Iranian Journal of Medical Ethics and History of Medicine

Evaluation of emotional intelligence and ethical skills’ association in third and sixth year dental students of Tehran University of Medical Sciences

Samaneh Razeghi

Considering the improvability of emotional intelligence throughout the life, if there is a meaningful relationship between emotional intelligence (EI) and ethical skills, the ethical skills of students would be promoted by conducting necessary programs. The purpose of this study was to determine the relationship between emotional intelligence and ethical skills of third and sixth year dental students of Tehran University of Medical Sciences. In this cross-sectional study, all third, and sixth year dental students of Tehran University of Medical Sciences were enrolled consecutively. Participants were asked to complete a Persian and Standardized Emotional Quotient Inventory (EQI) questionnaire based on the Bar-On questionnaire as same as Moral Skills Inventory, a standardized ethical skills questionnaire. The Data were analyzed using statistical tests. There was a significant relationship between some domains of emotional intelligence with some components of ethical skills. However, there was no significant relationship between total score of EI and ethical skills. Furthermore, no significant relationship existed between ethical skills’ score and demographic variables. Married students significantly had higher scores in Moral Courage component (P=0.03). The present study showed that there is no significant relationship between the total score of EI of the participants with their total score of moral skills.

Rethinking Article 495 of the Islamic Penal Code (the Liability of Physician) Based on the Emerging “Quality of Law” Principle

Hassanali Moazenzadegan

Since 1984, criminal law more than any other period has been specified under the framework of human rights and consequently limited based on its principal. It was followed by the emergence of a new approach called “quality of law principle”. In criminal law, which was presented by European Court of Human Rights for the first time then in the content of verdicts issued by this international judicial institute and reconsideration of criminal law legality principle, it has developed and become more consistent with social justice and manners. According to this principle, the qualitative law is a law which is consistent with quality elements of law based on human rights and moral principles. It is interesting to note that lack of each requirement voids the related law and according to Court’s case law, the existence of such law would not be different from lack of law. In present paper, through the investigation of physician liability and focus on article 495 of Islamic Penal Code as the key to legislation in this regard, and given the requirements of quality of law principle, it has been concluded that the above mentioned provision and all other articles related to this context are not consistent with elements of “the Quality of Law”, thus with failure to meet the minimum criteria of justice, social morality and human rights, the law fails to have the required quality and consequently, it is recommended to legislate based on the criteria of Quality of Law.

Which Is The Most Determinative In Emergency Cases? Patient Autonomy or Physician's Decision: A Clinical Case-Study

Seyed Saied Seyed Mortaz

A 62-year-old man referred to the emergency department 48 hours ago with chief complaint of repeated bloody vomiting. The patient is admitted and the necessary measures are taken. Within 24 hours, he received 6 units of blood. The patient has undergone endoscopy, but endoscopic endorsement has failed to stop the bleeding. The surgeon consulted and visited the patient. He considered urgent emergency laparotomy. The patient is alert and refuses surgery. The hemodynamic status of the patient is not stable and gastrointestinal bleeding continues. These questions are posed to medical staff and hospital managers: "What is our duty”? "Should we respect the choice of the patient and witness the progress of the disease and deterioration of the patient's condition"? "Can he be discharged from the hospital on the basis of the patient's refusal to take medical treatment"? "Can we take appropriate diagnostic and therapeutic measures with the use of legal capacity and support despite patient’s opposition? "How can one regard autonomy, beneficence, and nonmaleficence at the same time, in this situation "? In this study, which is one of the problems of medical ethics, the ethical, legal, and health aspects of the presented patient are discussed.

Structural Modeling of Relationship Between Spiritual leadership and Professional Ethics with Organizational Performance and Quality of Work Life with Role of Organizational Learning among Employees of Imam Reza Hospital, Urmia

Afsaneh abbaskhani

Today, the role of spiritual leaders is to stimulate employees by employing a spiritual perspective and creating cultural backgrounds based on human values to raise capable employees. On the other hand, professional ethics is one of the variables that has a significant impact on individual and group activities and outcomes of the organization. The purpose of this study was to investigate the relationship between spiritual leadership and professional ethics with organizational performance and quality of work life with the intermediate role of organizational learning among employees of Imam Reza Hospital in Urmia. The design of this research was a descriptive-correlational cross-sectional design model of structural equations. The statistical population of this research included 759 employees, 240 of them were selected by random sampling method. For data collection, standard questionnaires were used. Pearson Coefficient and Structural Equation Model Finding were used to analyze and examine the assumptions and the relation between the variants. The results show that there is a significant relationship between spiritual leadership variables and Professional Ethics with organizational performance and quality of life of employees (P<0.01, r=0.42, r=0.51), (P<0.01, r=0.36, r=0.75). Furthermore, the results showed that the intermediate role of organizational learning in the association between spiritual leadership and professional ethics with organizational performance and quality of work life (β = 0.17, β = 0.18, β = 0.16, β = 0.17) ) is confirmed. According to the findings, it can be concluded that paying attention to spiritual leadership and professional ethics can improve the organizational performance and quality of work life, as well as enhance organizational learning among the staff of Imam Reza Hospital.

