Iranian Journal of Medical Ethics and History of Medicine

Models for Assessing the Impact of Policies on Health Equity: A Review

Alireza Olyaeemanesh

Health inequalities in different populations continue to be the main challenge of health systems; Therefore, it is necessary to address health equity in the developed policies. The study aims to review the studies related to tools and models for assessing the impact of policies on equity in health. This study was conducted as a systematic review to identify the tools and models of assessing the impact of policies on equity in health and the process of assessing health outcomes from 2005 to 09/30/2022 in English and Farsi. National and international databases such as Scopus, PubMed/Medline, and Google Scholar were searched. First, 16901 studies were obtained. After the initial screening, 243 articles entered the abstract review phase. Then, 99 studies entered the phase of studying the text. Finally, 53 studies entered the final phase of analysis. Screening steps, identification of decision-making assessment scope, evaluation, and follow-up were the four dominant steps in most of the developed tools. The study showed that to choose the appropriate tool to assess the impact of policies on equity in health, it is necessary to pay attention to various factors such as assessment time, policy level, available resources, and the population affected by the desired policy.

Study of Research Misconduct Using an Analytical Approach to the Research System of Medical Sciences

Ehsan Shamsi Gooshki

Since research misconduct can be considered as an adaptive reaction against the limitations, pressures, and demands arising from inappropriate functions of the research system, to manage it, the activities of the research system should be investigated and traced during the path of transferring research policies (macro level) to research development programs in institutions (meso level) and research implementation by researchers (micro level). By introducing the macro-meso-micro analytical framework, this study clarified the tasks, strategies, and activities formed at three levels of the research system of medical sciences in Iran; from macro policies of research (macro) to operational plans for the development of research in universities and research centers (meso) and researchers as research conductors (micro). For this purpose, three analytical levels of the research system were explained and defined according to the assumptions of this framework. By performing a qualitative content analysis of the relevant texts, those activities that could be useful at different levels to support the research integrity were identified and presented as different strategies. The results showed that the research system, based on the existing analytical framework, is not seen as a mere macro-system without regard to the interaction of its parts, but rather a system in which there is cross-sectional influence and interaction among the components. This approach can improve the focus, clarity, and capability to study research misconduct, and by using micro, meso, and macro levels, it can trace challenges in the interactive path of various activities and functions of the research system and their intertwining.

The Strategy of Nursing Managers in Ethical Decision-Making: A Qualitative Content Analysis

somayeh Mohammadi

In the current health system conditions, the strategies adopted by nursing managers in their ethical decision-making can lead to different results for patients, nurses, and health systems. Therefore, the present study aimed to explain ethical decision-making strategies implemented by nursing managers. The present study was conducted using qualitative content analysis in 2022 at Shahrekord University of Medical Sciences. A total of 18 nursing managers were selected through purposive sampling and were interviewed using in-depth unstructured individual interviews. Data were analyzed using the method proposed by Graneheim and Lundman. The results revealed one main category (human-centeredness) and three subcategories (customer-centeredness, valuing employees’ dignity, and the conflict between respecting the rights of patients and employees and adhering to organizational policies). Nursing managers attempted to make their ethical decisions based on the principle of humanism by using customer-centeredness strategies, valuing employees’ dignity, and prioritizing the rights of individuals and employees over organizational rules. The results of the present study showed nursing managers make decisions in line with respecting the rights of patients and employees. However, sometimes these decisions conflict with the interests of organizations. In this regard, the existing obstacles that create the conditions for such conflicts should be identified. Increasing organizational commitment in managers can also be effective in decisions that benefit different groups of customers, personnel, and health organizations.

