Iranian Journal of Medical Ethics and History of Medicine

An overview of ethical issues in medical laboratories

Kobra Omidfar

Medical laboratory is one of the health service providers that intensely responsible for the life of patient / client. With an increase in the number and variety of laboratory tests in recent years, the role of laboratory science in identifying and assessing the cause of disease has been more recognized. Performing the laboratory tests with the utmost accuracy, precision and speed using up to date methods as well as protecting the rights, integrity and respecting human dignity and also the establishment of priorities and the requisites for quality management systems can have a significant impact on patient satisfaction and quality which are the characteristics of a good medical laboratory. The principle concept of doing good and not doing bad is the essence of every code of medical ethics. Therefore, in laboratory medicine like other areas of medical sciences, there are ethical questions that have become more complex with the development of diagnostic tests. Medical laboratory practitioners usually deal with issues of confidentiality of patient information, as well as issues related to research ethics, professional ethics and business ethics.This study has collected important and common topics of medical ethics in laboratory medicine which leads to increase readers’ and practitioners’ information in this field. It is hoped that such information could be effective and practical to improve the laboratorial services for patients.

Are hospital ethics committees necessary?

Fatemeh Hajibabaee

In order to improve service quality, there are various committees in hospitals including ethics committees, which may be among the most important and necessary establishments within the health care system. Hospital ethics committees are designed to ensure proper clinical decision-making and are responsible for monitoring the ethical provision of services in hospitals. They also aim to assist patients and health care professionals without interfering in the physician-patient relationship. This article was part of a comprehensive review study performed in 2014 and 2015 by searching database not restricted to any particular period of time. The keywords used to search the sources available in English included “hospital ethics committee”, “healthcare ethics committee”, “clinical ethics committee”, and “institutional ethics committee”. Since ethical counseling is one of the main tasks of hospital ethics committees, their existence in hospitals appears to be essential. There have been few studies on the functions of hospital ethics committees in Iran, and it seems necessary to investigate the activities of these committees in the country. Moreover, it is recommended that the Ministry of Health and Medical Education take more serious actions to establish and monitor ethics committees in hospitals throughout the country.

Human cloning technology by looking at the Sadraian anthropology

laila nikooienejad

Human cloning is among the newest and most advanced technologies in the field of medical sciences and genetics, and has been a popular topic of discussion throughout the 21^st century. The success of scientists in the use of this technology on animals has caused great concern for outstanding thinkers of various fields.

Some issues that necessitate research on this subject include: physical injuries caused by manipulation of ovaries, the cell nucleus, and the embryo the possibility of mental and emotional damage, and premature aging potential threats to human will and discretion a violation of human dignity and conflicts with religions and world-views.

A philosophical outlook on these issues can guide the researcher from the surface to the root of the problem and redirect such concerns, and at the same time shed light on the existing disputes between scholars of natural sciences and humanities regarding the cloning technology. This will be especially true if such an outlook is based on a tradition as rich as the Iranian Islamic philosophy. The present article uses analytical library research to investigate the anthropological teachings of Sadraian philosophy from the ontological and epistemological point of view. The article then proceeds to examine the outcomes and consequences of the cloning technology according to this doctrine.

It seems that the anthropological principles embedded in or hidden behind therapeutic or reproductive cloning technology are not in conflict with Sadraian anthropology.

The correlation between moral distress and burnout in nurses working in educational hospitals of Shahid Beheshti University of Medical Sciences during 2013

foroozan atashzade

Moral distress is a phenomenon that can result in feelings of disappointment, guilt, depression, insecurity, fear, discouragement, and depression in nurses, and can affect their personality and professional performance. Burnout in nurses could cause various complications in their families, personal and social lives, and organizations. The aim of the present study was to determinate the correlation between moral distress and burnout in nurses.

This was a correlative descriptive study conducted on 224 nurses selected by stratified randomized sampling. Data were collected through a demographic characteristics questionnaire Corley’s Moral Distress Scale and the Copenhagen Burnout Inventory. Data analysis was performed by SPSS 20 software and Spearman correlation tests.

In this study, mean of moral distress score, mean of personal burnout score, score of work-related burnout, and mean of client-related burnout were 1.31, 55.97, 54.35 and 51.28 respectively. The findings showed a positive significant correlation (P<0.001) between moral distress and all of its dimensions, and personal burnout, work-related burnout, and client-related burnout, although the correlation was low.

According to these findings, it is recommended to reduce the conditions and situations causing moral distress and burnout in order to promote job satisfaction and quality of nursing care.

The relationship between organizational commitments and non-ethical behavior tendency among the employees of Tehran University of Medical Science: an overview

Hossein Dargahi

Emphasis on the organizational commitment of employees is a soft management technique to enhance performance and efficiency. This study aimed to determine the relationship between organizational commitment in the employees of Tehran University of Medical Sciences (TUMS) and their tendency to display non-ethical behavior.

This study was a descriptive analytical and cross-sectional research conducted on the headquarters employees of Tehran University of Medical Sciences during 2013 and 2014. A sample size of 150 employees was determined using the Cochran formula. Research tools consisted of a researcher-made questionnaire measuring non-ethical behavior, and Allen & Meyer’s Organizational Commitment Scale. The validity and reliability of both questionnaires were confirmed. The response rate was 85%. Data were collected using the SPSS software, and Pearson’s statistical methods were applied.