Critical Approach to Inequivalence of Penetrating Injury’s Blood Money between Women and Men

Majid Ghoorchi Beigi

Penetrative injury is one of the injuries which the legislator has mentioned in the fourth book of the Punishment Code: ''it's an injury which occurs by sinking of a tool like spear or bullet in hand or leg; the blood money for men is one tenth of a complete blood money and for women there is a “Arsh". Interestingly, the legislator has determined the sanction of this blood money as a complete blood money while in women it is just an Arsh. The foundation of this view is based upon some of the jurisprudents; however, contemplation in jurisprudential references shows that a group of other jurisprudents believe that blood money of penetrative injury is same for men and women. This essay examines the arguments of the two sides by a descriptive-analytic method. Then, it tries to prove the weaknesses of the view believing in an Arsh for women, it shows that the focus of the Islamic law is on the point that the blood money of penetrative injury is equal for men and women (both one tenth).

Evaluation of Pharmacy Professional Ethics in Drugstores and Its Improvement Strategies from the Viewpoint of Students and Faculty Members of Tabriz School of Pharmacy

Moslem Najafi

Pharmacists, as a member of the health team face a lot of ethical challenges in performing their professional duties. This study was aimed to evaluate status, challenges and improvement strategies of pharmacy professional ethics in drugstores. It was a descriptive-analytic study carried out in 2015-2016. Data was collected using a standardized questionnaire related to principles of pharmacy professional ethics’ code from the viewpoint of qualified faculty members and students of Tabriz faculty of pharmacy. The overall score obtained for each principles of professional ethics code indicated moderate and high level status for each of the principles. However, there are some shortcomings in counseling to patients, consulting and interacting with physician, delivery of non-OTC drugs without any prescription, and accepting professional responsibility among the pharmacists. In addition, 71.5% of the professors and 75.5% of the students believed that inadequate income of pharmacists, the economic problems of drugstores, defects in the insurance systems, lack of proper culture for pharmacist's position, insufficient training of professional ethics at universities, priority of physician in Iran health system and giving gifts by some pharmaceutical companies are the main factors influencing professional ethics in pharmacies. Thus, comprehensive management is essential for improving professional ethics in pharmacies. In this regard, promoting professional ethics education, paying attention to economic problems of pharmacists and pharmacies, improving the performance of insurance organizations, developing culture to promote the position of pharmacists and serious supervision of health system officials on drugstores and pharmaceutical companies are necessary.

Analysis of the Actions of Qutlugh Terken (Kermanid Queen), in Order to Improve Medicine in Kerman (From 655 to 681 A.H.)

Jamshid Roosta

Reflecting on the Qara – Khitai of Kerman (from 619 to 704 A.H. / 1223 to 1305 A.D.), we can see that the rule of the dynasty, some women of Qara – Khitai, with expertise and competence into political, economic, scientific and cultural even reached into the kingdom of Kerman. Among these women the one that can be mentioned is -Qutlugh Terken (Terken Khatun), who was directly and indirectly involved in Kerman government for more than 40 years. So, the main question of this article is to assess measures of Qutlugh Terkan for promotion of Kerman's medical condition and further investigation of patients' rights. One of the findings of the present study was that Terken Khatun, build and equipped hospitals in Kerman with best facilities about eight hundred years ago, she also constructed an advanced school to train a new generation of intellectuals including physicians.

Role of Organizational Health and Job Satisfaction in Work Ethics of University Staff

Iraj Shakerinia

The aim of this study was to determine the role of organizational health and job satisfaction in Work ethics of university staff. The research method was descriptive-correlational and the statistical population of the study consisted of all the staff of the University of Guilan. In this study, 134 participants were selected by stratified random sampling method. The research tools consisted of three questionnaires, work ethics, organizational health and job satisfaction. In order to analyze the data, Pearson correlation and regression analysis were used. The results showed that there is a positive and significant relationship between organizational health and Work ethics (P<0.01). There is a positive and significant relationship between job satisfaction and work ethics (P<0.01). Also, regression analysis showed that organizational health and job satisfaction could explain 39% of the variance of work ethics (P<0.01). The findings of this study indicate the importance of organizational health and job satisfaction in explaining the work ethics of university staff.

Compliance with the Code of Nursing Ethics to Deal HIV/AIDS Patients among Nurses Work in Internal and Surgical Wards of On of the Hospitals in Shiraz in 2015

Haseli Sara

Ethical approach is one of the most important features of medical staffs expected to be used. One of the most important diseases that have been allocated to high moral challenges is HIV/AIDS. Nurses should provide standard care to these patients in their professional careers. In this descriptive study, 136 nurses working in the internal and surgical wards of one of the hospitals in Shiraz were selected through a cross-sectional questionnaire in 2015.Frequency of compliance with ethical values of nurses toward HIV/AIDS patients within various aspects showed that in total 40.4% of nurses in the observance of moral values has unsatisfactory performance, 33.1% relatively good performance and 26.5% has optimal performance. (P-value: 0.018)The mean score of different dimensions to separate parts of questionnaire showed no significant difference in dealing with AIDS patients among nurses according to different ages, sex and working years. The mean score of the separation of education in the respect of client/patient and keep his human dignity significantly differ between Diploma, B.S and M.S. Findings showed poor compliance with ethical code among nurses toward HIV/AIDS patients. Due to importance of ethical approach towards patients especially this vulnerable group of patients, regular educational program in relation to AIDS patients, in order to improve the quality of services, is recommended.

