Iranian Journal of Medical Ethics and History of Medicine

Journal Supplement for the National Ethics Congress: Important Considerations

Farzaneh Zahedi

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Co-Editors and Reviewers of the Supplement

این مقاله فاقد چکیده است

Pediatric Nurses' Adherence to Codes of Ethics: A Narrative Review

Naiire Salmani

Codes of ethics serve as essential guides for nurses in all medical settings to implement ethical principles, and they are especially important in pediatric wards. Given the vulnerability of sick children, it is crucial for pediatric nurses to provide care grounded in ethical codes and guidelines. This study aimed to review pediatric nurses' adherence to these codes of ethics. This review study was conducted by searching for articles using keywords such as “nurse,” “care,” “codes of ethics,” and “children” (and their Persian equivalents) through databases including Google Scholar, PubMed, Scopus, and SID from 2013 to 2024. A total of 1537 articles were retrieved initially. After reviewing the full-text English or Persian articles, 23 were assessed for quality, and 10 were selected for analysis. Pediatric nurses' adherence to ethical codes encompasses several key principles, including respecting the patient's family, establishing trust-based relationships, maintaining the privacy of sick children, demonstrating patience, taking responsibility for errors in patient care, and ensuring non-discrimination between sick children and families. To effectively adhere to codes of ethics in pediatric care, nurses must provide ethical care that is both patient-centered and family-focused, using ethical principles as a foundation for their practice.

A Review of Ethical Challenges in the Care of Elderly Patients

Fatemeh Ghonoodi

This study emphasizes that adherence to medical ethics principles by healthcare professionals is essential for improving the quality of care for elderly patients. With the aging population in Iran, the importance of this issue continues to grow. Therefore, integrating all care infrastructure to address healthcare challenges and identifying ethical issues in elderly care, along with efforts to resolve them, aligns with the practical application of medical ethics and meets the current and future care needs of this population. The present study aimed to identify and examine the ethical challenges in the care process of elderly patients. Using a systematic review approach based on Aveyard, databases such as PubMed, CINAHL, Web of Science, Scopus, Ethics Share, and Google Scholar were searched for articles published between 2017 and the present. The search used keywords including “ethical challenge,” “care,” and “elderly patients.” Inclusion criteria were articles published in English or Persian that were relevant to the research objective; studies without available full texts were excluded. Thirty articles that systematically analyzed ethical challenges in elderly care were included. The results indicated that the primary ethical challenges are respect for elderly patients’ autonomy, preserving their dignity and privacy, insufficient education and awareness regarding professional-patient communication, and a lack of elderly-friendly activities in healthcare settings. Additionally, the emotional difficulties caused by complex chronic conditions necessitate expanded access to appropriate psychological support for the elderly. This study highlights that these ethical challenges are influenced by cognitive, educational, practical, and structural factors. Consequently, integrated care approaches that prioritize elderly patients’ independent preferences and ensure strong physician-patient relationships in clinical decision-making are needed. To mitigate these challenges, appropriate educational programs aimed at enhancing both the quantity and quality of medical ethics education for healthcare professionals—including students, staff, and faculty—are essential. Given the significance of this issue, continuous educational programs should be developed for nurses and other healthcare professionals to familiarize them with existing ethical challenges and improve the quality of care provided to elderly patients.

Challenges of People Living with HIV in Equity Access to Health Care

Heshmatolah Heydari

Acquired Immune Deficiency Syndrome (AIDS) occurs in the final stage of infection with the Human Immunodeficiency Virus (HIV). According to the World Health Organization (WHO), approximately 39.9 million people were living with HIV worldwide as of 2024, with reported global incidence and mortality rates of 1.3 million and 630,000, respectively. In Iran, the prevalence and incidence rates of HIV are reported at 54,000 and 2,400 cases, with an annual mortality rate of 3,200. Access to healthcare is considered a primary goal of the health system, and the Universal Declaration of Human Rights recognizes the right to access health services as a common standard. However, people living with HIV, as a vulnerable group, may face barriers to accessing healthcare services. This study aims to explore the challenges faced by people living with HIV in accessing equitable healthcare. This qualitative study utilized a conventional content analysis approach, conducted between April and September 2024 in Iran. Participants included people living with HIV and healthcare providers, recruited through purposive sampling. Data were collected via 10 face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. Data analysis revealed 406 initial codes, which were then categorized based on similarities and differences into three main categories: 1) Factors related to clients (with subcategories: fear of transmitting the disease to others, poverty, physical problems, unfamiliarity with self-rights, and non-adherence to treatment regimens). 2) Factors related to the healthcare system (with subcategories: discrimination in access to health services, contemptuous attitudes from healthcare providers, incompetency of healthcare providers, fear of virus transmission, disclosure of patient information, negligence of medical centers in identifying infected people, and failure to conduct premarital tests). 3) Cultural factors (with subcategories: non-acceptance of infected people in the general culture, stigma, and discrimination in marriage and childbearing). The rights to access health services, confidentiality of information, marriage, financial protection, and participation in society should be considered essential for people living with HIV. Addressing these issues is crucial for ensuring that individuals with HIV can live with dignity and equal access to healthcare.

Moral Sensitivity Among Nurses in Cardiac Critical Care Units of Selected Hospitals Affiliated with Isfahan University of Medical Sciences in 2024

Seyed Ali Rasooli

Moral sensitivity, defined as the ability to recognize and assess the ethical complexities of clinical situations and make appropriate ethical decisions, is a crucial skill for nurses. Despite its importance, various studies report varying levels of moral sensitivity among nurses, suggesting a gap in this competency. Nurses’ continuous exposure to ethical dilemmas can lead to adverse outcomes, including psychological and moral distress, decreased job satisfaction, and compromised care quality. As moral sensitivity can differ across healthcare settings and may change over time, studies assessing its levels across different periods are essential. This study aims to assess the level of moral sensitivity among nurses in hospitals affiliated with Isfahan University of Medical Sciences in 2024. This cross-sectional descriptive study was conducted with 200 nurses working in cardiac intensive care units (CICUs) of four large hospitals affiliated with Isfahan University of Medical Sciences. Participants were selected using a random sampling method. Data were collected using a demographic information form and the Lutzen Moral Sensitivity Questionnaire. Data analysis was performed using SPSS version 26, employing descriptive statistics such as means and standard deviations. The findings revealed that the average moral sensitivity score among the nurses was moderate (60.17±13.04). When analyzing the different dimensions of moral sensitivity, the highest score was observed in the dimension of "honesty and benevolence" (15.30 ± 4.48), while the lowest score was found in the dimension of "professional knowledge" (3.25 ± 1.88). The mean scores for the remaining dimensions were as follows: "respect for patient autonomy" (7.44 ± 2.13), "awareness of how to communicate with patients" (15.18 ± 3.41), "experiencing ethical problems and dilemmas" (7.74 ± 2.03), and "applying ethical concepts in ethical decision-making" (11.95 ± 3.35). The study revealed that nurses demonstrated a moderate level of moral sensitivity, with the lowest scores in the dimension of professional knowledge. This suggests that nurses may not be sufficiently involving patients in their treatment and care decisions. Given these findings, it is critical for healthcare policymakers and nursing managers to implement continuous assessment and feedback systems to accurately evaluate nurses' moral sensitivity and professional knowledge. By identifying the weaknesses and educational needs of nurses, targeted training programs can be developed, ultimately enhancing nurses' moral sensitivity and improving the quality of care.

The Importance of Patient Autonomy in Home Care: A Systematic Review

Hedayat Jafari

With the increasing need for home nursing care, patient autonomy emerges as a crucial ethical principle in delivering care services. Therefore, this study aimed to investigate the importance of autonomy and individual independence in home-based patient care. In this systematic review, articles from PubMed, Scopus, ScienceDirect, Magiran databases, and Google Scholar search engine, published within the last 10 years, were used to search for articles related to autonomy and independence in home nursing care. The keywords used in the search were: "patient autonomy", "home nursing care", "nursing ethics" and "autonomy in nursing home care". After reviewing and filtering the articles based on the study's objectives, 20 articles related to autonomy in home nursing care were included in this systematic review. The findings of these studies indicated that various factors can influence patient autonomy at home-care, including: · Individual factors: age, gender, physical and mental health status of the patient; · Family factors: family support, family relationships, family culture; · Social factors: social support, access to social resources; · Organizational factors: care policies, organizational structure, organizational culture. Considering these findings and their comparisons, it can be concluded that to promote patient autonomy at home, all the mentioned factors should be considered. Some of the suggested solutions to promote patient autonomy are: · Educating the patient and family about patient autonomy; · Strengthening family support for the patient; · Providing social support services to the patient; · Developing care policies that support patient autonomy; · Improving organizational structure and culture. Patient autonomy is one of the essential ethical principles in home nursing care. Considering the factors affecting patient's autonomy, comprehensive solutions should be considered to promote it. Patient and family education, strengthening family support, providing social support services and improving organizational structure and culture are among the effective solutions in this field.

Ethical Considerations in Healthcare Policy-Making and National Planning: A Qualitative Study

Peyman Parvizrad

Healthcare policy-making and national planning are complex processes that require the integration of ethical principles to ensure fairness, effectiveness, and public trust. This qualitative study explores the key ethical considerations that should guide the development and implementation of healthcare policies and plans. A qualitative research design was utilized, incorporating semi-structured interviews with key stakeholders in the healthcare sector, including policymakers, healthcare providers, and patient representatives. A total of 15 interviews were conducted until data saturation was achieved. The interviews were transcribed verbatim and analyzed using thematic analysis. Thematic analysis identified seven key ethical considerations in healthcare policy-making and planning: (1) Equity and Justice – ensuring equitable access to healthcare regardless of socioeconomic status, race, or other demographic factors; (2) Autonomy and Informed Consent – respecting individual autonomy and ensuring informed decision-making in healthcare interventions; (3) Beneficence – prioritizing actions that maximize benefits and minimize harm; (4) Non-Maleficence – preventing harm to patients and communities; (5) Confidentiality and Privacy – safeguarding patient information and ensuring data protection; (6) Resource Allocation – making fair and justifiable decisions regarding the distribution of limited healthcare resources; and (7) Transparency and Accountability – promoting openness in policy decisions and ensuring accountability for outcomes. Ethical considerations play a critical role in shaping healthcare policies and national planning efforts. By integrating ethical principles into decision-making, policymakers and healthcare providers can foster policies that enhance public well-being, equity, and trust in the healthcare system. A structured ethical framework can help ensure that healthcare policies align with societal values and promote justice in health service delivery.

Nurse's Ethical Challenges During Global Crises: War and Beyond

Hedayat Jafari

Nurses are critical healthcare providers during global crises, particularly in situations of armed conflict and war, where they face unique and often overwhelming ethical challenges. These professionals are tasked with making immediate and difficult decisions under extreme conditions. This study aims to thoroughly examine the ethical challenges encountered by nurses during global crises, with a particular focus on armed conflicts and wars. This systematic review analyzed articles sourced from PubMed, Scopus, ScienceDirect, Magiran, and Google Scholar databases, using the following search terms: "nursing ethics," "war," "global crises," "ethical considerations in nursing during war," and "nursing ethics in armed conflicts." Following a thorough review and filtering process based on the study's objectives, seven articles were selected for inclusion. The findings highlight several ethical challenges faced by nurses during wartime. These challenges include: allocating limited resources under dire circumstances, providing care to both combatants and civilians without bias, maintaining patient confidentiality while cooperating with military authorities, and delivering care in hazardous and unpredictable environments. The ethical issues nurses encounter in global crises, particularly in war, include: 1) the tension between professional duty and political or military affiliations, 2) the ethical dilemma of allocating scarce resources in critical conditions, 3) the decision of which patients should be prioritized for treatment, and 4) the significant risks to life involved in providing care in conflict zones. Nursing care during global crises, especially in wartime, presents profound ethical dilemmas that demand rapid and sound decision-making. Adequate training in nursing ethics tailored to wartime conditions, as well as robust support for nurses in these high-pressure environments, are critical to addressing these challenges effectively.

Nursing Ethics in the Care of Elderly Patients: A Review of Challenges and Solutions

Negin Farid

As the global elderly population continues to rise, nursing care for this demographic faces increasing ethical challenges. The elderly are particularly vulnerable, requiring specialized care that addresses their physical, psychological, and social needs. However, these needs often present ethical dilemmas, including issues related to autonomy, informed consent, fairness in resource allocation, and managing conflicts between patients and their families. This systematic review aims to identify the ethical challenges nurses face in caring for elderly patients and to propose solutions that enhance the quality of care. A comprehensive search was conducted across several reputable databases, including PubMed, Scopus, CINAHL, and Google Scholar, using keywords such as "nursing ethics", "elderly", "ethical challenges", and "ethical care". Articles published between 2010 and 2023 in English and Persian were considered for inclusion. After an initial screening, 40 eligible articles were selected for final analysis, and thematic analysis was used to interpret the data. The findings reveal several key ethical challenges for nurses in elderly care, including respecting patient autonomy, navigating decision-making processes in cases of cognitive decline, ensuring confidentiality, and managing family pressures. Additional difficulties include resource shortages, high workload, and limited access to ethics training. Proposed solutions to address these challenges include continuous ethics education, the development of comprehensive ethics protocols, and the formation of interdisciplinary teams to facilitate more informed decision-making. Addressing ethical challenges in elderly care requires robust planning and action from health systems. By establishing clear ethical guidelines, promoting ongoing education, and fostering a supportive work environment, the quality of care for elderly patients can be significantly improved. Further research should evaluate the effectiveness of these strategies in mitigating ethical issues within nursing practice.