Psychosocial Determinants Related to the Ethical Performance of Researchers

Rahele Samouei

Compliance with ethical principles in research by researchers plays a fundamental role in providing evidence-based and practical findings, subsequently solving society's problems and advancing knowledge. Despite numerous educational workshops and awareness-raising efforts, some unethical research practices are still observed. Identifying relevant factors is essential for practical and preventive planning. In this regard, the present study aimed to identify psychosocial determinants related to the ethical performance of researchers in conducting and publishing research works. The study was conducted using a qualitative approach based on conventional content analysis. A total of 29 faculty members and researchers from the medical sciences universities in Iran in various fields and specialties were selected purposively and semi-structured interviews were conducted with the participants. Qualitative content analysis was used to categorize data and Lincoln and Guba’s criteria were employed to evaluate data. Data analysis led to the identification of 136 codes, 20 subcategories, and 4 main categories. The factors related to the ethical performance of researchers in conducting and publishing research works derived from interviews with researchers included "Laws", "Social Learning", "Knowledge and Literacy", and "Psychological Characteristics". According to the findings of this study, the ethical performance of researchers in the field of research is the result of the interaction of social, individual, personality, and legislative factors. Some factors, like personality traits, are long-lasting, resistant, and personal, while social factors are widespread, common, and more general. Research policymakers and managers can improve the ethical performance of researchers and place ethics at the center of attention in research by implementing educational methods, culture building, and behavior change

The Relationship Between Moral Foundations and Organizational Culture Among Nurses at Vali-e Asr Hospital in Borujen in 2023

Fatemeh Badr

Considering the important role of health organizations and the behavior and performance of nurses in achieving organizational goals, the moral foundations of nurses can significantly influence their behaviors and decisions and shape the organizational culture and atmosphere. Therefore, the present descriptive-analytical study aimed to investigate the relationship between moral foundations and organizational culture among 200 nurses selected using the census method at Shahrekord University of Medical Sciences in 2023. Data were collected through a demographic information form along with questionnaires to measure moral foundations and organizational culture. Data were analyzed using SPSS software version 16 via descriptive statistics (percentage, mean, and standard deviation) and analytical tests (t-test, analysis of variance (ANOVA), correlation coefficient, and linear regression). Pearson’s correlation coefficient revealed a significant relationship between the mean scores of moral foundations and organizational culture among nurses (r=0.61, P<0.001). The coefficient of determination (R²=0.372) showed approximately 37% of the variance in organizational culture can be predicted by moral foundations. Among the dimensions of moral foundations, loyalty to the group, respect for authority, and purity significantly predicted organizational culture (P<0.001). The mean score of moral foundations among nurses was acceptable at 98.55±15.8, while the mean score of organizational culture was favorable at 105.74±25.7. Based on the findings from the present study it can be concluded that by creating a moral atmosphere and promoting moral values such as loyalty to the group, respect for authority, and purity in nurses, the organizational culture can be enhanced

A Critical Review of the Ethical Aspects of the Electronic Health Record System (SPAS in Iran)

Ehsan Shamsi Gooshki

The electronic health record system (SPAS in Iran) records information related to the health of individuals in an electronic format. It is the center for collecting health information and data on outpatients and inpatients. This system records information such as the patient's full name, marital status, gender, date of admission, level of education, occupation, type of admission, and other relevant medical data. The core values and ethical requirements of SPAS include safeguarding citizens' rights, respecting individuals, observing justice and fairness, transparency, encouraging participation, and accountability. In this study, the ethical aspects of SPAS were evaluated using the model proposed by the World Health Organization (WHO) for ethical evaluation. This model emphasizes fundamental ethical principles such as human well-being and health, respecting individuals and communities, justice, and fairness. Concerning human well-being and health, SPAS can prevent unnecessary and redundant interventions and provide physicians with quick access to an accurate patient history. Furthermore, the system ensures the confidentiality of information, which is essential to respect individuals and communities. Regarding justice and fairness, the system can improve access to health services for disadvantaged and remote areas. Moreover, SPAS adheres to procedural ethical principles such as solidarity, transparency, participation, and accountability. Therefore, by critically examining the ethical dimensions of the electronic health record system (SPAS), the findings of the present study provide valuable insights for policymakers, health professionals, and regulatory organizations to ensure the ethical and efficient performance of electronic health record systems in Iran.