Ethical Importance of Psychological Capability for Affordability of Hajj

Marjan Shamspour

The most important conditions necessitating Hajj are financial affordability, physical, and psychological capacity. Most persons who become bound to make the Hajj ignore the psychological capacity. Each year many persons lacking psychological capacity, go on Hajj and cause other mentally qualified people deprived of travel. A number of these pilgrims undergo medical treatment or are hospitalized during their travel and some of them are returned back to the country. No study has been carried out so far on these special conditions, psychological capacity, of Hajj. In quantitative part of this study, information of all records existing in the medical center of Hajj during 2012-2015 was extracted. The information was analyzed by assistant psychiatrist, professor, and physicians based on DSM-IV-TR standards. In qualitative part, systematic information was extracted from authorities of Hajj organization. From studied records related to psychiatric disorders, cases of schizophrenia and psychotic disorders were identified as lacking mental and psychological capacity. The results of this study showed that about 16% of the people with mental disorders such as schizophrenia and psychotic disorders, and that their dispatch to Hajj's journey was in contradiction with the principles of jurisprudence and ethics. This study can be regarded as a religious and ethical guide for identifying the examples of people who have been deprived, to help policy makers of the Hajj system to apply more strict monitoring of the dispatch of pilgrims, eliminating the time spent by other pilgrims and defusing national pride, and helping to replace eligible people instead of those who are not qualified for Hajj.

An Analytical Look on History of Islamic Medical Ethics: A Case Study of Ibn al-Ja'zar, Ahwazi, Ibn Sina, and Jorjani Books

Akbar Aqhayani Chavoshi

Studying the history of medical ethics and analyzing the dynamics and effects of renowned physicians of the Islamic era and the exploitation of this precious heritage is indispensable. Therefore, in this research, by descriptive-analytic approach, , the books of Teb Al-fukhara and Al-Masakin, Ibn al-Jazar, Full medical industry, Ahvazi, Law in Medicine of Ibn Sina, and Kharazmshahi Save of Jorjani were investigated, by analyzing the guidelines and ethical recommendations contained in the physician and patient interactions, as well as their practical applications in this regard, six important principles of Islamic medical ethics were attained: trust in God, profitability, harmlessness, trusteeship, compassion, and goodness. Two principles of profitability and harmlessness have been more emphasized than other ones, which can indicate the significance of these two ethical principles in Islamic teachings. The ethical issues in the field of medical sciences during the Islamic period did not have the diversity, breadth, and necessity of the present. Thus, in pre-natal and human-era discussions, only the prohibition of abortion is mentioned and there is no debate about the end-of-life care of the patient.

Scientometrics Study of the Published Articles in Persian Journals in the Field of Biomedical Ethics

Ehsan Shamsi Gooshki

This research reviews the scientific productions of the field of biomedical ethics based on articles published in Iranian scientific journals in Farsi (Persian language). The findings showed that from 2003 to 2017, researchers have published 1238 Persian articles in this field. The average annual growth rate of published articles is 23.17 percent, but this growth has been declining since 2013. The citation rate of articles (0.4 per article) suggests a small impact. Shahid Beheshti University of Medical Sciences and Tehran University of Medical Sciences with the publication of 36% and 33% had the largest share in the publication of articles, respectively. Biomedical ethics research was interdisciplinary and researchers from the medical, nursing, and law sciences played a major role in compiling and publishing them. The topics such as medical ethics, medical education, and Islamic ethics were, repetitive subjects in articles, respectively. Only 22% of these articles referred directly to funding provided by universities and research centers.

The Effect of Spiritual Education on Spiritual Health of Nursing Students: A Quasi-Experimental study

Marjan Mardani - Hamooleh

Spiritual health (SH) is a supernatural force and endeavor to achieve perfection and peace of mind in life.When it is endangered, a person experiences loss of meaning in life. In nursing, caring services and SH are related to each other. It is necessary to promote the SH of nurses so that patients will receive better care. The study aim was the effect of spiritual education on SH of nursing students. In this quasi-experimental study, 76 of undergraduate nursing students were selected using random simple sampling method and divided into experimental group (EG) and control group (CG) (n= 38) with random allocation method. Educational intervention was done for the EG for a period of 4 weeks, a 60-minute session per week, but no intervention was performed for the CG. Four weeks after the intervention, the post-test was taken in 2 groups. Data were collected using the SH scale by Paloutzian and Ellison. Independent t-test didn’t indicate any difference before the intervention in the mean score of SH in 2 groups (t=-0.49, p=0.62), while in the post-test, the independent t-test indicated the mean score of SH was higher in the EG than in the CG (t=-2.14, p<0.03). After the intervention, there was a significant increase in the SH (t=-4.39, p<0.001) in the EG. The paired t-test indicated no difference in the SH in the CG compared to the pre and post-test (t=-0.25, p<0.79). Spritual education influenced SH of nursing students. It is recommended that spiritual education be considered as one of the strategies for promoting SH in students.

Evaluation of Moral Intelligence of the First and Sixth Year Dental Students in the Tehran University of Medical Sciences

Reza Yazdani

Moral intelligence as a dimension of intelligence can provide a framework for the proper functioning of human. This function can be effective in the clinical environment such as dentistry. Therefore, the present study examined ethical intelligence of the first and sixth year dental students in the Tehran University of Medical Sciences. The present cross-sectional study was conducted in 2018 among 106 of the first and sixth year dental students. The students were selected by census sampeling and the Lennic & Kiel's Ethical Intelligence Questionnaire were used for data collection. The variables were analyzed by SPSS-Ver.22 software using descriptive and analytical statistical tests. Findings of the study indicate that there is no significant relationship between the ethical intelligence of the first and sixth year dental students. Also, in the first year students, only the indirect relationship between ethical intelligence and mother's education (P value = 0.026) and the level of household economic condition (P- value = 0.009) were found. In the sixth year students', only the direct relationship between ethical intelligence and the level of household economic condition was found (P -value = 0.015). This study showed that the ethical intelligence of dental students during education was not significantly improved, which indicates that the educational system not effecient on for promoting ethical intelligence of dental students.