Ethical Challenges of Nurses in Caring for Patients with Chronic Mental Illness

Negin Farid

Nurses, as key members of the healthcare team, face complex ethical issues when caring for patients with chronic mental illnesses. These challenges include maintaining confidentiality, obtaining informed consent from patients with limited cognitive abilities, managing conflicts between patient rights and safety requirements, and addressing social stigma. Inadequate attention to these challenges may lead to reduced care quality and psychological stress for nurses. A better understanding of these challenges and the provision of appropriate solutions is essential. This study was conducted through a simple review approach. A comprehensive search was first conducted in PubMed, Scopus, PsycINFO, and Google Scholar databases. Combined keywords such as "ethical challenges," "nursing," "chronic mental illness patients," and "ethical care" were used. Inclusion criteria included studies published in English and Persian from 2010 to 2023, including research, review, and qualitative articles related to the topic. A total of 150 articles were identified, and after evaluating their quality and relevance, 30 articles were selected for final analysis. Data were analyzed using thematic and comparative analysis methods. The findings revealed that nurses face multiple challenges, including maintaining confidentiality when interacting with families, obtaining informed consent from patients with cognitive disorders, and managing ethical conflicts between patient safety and individual freedom. Additionally, a lack of specialized ethical training, the absence of clear protocols, and the pressure from the social stigma of patients were identified as key challenges. The ethical challenges faced by nurses in caring for patients with chronic mental illness require special attention from relevant organizations. Providing continuous education, developing ethical guidelines, and creating psychological and legal support can help mitigate these challenges. Further studies on practical, experience-based solutions to address these issues are recommended.

Barriers to Reporting Medication Errors Among Nurses in Iran: A Narrative Review

Faezeh Rostamian

Reporting medication errors is essential for improving patient safety and enhancing the quality of nursing care. By identifying and reducing medical and treatment errors, reporting helps foster better care practices. However, various barriers prevent nurses from reporting errors, allowing mistakes to persist in clinical environments. This study aims to identify the barriers to medication error reporting among nurses in Iran through a narrative review. This narrative review involved searching articles from several databases, including ScienceDirect, PubMed, SID, Scopus, CINAHL, Magiran, and Google Scholar, using keywords such as "nurses," "barriers to reporting," "causes of non-reporting," "medication errors," "drug mistakes," "Iran," and their English equivalents. Research articles in both Persian and English, published between 2011 and 2024, which focused on barriers to medication error reporting among nurses in Iran and offered full-text access, were selected for review. Initially, 67 articles were identified. After reviewing the titles, abstracts, and in some cases, full texts, 23 articles were selected and analyzed based on their alignment with the research aim. The review revealed that barriers to reporting medication errors among nurses in Iran are influenced by individual, organizational, and cultural factors. Individual barriers include fear of legal and professional consequences, concerns about negative impacts on performance evaluations, and fear of being labeled incompetent. Organizational barriers consist of workload pressures, lack of time, inefficient reporting systems, and a lack of support from managers and colleagues. Additionally, a weak safety culture in hospitals and insufficient training on the importance of error reporting further hinder the reporting process. The findings of this study indicate that barriers to reporting medication errors among nurses in Iran are primarily due to individual, organizational, and cultural factors. To address these barriers, it is crucial for hospital administrators and healthcare system officials to provide appropriate training and foster a supportive environment that encourages error reporting. Regular training sessions, coupled with positive, non-judgmental feedback on error reporting, can enhance nurses' trust in the reporting system. Strengthening reporting systems and cultivating a safety culture with active involvement from both nurses and administrators will not only improve the quality of nursing care but also reduce medication errors.

Home-Based Care Ethical Issues and Solutions: A Review Study

Shima Yadegar Tirandaz

In recent decades, care delivery has shifted from hospital settings to community and home-based care due to factors such as an aging population, cost control, patient preferences, and advancements in technology. While home care offers advantages like patient independence and care aligned with individual values, it also presents unique ethical challenges. These challenges arise from the home environment, which may not be designed for medical care, as well as potential conflicts between the values of patients and care providers. This study aims to explore the ethical issues in home-based care and propose solutions. This review was conducted by analyzing original articles from PubMed, Scopus, WOS, and Google Scholar, using the keywords "Home-Based Care" and "Ethical Issues" until November 2024. A total of 10 studies relevant to the study’s focus were included. The studies identified several ethical challenges in home-based care, including: respecting patient autonomy, establishing trust, managing patient resistance to care, balancing autonomy with benevolence, the risk of harm, justice concerns, limited resources, managing patient expectations, decision-making capacity, disagreements on treatment, access to healthcare providers, caregiver roles, maintaining professional relationships, providing truthful information, conflicts between families and patients, self-medication, medication access, sudden changes in condition, care coordination issues, inadequate treatment due to resource limitations, insufficient psychosocial support, life-saving decisions, communication problems, ineffective care, and cultural conflicts. To address these challenges, the following solutions were proposed: respecting patient values, beliefs, and preferences; supporting patient rights in family conflicts; promoting independence; building trust through respectful communication, empathy, and encouragement; ensuring patient dignity; maintaining healthcare workers' moral obligations; avoiding coercion; adhering to legal and ethical principles; facilitating patient participation; reducing caregiver burden; providing adequate resources; and educating and guiding patients and families. Ethical challenges are inherent in home-based care. If not properly identified and managed, these issues can negatively impact the quality of care. Home care organizations and providers must implement ethical strategies to uphold patients' independence and dignity within their home environment.

Strategies for the Promotion and Development of Socio-Cultural Indicators Affecting Professional Commitment in Nursing Students

Mandana Arash

Professional commitment is a key indicator of success in the nursing profession. Nursing schools play a critical role in fostering this commitment by instilling the values and responsibilities associated with the profession. Developing a culture of commitment and integrating it as a societal value is essential for cultivating professional behavior in students. This study aimed to identify strategies for enhancing and developing socio-cultural factors that influence professional commitment among nursing students. This applied research employed a qualitative approach. Twenty professional experts were selected through purposive sampling in 2021. Data were collected using semi-structured interviews, guided by the principle of theoretical saturation, and analyzed using content analysis. Six major components were identified as influential strategies: 1. Participation of communication media in the cultural and scientific advancement of the profession; 2. Attention to cultural differences between universities and healthcare centers; 3. Promotion of a culture of commitment in universities and clinical settings; 4. Attention to the alignment between individual culture and professional culture; 5. Attention to ensuring the profession benefits from social support; 6. Attention to the promotion of a culture of work and effort in society. These components were reflected in 20 specific indicators, including: raising awareness, instilling a sense of need, fostering concern among academic communities, educating nurses, resolving cultural conflicts, creating conducive educational environments, employing committed faculty, embedding commitment in the culture and as a duty, aligning individual and professional cultures, promoting social prestige and recognition of the profession, addressing local cultural aspects and gender roles, and enhancing flexibility and participation in social interactions.
The development of professional commitment in nursing students can be significantly enhanced through the promotion of ethical and professional principles and the establishment of a supportive socio-cultural environment. Embedding professional commitment within cultural frameworks contributes to students’ sense of responsibility and its sustainability in professional practice.

Relationship Between Moral Reasoning and the Quality of Care of Nurses Affiliated with Yasuj University of Medical Sciences in 2024

Milad Amiri

The nursing profession has a moral nature. Explaining and clarifying the role of moral reasoning in the quality of nursing care in nurses helps improve the quality of services in the treatment system and, as a result, increases the satisfaction of patients. This study aimed to determine the relationship between moral reasoning and the quality of nursing care in nurses affiliated with Yasuj University of Medical Science in 2024. The present study is cross-sectional and correlational, which was conducted on 187 nurses working in the clinical departments of Shahid Jalil, Shahid Beheshti and Imam Sajjad hospitals in Yasuj City in 2024. Participants were selected using systematic random sampling. Questionnaires of nursing ethical dilemmas and the quality of nursing care were used to collect information. T-test, one-way analysis of variance (Bonferroni post hoc test), and linear regression were used. Data analysis was done using SPSS 26 software. In this study, the mean and standard deviation of moral reasoning and quality of nursing care are 38.86 ± 5.39 and 199.34 ± 18.83, respectively. These results indicate the average level of moral reasoning and the desired level of nursing care quality. Also, the results of the study showed that there is a significant and positive relationship between moral reasoning and the quality of nurses' care (p = 0.01 and r = 0.188). On the other hand, with the increase in familiarity with ethical challenges and problems, the quality of nursing is decreased (p=0.007 and r=0.188) The findings of this study showed that nurses' moral reasoning is positively and significantly related to the quality of nursing care. This shows that nurses' ability to analyze and solve ethical issues can lead to providing better and more responsible care. However, reducing the quality of care by increasing nurses' awareness of ethical dilemmas highlights an important challenge. This may be due to the complexities involved in ethical decision-making, conflicts in the workplace, or the pressures of dealing with ethically difficult situations. Based on this, it is suggested to design and implement educational and support programs to strengthen the moral and psychological skills of nurses to prevent the negative effects of awareness of moral dilemmas on the quality of care and at the same time strengthen their moral reasoning.

The Effect of Spiritual Intelligence Training on Nurses' Spiritual Care Competency in Patient Care: A Review Study

Fatemeh Mahboob Bashari

Spiritual intelligence, defined as the capacity to effectively utilize religious and spiritual resources, plays a crucial role in providing high-quality nursing care. This study aimed to investigate the effect of spiritual intelligence training on nurses' competency in caring for patients. This review study utilized a comprehensive search strategy, including Persian and English keywords (Spirituality, Spiritual Intelligence, Spiritual Care, and Nursing) within the PubMed, Scopus, Google Scholar, and SID databases, covering the period from 2017 to 2023. A total of 21 full-text articles (in English and Persian) were selected and analyzed. The findings revealed that 45% of the nurses assessed exhibited below-average levels of spiritual care competency. Most studies demonstrated a significant positive correlation between spiritual intelligence and nurses' competence in providing spiritual care. Spiritual intelligence fostered the development of nurses' beliefs, personality traits, and a strong desire for personal and professional growth, ultimately enhancing the quality of nursing care. Furthermore, male gender, place of residence, and religious adherence emerged as predictors of nurses' spiritual care competency. Studies consistently highlighted the increased importance of spiritual dimensions during illness and hospitalization, emphasizing the critical need for nurses to provide comprehensive spiritual care.Based on this review, it is evident that ethical challenges exist within nursing care, and some nurses may not adequately address the spiritual needs of their patients. Therefore, promoting spirituality in nursing care through spiritual intelligence training is essential to enhance the quality of nursing practice.

Attitudes Towards Euthanasia Among Intensive Care Nurses

Reza Shabanloei

Euthanasia, often referred to as mercy killing or an "easy death," remains a deeply controversial issue, particularly in Islamic countries where it is both ethically and legally prohibited. Nurses working in intensive care units (ICUs) are more likely than other healthcare professionals to encounter situations related to end-of-life care, given the critical condition of the patients they serve. Consequently, their attitudes toward euthanasia hold significant ethical and professional implications. This descriptive-analytical study was conducted to explore the attitudes of ICU nurses toward euthanasia in a context where it is culturally and legally forbidden. A total of 194 nurses from eight hospitals affiliated with Tabriz University of Medical Sciences participated. Data collection instruments included a demographic questionnaire and Holloway’s Attitudes Toward Euthanasia Scale. Data were analyzed using descriptive statistics, t-tests, and ANOVA. The mean attitude score towards euthanasia was 71.95 ± 4.99 out of a possible 120. Overall, 74% of participants scored below 75, reflecting a generally negative attitude toward euthanasia, while 26% scored above 75, indicating a more favorable view. No statistically significant association was found between attitudes toward euthanasia and any demographic variables (p ≥ 0.05). Despite the legal and religious restrictions against euthanasia in Iran, a portion of ICU nurses demonstrated a positive attitude toward the practice. Given the potential impact of these attitudes on patient care, nursing managers and educational authorities should address even minimal levels of support for euthanasia. Targeted training and ethical guidance are essential to ensure that patient care remains aligned with legal and moral standards, particularly in ethically sensitive clinical situations.