Considering Futile Treatment as Extravagance and Approving its Illegitimacy: A Comparative Study of Medical Ethics and Islamic Jurisprudence

Saeed Nazari Tavakkoli

Treating patients whose lives are in danger or threatened by irreparable harm, is an obligatory act. However, sometimes, due to old age, the severity of the disease, or the lack of definitive treatment, the patient faces a situation where, according to the diagnosis of the medical staff, starting or continuing the treatment has no effect on patient recovery, or the effect is so insignificant that is ignored in medical practice. This study was conducted using a descriptive and analytical method based on library resources to compare “futile treatment” in medical ethics with “Israf” (extravagance) in Islamic jurisprudence so as to indicate the level of conceptual compatibility between these two concepts. Moreover, considering the illegitimacy of extravagance in jurisprudential teachings, it was attempted to explore whether it is illegitimate, according to Islamic rules, to perform futile treatment. To do so, first, futile treatment and its characteristics in medical texts were defined. Second, the ethical considerations of performing such treatment were explained based on the teachings of medical ethics. Third, extravagance was analyzed in terms of concept, topic, and sentence by referring to valid lexical, jurisprudential, narrative, and interpretative resources. Finally, based on a comparative study, the level of compatibility of futile treatment with extravagance was investigated. The findings of this study showed futile treatment is an example of extravagance as it causes the waste of personal or public property, lacks rational purpose, and does not lead to patient recovery or promotion of health status. Therefore, futile treatment is not considered an obligatory act but even an illegitimate one as it is a clear example of extravagance. In addition to punishment in the afterlife, it entails civil liability as it results in the loss of others’ property.

New Ethical Principles in the Dissection Hall: A Brief Overview of the History of Ethical Developments

Sedigheh Ebrahimi

Medical science and ethics form an integral part of medical curricula. Cadaver dissection is the preferred educational tool in the early stages of medical education which provides a suitable opportunity to sow the seeds of medical ethics in the minds of future physicians. This review study aimed to investigate unethical events in the history of dissection and subsequent ethical evolutions in human dissection to highlight the need to uphold the ethical values related to donor bodies in the dissection hall. To find and evaluate related documents, the articles published from 2005 to 2023 were searched in Scopus, PubMed, Google Scholar, and Research Gate databases using relevant keywords. The results indicated that in the past, cadaver dissection was performed on the bodies of executed criminals or through illegal methods, and until the early 1960s, the ethical principle of respect for autonomy was overlooked. However, from the 20^th century onwards, the use of donated bodies with informed consent became prominent, allowing universities in the 21^st century to utilize this resource for education, thereby providing an acceptable solution to fill the ethical gaps in dissection. Clarifying the ethical standards associated with the use of donated bodies is essential for medical students. The human body represents a valuable scientific resource that warrants respectful treatment following established ethical guidelines and laws. Adhering to the highest ethical standards within educational institutions is necessary to ensure donors feel confident in their decisions.

Bystanders to Medical Unprofessional Behaviors: A New Ethical Perspective

Mina Mobasher

This Article has no Abstract.

Persian Plague or Abu Chafchir Plague (1772-1773): Its Origin and Consequences

Reza Karami

Epidemic diseases have historically posed significant threats to human societies, with the plague being one of one of the deadliest. Between 1772 and 1773, an outbreak of plague, known as Abu Chafchir or Abu Khanjar, occurred in Ottoman Iraq, inflicting severe damage on the local economy. This outbreak spread throughout the Persian Gulf and southern Iran; hence it was also referred to as the Persian plague in European accounts. This study aimed to investigate the effects of this plague on human societies and its scope from various dimensions. The study was conducted using library-based and historical methods with a descriptive-analytical approach. Persian, Arabic, and English resources were extracted from domestic databases as well as the archives of British newspapers and the digital archive of Qatar, as important foreign archives. The findings indicated that Mesopotamia was one of the important centers for the outbreak of the plague, and the Persian plague spread to neighboring countries from this region. The results also revealed that the initial attempts to implement quarantine measures in Iran were made during the Karimkhan Zand dynasty and some preventive measures were taken for the first time in response to this plague. Moreover, the transregional trades and movement of commercial and pilgrimage caravans in these areas increased the spread of this disease. This plague changed the political and economic relations of these regions with other countries and resulted in a dramatic population decline

Is it Possible to apply an Advance Directive in Iran’s Health System?

