with their patients in the city of Tehran during 2014.In this descriptive cross-sectional study, 410 dentistry students of various universities throughout Tehran were selected randomly. Data were collected using the questionnaire of demographic data and Interpersonal Reactivity Index to assess dispositional empathy. Data analysis was performed using SPSS 16 statistical software.The students had a mean empathy score of 53.06 (SD = ± 1.03), with the highest level pertaining to the imagination dimension (14.41 ± 4.65). Age, gender, and educational level had significant relationships with empathy (P < 0.01). Female students reported higher emotional empathy (P < 0.01), but no significant relationship was found between empathy and the university of attendance.Empathy scores of undergraduate dentistry students were lower than ideal and acceptable levels. Therefore it seems necessary to design proper educational programs to improve empathy among dentistry students.

Mediating role of organizational identification in the relationship between professional ethics, organizational citizenship behavior, and job deviation behavior

Shiva Maleki

Abstract Ethical and moral values lie at the root of employee behavior and activities. Hence, observance of professional ethics and the related benefits are among the most fundamental research topics in organizational areas. This descriptive-correlational research was performed according to the practical study objectives and through adopting a data collection approach. With the aim of exploring the mediating effect of organizational identification on the relationship between professional ethics, organizational citizenship behavior and job deviation behavior, a sample of 225 employees and hospital specialists were chosen from the cities of Maku, Showt and Poldasht using random stratified sampling. Data were gathered through standard questionnaires of Van Dick’s organizational identification, professional ethics, citizenship behavior and deviation behavior. In order to evaluate the relationship among variables measured in a conceptual model, Structural Equation Modeling was used. The results showed that there is a positive and significant relationship between organizational identification and professional ethics (r = 0.177) and organizational citizenship behavior (OCB) (r = 0.179). Findings also showed that the relationship between professional ethics and citizenship behavior and deviation behavior is mediated through organizational identification. In the above-mentioned model, all regression weights were statistically significant, except for the relationship between professional ethics and deviation behavior. The results of this study indicated that professional ethics strengthened organizational identification on the one hand, and organizational identification strengthened citizenship behavior and reduced the deviation behavior of the employees and hospital specialists on the other hand.

The relationship between social capital and altruism and the ethical attitudes of physicians

Lotfali Khani

Social capital and altruism are the most effective factors on the cultural development of a society and can play an important role in promoting ethics within the health care system. The purpose of this study was to investigate the relationship between social capital and altruism and the ethical attitudes of physicians. This correlational and descriptive study was performed on 322 doctors working in medical centers in west Azerbaijan during 2013 who were selected by cluster-random sampling. Onyx and Bullen social capital scale, Carlo et al. altruism scale and Karamporian et al. ethics questionnaire were used to collect data. The results of this study indicated that there was a significant positive relationship between the ethical attitudes of physicians and altruism (R = 0.238), the structure subscale (R = 0.489), cognition subscale (R = 0.581) and relationship subscale (R = 0.554) of social capital. The significance level was set at p < 0.05 in this study. The multi-variable correlation coefficient and enter method indicated that social capital subscales can influence the ethical attitudes of physicians (0.457). The results showed that there was a correlation between social capital and altruism and ethical attitudes in the medical profession. Thus, it seems that promoting social capital and altruism can positively influence individuals’ ethical attitudes in the medical profession.

Challenges associated with patient autonomy in Iranian hospitals: a qualitative study

Effat Sadeghian

Patient autonomy is the opposite of paternalism and an essential element in individualised, patient-centred, ethical care. Challenges associated with patient autonomy are culture-related and have not been fully investigated in Iran so far. The aim of this study was to explore the challenges to the autonomy of patients in Iranian hospitals.This was a qualitative study using conventional content analysis methods. In 2013 13 patients, 7 nurses and 1 doctor were selected from three Tabriz and Hamadan teaching hospitals using purposive sampling to participate in semi-structured interviews. The interviews were subjected to qualitative content analysis and analysed using the MAXQD10 software.Fifteen categories and three themes were identified. The three main themes related to challenges associated with patient autonomy were: interpersonal factors, altered relationships, and organisational constraints. In summary, this study revealed some challenges associated with patient autonomy that the treatment team, managers and planners in the health care system should target in order to improve patient autonomy.