Investigating the Ethical Challenges of Nurses in End-of-Life Care at Home for Elderly Patients: A Review Study

Zahra Maddah

With the increasing elderly population and the growing demand for home healthcare and end-of-life care services, nurses are facing expanded duties and responsibilities. This intensification of responsibilities can expose them to significant ethical challenges. This study aimed to investigate the ethical issues nurses encounter in providing end-of-life care at home for elderly patients. This review study involved a comprehensive search of databases including PubMed (Medline), Google Scholar, ISI Scopus, ProQuest, Science Direct, SID, IranDoc, IranMedex, and Magiran. The keywords used were: nursing ethics, ethical challenges, end-of-life care, and home care, along with their Persian equivalents. The search covered literature published between 2000 and 2024. The review identified several prominent ethical challenges faced by nurses in home-based end-of-life care, including: lack of attention to patients’ rights and independence, disrespect for the dignity of elderly patients, inadequate empathetic care, poor communication, and unsafe home environments for nurses. These challenges may lead to moral distress, as well as psychological and emotional consequences for both the care providers and the elderly patients. Given the serious ethical challenges nurses face in end-of-life home care for the elderly, it is essential for them to be well-versed in ethical principles relevant to this context. Enhancing awareness and competence in ethical practices can help nurses uphold patient rights, promote autonomy, and provide high-quality, compassionate care through effective communication and support.

Ethical Challenges of Artificial Intelligence in Academic Writing and Dissemination

Mohammadreza Dinmohammadi

In recent years, artificial intelligence (AI) has significantly impacted the publication of research articles, transforming the landscape of academic writing and dissemination. However, the integration of AI in this process presents significant ethical challenges that require careful consideration. This review study utilized a comprehensive search strategy, employing keywords such as "artificial intelligence," "publication ethics," "ethical challenges," "academic integrity," and "research dissemination" to identify relevant articles in scientific databases including PubMed, Scopus, CINAHL, and Google Scholar. The search included articles published between 2010 and 2024 in both English and Persian. Research articles, systematic reviews, and case reports that included the specified keywords in their titles and abstracts were selected. A total of 150 articles were screened, and 50 relevant studies were included for detailed analysis. The analysis identified several ethical challenges associated with the use of AI in academic publishing. Concerns regarding academic integrity are paramount, as AI-generated content can blur the lines between original research and automated writing, raising concerns about authorship and plagiarism. Furthermore, the reliance on AI tools for data analysis and manuscript preparation can raise questions about the accuracy and validity of research findings. additionally, the potential for bias embedded within AI algorithms is a significant concern, as it can influence the selection of research topics, the framing of research questions, and even the peer review process. The lack of transparency in AI-driven editorial processes can further undermine trust in academic publishing. This review underscores the urgent need for robust ethical frameworks and regulations to guide the responsible use of AI in academic publishing. Increased awareness and training among researchers and editors regarding the ethical implications of AI are crucial. Interdisciplinary collaborations are essential to address these challenges effectively and ensure the integrity and trustworthiness of academic research in the AI era.

Ethical Considerations in Televisits: A Framework for Safe and Effective Implementation

Fatemeh Rahimi

Televisits offer significant potential for enhancing healthcare accessibility, reducing costs, and improving patient satisfaction. However, their effective implementation requires careful consideration of ethical principles to ensure patient safety, privacy, and quality of care. This paper examines key ethical considerations for televisit implementation across three stages: pre-visit, during-visit, and post-visit. Pre-visit considerations include careful patient selection to ensure suitability for remote care, establishing a strong physician-patient relationship based on trust and obtaining informed consent, and demonstrating cultural sensitivity and inter-professional coordination. During the televisit, optimal technical conditions are critical, including reliable internet connectivity, high-quality audio-visual equipment, and a conducive physical environment. Comprehensive and transparent documentation of the televisit encounter is essential. Post-visit considerations include evaluating patient experiences, addressing any identified issues, and ensuring timely follow-up for continuous quality improvement. Ethical considerations extend beyond the clinical encounter. Addressing technical challenges such as data security, privacy breaches, and equitable access for all populations, including those with disabilities, is crucial. Transparent reimbursement mechanisms and ongoing education for both patients and healthcare providers are essential for successful televisit integration. The successful implementation of televisits requires a multi-faceted approach that addresses ethical considerations at all stages. Developing comprehensive guidelines, adhering to international standards, and establishing robust oversight mechanisms are essential for ensuring the safe, effective, and equitable utilization of this innovative technology in healthcare delivery.

Assessment of Compliance with the Patients’ Rights Charter by Healthcare Staff from the Perspective of Hospitalized Patients in Shahid Rahnemoon Hospital, Yazd

Elahe Rahmani Samani

An efficient healthcare system relies on active participation and a strong relationship between healthcare providers and recipients. Observing the Patients’ Rights Charter is an essential aspect of delivering high-quality healthcare services. However, the existence, formulation, and dissemination of the charter do not ensure its implementation and compliance. Therefore, evaluating adherence to the charter is critical. This study aimed to assess compliance with the Patients’ Rights Charter at Shahid Rahnemoon Hospital, Yazd. This applied, descriptive-analytical study was conducted cross-sectionally at Shahid Rahnemoon Hospital, Yazd, in 2024. The study population included all hospitalized patients in the hospital. Cluster random sampling was used, and a standardized questionnaire developed by Parsapour et al. measured adherence to the Patients’ Rights Charter. Data analysis was performed using the Mann-Whitney and Kruskal-Wallis tests via SPSS software version 26. The findings revealed that patients perceived an average level of adherence to the Patients’ Rights Charter in Shahid Rahnemoon Hospital (mean ± SD: 53.99 ± 11.10). The highest compliance was observed in the domain of respect for patients and protection of privacy (mean ± SD: 78.12 ± 2.65), whereas the lowest compliance was reported for the existence of a complaint resolution system (mean ± SD: 2.97 ± 1.74). Patient satisfaction, a vital indicator of healthcare quality, is closely linked to the observance of patients’ rights. To improve compliance, it is recommended to:
1. Raise staff awareness about the importance of adhering to patients’ rights.
2. Educate patients about their rights through staff training and media campaigns.
3. Develop plans by hospital management to address areas of non-compliance.
4. Foster greater collaboration between staff and patients.
5. Follow up on violations of patients’ rights and implement legal measures to ensure compliance.
6. Regularly monitor adherence to patients’ rights to enhance patient satisfaction and staff commitment to ethical practices.

Evaluation of Participants' Awareness of Informed Consent Forms in Clinical Trials at Iran University of Medical Sciences in 2020

Saeedeh Saeedi Tehrani

Obtaining informed consent is a fundamental ethical and legal right of participants in clinical trials. It ensures that individuals are adequately informed about the research, including its nature, potential risks and benefits, and their role in the study. This knowledge empowers participants to make informed decisions about their involvement. This study aimed to evaluate the awareness of participants regarding the information provided in informed consent forms (ICFs) for clinical trials conducted at Iran University of Medical Sciences (IUMS) in 2020. This study evaluated the accuracy of the content of ICFs of registered clinical trials and assessed participants' understanding of the information presented. ICFs were reviewed using a ministerial checklist. Participants were subsequently contacted to assess their comprehension of key aspects of the trial as outlined in the ICF. Analysis revealed a discrepancy between the information presented in the ICFs and participants' actual understanding. Despite adequate coverage of certain aspects, such as the research nature of the interventions (98.2%) and the mention of specific benefits (92.7%), significant gaps were observed in participants' comprehension of crucial information. Notably, lower levels of understanding were observed regarding the possibility of invasive interventions (25.7%), the random assignment of participants to study groups and the potential use of placebos (44%), and the possibility of not personally benefiting from the research outcomes (44%). Additionally, only 47.7% of participants reported understanding the confidentiality of their information. These findings highlight the need for improvements in the process of obtaining informed consent. While researchers may adequately address the overall research objectives and potential benefits, crucial aspects such as the potential for invasiveness, randomization procedures, and the possibility of no direct personal benefit may not be adequately communicated to participants. Enhancing participant understanding of these critical aspects is crucial for ensuring truly informed consent and upholding ethical research practices.

Research Misconduct Cases Reviewed by the National Committee for Ethics in Biomedical Research of Iran

Ehsan Shamsi Gooshki

Research misconduct cases reviewed by ethics committees serve as a valuable source of data for managing potential future misconduct. This study examines the reported cases within closed research misconduct files of the National Committee for Ethics in Biomedical Research of Iran, aiming to identify common manifestations of misconduct and influential factors across various activities within the research system. Documentation from 100 closed cases reviewed by the National Committee for Ethics in Biomedical Research during 2016 and 2017 was analyzed. A documentary research method and qualitative content analysis were employed. Using a directional analysis approach, the manifestations and factors contributing to misconduct in each case were extracted and categorized. Subsequently, causal relationships between the reported factors were defined. Twenty-one manifestations of research misconduct were identified, most of which involved undesirable micro-level activities, particularly the failure to adhere to ethical standards in research publication. Although negative impacts were observed at the meso level, including issues with research oversight, training in research standards and skills, journal management structures, and administrative and financial structures within universities, macro-level activities and deficiencies in research system performance—such as inadequate investment and financial resource allocation—were not addressed. Twelve causal relationships contributing to research misconduct were identified, highlighting how inadequate performance across different levels of the research system—including administrative structures for research approval and funding, research infrastructure, research evaluation, training, journal management, and oversight mechanisms—can interact and exacerbate misconduct. A key finding was the insufficient reporting of reasons for research misconduct in case documentation. Ethics committees appear to lack significant focus on analyzing the underlying causes of misconduct. Detailed and precise reporting of misconduct reasons, alongside independent studies, would provide decision-makers with valuable insights for preventing future occurrences.

Ethical Challenges of Truth-Telling for Terminally Ill Patient

Neda Yavari

Communicating the truth about a terminally ill patient’s diagnosis and prognosis is a profound ethical challenge in healthcare. While patients have the right to know the details of their medical condition, grounded in the ethical principle of autonomy, healthcare providers often grapple with concerns about causing distress or hopelessness. These concerns sometimes lead to paternalistic approaches where information is either manipulated or withheld from patients in end-of-life stages. Research on the timing, method, and extent of information sharing with terminally ill patients has yet to reach a consensus. The challenge is further complicated by cultural differences regarding death, as well as varying family and social dynamics. This article explores the views and experiences of both healthcare providers and patients regarding the ethical challenges associated with truth-telling in end-of-life care. This qualitative study involved semi-structured, in-depth interviews with 27 healthcare providers, 20 patients, and 15 caregivers. Participants were selected through purposive sampling, and interviews were conducted until data saturation was achieved. The data were analyzed using conventional content analysis. The findings were organized into four key themes:
1.Diverse methods of truth-telling employed by healthcare providers, influenced by personal values, institutional policies, and cultural contexts.
2.Patients’ and families’ preferences for receiving information, which frequently conflicted with healthcare providers’ practices.
3.The impact of timing, manner, and setting of truth-telling on the emotional health of both patients and their families.
4.The necessity for a patient-centered approach that acknowledges the unique circumstances, values, and preferences of patients and their families.
This research highlights the ethical complexities involved in truth-telling for terminally ill patients. While respecting patient autonomy is fundamental, the manner and timing of delivering the truth are crucial to maintaining trust in the physician-patient relationship and safeguarding the patient’s mental health. Further research should focus on developing effective communication strategies and support systems for healthcare providers engaged in end-of-life care. Educational programs should prioritize improving communication skills, cultural sensitivity, and ethical decision-making to enhance best practices and alleviate the emotional challenges faced by healthcare professionals in this sensitive area.

The Effect of Using Student Reflective Narratives to Observe Dignity and Respect for Patients’ Rights in Clinical Education

Hoda Ahmari Tehran

Research shows that stress in medical students leads to burnout and a loss of respect for patients’ rights. These declines in mood and an increase in malpractice are particularly evident during the internship period. On the other hand, literature highlights the importance of reflective practice in education. This study investigates the effect of using student reflective narratives on observing dignity and respect for patients’ rights in clinical education. A mixed-methods study based on reflective learning theories (Gibbs' Reflective Model) was conducted over 12 months with 48 intern students. In a quasi-experimental design, 38 medical students were randomly assigned to either an intervention or a control group. Only students in the intervention group were allowed to engage in conversations with patients and inquire whether they had properly respected the patients’ rights and dignity. The students then reflected on their performances. In the first week, a pretest was conducted in both groups. The intervention group received reflective education and participated in reflection writing during the second and third weeks. In the final week, a post-test was conducted for both groups. To explore students’ perceptions of the effectiveness of reflecting on their performance, a qualitative content analysis was carried out, including 12 semi-structured interviews and 144 reflection notes. The mean scores of students’ performance regarding respect for patients in the intervention group improved significantly in the post-test (12.32 ± 1.21) compared to the pretest (9.85 ± 1.39) (p < 0.05). An independent t-test indicated that the difference in post-test scores between the two groups was significant (p = 0.01). From the interviews, four main themes emerged: improving empathy and understanding patients’ feelings, paying attention to patients’ humanistic dimensions, respecting patients’ autonomy and rights, and promoting interpersonal communication skills. This study demonstrated the positive emotional effects of reflective narrative writing interventions on medical students in observing dignity and respecting patients' rights. It is recommended to incorporate reflective narratives into medical education programs to enhance these qualities.