Mina Mobasher

Deciding on whether to continue life-prolonging treatments for terminal patients is a major challenge in healthcare. Advance directive emerges as a proposed solution to this issue in the world. The patients record their preferences regarding the continuation of life-prolonging treatments while they still are able to make decisions. Although advance directive is morally justifiable from the perspective of principlism, respecting the patient’s right to autonomy and assessing the benefits and drawbacks of providing such services, the religious beliefs of patients, their families, and healthcare providers always exert a significant influence on this matter. In Islam, preserving human life heavily affects these decisions. Several juridical and legal rules can culminate in different decisions on the continuation or termination of life-prolonging treatments including the absolute legal power of the owner to exercise dominion^{^[1]} or control over property and permission of intervention in their body^{^[2]}, the rules of prohibition on causing the death^{^[3]}, the sanctity of human killing^{^[4]}, the rule of prohibition of detriment^{^[5]}, the concept of unstable life^{^[6]} in Article 372 of the Islamic Penal Code and the rules of preventing losses^{^[7]}, and the rule of sanctity of idle^{^[8]}. Nevertheless, given various types of will in Islamic Jurisprudence and according to the contract of agreement^{^[9]}, it is possible to record the patient’s request regarding how to continue the treatment. This study indicated that implementing advance directives in Iran’s health system requires a more accurate analysis of moral, legal, and jurisprudential foundations.

[1] (tasli¯t)

[2] (ezn dar tasarof)

[3](nafy al-d.arar )

[4] (Hormat Ghatl)

[5] (la¯ d.arar wa la¯ d.ira¯r fi¯ al-isla¯m)

[6] (Ghayr-Mustaqarr)

[7] (‘usr wa al-h. araj, al-)

[8] (hormat laghw)

[9] (agde solh)

[1]. (tasli¯t)

[2]. (ezn dar tasarof)

[3]. (nafy al-d.arar )

[4]. (Hormat Ghatl)

[5]. (la¯ d.arar wa la¯ d.ira¯r fi¯ al-isla¯m)

[6]. (Ghayr-Mustaqarr)

[7]. (‘usr wa al-h. araj, al-)

[8]. (hormat laghw)

[9]. (agde solh)

A Memorial of the Late Professor Seyed Mahmood Tabatabaei, “Tabibe Zolfonun”

Rasool Esmalipour

This Article has no Abstract.

UNESCO Draft for Ethical Issues in Neurotechnology: Lessons and Requirements for Emerging Countries in the Field of Neurocognitive Technology

Ata Pourabbasi

This Article has no Abstract.

Introduction and Critique of the Paper "The Impact of Iranians on Chinese Medical Beliefs via Religions"

Sina Moradi Mansour

This Article has no Abstract.

Proposing a Charter for Ethical Peer Review of Scientific Works in the Field of Health: A Commentary

Hasan Ashrafi-rizi

The ethics of reviewing scientific works is a crucial aspect of research ethics in the field of health, where the outcomes significantly impact prevention, diagnosis, treatment, rehabilitation, and management, highlighting the importance of the quality of research results. Accordingly, this study aimed to develop a charter for the ethical peer review of scientific works in the field of health. The significance of this commentary lies in that researchers’ and reviewers’ adherence to ethical principles can contribute to enhancing the quality of scientific works aimed at prevention, diagnosis, treatment, rehabilitation, and management in the field of health. This charter can serve as a framework for scientific work review systems, assisting research managers in identifying the ethical components essential for reviewing scientific works in the field of health to develop effective research policies and plans. Moreover, it would help reviewers and practitioners at journals, research centers, and institutes, facilitating accurate, fair, and unbiased reviews of scientific works in the field of health.