Relationship between Empathy and Spiritual Attitude among Nursing Students in Tehran

Masoomeh Ahmadi

Empathy is considered an essential prerequisite for a nurse to effectively care for a patient. Also, spirituality is an important component in nurse-patient relationships. The aim of this study was to determine the relationship between empathy and spiritual attitude among nursing students. In this descriptive and correlation study, the samples consisted of 272 nursing students that were studying in 3 Medical Sciences Universities in Tehran, 2017. Samples were selected through convenience sampling method. Data were collected by demographics’ data form, validated and reliable scales of empathy and spiritual attitude. Data were analyzed by descriptive and analytical (Pearson Coefficient, Independent T test, and ANOVA) statistics. The students had a mean empathy score of 106.982 ± 14.65 that this was more than median scores of scale (60). Furthermore, they had a spiritual attitude score of 115.79 ± 15.8 that this was more than median scores of scale (86). Findings indicated that a significant relationship between empathy and spiritual attitude among nursing students (r=.265, p=.0001). Gender, educational level, interest in nursing, work status, and the average score of the previous term had significant relationships with empathy (P < 0.05). Interest in nursing and work status had significant relationships with spiritual attitude (P < 0.05).Research findings support the hypothesis of association between empathy and spiritual attitude. Since empathy has a significant relationship with spiritual attitude, it seems that nursing students’ empathy will increase by promoting their spiritual attitude.

The Status of Informed Consent Process in Pediatrics’ Wards of an Educational Hospital

Sedigheh Ebrahimi

Involving children in their own treatment decision-making improves their abilities. Factors such as the ability to reason, previous children's experiences in relation to the subject as well as information, and their general understanding of the subject affect the child's ability to make decisions. The current laws of informed consent in children allow alternate decision makers to decide on their own. Our goal in this study was to examine the current conditions for the informed consent of children in to provide appropriate guidelines in this regard. In this qualitative study, participants were selected through targeted sampling. The data were collected by semi-structured interview with open questions. Coding and classification was carried out using continuous comparative analysis. Participants included 6 admitted children, 15 parents of children, and 4 pediatricians. Three general categories of "satisfaction culture", "environmental conditions", and "child world" were extracted. Parents and children were not clear about the purpose of obtaining consent. The gender of children was not significantly affected by the process of obtaining formal consent in medical settings. The existing conditions have created a non-appropriate balance in the expectations of parents regarding the treatment decisions and giving vital information and treating the child by doctors disregarding child’s competency. This defective balance can, in the meantime, cause instability and harm to human dignity and autonomy of parents and children, waste of resources, challenging the sense of trust in the community towards doctors and the lack of growth in child’s decision-making power.

The Role of Abbasid Caliphs in Transferring Doctors from the Bakhtiasha Family to Baghdad

Masoomeh Gharedaghi

Gandhi Shapur was one of the largest medical centers in the late Sassanid and early Islamic schools in Baghdad. The doctors, who often had a field teaching at Gandhi Shapur, moved to the city during their transfer to Baghdad, and accordingly they gave a kind of scientific center to the capital of the new Islamic government. Among the doctors of this scientific center was the Bakhtiyad dynasty, which in this study we explored the role of this family in medicine. The study shows that Jundishapur University hosted a large number of Greek, Indian, Nestorian scholars and scholars working at the center, and the head of the Faculty of Medicine was led by the Bakhtiyad family. The desire of the Abbasid caliphs to boost the city of Baghdad such as the Sassanid Centers of Science and Technology, and their success in that area, were the factors that invited the scientists from Jindi Shapur and the caliphate support from them. The transfer of scientific activities of Ajar George Bin Bakhtih from Jindi Shapur to Baghdad was an introduction to the decline of the scientific star of this center and the influence of Iranian culture on Islam. Several factors such as the scientific need, attention and support of caliphs from scientists and conversion of the city of Baghdad to the center of the sciences were the causes for invitation of the Bakhtiyad family to Baghdad. In this study, we assess the activities of the Bakhtiyad family in the government of Abbasid caliphs.

Evaluation of Association between Nurses' Spiritual Well-Being and Job Satisfaction in Educational-Therapeutic center Shohadaye Tabriz

Soraya Golipoor Khanmiri

One of the most effective factors on organizational behavior is the Nurses’ job satisfaction. Spiritual wellbeing of nurses is an inseparable personal element that influences their job satisfaction. The aim of this study was assessing association between Nurses' spiritual well-being and job satisfaction in Educational-Therapeutic center of Tabriz Shohada. The study population was nurses of Shohada hospital. In this study, 155 participants were selected by stratified Simple random sampling method. The research tools consisted of two questionnaires including spiritual well-being scale (SWBS) and job satisfaction (MSQ). In order to analyze the data, descriptive (frequency, percent, mean, standard deviation) and inferential (independent t, Pearson, Spearman, ANOVA Tukey test) were used. The results showed that there is a positive and significant relationship between nurses' spiritual well-being and their job satisfaction (P<0.05). Also, mean score of nurses' job satisfaction was 61.89 (12.63) and mean score of spiritual well-being was 89.85 (13.64) and both were above average (P<0.05). Type of employment, age, and sex had significant relationship with job satisfaction (P<0.05). According to the findings of this study, it is recommended that the relevant stakeholders and authorities increase their nurses' job satisfaction, pay special attention to the issue of spiritual health and improvement of it, because increasing spiritual health increases nurses’ job satisfaction and ultimately lead to better Care services will be better for patients.