The Necessity of Social Solidarity and Sustainability Principles in Health System Programs

Mehran Seif-Farshad

Health care services, in addition to being recognized as fundamental rights in various global human rights declarations, play a crucial role in advancing the development of human societies. The four principles of biomedical ethics introduced by Beauchamp and Childress—autonomy, non-maleficence, beneficence, and justice—are pivotal for ethical analysis and decision-making. However, certain other dimensions, which may not be explicitly addressed within these principles, are essential for policymaking at both macro and micro levels in health care. Two such important principles are social solidarity and sustainability, both of which hold a prominent position in health systems planning. The principle of social solidarity refers to the ways in which unity, cohesion, and collaboration are fostered within a community. A socially cohesive society embraces cultural diversity, respects human rights and the rule of law, and demonstrates a shared commitment to social order and collective responsibility. Social solidarity can significantly reduce health risks by creating a strong societal framework where cooperative efforts foster conditions for well-being, minimizing disability and disease. On the other hand, a health care system is fundamentally responsible for establishing and maintaining a sustainable and high-quality care environment. Sustainability in health services is achieved when ethical obligations—such as maximizing possible benefits, balancing risks against benefits, ensuring fairness (including for future generations), and respecting public rights—are prioritized. Continuity of health care ensures better coordination and improved delivery of services. Disruptions in health policies or intermittent provision of health services can severely undermine public trust. A conceptual understanding of sustainability and continuity in public health ethics is crucial, as these principles ensure that health policies, programs, and services enable access to the highest attainable standard of health, free from economic, social, or political instability. However, sustainability should not imply stagnation; services must remain responsive to the evolving needs of populations and societies. Ignoring these two principles in health policymaking and program design can seriously erode public trust and ultimately harm individual and Health system planning, should be changed to Health care programs.

Moral Sensitivity in Psychiatric Nurses: A Qualitative Content Analysis

Mohammad Javad Hosseinabadi ‑Farahani

Moral sensitivity is a fundamental characteristic of professional ethics in nursing, significantly influencing patient care. This qualitative study aimed to explore the concept of moral sensitivity among psychiatric nurses. The study employed a qualitative approach using content analysis. Participants included 15 psychiatric nurses working at Razi Psychiatric Hospital in Iran, selected through purposive sampling based on defined inclusion and exclusion criteria. After obtaining ethical approval, data were collected through semi-structured, in-depth interviews. The interviews were audio-recorded, transcribed, and managed using MAXQDA software. Data analysis was conducted following Granheim and Lundman’s five-step method (2004), and the trustworthiness of the findings was ensured using Guba and Lincoln’s criteria. The findings revealed three main categories and six subcategories:

Ethical Knowledge (comprising clinical experience and education, and professional development).
Ethical and Legal Conflicts (including discrepancies between ethical principles and legal frameworks, and challenges in ethical decision-making within complex legal situations).
Ethical Atmosphere (encompassing individual ethics and organizational ethics).

Based on these findings, it is recommended that these insights be integrated into nursing education, research, and management to enhance care for patients with psychiatric disorders.

Challenges of Human Resource Allocation in the Health System

Kourosh Delpasand

All health systems face the dual challenge of resource shortages, which prevent them from providing all the services needed by society, while also striving to enhance justice in access to health services and care. The prioritization and allocation of resources are critical issues in the health sector, and ensuring fairness in these processes requires consideration of various criteria. This study aims to examine the methods of allocating human resources in the health sector and explain the challenges associated with allocating skilled human resources in the country. This qualitative study involved faculty members and individuals with a history of responsibility in the university. Data collection was conducted through interviews, which were arranged based on mutual agreement with participants. Interviews continued until saturation was reached, meaning they concluded when participants had no further information to provide and the interviewer had no additional questions aligned with the research objectives. The findings were categorized as follows:

Prioritization Issues: The prioritization of resources is often directed towards newly established departments and hospitals, and personnel are allocated to new branches to launch new fields. The definition of processes important to the Ministry of Health is based on specific provincial conditions, which may not be included in standard lists. Prioritization should, therefore, be determined based on relevant indicators and the performance of personnel.
Organizational Challenges: Organizational charts are outdated, and organizational structures are often unresponsive. Recruitment is based on obsolete charts, and there are discrepancies between created positions and the personnel recruited to fill them. Political influences, such as deception and hypocrisy, also complicate the allocation process.

Population Considerations: The floating population of each province must be considered in resource allocation. The periodic involvement of some individuals as companions and contract personnel in advisory roles alongside university presidents poses challenges. A gradual approach with well-defined management and realistic goals should be implemented over a five-year period.

Management and Decision-Making: Human resource managers in universities lack decision-making authority. A national team of managers, specialists, and experts should be formed to address human resources needs. Human resources should be identified based on the estimated needs of existing fields. It is also essential to establish efficiency measurement frameworks grounded in relationships, but the Ministry of Health lacks specific notifications regarding these matters. Efficiency should be measured based on personnel performance and appropriately defined indicators.
Emerging Challenges: The migration of specialists in various fields, combined with reluctance among doctors to pursue specialist-level studies in areas such as emergency medicine and pediatrics, further exacerbates human resource allocation challenges. Adding specialist experts and evaluating personnel before hiring are essential measures to address this issue. Additionally, consideration should be given to restructuring the Ministry of Health by dividing it into separate sub-units with distinct financial and management mechanisms.

This study identifies and extracts the criteria used for prioritizing and allocating resources within the health system. According to experts and policymakers in health and medical organizations, additional criteria should be considered beyond traditional metrics when prioritizing and allocating human resources.

Cutting the Financial Relationship Between Doctor and Patient: A Key Solution to Health Ethics Challenges

Mohsen Rezaei Adaryani

The relationship between healthcare providers and patients is often marred by financial issues, which present significant ethical challenges. These financial interactions can be categorized into direct and indirect communications, both of which give rise to various ethical dilemmas. In direct financial communication, issues such as under-the-table payments, fee splitting, self-referral, inappropriate referrals, induced demand, and unnecessary surgeries or hospitalizations are prevalent. These practices compromise the ethical standards of medical care. On the other hand, indirect financial communication occurs when a small portion of the healthcare cost is paid by the patient, while the majority is covered by intermediary institutions like insurance companies or the Ministry of Health. The family physician system, with accurate patient referrals and cost management, supports this model. Under such a system, service tariffs align with actual costs, creating "real" tariffs, and reducing opportunities for many ethical challenges to arise. The current health system provides practical examples of the disconnection of financial relationships, notably through policies such as the Accident Insurance Law (Article 92 of the Fourth Development Plan) and the family physician system within the Imam’s Relief Committee. Health centers involved in treating injured patients and staffed with experienced personnel have observed and reported significant improvements following the implementation of the Accident Insurance Law, highlighting the positive impact of financial disconnection on healthcare ethics. This study demonstrates that cutting financial ties between doctors and patients, through indirect financial communication models and accurate referral systems, is an effective solution to addressing a wide range of ethical challenges in healthcare.

COVID-19: An Opportunity to Restore Lost Trust? A Narrative Review of Trust Trends Before and After the Pandemic

Hanieh Karimi

Trust between doctors and patients is a cornerstone of improved health outcomes and quality medical care. However, this trust has eroded in recent decades due to various factors. The global crisis of the COVID-19 pandemic presents a unique opportunity to examine and analyze changes in public trust towards the healthcare system. This narrative review explores the state of public trust in healthcare before and after the COVID-19 pandemic, analyzing the factors influencing this trust and proposing strategies for its maintenance and rebuilding. A narrative review was conducted, with information gathered from searches in reputable national and international scientific databases like PubMed, ScienceDirect, Springer, and Scopus. Relevant articles from Iranian databases such as Magiran and IranMedex were also included. The review focused on the components of trust, factors affecting it, and challenges faced by the healthcare system during the pandemic. The review revealed significant changes in the components of trust in doctor-patient relationships due to the COVID-19 pandemic. Prior to the pandemic, public trust in physicians had been declining due to factors such as perceived inequities in treatment, medical errors, and unprofessional behavior by some healthcare professionals. For example, surveys indicate a decline in public trust in healthcare professionals in the United States, dropping from 73% in 1966 to 34% in 2012. The COVID-19 pandemic significantly exacerbated this decline, with many people distrusting governmental institutions, pharmaceutical companies, and media outlets perceived to be providing misleading information. A study in Poland found that 31% of respondents viewed the pandemic as an exaggerated threat, while 3% considered it entirely fictional. However, the dedicated service and transparent communication of some institutions and healthcare personnel during the COVID-19 crisis partially restored public trust. This led to the emergence of a concept known as "dual trust," where people not only trust individual physicians but also pay closer attention to the overall performance of the healthcare system and governments. Dual trust has implications not only for the quality of healthcare services but also for the success of prevention and treatment programs. The COVID-19 crisis has had a profound impact on public trust in the healthcare system. To maintain and rebuild this trust, effective measures are essential. These measures should focus on enhancing service quality, fostering scientifically informed citizens, ensuring transparent communication, and promoting positive interactions between doctors and patients.

An Islamic Bioethics Framework for Decision-Making on the Life Support of Periviable Newborns

Forouzan Akrami

For many years, the question of whether or not to resuscitate periviable newborns has been a topic of debate among perinatologists, neonatologists, and ethicists. Unlike other studies that focus on the value and sanctity of human life during intrauterine development, the present study seeks to address the ethical question of what constitutes the right decision regarding life-support measures for newborns born at peri-viability ages, within the ethical norms of the Islamic tradition. This study assumes the inherent value of every moment of human life and acknowledges the human dignity of individuals from the time of conception. This multi-method study was conducted in three parts: (1) a review of the ethical frameworks presented for supporting the lives of periviable newborns, (2) an explanation of the principles of Islamic bioethics based on common Sunni and Shiite sources, and (3) the development of an Islamic bioethics framework. According to the ethical principles of the Islamic tradition—contrary to secular biomedical ethics—first and foremost, efforts should be made to preserve and prolong the life of periviable newborns regardless of their anticipated quality of life. Second, in decisions involving life and death, the priority is not the preferences of the infant's parents but rather the saving of the infant's life and its preservation by the physician and medical team. Nonetheless, parental participation in the decision-making process is essential. Preserving life, however, is not an absolute obligation; the aim of life-support measures is not merely to extend the infant's life for a short period but to do so in proportion to the prognosis and expected benefits. Specifically, these measures should be considered when there is a significant probability of the newborn’s survival. This requires a case-by-case assessment of risks, taking into account the newborn’s clinical condition, as well as regional resources and conditions. It is recommended to use the proposed Islamic bioethical framework to develop a clinical guideline that includes criteria for classifying infants born at the edge of viability based on their clinical condition. Ethical decisions to intervene should then be based on the infant's clinical state, probability of survival, and the resources available in the region.

Promoting Ethical Motivation in Health Care Organizations: Ethical Accreditation of Healthcare Service Facilities: A Review Study

Seyed Ali Enjoo

Organizational ethics in healthcare literature encompasses a set of complex and interrelated topics. It is regarded as the frontier of medical ethics or the next stage in the evolution of bioethics. To effectively address organizational ethical issues within healthcare organizations, it is crucial to understand both the similarities and differences between competing concepts. Moreover, the presence of financial and contractual concerns often makes it challenging to motivate managers to enhance the ethical climate of their organizations. This study aims to develop a deeper and more comprehensive understanding of organizational ethics in the healthcare system. This review study involved a comprehensive search of the literature on healthcare system ethics, utilizing the following databases: PubMed, Scopus, Web of Science, and CINAHL. Additionally, grey literature from published books on Healthcare Organization Ethics and websites of organizations such as JCAHO and VBN were also included. The search strategy employed a combination of keywords such as 'health ethics,' 'organizational ethics,' 'health organizations,' 'ethical decision-making,' 'manager motivation,' and 'CEO incentives.' Only English-language sources with accessible full-texts were considered. All search results were reviewed, and duplicates were removed. This study offers a comprehensive overview of the existing literature on organizational ethics in healthcare, providing a detailed map of key texts in the field.