Association of Moral Reasoning with Clinical Belongingness and Their Influential Factors among ICU Nurses

Milad Amiri

The intensive care unit (ICU) is a challenging and stressful environment where nurses encounter difficult ethical decisions daily. Therefore, this study aimed to determine the correlation between moral reasoning and clinical belongingness among Iranian ICU nurses. This cross-sectional, descriptive-analytical study was conducted on 126 nurses working in the adult ICUs of hospitals in Yasuj, Iran in 2023 using census sampling. Questionnaires measuring clinical belongingness and moral reasoning were used to collect data. Data were analyzed using independent samples t-test, ANOVA, regression, and Pearson’s correlation coefficient via SPSS-26 software. The findings revealed that the mean scores for clinical belongingness and moral reasoning among the nurses were 109.68 ± 13.75 and 36.07± 5.50, respectively, indicating good clinical belongingness and moderate moral reasoning. Moreover, a statistically significant relationship was identified between the place of service and clinical belongingness (p = 0.02), while no significant relationship was found between clinical belongingness and moral reasoning (p>0.05). Although no significant relationship was established between clinical belongingness and moral reasoning, certain demographic characteristics showed a significant predictive relationship with nurses' clinical belongingness. Accordingly, it is recommended that nursing officials and managers utilize these findings to improve moral reasoning and the sense of belonging to the clinical environment among nurses.

Identifying Factors Influencing Upholding Research Ethics from the Perspective of Postgraduate Students: A Qualitative Study

Maryam Afshari

Research ethics is a branch of professional ethics that deals with the ethical principles guiding the research process from the beginning to the end. Ignoring ethical issues in research sometimes occurs unintentionally and simply due to a lack of awareness regarding professional research ethics. Therefore, this study aimed to identify facilitators and inhibitors of adherence to ethics in research conducted by postgraduate students at Hamadan University of Medical Sciences. This qualitative study was conducted using an inductive content analysis approach. The target population included postgraduate students at Hamadan University of Medical Sciences. Data were collected through semi-structured interviews with 29 students who were selected using purposive sampling. Data were analyzed using the method proposed by Diekelmann et al. For data validation, Strauss and Corbin’s method was utilized. Factors influencing adherence to research ethics included individual and personality traits (accuracy and ethical conduct of students and professors and having sufficient information about research ethics) and environmental factors (information dissemination and familiarity with research methods, the professors’ interactions with students, confidentiality of information, strictness of professors, having a clear framework from the university, respecting students’ rights, and establishing deterrent regulations). Strengthening facilitators and mitigating inhibitors of adherence to research ethics requires joint efforts from students, professors, and the university. Students need to develop accuracy and awareness, and professors should serve as ethical role models. University officials are required to create and propose clear frameworks for adhering to ethics, to be followed by all individuals involved in research.

The Indices of Evolutionary Medicine

Hamidreza Namazi

Recognizing diseases and their causes is one of the most critical issues in medicine, forming the foundation of treatment. Disease responses and complications might differ among individuals, with some exhibiting more resistance to certain illnesses due to genetic or environmental factors. Furthermore, we are currently witnessing the emergence of new diseases for which definitive treatments have yet to be developed. This evidently underscores the need to explore the fundamental causes of diseases. Evolutionary medicine has been discussed in Western medical discourse for less than half a century. Grounded in Darwinian principles, this theory examines the issues humans have faced, both naturally and as influenced by social conditions, throughout our evolutionary history. Research in evolutionary medicine indicates that human health and illness are shaped not only by immediate biological and environmental factors but also by the long history of human evolution and the transformations that have occurred over time. Accordingly, this study introduced 13 key indices of evolutionary medicine, highlighting its significance and application in medicine and healthcare. Moreover, it emphasized the necessity for greater attention to this concept from both medical science and interdisciplinary perspectives.