The average organizational commitment of the employees in this study was 62.32, which is considered as moderate. It should be added that the majority of the employees did not demonstrate a tendency for non-ethical behavior.

Although the average organizational commitment was not high in TUMS employees, it was not correlated to their non-ethical behavior tendency. It seems that the organizational commitment of TUMS employees is influenced by other factors such as supervisor and organizational ethics, which can be the subject of future studies.

A psychometric evaluation of an instrument for measuring residents’ attitude towards caesarean vs. natural vaginal delivery

Omid Asemani

In recent years, there has been a significant increase in the rate of cesarean section in Iran. Physicians can have an active role in controlling this rate as they are truthfully consulted and followed by the general public. The Iranian Ministry of Health and Medical Education has also adopted new policies to control the national cesarean rate. The present study aims to determine the knowledge and attitude of medical residents towards elective cesarean section versus normal vaginal delivery (NVD) in 2015.

In this cross-sectional study, residents of four major fields of specialty (obstetrics and gynecology, pediatrics, general surgery and internal medicine) were interviewed using a researcher-made questionnaire. The face and content validity and reliability of the instrument were determined, and data analysis was performed using SPSS version 21.

The Cronbach’s alpha coefficient was 0.77. A total of 108 residents with the mean age of 32.89 participated in the study. Of this number, 53 reported at least one personal experience of childbirth (their own or that of their wives) with a satisfaction rate of 9.5 and 6.3 out of 10 for NVD and cesarean respectively. The mean score of the domains of "knowledge", "attitude" and "function" were 3.5, 3.6 and 3.3 (out of 5) respectively. There was a meaningful correlation between the variable of "sex" and the domain of "knowledge", "specialty" and all three domains, and "methods of delivery" and the two domains of "attitude" and "function". 34.3% of the residents chose "mandatory public education of pregnant women" as the first step to decrease the cesarean rate.

It can be concluded that educating pregnant women should be the main strategy for decreasing the cesarean rate in Iran. Considering the significance of medical specialists’ "knowledge", "attitude" and "function” with regard to the method of delivery chosen by pregnant women, it is recommended to develop specialty educational programs in line with the policies of the Iranian Ministry of Health to decrease the cesarean rate

Ethical considerartions in the clinical management of infants with severe combined immunodeficiency

Marjan Mardani Hamooleh

Severe combined immunodeficiency (SCID) is an inherited primary immunodeficiency syndrome characterized by a profound deficiency in T-lymphocytes and variable defects in the B-lymphocyte number. The present study aimed to evaluate the ethical aspects of the clinical management of children with SCID. This report is based on the case of a 6-month-old male infant with SCID diagnosis presented during the Medical Ethics Grand Rounds in the Children's Medical Center in Tehran, Iran.

The patient had a positive history of recurrent infections and frequent hospitalization. His parents were consanguineous and came from a low socioeconomic level of the community. He was the fourth child of the family. The first and second children were healthy girls, while the third child was a boy with a history of numerous problems post vaccination who had eventually died of widespread infections. The physician had recommended bone marrow transplant, but the parents had been directed by a neighbor to visit a religious healer.

Timely management of severe combined immunodeficiency can reduce complications and improve the patients’ quality of life. The need for early screening tests is therefore ethically justified, although ethical issues surrounding the subject should not be overlooked. Instances of these issues include: neglecting the scientific criteria necessary to conduct the tests the economic burden imposed on the family of the child failure to provide sufficient information to parents and ignoring their consent to conduct testing and treatment lack of equitable access to diagnostic and treatment facilities and lack of attention to the child’s autonomy. It should, however, be noted that in certain cases, healthcare providers could perform their management activities with an ethical and supportive approach, taking into account all physical and psychological needs of infants with severe combined immunodeficiency, as well as those of their families

Patients\' views on observance of nursing ethics in Imam Hussein Hospital in Shahroud during 2015

Behzad Foroutan

Ethics is important in all professions, particularly in nursing, since morality and commitment in nurses can play a significant role in improving patients’ health and recovery. The nursing profession is therefore rooted in ethics, and the observance of nursing ethics is more important than other aspects of health care. This study aimed to determine patient's views on standards of professional ethics in nursing practice in Imam Hussain Hospital during 2015.

This was a cross-sectional study conducted on 575 patients in different wards of Imam Hussein Hospital in Shahroud. Research instrument was a 22-item questionnaire designed by the researchers to evaluate nurses’ observance of professional ethics in the three dimensions of accountability, improvement of care quality, and respect for patients. Data analysis was performed using SPSS 20 software.

The mean age of participants in this study was 51.32 (± 19.03), and 299 participants (52%) were male. The mean total score of professionalism was 18.38 (± 2.74), and the relationship between age and observance of professional ethics was statistically significant (P = 0.006).

According to the subjects of this study, the nurses’ observance of professional ethics was relatively good and at a desirable level. It is recommended to utilize a variety of learning styles and employ the services of professors of nursing ethics in order to enhance the quality of nursing education with respect to professional ethics.