Ethical Challenges in Parental Refusal of Mandatory Vaccination of Children: Balancing Parental Autonomy and Public Health

Leila Afshar

According to the World Health Organization (WHO), vaccination has significantly reduced the burden of infectious diseases. However, low disease rates do not eliminate the need for continuous monitoring to address the threat of potential outbreaks. The presence of unimmunized individuals can place any community at risk of disease outbreaks. This review aimed to explore the ethical challenges associated with parental refusal to vaccinate children and to identify knowledge gaps in this area for further research within the country. A comprehensive search was conducted using PubMed and ScienceDirect. The final selection included 35 academic articles, one book, and one master’s thesis. In Iran, as in many other countries, anti-vaccination movements have grown in recent years, particularly following the rollout of COVID-19 vaccines. These movements often oppose vaccination for reasons such as philosophical or religious beliefs, poor health literacy, mistrust in healthcare systems, and personal or social experiences. The debate surrounding mandatory vaccination has persisted, primarily due to ethical concerns about coercion. One of the central ethical challenges involves the conflict between parental autonomy and public health. The degree to which parental autonomy is respected is a critical issue in the ethics of vaccination. Factors such as misinformation, inadequate information, or misinterpretation of information can constrain parental autonomy. Conversely, the state has a duty and vested interest in safeguarding children from harm, which may lead to challenging parental autonomy in cases where a child’s well-being is at risk. In conclusion, the extent of parental autonomy in planned interventions such as vaccination depends on the balance between the benefits and burdens of the intervention, taking into account the ethical principles of beneficence and non-maleficence. The greater the benefit, the less decisive parental autonomy becomes, and vice versa. Various studies addressing this issue have proposed strategies such as public education, organizing community-level vaccination discussions, educating vaccine-hesitant parents with evidence-based information, providing trustworthy resources for research, identifying factors influencing parental autonomy, conducting regular follow-ups, and implementing negative policies, including legal enforcement, fines, and restrictions on access to daycare centers and schools.

Survey on Measuring Patients' General Trust in Doctors

Fatemeh Sadat Asgarian

Trust is one of the most important aspects of human relationships, providing the foundation for participation and cooperation among individuals. It is also one of the most valuable social assets within the healthcare system. If trust is disrupted, it can impose significant costs on the system. The purpose of this study is to measure the level of patients' trust in doctors and its impact on the treatment process at Shahid Beheshti Hospital, Kashan. In this study, 325 patients referred to the emergency department of Shahid Beheshti Hospital in Kashan were selected. After applying the inclusion and exclusion criteria, 310 participants remained in the study. The General Trust Instrument was used for this research. This questionnaire consists of 33 questions covering six dimensions: patient-centered care (6 questions), macro-level patient care policies (6 questions), provider expertise (4 questions), quality of care (9 questions), communication and information provision (6 questions), and quality of collaboration between providers (2 questions). Scores ranged from 0 to 100, categorized as follows: 0–20 indicates very low trust, 20–40 low trust, 40–60 moderate trust, 60–80 high trust, and 80–100 very high trust in healthcare. Out of the 310 participants, 157 (50.6%) were male, and 153 (49.4%) were female. The mean age of the patients was 56.6 ± 20.6 years. Among the patients, 178 (57.4%) had acute illnesses, while 132 (42.6%) had chronic illnesses. The mean and standard deviation of the total score for the General Trust Questionnaire was 95.59 ± 13.8. This study demonstrated that the general trust score of patients in the doctors at this center is high. In delivering healthcare, interventions alone are insufficient; improving the quality of services is essential to enhance patient trust and satisfaction.

Ethical Decision-Making in Pediatric Nursing: Managing Critical and Serious Conditions

Azam Khorshidian

Nurses are committed to protecting the rights of their patients. However, significant challenges often arise in their communication with physicians and patients. In some situations, nurses feel that patient autonomy is not respected, and sufficient, appropriate information is not provided to patients and their families. These challenges are particularly pronounced in pediatric nursing, as children often cannot fully express their needs. Pediatric nurses must be especially sensitive to the vulnerability of children and their families, actively supporting their welfare and best interests. When a child is suffering from a serious illness or nearing the end of life, the ethical challenges become even more complex. Some of these challenges include:
- How should healthcare decisions be made for these children?
- Who should make these decisions?
- How is the best interest of these children determined?
- Who can best advocate for children's rights?
- When treatment involves life-sustaining therapies (LST), is preserving life more important than ensuring quality of life?
- Who has the authority to transition from therapeutic or life-sustaining interventions to palliative care?

To address these challenges, nursing associations in various countries have developed ethical charters. However, no universal consensus or definitive solutions exist for navigating these complex clinical situations. Consulting experts across different fields and developing comprehensive professional ethics codes can serve as valuable guidance for pediatric nurses making ethical decisions in cases of serious illness.

Oversight of Research Ethics Committees in Knowledge-Based Projects

Saeed Biroudian

Effective oversight of scientific research is essential for ensuring adherence to ethical and legal principles, particularly in medicine and health sciences. This oversight plays a crucial role in maintaining research validity and safeguarding human health. As knowledge-based and technological projects continue to expand, the responsibilities of ethics committees become increasingly significant. Recognized as independent and credible entities, these committees conduct rigorous reviews of research initiatives. This article critically examines the significance, methodologies, and impact of ethics committee oversight on the quality and credibility of scientific research in knowledge-based projects. This study employs a review methodology, synthesizing data from established guidelines and regulatory frameworks governing ethics in biomedical research, as outlined by the National Committee on Ethics in Research of the Ministry of Health and Medical Education. Additionally, a comprehensive review of relevant scientific literature and empirical studies was conducted, focusing on the oversight of approved projects from reputable contemporary sources. The analysis indicates that knowledge-based projects require heightened ethical scrutiny compared to other research initiatives. This necessity arises from the imperative to adhere strictly to ethical standards outlined in research proposals. Rigorous oversight significantly enhances research quality while mitigating ethical violations. Furthermore, active engagement by ethics committees fosters a stronger commitment among researchers to uphold ethical principles. By offering targeted guidance and training, these committees contribute to the development of high-quality research proposals. Effective oversight by ethics committees is instrumental in enhancing the quality and credibility of scientific research, particularly in emerging technologies and knowledge-based projects. This oversight not only reduces ethical infractions but also strengthens public trust in research findings. Therefore, continuous advancements in ethical training and researcher awareness are imperative. Improving oversight mechanisms will further elevate ethical standards and reinforce responsible research practices within this domain.

Survey of COPE, ICMJE, CIOMS, and WAME Statements/Opinions on the Use of AI in Scientific Publications

Abdolhassan Kazemi

Journals have begun publishing articles in which chatbots, such as Bard, Bing, and ChatGPT, have been utilized, with some even listing chatbots as co-authors. The legal status of authorship varies by country, but under most jurisdictions, an author must be a legal person. Chatbots do not meet the International Committee of Medical Journal Editors (ICMJE) authorship criteria, particularly requirements such as giving “final approval of the version to be published” and being “accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.” No AI tool can “understand” a conflict-of-interest statement or sign it, nor do chatbots have independent affiliations apart from their developers. Since authors submitting a manuscript must ensure that all listed authors meet the required criteria, chatbots cannot be considered authors. Authors should disclose the use of chatbots and provide detailed information about how they were employed. The extent and type of chatbot usage in journal publications should be clearly indicated, in line with the ICMJE recommendation to acknowledge writing assistance and detail the study's methods and results. When chatbots or AI tools are used to draft new text, authors must note such use in the acknowledgments. All prompts employed to generate text, convert text into tables or illustrations, or draft figures should be specified. If an AI tool was used for analytical work, reporting results (e.g., generating tables or figures), or writing computer codes, this should be explicitly stated in the paper’s Abstract and Methods sections. For transparency and reproducibility, authors should include the complete prompt used to generate results, the query’s time and date, and details of the AI tool, including its version. Authors remain fully responsible for material generated by a chatbot, including its accuracy and the absence of plagiarism. They must also ensure appropriate attribution of all sources, including original sources for content produced by the chatbot. Authors must confirm that the work reflects their data and ideas and is free from plagiarism, fabrication, or falsification. Otherwise, submitting such material for publication constitutes scientific misconduct. Proper attribution of quoted material, with full citations, is essential, and cited sources must align with the chatbot’s claims. Since chatbots may omit sources opposing the viewpoints in their output, it is the author’s responsibility to identify, review, and include such counterviews in their articles. (It is worth noting that biases are not exclusive to AI; human authors are also subject to them.) Editors and peer reviewers should disclose any use of chatbots in manuscript evaluation or correspondence. If they employ chatbots in communications with authors or colleagues, they must clarify how the chatbot was used. Editors and reviewers are responsible for any content and citations generated by chatbots. They should also be mindful that chatbots may retain the prompts and manuscript content provided to them, which could breach the confidentiality of submitted manuscripts. Authors must specify the chatbot used and the exact prompts (query statements) employed. They should detail steps taken to mitigate the risks of plagiarism, provide balanced perspectives, and ensure the accuracy of all references. Editors require effective tools to detect content generated or modified by AI. These tools should be universally accessible, regardless of financial constraints, to uphold scientific integrity and minimize the risk of misinformation that could adversely affect public health. Many medical journal editors currently rely on manuscript evaluation approaches that are not designed to address AI-related challenges, such as manipulated or plagiarized text, fabricated images, and papermill-generated documents. This puts them at a disadvantage when distinguishing legitimate from fabricated content, and the emergence of chatbots exacerbates these challenges. Access to advanced tools that enable efficient and accurate content evaluation is particularly vital for editors of medical journals, where misinformation can have severe consequences, including harm to patients.

Ethical Considerations in the Application of Stem Cell Technology in Research and Clinical Practice

Khalil Hajiasgharzadeh

Stem cell technology and regenerative medicine are interdisciplinary fields that integrate engineering, molecular and cellular biology, and medical science to repair tissues and treat diseases using stem cell-based methods. The primary goal of this scientific field is to enhance the quality of life by replacing damaged cells and tissues with healthy ones, thereby improving injuries and disabilities. With recent advances in biomedical science and the unique potential of stem cells in treating diseases, ethical considerations surrounding this technology have become increasingly significant. Following a brief introduction to stem cell technology, this review explores ethical challenges, including the justifications for using stem cells, informed consent from patients, preservation of human dignity, and the social and cultural impacts associated with their application. As research in this field continues to expand, yielding numerous innovative findings and attracting growing interest from researchers, there has also been an increase in unproven commercial treatments that have not undergone necessary regulatory stages. The direct marketing of products in preclinical stages to consumers further underscores the importance of ethical considerations in the use of stem cells. Additionally, the unprincipled use of stem cells may lead to adverse effects, such as cancer or vascular diseases, exacerbating patients' conditions rather than improving them. The findings of this review emphasize the need to adapt existing laws and regulations to address ethical concerns and provide recommendations for enhancing ethical standards in clinical research involving stem cells. The results can serve as a guide for researchers and policymakers in addressing ethical challenges in stem cell research, ultimately improving the quality and safety of clinical research in cell therapy and regenerative medicine.

Conflict of Interest in Research

Samaneh karimian

Conflict of interest refers to situations in which professional judgment or actions related to a primary interest are unduly influenced by secondary interests. In scientific communication, such conflicts can compromise professional decision-making and threaten the integrity of research outcomes. As educational, research, and clinical activities in the medical field expand, the prevalence of conflicts of interest across healthcare domains has increased. Despite the efforts of organizations such as the International Committee of Medical Journal Editors and the Committee on Publication Ethics, which have established guidelines for conflict of interest disclosure, there remains a significant gap in awareness and understanding among researchers. This highlights the urgent need for increased attention to this issue. The UK National Research Ethics Advisory Panel defines conflict of interest as situations where professional judgment concerning a primary interest, such as patient welfare or the credibility of research, is improperly influenced by a secondary interest, such as financial gain. In clinical research, therapeutic studies primarily aim to validate the safety and efficacy of new drugs or devices. This goal should take precedence over secondary concerns, such as economic benefits derived from pharmaceutical production. Good Clinical Practice (GCP) guidelines and the International Conference on Harmonization (ICH) stress that researchers have primary responsibility for the health and medical care of participants. Therefore, any conflict of interest represents a significant risk to participants, potentially compromising their welfare. To safeguard scientific integrity, institutions must enforce policies that uphold ethical principles, require researchers to disclose conflicts of interest to ethics committees, and implement measures to mitigate associated risks. Identifying and managing conflicts of interest based on their potential impact is crucial to preserving the credibility of clinical research. Members of ethics committees, like researchers, must disclose their conflicts of interest, as they significantly influence study processes. Transparency in research funding is essential to minimizing bias and managing conflicts of interest. Effective strategies for addressing conflicts of interest include the development of comprehensive policies and guidelines, the maintenance of an electronic database for conflict disclosure, and the promotion of regular training for ethics committee members and researchers on managing such conflicts. Collaborative learning initiatives and the ongoing refinement of institutional policies further enhance the management of conflicts of interest, ensuring the integrity of scientific research.