Challenges and Considerations of Professional Ethics in Midwifery During the COVID-19 Pandemic: A Qualitative Content Analysis

Shahrbanoo Salehin

The COVID-19 pandemic is a public health emergency that has challenged many ethical issues. This study aimed to investigate the challenges and considerations of midwifery professional ethics during the COVID-19 pandemic. Employing qualitative content analysis, raw data were collected through an extensive literature review, utilizing purposive sampling until data saturation was achieved. Data trustworthiness was ensured based on Lincoln and Guba's criteria and data were analyzed using an inductive method. A total of 4 themes and 17 main categories were extracted. The themes and categories included: 1. Ethical challenges in deciding on midwifery care and place of delivery (ethical challenges of home birth, ethical challenges of hospital delivery, facing ethical challenges), 2. Clinical ethical principles (beneficence, equitable distribution and justice, solidarity, trust, duty to care), 3. Ethical principles in management (equal concern and respect, minimizing harm caused by the pandemic, inter-sectoral cooperation, evidence-based decision-making), 4. Support for midwives' rights (psychological support for midwives, gender considerations among midwives, midwifery training, workplace health, support policies). Midwives encounter various ethical challenges in pandemics. Thus, developing an ethical framework for decision-making in pandemics can help address these challenges.

A Historical Investigation of the Establishment and Evolution of Tehran’s Insane Asylum (Dar al-Majanin) during the Qajar and Pahlavi Eras

Elham Malekzadeh

This study examined the history of the establishment and evolution of Tehran’s insane asylum during the Qajar and Pahlavi periods. The significance of this study in medical history lies in its exploration of the founding of one of Iran’s earliest medical institutions and the factors that influenced its subsequent transformations. Given its focus on the development of insane asylum (Dar al-Majanin) and the public’s appeals for its improvement, this study offers valuable insights into the social history of the period. Employing a descriptive-analytical approach and relying on unpublished archival documents, this study presented a narrative of the history of madness that shed light on the untold stories of the mentally ill (Majanin) and prevailing societal beliefs about them. These beliefs profoundly influenced the treatment of patients within these institutions. The findings revealed that while the care provided to the mentally ill improved during this period, ongoing challenges persisted due to limited resources and a growing patient population. The prevailing attitude of officials toward the mentally ill was primarily one of containment, aimed at protecting the public from perceived threats.

The Relationship Between Organizational Support and Compassion Fatigue in Emergency Department Nurses: A Cross-Sectional Study

Yousef Mohammadpour

Organizational support is a key factor that may influence and moderate compassion fatigue among nurses. Therefore, this descriptive-analytical study aimed to explore the relationship between organizational support and compassion fatigue in emergency department nurses. The research population consisted of all nurses in the emergency departments of educational hospitals in Urmia, Iran in 2024. A total of 150 nurses were randomly selected based on the inclusion criteria for the study. Data were collected through three questionnaires including a demographic information form, Eisenberger’s Organizational Support Scale, and Figley’s Compassion Fatigue Scale. Data analysis was performed using SPSS software version 15. The results indicated a significant negative relationship between organizational support and compassion fatigue (r=0.45 and p< 0.05). The mean score for organizational support among emergency department nurses was 21.13± 0.54. Moreover, the mean scores for compassion fatigue, compassion satisfaction, and secondary traumatic stress were 27.73 ± 8.54, 38.73 ± 1.81, and 28.45 ± 4.82, respectively. The overall mean score for the nurses' job quality was 31.93 ± 4.32. Given the results of the present study and the role of organizational support in reducing compassion fatigue among nurses, it is crucial for nursing managers and policymakers to take certain measures such as improving working conditions and addressing the needs of nurses to enhance organizational support, consequently helping to reduce and mitigate compassion fatigue among nurses.

Compliance with the Right to Safe Motherhood and Its Predisposing, Reinforcing, and Enabling Factors Based on the Precede-Proceed Model from the Perspective of Midwifery Students