Moral Sensitivity and Its’ Relationship with Self- Efficacy in Operating Room Nurses Affiliated to Educational- Therapeutic Centers in Ardabil University of Medical Sciences, 2017

Zahra Etebari Asl

Moral sensitivity is one of the most important factors in improving the quality of nursing cares and nurses' performance. This research aimed to determine the relationship between moral sensitivity and self- efficacy in operating room nurses affiliated to educational- therapeutic centers in Ardabil University of medical sciences. This descriptive-correlation study was carried out on a sample of 144 nurses of operating room by census method in 2017. Data were collected by using moral sensitivity standard questionnaire and clinical performance self- efficacy. Data were analyzed using statistical tests: Pearson correlation coefficient, independent t- test and one way ANOVA by SPSS15 software. The mean of nurses' age was 30±6.07 years old. The majority of nurses were female (%54) and majority of them were in operating room discipline (%59). The mean and standard deviation of moral sensitivity score was 87±11.00 and the total self-efficacy was 129±13.00. Pearson correlation coefficient showed a significant statistical correlation between self-efficacy score and moral sensitivity of nurses (P<0.0001, r=0.882). The results of this study showed that moral sensitivity and self-efficiency of operating room nurses is high. Furthermore, it seems that high moral sensitivity increases self-efficacy. However, moral sensitivity and self-efficacy of nurses can be improved by holding ethical and professional workshops.

Evaluation of Moral Sensitivity in Nursing Students of Bushehr University of Medical Sciences in 2016

Faezeh Jahanpour

Nurses need to be familiar with the ethical issues of nursing and its sensitivity to all communications and interventions with patients. This sensitivity as a basis for nursing ethics should be considered from the beginning of nursing education. This study aimed to investigate the moral sensitivity of nursing students of Bushehr University of Medical Sciences. This descriptive cross-sectional study was conducted to determine the ethical sensitivity of 73 nursing students using standard questionnaire of ethical sensitivity of nurses in decision-making. Its validity and reliability were confirmed in previous studies (α=0.8). Dimensions of the questionnaire were: amount of respect for patient independence, level of knowledge about the relationship with the patient, level of professional knowledge, experience of difficulties and ethical conflicts, and the use of ethical concepts in ethical decision-making, honesty and benevolence. 0-50 were considered as low moral sensitivity, 50-75 as moderate, and 75-100 as high. All nursing students of the third and eighth semester were enrolled in the census in 2016. The average students' moral sensitivity was moderate (68.15±13.99). The highest average was for "honesty and benevolence", and the least for "professional knowledge" and "the use of ethical concepts in moral decision-making". The average moral sensitivity of the eighth semester students was higher than the third semester. There was a significantly relationship between students' moral sensitivity and academic term (p=0.000). Low ethical sensitivity in nurses leads to inappropriate decision-making; therefore, appropriate educational programs should be considered to increase the moral sensitivity of nurses and nursing students from the beginning of education.

Philosophical Challenge in Physicalistical Approach in Modern Medicine

Ahmad Shahgoli

Science of medicine is affected by metaphysics and non-experimental foundation, although it proves its issues by experimental methods. Nowadays, lots of evidence confirm the effects of metaphysical assumptions in experimental sciences including medicine. These assumptions are not experimental but have serious impact on determining the methods, structures, and orientation of science. In comparison with other experimental sciences, medicine is more affected because it concerns with one of human dimensions; which means the body. Each medical school, desirable or nondesirable, has a special viewpoint about the human and when it studies the body, issues like existence of soul and divine aspect of the man has a particular standpoint that cause change the in some of medicine’s directions. Then, study the metaphysical foundations in medicine is necessary. From which, we concerned the anthropological basis in this study that include: 1.Positivistic approach to man 2.Biological concept of man 3. Neglect of human’s spirituality 4.Mechanical viewpoint 5.Partailism approach 6.A purely material view of death. This article, criticizes these approaches. In conclusion, modern medicine has defaced metaphysical foundations which must be revised. As these foundations have influenced medicine’s methods and directions, evaluation of the aforementioned influence on medicine seems necessary.

Examining the Implications of Biomedical and Humanistic Philosophy on Medical Education

Zahra Asgari

Medical Philosophy is essential part of medical ethics and history. I has long history and owes its current status to developments resulted by historical, philosophical, social, and cultural experiences. The most important reflection of its revolution is its influence on the goals and missions of higher education in different time periods. In this study, two of the most important philosophical perspectives towards the medical education are compared with the aim of investigating possibilities and limits of each perspective in general education, specialized education, and treatment. The descriptive-analytical method is used for this comparison. These two perspectives are: 1) biomedical philosophy, which is based solely on human biological mechanisms, and 2) humanistic philosophy, which is based on the integrity of the human being. The results of this study show that medical education from the perspective of the biomedical philosophy focuses on specialized education, and treatment from this perspective is performed in the form of a patriarchal relationship. Whereas, from the humanistic perspective, general education is based on the integrity of the human being (including biological, psychological, and ontological) together with the specialized education. Treatment in this approach is achieved through a collaborative relationship between the physician and the patient.