Exploring the Concept of Patient Advocacy

Reza Negarandeh

Patient advocacy is a cornerstone of ethical healthcare practice, encompassing actions that protect patient rights, uphold their autonomy, and ensure they receive high-quality care. Nurses are often seen as being in the best position to play this vital role. This conference abstract aims to provide a comprehensive understanding of patient advocacy and identify strategies for enhancing advocacy practices in healthcare settings. In this comprehensive review, scientific literature, including peer-reviewed articles, professional guidelines, and relevant policies, was retrieved and reviewed. Data extracted from the literature were synthesized using quantitative content analysis to identify different forms of patient advocacy, including clinical advocacy and systemic or workplace advocacy, as well as strategies to improve the necessary skills for each. Clinical advocacy involves ensuring patient safety, supporting informed decision-making, and advocating for appropriate pain management. Improving clinical advocacy requires a multifaceted approach that prioritizes building trust and rapport with patients to foster effective communication and shared decision-making. Encouraging patient participation in their care, supporting self-management strategies, fostering effective communication within the healthcare team, and staying informed about relevant ethical, legal, and policy developments are essential components. Workplace or systemic advocacy, on the other hand, focuses on addressing broader issues within the healthcare system that impact patient care. Improving systemic advocacy involves identifying and analyzing systemic issues, such as healthcare disparities, resource limitations, and policy barriers, through data collection, stakeholder engagement, and thorough analysis. Strategies to address these issues include policy advocacy, improved resource allocation, and quality improvement initiatives. Building strong partnerships with other healthcare professionals, community organizations, and policymakers is key. Additionally, promoting education and awareness within both the healthcare workforce and the public is crucial. Leveraging technology to enhance data collection, communication, and mobilization efforts can further support systemic advocacy initiatives. By implementing these strategies, healthcare professionals can effectively advocate for systemic change, improve the quality of care for all patients, and create a more equitable healthcare system. Patient advocacy is a dynamic and multifaceted role that requires continuous learning and adaptation. By embracing the principles outlined in this synthesis, nurses can effectively champion patient rights, improve the quality of care, and contribute to a more equitable healthcare system.

Ethical Considerations of Pregnancy in the “Supporting Families and Population Rejuvenation Law”

Kobra Joodaki

Women play a central role in human reproduction, with the continuation of the human race relying on their pregnancies. When women contribute to this vital social function for the survival of humankind, society has a moral obligation to safeguard their health. While healthcare interventions benefit the fetus, the fetus is entirely dependent on the mother, and any treatment must occur through her body. Consequently, the best strategy for improving fetal health lies in enhancing the care and support provided to pregnant women. The current state of population dynamics, associated challenges, and the introduction of general population policies led to the formulation and enactment of the "Supporting Families and Population Rejuvenation Law." This legislation aims to address many—though not all—of the challenges related to population growth and childbearing. The efforts to combat population aging and meet demographic needs are laudable, and the law includes several economic incentives to encourage childbearing. However, financial incentives alone are insufficient to address the complex reasons behind individuals' unwillingness to have children. Cultural, social, and political factors also play significant roles, and these are addressed to some extent within the law. Notably, specific provisions focus on supporting infertile couples, assisting pregnant women, and offering solutions to address illegal abortions. Regrettably, during the drafting of these provisions, the expert opinions of relevant scientific associations were overlooked. As a result, numerous ethical and scientific challenges have emerged in the implementation of the law, leading to deviations from its intended objectives. In particular, certain sections fail to adequately protect the fundamental rights of pregnant women. This article aims to analyze these challenges and propose solutions grounded in the principles of medical ethics.

Ethics in Rehabilitation Research: A Review of Concerns, Challenges, and Ethical Principles

Shima Shirozhan

The rising prevalence of disabilities worldwide has drawn significant attention to the need for effective measures in preventing disabilities, managing existing conditions, and rehabilitating individuals with disabilities. These efforts can only be effective if grounded in evidence derived from high-quality research. A fundamental aspect of ensuring research quality in rehabilitation is adherence to ethical principles, which not only improve the study's quality but also safeguard the rights and address the needs of individuals with disabilities. Despite its importance, ethical considerations in rehabilitation research have received insufficient attention, and there is a lack of comprehensive insights into the challenges and ethical principles specific to this field. This study aims to review the concerns, challenges, and ethical principles pertinent to rehabilitation research.
This narrative review synthesizes existing evidence on ethics in rehabilitation research. A systematic search was conducted using English keywords such as "Ethics," "Rehabilitation," "People with Disabilities," "Disability," "Research," "Study," "Code of Conduct," "Challenge," "Issue," and "Concern" in databases including PubMed, Embase, and Web of Science up to the year 2024. Additional searches were performed via Google Scholar and the reference lists of relevant articles and key journals. From 150 extracted studies, 21 articles were selected for full-text review after initial screening. Ultimately, nine studies meeting inclusion criteria (relevance, English language, and full-text access) were included in the final analysis. The findings revealed that ethical principles and guidelines in rehabilitation research receive less attention compared to research involving other vulnerable groups. In addition to the four primary ethical principles, rehabilitation research requires greater focus on specific areas, such as assessing the decision-making capacity of individuals with disabilities for voluntary participation and obtaining informed consent. Challenges including cognitive impairments, speech disorders, and the complexity of symptoms and their effects create difficulties for researchers in study design and execution, thereby impacting research quality. A critical ethical concern in rehabilitation research is the potential decline in research quality due to inherent challenges in conducting studies with individuals with disabilities. Researchers must be aware of these challenges before initiating their studies and approach rehabilitation research with a strong commitment to ethical practices. Establishing standards and ethical guidelines for this vulnerable population, along with oversight by ethics committees, can significantly enhance the ethical standards and quality of rehabilitation research. The findings of this review can assist researchers, managers, and policymakers in addressing these issues. Future efforts should prioritize the development of robust ethical frameworks for rehabilitation research.

Ethical Considerations in Post-Crisis and Disaster Rehabilitation

Mohammad Javad Hosseinabadi Farahani

Rehabilitation in disaster contexts, as part of the overall medical response, faces unique challenges, particularly during the early stages of post-disaster intervention. This is largely due to the relatively new integration of rehabilitation into disaster management. The four principles of bioethics—autonomy, beneficence, non-maleficence, and justice—are essential considerations in immediate post-disaster relief efforts and in the subsequent long-term rehabilitation processes. This review study involved a purposeful search of reliable databases using predetermined keywords, covering the period from 2000 to 2024. The reviewed studies highlight several ethical dilemmas in delivering rehabilitation services after crises and disasters. These challenges arise due to factors such as:
· Resource limitations,
· Insufficient focus on rehabilitation within health systems,
· Shortages of rehabilitation specialists,
· Inadequate follow-up cares post-discharge,
· Limited awareness of the significance of rehabilitation, and
· Stigma associated with disability.
Despite these challenges, it is critical to uphold the four principles of biomedical ethics even in crisis situations. Adhering to these principles ensures that rehabilitation services align with professional norms, ethical standards, and the medical aspects of the local culture. Furthermore, policies aimed at enhancing the status and importance of rehabilitation immediately after crises and disasters must emphasize the equitable distribution of resources.

Ethical Considerations in Post-Crisis and Disaster Rehabilitation

Mohammad Javad Hosseinabadi Farahani

Ethical Challenges in Admission and Resource Allocation for Patients in Need of Rehabilitation Services

MohammadJavad Hosseinabadi Farahani

Ethical challenges and concerns have long been a part of healthcare, primarily focusing on acute care or end-of-life decisions. However, with the growing elderly population and society's emphasis on restoring patients to the highest possible level of functioning, ethical dilemmas in rehabilitation care have garnered increasing attention. Ethical decisions are a routine part of rehabilitation care. While some are straightforward, such as obtaining informed consent for therapeutic and rehabilitation procedures, others are far more complex. Among the most significant challenges are resource allocation and the selection of patients for rehabilitation services. The process of selecting patients for admission to rehabilitation centers is typically carried out by specialist physicians. However, many centers face demand that exceeds their capacity, necessitating difficult decisions about patient prioritization. Although some centers may have clear guidelines, patient selection is often subjective, involving multiple factors such as:

Clinical considerations: Diagnosis, prognosis, secondary complications, and learning ability.
Non-clinical factors: Social, occupational, personal, and financial circumstances.

This subjectivity in patient selection raises several ethical concerns. The rights, duties, and responsibilities of both patients and physicians must be carefully weighed. The potential for injustice exists when decisions become overly subjective, leading to possible inequities in resource allocation. Balancing the ethical principles of beneficence (acting in the patient’s best interest) and justice (fair distribution of resources) is essential but can be challenging, as these principles may occasionally conflict. To address these issues, members of the rehabilitation team, particularly physicians, must strive to minimize subjectivity in their decisions. Additionally, it is important to implement follow-up mechanisms for patients initially denied admission, ensuring that any changes in their condition are reevaluated. Medical and rehabilitation ethicists should prioritize the development of clear, evidence-based guidelines for patient selection and admission. These guidelines should be made accessible to the rehabilitation team to promote fairness, transparency, and consistency in decision-making, ultimately ensuring that resources are allocated equitably to those in need.

"The Other" and Public Health Ethics with Emphasis on the Views of Avicenna and Levinas

Abdollah Salavati

When we think of public health, we often picture patients, doctors, nurses, healthcare professionals, and medical facilities. However, this is only part of the picture. Public health operates within a 360-degree environment, which extends beyond these visible elements to include health policy and governance, laws, social dimensions, the environment, technology and data, societal and cultural factors, individual participation, education, and safety. Neglecting this comprehensive environment risks destabilizing public health. Though health can be conceptualized within this framework, it remains vulnerable to threats. A critical challenge within this environment is the potential to overlook the human element, leading to large-scale systems and plans that marginalize and exclude individuals—a risk that must be conscientiously avoided. When "the Other" is perceived as merely a "thing," "patient," "customer," "financial opportunity," or "a solution to problems," what emerges is a reductionist perspective that dehumanizes the individual. In such a framework, public health ethics lacks a solid foundation. This research seeks to analyze and critique this reductionist perspective on health ethics, drawing from the "Other"-centered views of Avicenna, the great philosopher of the Islamic world, and Emmanuel Levinas, the prominent French thinker. The methodology of this research employs a phenomenological approach, describing the lived experiences of public health and their intersection with ethics through the lens of Avicenna's and Levinas' philosophies. Avicenna's philosophy emphasizes that external factors such as reputation, status, outward behaviors, and age can obscure our perception of others. His views highlight the human tendency to be distracted by falsehoods and the joy derived from discerning truth. Levinas' concept of "the Other" as an infinite entity and a responsibility to be borne challenges us to transcend the self and recognize and respect the "Other" within a 360-degree environment. Together, their metaphysical perspectives provide a foundation for moving beyond the limitations of the self and fostering an ethical framework that perceives "the Other" in an infinite light. Policies, planning, management, and actions that reduce "the Other" to mere economic considerations inevitably lead to the marginalization of certain groups, such as rural or disadvantaged communities. This undermines efforts to achieve distributive justice, including providing essential medicines and healthcare services for all. Consequently, such an approach erodes public health ethics and reduces "public health" to "healthcare for those who can afford it." In our tradition, "the Other" is regarded as "God's family," irrespective of race, religion, social status, or other distinctions. A hadith states: "All human beings are the family (dependents and household) of God. Therefore, the most beloved person to God is the one who is beneficial and helpful to God's family and brings joy to the members of this household." This teaching underscores the need for healthcare providers, institutions, and policymakers to embrace the universal kinship of humanity. Without cultivating a mindset that transcends the self and embraces the infinite, public health remains incomplete. Without this shift, the sun of wellness will not shine equally on all, and hope will give way to despair. In this context, the "I" of the physician, the "I" of the healthcare worker, the "I" of the healthcare institution, the "I" of policy, and the "I" of processes and procedures risk devaluing, suppressing, or erasing "the Other" through reductionist thinking. This, in turn, leads to the erosion of the moral foundation of public health.

Avoidable Suffering at the End of Life

Mamak Tahmasebi

Avoidable suffering at the end of life refers to the unnecessary pain and distress experienced by individuals with terminal illnesses—pain that can often be alleviated through effective palliative care practices. Addressing this issue is critical for improving the quality of life for both patients and their families during this challenging period. The recognition of holistic care, which considers physical, emotional, spiritual, and social needs, has fueled efforts to enhance end-of-life care to reduce suffering and uphold patients' autonomy. Numerous studies indicate that many terminally ill patients endure avoidable physical and emotional pain as they approach death, highlighting gaps in healthcare delivery. For instance, research from the National Center for Health Statistics reveals that a significant number of hospice patients report unmanaged pain despite the availability of effective interventions. Psychological distress, including anxiety and depression, is also prevalent among terminally ill patients, underscoring the need for comprehensive care that integrates mental health support. Furthermore, neglecting spiritual and social needs can leave patients feeling isolated and despairing, exacerbating their suffering. Ethical considerations in pain management at the end of life remain a subject of debate, particularly concerning the principles of beneficence and non-maleficence. The principle of double effect, which permits actions to relieve suffering even if they may unintentionally hasten death, continues to spark controversy among healthcare providers, patients, and families. Additionally, ethical dilemmas arise in advanced care planning, particularly in respecting patient autonomy while navigating complex end-of-life decisions. Addressing avoidable suffering at the end of life requires a multidisciplinary approach that honors patients' values and preferences while striving to minimize unnecessary distress. As research and clinical practices advance, healthcare systems must prioritize strategies to reduce avoidable suffering and ensure patients' dignity during their final days.