Robab Latifnejad Roudsari

The right to safe motherhood encompasses several goals, including reducing maternal mortality, ensuring safe pregnancy and childbirth, and giving birth to healthy children. This study aimed to determine the degree of compliance with the right to safe motherhood and to identify its predisposing, reinforcing, and enabling factors based on the precede-proceed model from the viewpoint of midwifery students. This cross sectional study was conducted using the census method on 151 midwifery students at Mashhad University of Medical Sciences, Mashhad, Iran in 2021 and 2022. Data were collected through a demographic questionnaire, a researcher-made questionnaire to assess compliance with the right to safe motherhood, and a questionnaire to measure its predisposing, reinforcing, and enabling factors on a self-report basis. Statistical methods including Pearson’s and Spearman’s correlation coefficients were utilized to analyze data. The overall mean score of compliance with the right to safe motherhood was 116.6±38.8 with a range of 13-187. Regarding predisposing factors, 58.6% of students had an average to high level of awareness, 80.15% had a positive attitude, and 56.7% highly valued compliance with the right to safe motherhood. Concerning reinforcing factors, the encouragement by clinical mentors (94.8%) as well as legal support (94.6%), and in terms of enabling factors, proficiency and expertise in human resources (71.9%) were recognized as the most influencing factors in promoting compliance with the right to safe motherhood. Moreover, there was a strong positive correlation between enabling factors and compliance with the right to safe motherhood (r=0.950, p=0.488). The results suggest that from the perspective of midwifery students, the level of compliance with the right to safe motherhood is moderate. Given the relationship between enabling factors and compliance with the right to safe motherhood, educational and executive officials in midwifery are recommended to consider the role of these factors to improve the level of compliance with the right to safe motherhood to enhance the quality of midwifery services.

Attitudes of Medical Students Toward Patient-Centered Care at Iran University of Medical Sciences in 2023-2024

Mahshad Noroozi

Patient-centered care, which prioritizes patients' needs, values, and preferences, is a cornerstone of modern healthcare delivery. This study aimed to evaluate the attitudes of medical students at Iran University of Medical Sciences toward providing patient-centered care. This cross-sectional study included medical students in all academic degrees at Iran University of Medical Sciences. Data were collected through the Patient-Practitioner Orientation Scale (PPOS) distributed online. The collected data were analyzed using SPSS version 26. Of the 389 participants, 48.6% were male and 51.4% were female, with a mean age of 24.02±2.435 years. Moreover, 41.09% of the participants were in the clerkship stage, 40.9% were in the internship stage, and 14.7% had at least one parent who was a physician. The most preferred specialties were cardiology, surgery, and ophthalmology, respectively. The mean scores for the overall PPOS, sharing subscale, and caring subscale were 3.61± 0.50, 3.39± 0.64, and 3.83± 0.56, respectively, indicating a predominantly physician-centered attitude among students. There was a significant relationship between the mean scores of the three parts and gender (P-value<0.001), with female students demonstrating more patient-centered attitudes. Academic degree was significantly associated only with the mean score of the sharing subscale. The findings suggest that most medical students at Iran University of Medical Sciences exhibit a physician-centered attitude toward the physician-patient relationship. The results highlight the need for educational programs to promote patient-centered attitudes and enhance patient participation in diagnostic and treatment processes among medical students.

Ethical Considerations in Decision-Making for an Elderly Alzheimer's Patient: A Case Report

mojtaba parsa

In the current era, the alarming increase in the number of patients with Alzheimer's disease has led to greater attention to issues related to care and alternative decision-making for this special group in society. The four ethical principles of "beneficence", "non-maleficence", "respect for autonomy", and "justice" serve as fundamental guidelines in medical decision-making. This study presents a case report of an elderly Alzheimer's patient and the ethical issues related to medical decision-making in the absence of a substitute decision-maker. Typically, for individuals lacking decision-making capacity, decisions are made by a substitute decision-maker and, in some countries, an advance care directive. In the absence of these, the medical team may make decisions in the best interest of the patient, considering the individual's cultural and social conditions, while taking into account the aforementioned ethical principles.

Geriatric Medicine or Geriatric Medicalization?

Navid Ravan

Medical considerations about aging are as old as medicine itself. However, due to the controversy about whether aging should be classified as a disease or merely a stage of life, geriatric medicine was separated from medicine with a considerable lag. The differentiation of geriatrics from other medical specialties is not rooted in subjecting a specific organ of the body or specific pathophysiological processes but based on a particular stage of life. On the other hand, different stages of life, such as old age, are also subjects for medicalization. Therefore, geriatric medicine may sometimes be threatened by geriatric medicalization and its associated harms. In addition, the relativity and ambiguity in defining the concept of aging and its dependence on social contexts can lead to confusion in understanding the subject matter of geriatric medicine. Mitigating these harms requires philosophical and ethical reflection on health and disease concepts as well as on the essence of aging. Considering that Iran is expected to face an aging crisis in the coming decades, this philosophical reflection at different levels among researchers in the philosophy of medicine and medical ethics, researchers and practitioners in geriatrics, as well as among civil society, can lead to separating geriatric medicine from geriatric medicalization, hence increasing the integrity and efficiency of geriatric medicine, and promoting the health status of the elderly.