The Relationship between Spiritual Intelligence and Patient Advocacy in Educational Hospitals in Khorramabad 2017

Nasrin Imanifar

Patient Advocacy is one of the vital duties of nurses. The purpose of this study was to determine the relationship between spiritual intelligence and patient advocacy in educational hospitals in Khorramabad during 2017. This was a correlational descriptive-analytic study that was performed on 250 nurses working in educational hospitals in Khorramabad in 2017. The criteria for entering this study included a minimum degree of nursing and one year of clinical work experience. Participants in this study were selected by random sampling method. Data collection tools consisted of Hank’s advocacy Questionnaire and King's spiritual intelligence. Data were analyzed using descriptive statistics (mean, standard deviation) and inferential (correlation coefficients and regression coefficients) using SPSS v.21 software. Sixty seven percent (164 persons) were female and 37.5% (79 persons) were male. Sixty three percent of participants had a work experience of less than 5 years. The findings of this study showed the mean score of spiritual intelligence of nurses was 80.88 ± 11.19. The average score for patient advocacy was 155.73 ± 21.41. Pearson correlation coefficient showed that there was a significant correlation between spiritual intelligence score and Advocacy and its components (p = 0.624). The mean score of spiritual intelligence in nurses was high in the King questionnaire. The average score for patient advocacy was Hanks' questionnaire in the medium range. The present study showed that there was a significant positive correlation between spiritual intelligence and patient advocacy. As spiritual intelligence is acquired, spiritual intelligence can be promoted through classes and workshops, thereby increasing the patient advocacy and increasing the safety of patients.

The Impact of NAB Plan (Superior ethics badge) Implementation on the Professional Ethics of the Nursing Personnel at Baharloo Medical Education Center

Zahra Ghazi

Superior ethics badge (NAB plan), that is election of most moral person, best nursing and midwifery in a university is a kind of professional ethics. The purpose of this study was to investigate the effect of the implementation of the NAB plan on the professional ethics of nursing staff in Baharloo Hospital. This semi-experimental study was done in before and after design. A 360-degree questionnaire as a data collection tool was used to assess ethical nursing staff in a checklist consisting of 5-4 questions. The five-choice Likert scale was used to describe the data from the central indices and in the inferential part, the t-test, for independent and dependent variables, repeated measure ANOVA and ANOVA were used. The results of the present study showed that the implementation of the NAB plan has a significant effect on the ethics of the nursing staff from the general viewpoint of the evaluators (P <0.001). Also gender, age (30-20 years old were more than 30 years old), education, employment status (formal, covenant, etc.), marriage status and work experience in implementation of the NAB plan had a significant effect on professional ethics of nursing staff but the interactive effect of participants' demographic characteristics was not significant. The results of current study showed that the implementation of the NAB design (superiority of ethics) in Baharloo Hospital promoted the professional ethics of the nursing staff.

Assessment of Patient Satisfaction from Quality of Care Services in Shahid Beheshti Hospital in Ghorveh City in 2015

Afrooz Hosein

Patients’ satisfaction of treatment centers is one of the most important indicators for the quality of care and treatment services. Taking care of patients’ satisfaction has essential role in managing programs of health services. The aim of study was to evaluate patients' satisfaction with the quality of services provided in Shahid Beheshti Hospital in Qorveh in 2015. The research method was cross-sectional and descriptive-analytic. The statistical population of the study consisted of 384 patients selected in one stage cluster sampling from different parts of hospital. Patient satisfaction was evaluated by means of questionnaire that its validity and reliability was confirmed. Information was analyzed by statistical software SPSS 20 and t-test. The results showed that most of satisfaction was related to the emergency department and the lowest levels of satisfaction was related to ICU. Overall satisfaction from health services of Shahid Beheshti hospital was 72%. In this study, the satisfaction and habitat of patient had meaningful relationship, but other factors had not significant relationship with patient statisfaction. In recent years, patient satisfaction had an acceptable level due to dramatic improvements in health system. Nevertheless, the problems and weaknesses in the health care field also should be concerned and resolved and we have to improve the quality of services.

Moral Evaluation of Fetal Reduction

Mohammad Rasekh

Science considers using technologies for treatment of infertility as the important cause of multifetal pregnancies. Fetal reduction is a clinical procedure developed for reducing the number of fetuses in multifetal pregnancies in order to avoid their common complications. Three aims may be offered for fetal reduction: (1) pregnancy preservation, and prevention of and decreasing risks of multifetal pregnancy to the mother and the remaining fetuses (high-end multifetal reduction); (2) eliminating fetuses bearing certain kind of illnesses (selective reduction); and (3) just preventing multiple birth where no considerable risk threatens the mother or the fetuses (elective reduction). Moral evaluation on fetal reduction techniques varies depending on which of the mentioned aims is followed. However, in many cases this is “medical necessity” that morally justifies the reduction. Nevertheless, given the difficulty of reaching a decision on this issue, risks involved in fetal reduction procedure, and its psychological implications for the mother and the father, it is seriously recommended to avoid such an action by methods that prevent multifetal pregnancy.

Assessing Construct Validity of Spiritual Inteligence Scale in Iranian Students

Abdollah Khorami Markani

Spiritual intelligence is a set of personal capacities that helps to adaptation and problem solving. The aim of this study was determining domains and construct validity of cultural and religious context of spiritual intelligence scale in Iranian students. In this mixed methodological study, we assessed the existing scales, and selected 62 items. Then we interviewed with 67 students and derived 42 items. We determined the scale construct validity by exploratory factor analysis with 1000 students' samples that were selected by stratified random sampling from universities. The ethics permission of study was obtained from ethical committee of Tehran university. Factor analysis reduced items number from 104 to 39. Among 10 dimensions in theoretical model, 7 dimensions explained the 60.21% of scale total variance. These dimensions were meaning perception and religious works effect; perception and extension of consciousness; perception of extraordinary phenomena superior than material being; existential critical thinking; personal meaning production ability; problem solving by using spiritual resources, and spiritual adaptation in interpersonal relationship. Inter items’ reliability was determined by internal consistency as 0.731 to 0.906 and the scale total reliability was 0.945. A 39 items’ spiritual intelligence scale with optimal psychometric properties and acceptable structural model based on Iranian religious and cultural practices can be used as a valid and reliable scale in community of Iranian students.