Musts and Must-Nots of Continuing Professional Development: A Focus on Professionalism and Professional Ethics

Leila Afshar

Evidence from national and international institutions highlights a significant clinical practice gap, including the failure to adhere to best evidence-based practices at the point of care. This issue is multifaceted, stemming from incomplete information, poor communication by practitioners—resulting in inadequate patient compliance and understanding—and various environmental or social factors. A significant portion of these shortcomings lies in areas commonly referred to as professional behavior and professional ethics. While considerable efforts have been directed toward knowledge translation and implementing best clinical evidence, equivalent attention must be given to integrating professionalism and professional ethics into continuing medical education (CME) or, more aptly, continuing professional development (CPD). These aspects, however, appear underemphasized or even neglected in many CPD programs. This article seeks to address the essential "musts" and "must-nots" for designing an effective CPD program that incorporates professionalism and professional ethics as foundational components.

Challenges of Professional Commitment in the Digital Age

Saeedeh Saeedi Tehrani

Professionalism in medicine refers to adhering to principles and behaviors that uphold the dignity of patients and promote public welfare. In the digital age, maintaining these principles in cyberspace has become increasingly important, necessitating attention to ethical and legal considerations. Virtual platforms can enhance communication between doctors, patients, and the broader public, increase awareness, and facilitate educational processes. Additionally, these platforms offer opportunities for networking and the exchange of information among professionals. The rise of social media has significantly influenced professional interactions. Particularly in the post-COVID-19 era, individuals are increasingly turning to these platforms for health information. Studies reveal that the global number of internet users exceeds 3.7 billion, while in Iran, the figure surpasses 78 million. Furthermore, research highlights the significant impact of information shared by doctors on social media and other public platforms, as the public places substantial trust in this group and actively seeks accurate information from them. Ethical considerations are critical in guiding the online presence of medical professionals. This article examines professionalism in cyberspace and outlines the ethical requirements for medical professionals operating in this domain. Protecting patients' interests remains the primary obligation of professionals. Consequently, any behavior that undermines professional reputation or diminishes public trust is deemed unprofessional. Key ethical requirements for professionals in virtual spaces include:

Respecting patient confidentiality and privacy.
Upholding the good reputation of oneself and the medical profession.
Avoiding defamatory behavior, rumors, or labeling.
Demonstrating honesty in providing information.
Acting responsibly and avoiding discriminatory attitudes.
Refraining from disparaging the competence of other professionals in medical advertisements.

Adhering to these ethical standards is essential to maintaining public trust in the medical profession. Therefore, training, evaluating, and monitoring the behavior of professionals in cyberspace are particularly important for upholding and promoting professional and ethical standards.

Health Needs Assessment Based on Capabilities Theory

Reza Khadivi

Over the past few decades, various models have been employed to assess health needs and allocate resources within the health sector. These models include economic approaches based on cost-effectiveness, epidemiological methods using indicators such as disease burden or disparities in health outcomes between socioeconomic groups, and comparative studies between societies or countries. Efficiency and equity are often seen as competing goals in the resource allocation process, making it challenging for health systems to achieve both simultaneously. Traditional approaches primarily focus on deficiencies and adopt an individualistic perspective. When individuals experience limitations due to disease or disability, the relationship between their health status and social functioning is not always directly linear. Disease and disability inherently tend to widen the gap between individuals and their ability to fulfill normal roles, responsibilities, primary social dependencies, and desired capabilities. The capability approach advocates for respecting the life contexts of individuals and collaborating with them to enhance their skills, assets, and capabilities. Instead of focusing solely on deficiencies and addressing them through resource redistribution, this approach emphasizes empowering individuals to manage their lives with minimal external interference. These capabilities encompass skills that allow individuals to navigate their social, economic, and personal environments effectively. They include:

Interpersonal skills for fostering meaningful relationships.
Technical skills for managing routine aspects of life.
Emotional and psychological resilience to cope with challenges.
Purpose-building abilities to find meaning and direction in life.

Such capabilities equip individuals to manage both the normal struggles of everyday life and significant life events. As capabilities are enhanced, individuals gain greater control over their life circumstances, thereby becoming more resilient. The ability to control one’s life world is a fundamental capability. The unequal distribution of this ability forms the foundation of health inequities, as not everyone has the same capacity to exercise such control. Health needs assessments based on the capabilities theory align more closely with the goals of achieving and sustaining equity in healthcare. By focusing on empowering individuals and addressing their life contexts, this approach provides a more holistic and equitable framework for health resource allocation.

Juridical, Legal, and Ethical Aspects of "Under-the-Table Payments " from the Perspective of Experts and Shia Grand Ayatollahs

Mojtaba Parsa

"Under-the-table payment" refers to money a physician demands and receives from a patient, in addition to the established and approved medical tariff, typically for medical services such as surgical operations. This study aims to examine the ethical, legal, and juridical aspects of this phenomenon, which has become common among many physicians. This qualitative study is based on semi-structured interviews with 17 experts from various fields, including Islamic jurisprudence, law, professional ethics, philosophy of ethics, medical ethics, health economics, and social psychology. The interviews were analyzed using the conventional content analysis method. Additionally, the opinions (fatwas) of 11 Shia Grand Ayatollahs on under-the-table payments were obtained by posing a specific question to them. The findings from the expert interviews revealed several concerns regarding under-the-table payments, including:
· Disregard for patients' best interests, particularly causing harm to poor patients;
· Undermining trust between doctors and patients;
· Violations of national laws and public policies;
· Promotion of lawlessness;
· Breaches of medical and ethical obligations by physicians;
· Coercion or undue pressure on patients to pay such fees.
Experts emphasized that medicine is a profession in which patients' interests should take precedence over those of doctors, and in this practice, this fundamental principle is violated. Furthermore, in the fatwas issued by the majority of Shia Grand Ayatollahs - particularly those with governmental perspectives - nearly all deemed this practice impermissible, with some explicitly declaring it forbidden (haram). Receiving under-the-table payments is ethically, legally, and juridically problematic, and in some cases, is considered impermissible, particularly for the physicians involved. However, it is generally not considered problematic for patients who are coerced into making such payments.

Retracting or Discrediting Articles: Dos and Don'ts

Mina Mobasher

As scientific output continues to grow and researchers strive to share their findings, the number of article retractions and cases of discreditation has also increased. Articles may be discredited for several reasons, including authors voluntarily admitting to errors in their work, discoveries of research misconduct, or concerns raised by reviewers or readers about the authenticity of the research. Retractions can harm public trust in science and have broader implications, such as damaging the reputation of the universities, research centers, and institutions associated with the retracted papers. This study considers the causes, contributing factors, and impacts of research discreditation, drawing on international guidelines and credible publications. It will examine the types of research misconduct and other issues that lead to article retractions. Additionally, the study will analyze cases of retracted articles authored by Iranian researchers using Retraction Watch. The Committee on Publication Ethics (COPE) identifies eight key reasons for journal editors to retract published research. According to COPE guidelines, retraction may occur when there is clear evidence of issues such as data or image manipulation that invalidate the findings. Other grounds for retraction include plagiarism, duplicate submission or publication without proper disclosure or permissions, inadequate oversight during data collection, violations of regulations like copyright laws, unethical research practices, flawed peer review processes, and undisclosed conflicts of interest. Additionally, other studies have pointed out factors contributing to article retraction, such as the pressure on researchers to publish, a lack of essential skills to conduct valid and reliable research, and inadequate training in research ethics. In the context of Iranian author retractions, common issues include authorship manipulation and plagiarism. With the growth of research and scientific production in universities and research centers, it's becoming increasingly important to address the issue of article retractions. By understanding the underlying causes, we can develop effective guidelines and oversight strategies while also providing researchers with the necessary training to prevent such issues in the future.

Ethical Dilemmas in Health Policymaking

Tahmine Salehi

Ethical considerations have been underemphasized in health system policymaking compared to areas like clinical ethics and biomedical research. Allocating resources effectively, promoting equitable access, and resolving societal needs within the health system necessitate robust ethical frameworks. Neglecting these frameworks creates significant dilemmas and challenges. An analysis of health system policymaking and macro-decision-making reveals a pervasive disregard for systemic ethical thinking. A primary ethical dilemma stems from conflicts of interest, leading to policy choices that may not prioritize ethical service delivery. This can manifest as over-provision, non-standard services, or diminished quality of care. Economic constraints pose another critical dilemma, characterized by inadequate health expenditure as a proportion of gross domestic product (GDP). This limits equitable access to healthcare and exacerbates inequities in resource distribution. A prime example is the neglect of the network-based health system, favoring hosp ital-centric development and an overemphasis on specialized care over comprehensive primary care. Determining the appropriate model for the health system – enterprise-driven or governance-oriented – presents a fundamental conflict. This choice significantly influences health policy decisions. Furthermore, the simultaneous role of policymakers as both providers and purchasers of healthcare services fuels conflicts of interest and incentivizes "induced demand."Shifting towards an ethical perspective in health system policymaking requires a systemic and comprehensive approach. Incorporating ethical considerations into policy decisions, recognizing the unique characteristics of the health market, and addressing conflicts of interest are crucial for improving system performance. This approach would likely prioritize network-based care, strengthen primary care, enhance referral systems, develop a robust primary care workforce, and elevate the importance of health education within the system.

Ethical Considerations in the Use of Artificial Intelligence in Healthcare

Mohammad Shojaeinia

Artificial Intelligence (AI) represents a transformative and innovative approach in healthcare with the potential to revolutionize diagnostic, therapeutic, administrative, educational, research, and managerial processes. Given that AI systems influence reasoning, decision-making, and the delivery of care, their implementation faces challenges, particularly ethical considerations rooted in the unique nature of the healthcare system—where patient welfare, trust, and the autonomy of healthcare providers hold paramount importance. This study adopts a qualitative approach. Various information sources, including journals, articles, and publications, were reviewed. The applications of AI in clinical environments and its impact on individuals' interactions with healthcare systems, decision-making processes, and clinical workflows were analyzed, and relevant ethical considerations were extracted. The results indicate that the integration of AI in healthcare, despite its extensive benefits in prevention, diagnosis, treatment, prediction, decision-making, process automation, medication and therapeutic recommendations, surgical guidance, personalized medicine, telemedicine systems, and numerous other applications, is accompanied by a set of ethical considerations. Addressing these considerations is crucial to ensure the responsible and equitable use of these technologies. These include concerns related to patient privacy and data security, biases in AI systems, transparency, explainability, interpretability, accountability, informed consent, impacts on the relationships between healthcare providers and patients, equitable access to AI benefits, the appropriate and judicious use of technology, ethical use of automation, preservation of human dignity, effective oversight and regulation, legal and legislative issues, and long-term implications such as preventing misuse of predictive data by insurers or employers, among other patient rights-related issues. The utilization of AI in healthcare necessitates the development of ethical and legal frameworks that balance technological innovation with the humanistic principles underpinning healthcare systems. This ensures that while leveraging the advantages of AI, privacy, justice, equity, and human dignity are safeguarded. Emphasis on continuous monitoring and aligning AI-based systems with human values can foster trust in these technologies, ensuring that AI is used responsibly and adheres to ethical standards, ultimately serving to enhance public health outcomes responsibly and equitably.

Financial Relationships and Conflicts of Interest Between Physicians and Patients: Guideline to Professional Ethics for Medical Practitioners, Medical Council of Islamic Republic of Iran

Saeed Biroudian

Conflicts of interest, particularly financial ones, pose a significant ethical challenge in the medical field. They can compromise clinical decision-making, erode patient trust, and ultimately diminish the quality of healthcare. This study reviewed ethical documents and guidelines published by the Medical Council of the Islamic Republic of Iran, including the Charter of Rights for the Medical Community. A comprehensive review of relevant scientific literature on conflicts of interest in healthcare was also conducted. The analysis revealed that financial relationships between physicians and external entities, such as pharmaceutical companies, can create conflicts of interest that negatively impact patient care. These conflicts can erode patient trust and lead to suboptimal clinical decisions. The Medical Council's ethical guidelines address these concerns by emphasizing the importance of transparency regarding financial ties and relationships. They advocate for the disclosure of such relationships to patients and the implementation of educational programs to enhance physician awareness of ethical principles and conflict-of-interest management strategies. Adherence to the ethical guidelines established by the Medical Council of Iran is crucial for effectively managing conflicts of interest in the physician-patient relationship. By prioritizing transparency, disclosure, and ongoing education, healthcare professionals can mitigate potential conflicts and maintain the highest standards of ethical conduct in patient care.