Defensive Medicine: A Serious Threat to Iran's Healthcare System

Ehsan Shamsi Gooshki

Defensive medicine refers to actions taken by doctors and other medical professionals to protect themselves against potential threats and risks, particularly to prevent patient complaints or convictions in court, which is carried out in various forms including positive and negative defensive medicine. Since the primary motivation behind such actions, often viewed as morally unjustified, is to avoid legal proceedings and lawsuits, court rulings against doctors can intensify these behaviors. Reports of criminal sentences against some doctors in Iran and reactions from professional associations highlight the significance of this issue. This study examined the effects of such sentences on the healthcare system by referring to available documents and data on the widespread prevalence of defensive medicine in Iran, offering some suggestions for managing the issue. The objective of the study was to emphasize the importance of acknowledging the defensive motivations of doctors in healthcare and its influential factors, particularly the fear of criminal convictions, which can increase defensive behaviors among doctors and amplify their negative impacts on the healthcare system.

Promoting Ethical Virtues as a Path to Divine Knowledge: The Interconnection of Religion and Ethics in Spinoza's Perspective

Hosein Fasihi

In the realm of philosophy, numerous thinkers have offered profound, and at times amazing, insights into the nature of existence. Among them, Spinoza stands out with his unique perspective, establishing a deep connection between ethics, religion, and the divine nature. Spinoza posits that religious texts, beyond their religious teachings, serve a motivational role in inspiring moral behavior. He locates the foundation of virtue within human nature and essence, arguing that the moral quality of actions is not inherent but is derived from God as the ultimate source of good and evil. Ultimately, adhering to the principle of universal necessity, Spinoza extends this concept to ethics, viewing it as an expression of divine nature. This perspective implies that morality and all human actions unfold within the framework of natural and divine necessity. An examination of Spinoza's views reveals a profound unity between humanity and the divine, characterized by a harmonious and interactive relationship between religion and ethics. Within Spinoza's philosophical system, these two categories are aligned, guiding individuals toward happiness and virtue. This innovative approach not only enriches our understanding of Spinoza's thought but also, by bridging religion, reason, and health, opens avenues for reconsidering medical ethics and spirituality in the contemporary world. This study, through a critical analysis of Spinoza's views, lays the groundwork for future investigations into moral philosophy, religion, and medical ethics, fostering a constructive dialogue between tradition and modernity.

A Comprehensive Practical guideline for Breaking Bad News to Patients and Their Families in Intensive Care Units: A Qualitative Study

Mohammad Ali Hosseini

Conveying bad news to patients and their families is a process that requires team collaboration. Different countries have taken into consideration providing suitable solutions. This study aimed to develop an practical guideline, according to the experiences of patients, families, and healthcare providers in intensive care units across three phases. In the first phase, in-depth interviews were conducted with 31 participants selected through purposive sampling, and the initial draft of the practical guideline was created. In the second phase, the initial draft was discussed and reviewed by experts in two focus group meetings, and a secondary draft was developed. In the third phase, the practical guideline compiled by the Delphi method was validated by 43 experts in policymaking and decision-making. Finally, an practical guideline to deliver bad news to patients and their families was developed with 8 main steps and 43 sub-steps. The main steps included before delivering bad news (assessment, planning and preparation, coordination), during delivering bad news (announcing bad news, emotional support, summary and documentation), and after delivering bad news (referral, follow-up). This practical guideline is intended to facilitate the process of delivering bad news in intensive care units to achieve the desired outcomes and reduce the resulting consequences and harms. Accordingly, healthcare providers are recommended to consider the importance of patient and family preferences, adhering to scientific and standard methods for delivering bad news, and upholding the principles of professional ethics.