“As Infertile” Couples and Iranian Legal System: A Theoretical and Comparative Study

Mohammad Rasekh

Development of new methods of treatments for infertility has given rise to a serious question as to the access to such methods. Determination of the ones who can access the mentioned treatments and the limits of this access, depends to the definition of infertility. The Law of the method for Embryo Donation to Infertile Couples according to Iranian legislature considers the infertile couple who “cannot reproduce in accordance with credible medical certificate” as eligible to receive the donated embryo. However, applicants for modern infertility treatment methods have gone beyond infertile couples and include those couples who wish, based on credible medical evidence, to avoid having unhealthy children, especially by using donation methods or surrogacy. Accordingly, having supported a preventive approach to ARTs, a new concept of infertility will appear on the horizon. Expanding this concept to couples who are considered fertile from a common medical perspective but give birth to seriously unhealthy children shall inevitably lead us to revise the common legal concept of infertility. Therefore, by resorting to ethical reasoning, laws, and regulations of various legal systems and Fiqhi opinions we can develop another interpretation of Embryo Donation Law and argue for the access of the “perceived as infertile” couples to the infertility treatment with the help of third parties.

Moral Intelligence and Its Relative Demographic Factors in Medical and Nursing Students Studying at Islamic Azad University of Mashhad

Arezou Farajpour

Today, health care providers are moving toward becoming professionals, so only academic knowledge and skills are not enough in complex medical environments, morality is an integral part of medical decision making and paying no attention to it may have adverse effects on quality of care. This Research investigated the moral intelligence and its relative demographic factors between medical and nursing students. In this descriptive cross-sectional study, 214 students were selected by census sampling. Data were collected by using Kiel & lennik questionnaire which its reliability is reported as r=0.94 and has been validated in previous studies. The mean age of students was 21.79±2.82 years. The moral intelligence mean scores in medical and nurse students were 76.44±7.10 and 74.07±8.26, respectively. There was no significant relation between demographic factors and moral intelligence scores but there was significant difference among nursing and medical (p=0.025) and the first and last year students (p=0.002). Trustworthy domain was significantly higher in medical students (p=0.003). Although the results indicate that the students' moral intelligence score is in good condition, this situation can be upgraded to be very good and excellent. The significant difference in the score of moral intelligence in first and last year students shows the effect of educational curriculum. There was significant difference in the scores of medical and nursing groups. So, the educational climate and curriculums can effect on moral intelligence development. Therefore, considering the proven effect of moral intelligence on the quality of professional performance, ethical dimensions, and professionalism in clinical education should be emphasized, evaluated, and monitored more than ever.

Comparison of the Moral Conflict of Pre-Hospital Emergency Personnel with Nurses of ophthalmology departments in Isfahan Ophthalmology Hospitals in 2017

Arash Ghodousi

Professional nurse should be familiar with the principles of biomedical ethics and how to deal with situations of moral conflict. Nurses encounter a variety of ethical conflicts in their work environments, which, if not properly educated for that, may be destructive. One of the first steps to recognize and help resolve moral conflicts seems to be a better understanding of the underlying causes of these conflicts. For this purpose, this study compared the exposure of pre-hospital emergency staff and nurses of the ophthalmologic departments in Isfahan with ethical conflicts in their careers. This descriptive-analytic study was performed on 44 pre-hospital emergency personnel and 42 nurses in ophthalmic and postgraduate degrees. Data were collected using Falco's moral conflict questionnaire. The results were analyzed using descriptive statistics such as frequency distribution tables, dispersion indexes, and mean and analytical statistics such as T test and ANOVA. Data were analyzed using SPSS software version 8. The results of this study showed that the prevalence of ethical conflicts among pre-hospital emergency personnel with a mean of 61.65 was higher than nurses in ophthalmic departments with an average of 40.23. Therefore, according to the results of this study, the degree of exposure to ethical conflict situations for pre-hospital emergency personnel more common in comparison with the staff of the elective hospital units in more stressful situations. The degree of exposure to ethical conflict situations is also more significant for pre-hospital emergency personnel than nurses in the ophthalmic departments.

Evaluation of Factors that Affect Patient's Trust in Emergency Physician; A Qualitative Study in Imam Khomeini Hospital Complex

Talayeh Mirkarimi

Trust is one of the most important issues in patient-physician relationship and affects the treatment acceptance and followup from the patient and optimal outcome. Patient trust to emergency physician is different from other physicians in many ways because of patient’s urgent situation and lack of choice in physicians. This paper explores the reasoning for (dis)trust in emergency physicians in Imam khomeini hospital. A qualitative study in Imam khomeyni hospital was done including 5 recorded focused groups (with 3-6 patients in each group) and 8 in-depth interviews with patients. Patient trust’s issues were divided into 2 major groups: 1- issues that depend on emergency physicians (including professionalism; practical skills and physician’s personal factors) 2-issues independent to emergency physicians (including patient’s previous beliefs; environmental and hospital’s factors and patient’s personal factors). Many factors about emergency physicians like personal factors that are extracted from this study were similar to other physicians. In other hand, it seems that patient trust in emergency physicians is affected by environmental factors especially hospital related factors and it is better to consider it as an integrated foundation and not only trust between persons.

The Evaluation of Patients’ Tendency and Their Family to Discloser of Malignant Disease

Shiva Rafati

Considering the increasing prevalence of the malignant diseases and their great effects on the different aspects of the patients’ life and even their family, the disclosure of its diagnosis and trust telling to the patients have been changed to one of the main medical ethics challenges. This study aimed for the evaluation of patient’s tendency and their family to disclosure of malignant disease. This study was a cross-sectional research. It has been done with a questionnaire on the 270 people. The sample consisted of three groups: 100 patients without cancer disease, 100 patients’ family members, and 70 patients with cancer disease, who referred to Mustafa Khomeini Hospital. The data were analyzed through SPSS-16 software in this study, 74% of the patients with cancer and 85% of patients without cancer and 50% of patients’ families had tendency to know the diagnosis of malignant disease. In the case of prognosis, 39% of cancer patients and 75% of without cancer patients, were agreed to complete knowledge, and 42% of cancer patients and 22% of without cancer patients, agreed on relative knowledge. Regarding the result of this study and respecting the individuals' rights, it seems better for the patients with malignant disease to be informed of their diagnosis and prognosis by the health care workers. Furthermore, it would be better to implement strategies for improvement of patient-physician relationship through physicians' communication skills with patients.

A Review of the Ethical Challenges in Health Technologies (Case Study: Digital Health Technologies)

Hossein Aliahmadi Jeshfaghani

Recent developments in the digital domain and its influence in the health sector have led to the development of digital health technologies. The development of these technologies in addition to the benefits such as lowering medical care costs and improving the quality of patient care, has introduced new ethical challenges into the field of medicine. In this study, 25 articles were identified on the ethical challenges in digital health technologies by using literature review. These articles were in areas of mobile health, electronic health records, telemedicine, electronic health, wearable and big data technologies. The ethical challenges found in the articles reviewed in the field of digital health include: the privacy challenges that are due to the creation of huge data sources in this type of technology, how to ensure access justice, challenges for determining the responsibilities of surgical and technical members in telemedicine technologies, changing the patient's role, challenges regarding data ownership and patient access to raw data, the challenge of balancing the privacy of patient information and data sharing in advancing the community's science and health big data, and guaranteed quality of provided health information. These surveys can be effective in identifying challenges and developing ethical guidelines before developing and applying these types of technologies.

The Ethical Study of Abortion from Peter Singer`s View

Marziye Karimi behzad

Abortion is one of the most controversial and debatable issues of human history. Those who analyze social issues from moral perspective claim satisfying preconditions of abortion would compensate its unwanted consequences. Nowadays some philosophers in order to define abortion in a more reasonable way propose abortion as a new concept using moral theories such as deontologism, utilitarianism and virtue ethics for defining abortion. The goal of this study is to analyze Peter Singer’s utilitarianism, Australian philosopher, attitude toward abortion. In this article, we try to study abortion in different moral views in a descriptive and analytical way and determine moral order in different branches of utilitarianism viewpoint. But considering lack of reasons to rationalize utilitarianism theory which Singer himself admits its inefficiency in some occasions, practicing other moral theories could be helpful in order to propose a suitable solution for moral issues of abortion.

Crediting Islamic Model of Stress Management in Stressful Organizations

Zahra Sajadi

The increasing number of social and individual problems caused by occupational stress have been indicative of the ineffectiveness of the previous models despite many attempts. This article is intended to measure the current status of organizations in order to correct and reduce staff stress. After obtaining the reliability and validity of the model derived from the review of literature and interviews and the questionnaire of expert opinion, the model test required a field study, so a researcher-made questionnaire was developed with the allocation of 90 items. The questionnaire was prepared for distribution in the high-stress zone of six hospitals including public, military, and private hospitals. After receiving the opinions of the employees in the high-stress zones and analyzing the findings of the statistical population, the conceptual model of occupational stress management from the point view of Islam was obtained and it was based on "God-belief, continuity of life after death and centrality of ethics". Considering that hospitals are one of the most important occupational organizations, the model test was used in the high-stress zones of hospitals' and proved the researchers’ hypothesis. So, the obligation to strengthen religious beliefs was explained in these organizations and the model of occupational stress management of employees from the Islamic point of view was confirmed by assessing the status of organizations. The indicators, components, and dimensions of the above model can be used by authorities of health policy such as Iranian medical council, the ministry of health and medical education, and medical sciences’ universities.

The Virtue of Not Being; Reviewing and Criticizing of Benatar’s Approach of Avoiding Ethical Preference of Not Being

Rahim Dehghan Simakani

David Benatar, influenced by Nietzsche and Schopenhauer, sees the life of this world full of pain and suffering, and believes that not being in this world is preferred to be. The purpose of this article is to challenge Benatar's approach in an analytical and citation way. Benatar expresses two arguments for his claim. One is the argument of asymmetry and the other is the quality of life argument. In this paper, both of his arguments are explained and criticized. In the first argument, Benatar provides ample of evidence for his claim that he does not provide the preference for the pain and suffering which humankind experiences in this world. In the second argument, while ignoring the element of individual satisfaction and the independence of the personality of human beings, their judgments regarding their lives are considered to be due to optimism, and believes that humans, because of their ability to get accustomed to the conditions believe that their being is preferred to not being. By this statement, instead of solving the problem of suffering, he cleansed the principle of the problem and preferred not being. The morality of abortion, the immorality of reproduction and marriage, the validity of non-voluntary euthanasia, and the belief in the extinction of the human race are consequences of Benatar's approach, which are untenable.