Reflection in Medical Education: A Strategy for Enhancing Professional Development

Homa Sadeghi Avval Shahr

Effective medical education requires the cultivation of essential professional attributes, including ethical reasoning, communication skills, empathy, and professionalism. Traditional teaching methods often fall short in adequately developing these crucial aspects. Reflection-based learning, with its emphasis on self-analysis and critical thinking, presents a promising pedagogical approach to address these limitations. This review study examined the literature on reflection in medical education. A comprehensive search of the Web of Science, PubMed, Scopus, and Google Scholar databases was conducted using keywords such as "education," "reflection," "professionalism," "professional behavior," and "medical students" from 2010 to 2024. Eighteen relevant articles were selected and analyzed for their type, focus, and conceptual implications. Different approaches to integrating reflection into professionalism education were then categorized and analyzed. The reviewed literature highlights a multifaceted approach to incorporating reflection into medical education. Key strategies include contextual reflection, linking reflections to specific clinical experiences; utilizing structured frameworks such as the Gibbs Cycle to guide the reflective process; fostering peer-to-peer learning through discussions, peer feedback, and mentorship; and seamlessly integrating reflection as an ongoing and assessed component of the medical curriculum. Findings suggest that an educational approach emphasizing practical application, experiential learning, and structured reflection opportunities can significantly enhance students' understanding of professional behavior. This approach is anticipated to lead to improvements in communication skills, ethical reasoning, empathy, and self-awareness, ultimately contributing to better patient care and a stronger medical workforce. Reflection-based learning offers a valuable strategy for developing professional competence in medical education. This approach necessitates the active integration of reflection into clinical learning activities, utilizing structured frameworks, and providing ample opportunities for peer and faculty support. Future research should rigorously investigate the impact of specific reflective activities on tangible improvements in clinical skills and behaviors.

The Impact of Professional Ethics Training on the Spiritual Care Competence of Emergency Nurses

Tahereh Toulabi

Nurses, as the largest group of healthcare workers globally, are responsible for providing holistic care to patients. Holistic care encompasses physical, mental, social, and spiritual dimensions. This study aimed to determine the effect of professional ethics training on the spiritual care competence of emergency nurses. This two-group field trial study with a pre-test and post-test design was conducted with 84 nurses working in the emergency departments of Lorestan University of Medical Sciences. Participants were selected through stratified random sampling. The intervention group participated in four workshops. The study tool was the Spiritual Care Competency Questionnaire. Data analysis was performed using SPSS, employing descriptive statistics (mean, median, and percentage) and inferential statistical tests, including repeated measures ANOVA, independent t-tests, and Fisher’s exact test.
The study included two groups: intervention (n = 42) and control (n = 42). Most participants in both groups were women. A significant difference was observed in the average total spiritual care competence scores and its dimensions (excluding the self-knowledge subscale) over different time points in the intervention group (P < 0.001). However, for the self-knowledge subscale, no significant difference was found in the average scores between the control and intervention groups at different time points. The results of this study demonstrated that professional ethics training improves nurses' spiritual care competence. By conducting workshops, training programs, and in-service courses on professional ethics and spiritual care, the quality of nursing care can be enhanced, ultimately improving patient safety. It is recommended that healthcare policymakers and nursing managers prioritize professional ethics as the foundation of all nursing practices. Employing innovative and engaging methods, such as the scenario-based approach used in this study, can further support the development of professional ethics in nursing.

Telehealth: Ethical and Legal Challenges in the Healthcare System

Mohammadreza Dinmohammadi

Telehealth has emerged as a rapidly expanding method for delivering healthcare services, especially during the COVID-19 pandemic. This approach has opened new avenues for accessing medical care and contributed to reducing healthcare costs. However, the growth of telehealth has introduced significant legal and ethical challenges that warrant thorough investigation. This review study employed keywords such as "telemedicine," "telehealth," "ethical challenges," "legal challenges," and "healthcare system" to search scientific databases including PubMed, Scopus, CINAHL, and Google Scholar. Articles published in English and Persian between 2010 and 2024 were reviewed. Eligible sources included research articles, systematic reviews, and case reports focusing on legal and ethical issues related to telehealth. Following an initial screening, articles were assessed based on quality and scientific credibility, and the selected works were analyzed for the final synthesis. Telehealth presents several critical challenges that must be addressed to ensure safe and equitable care delivery. One of the foremost concerns is patient privacy and data protection; the exchange of sensitive health information necessitates robust security protocols and adherence to data protection regulations to uphold patient confidentiality and trust. Another key issue is informed consent, which must be adapted to the virtual context to ensure patients are adequately informed of both the benefits and potential risks associated with telehealth services. While telehealth enhances healthcare accessibility, it may also deepen existing health disparities due to unequal access to digital technologies. Therefore, investments in communication infrastructure and digital literacy are essential to promote inclusivity and equal access to care. Although telehealth offers substantial benefits—including improved access, convenience, and enhanced coordination of care—its legal and ethical implications must not be overlooked. To fully realize its potential, stakeholders must collaborate in developing comprehensive regulations and ethical frameworks. Addressing these challenges is imperative to advancing telehealth in a manner that ensures patient safety, protects rights, and promotes health equity.

Evaluation of the Effect of Guided Reflection on the Communication Skills of Undergraduate Nursing and Midwifery Students

Kosar Alizadeh

Effective communication with patients is not only a crucial element of professionalism in healthcare but also plays a significant role in achieving care and treatment goals. In light of the importance of active learning strategies and reflective practices in education, this study aimed to evaluate the effect of guided reflection on the communication skills of undergraduate nursing and midwifery students. This semi-experimental study with a pre-test and post-test design was conducted at the Faculty of Nursing and Midwifery, Iran University of Medical Sciences. A total of 50 second- to fourth-year undergraduate students in nursing and midwifery voluntarily participated in the study following a public invitation. Data collection tools included a demographic questionnaire and a patient communication skills questionnaire developed by Javaher et al. The intervention consisted of four 90-minute interactive training sessions conducted weekly via Google Meet. The first two sessions focused on teaching components of professionalism with an emphasis on patient communication and reflective practice. The final two sessions included scenario presentations, film viewings, opportunities for reflection, and shared discussions. Data were analyzed using descriptive and inferential statistical tests in SPSS version 24. The findings indicated a positive change in the overall communication skills score immediately after the training and one month later, although the change was not statistically significant. In specific areas of communication skills, the "conscious initiation" domain showed a statistically significant improvement from pre-intervention to immediately after (P=0.005) and one month after the training (P=0.011). Additionally, in the domain of "unconditional acceptance of the client," pairwise comparisons revealed a significant improvement in scores one month after the intervention compared to the pre-intervention phase (P=0.02). Although guided reflection showed some promise in enhancing specific aspects of communication skills among nursing and midwifery students, the overall impact was not statistically significant. Further research with larger samples and longer follow-up periods is recommended to more conclusively determine its effectiveness.

Moral Courage in Intensive Care Nurses: Exploring the Predictors of a Professional Virtue

Alireza Nikbakht Nasrabadi

Moral courage is essential for intensive care unit (ICU) nurses to navigate complex ethical dilemmas and advocate for patient rights. Despite its importance, the factors that influence the expression of moral courage remain poorly understood. This review aims to identify key predictors of moral courage in ICU nurses, offering valuable insights to enhance ethical decision-making and improve patient care in critical care settings. This review followed the Cochrane systematic review principles and adhered to PRISMA guidelines. A comprehensive literature search was conducted using both English and Persian keywords related to "moral courage," "ICU nurses," and "predictors." International databases such as PubMed, Scopus, and Web of Science were searched, along with grey literature from Google Scholar. No time frame restrictions were applied. Inclusion criteria included observational studies that focused on predictors of moral courage in ICU nurses, while studies such as clinical trials, reviews, opinion pieces, and those lacking primary data were excluded. Two authors independently screened and extracted data, resolving discrepancies through consensus with a third author. The Newcastle-Ottawa Scale (NOS) was used to assess study quality, and relevant data were systematically organized into an extraction table. A total of 136 articles were initially identified, with 24 observational studies included after screening. The final selection consisted of 4 cross-sectional studies and 8 cohort studies. Key predictors of moral courage in ICU nurses were identified, including age, gender, professional experience, ethical training, and workplace support. Older and female nurses were more likely to demonstrate moral courage, while nurses with more years of experience and formal ethical training exhibited a stronger ability to confront ethical challenges. Additionally, a supportive work environment and personal ethical beliefs were found to significantly influence the likelihood of nurses advocating for patients and addressing unethical practices. These findings emphasize the importance of both individual and organizational factors in fostering moral courage. This review identifies age, gender, professional experience, ethical training, and workplace support as significant predictors of moral courage in ICU nurses. These findings highlight the critical role of individual characteristics and organizational support in promoting ethical behavior and moral courage in critical care settings.

Commitment to Care, Commitment to Education: An Exploration of the Ethical Dimensions of Patient Education in Healthcare

Azar Darvishpour

Patient education is a fundamental component of healthcare that enhances patient outcomes, satisfaction, and self-management. Healthcare professionals have a responsibility to deliver high-quality patient education that is personalized to meet the unique needs and circumstances of each patient. Adhering to ethical principles—ensuring the provision of accurate, unbiased information while respecting patient autonomy and decision-making capacity—is crucial in this process. This study aimed to explore the ethical dimensions of patient education. This study employed a systematic review approach. A comprehensive search was conducted in the PubMed, Scopus, Web of Science, and Google Scholar databases using the keywords ethics, patient education, and ethical adherence for the period 2014–2024. Inclusion criteria encompassed studies that focused on the ethical aspects of patient education and adherence. Data were analyzed using qualitative content analysis. Out of 216 identified articles, 20 met the inclusion criteria. Three key categories emerged from the data analysis: (1) Commitment to Care, encompassing client-centered education and patient support with emotional reassurance; (2) Commitment to Education, including structured educational programs and communication skills of healthcare professionals; and (3) Adherence to Ethical Principles, which involved respect for patient autonomy and confidentiality. The study underscores the significance of healthcare professionals' dual commitment to both care and education in delivering effective patient education. Awareness of the ethical dimensions of patient education is essential for ensuring that educational interventions are patient-centered and aligned with ethical standards. Future research should explore the interplay between patient-centered care, autonomy, and healthcare professionals’ communication skills in relation to patient education outcomes.

Assessment of the Level of Adherence to Ethical Principles in Research by Researchers at Iranian Medical Sciences Universities (Eight Regions)

Khadijeh Ahmadzadeh

Research ethics is a fundamental component of the scientific process and is crucial for ensuring the integrity and reliability of research outcomes. Researchers must recognize that the results of their studies can impact individuals and societies. Therefore, accountability and transparency in conducting research are of particular importance. Adherence to ethical principles not only enhances the scientific credibility of researchers but also contributes to the advancement of science and technology. This study aimed to assess the level of adherence to research ethical principles among researchers at Iranian Medical Sciences Universities. This descriptive-analytic, cross-sectional study focused on researchers from Iranian universities of medical sciences. The data collection tool was a research ethics compliance questionnaire, which was distributed to researchers at medical universities in Region Eight. The questionnaire contained 40 items across 9 dimensions: respect for subjects' moral rights, free thinking, professional responsibility, social responsibility, accuracy, emotional impartiality, honesty, Originality, and legitimacy. Data were analyzed using SPSS version 24 software. In addition to descriptive statistics, Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests were also applied. A total of 230 researchers participated in the study, 193 of whom were faculty members. The results indicated that the average score for adherence to ethical principles in research was 3.174, reflecting a high level of adherence. The results also revealed that the dimensions of legitimacy and accuracy had the highest average scores (21.7 and 22.5, respectively). Significant differences were observed in adherence to ethical principles based on educational degree, academic rank, age, and work experience (p < 0.05). Spearman's correlation indicated a significant inverse relationship between adherence to ethical principles and educational degree, meaning that higher educational levels were associated with lower adherence to ethical principles in research. Overall, the findings of this study show that most researchers in the eight regions of Iranian medical sciences universities adhere to ethical principles in research at a high level.

The Relationship Between Ethical Culture and Job Commitment of Nurses Working in Educational and Medical Centers of Hamadan University of Medical Sciences

Mehran Saadatmand

Promoting an ethical culture is crucial for ensuring job commitment and competent clinical care among nurses. Ethical culture encompasses shared understandings and perceptions that guide ethical conduct within an organization. Job commitment reflects an individual's psychological and emotional attachment to their job. This study aimed to investigate the relationship between ethical culture and job commitment among nurses working in educational and medical centers affiliated with Hamadan University of Medical Sciences. This descriptive correlational study included 170 nurses selected from teaching hospitals in Hamadan using the Morgan table and based on inclusion criteria. Data were collected using demographic questionnaires, the Gobel et al. Ethical Culture Questionnaire, and the Schaufeli Job Commitment Questionnaire. Data analysis was performed using SPSS version 22 software. A significant and positive correlation was found between ethical culture and nurses' job commitment (r=0.42, p<0.05). Ethical culture was significantly higher among nurses with more work experience and female nurses compared to their counterparts. Additionally, job commitment was significantly higher among male nurses and those with formal employment status. The findings demonstrate a strong positive correlation between ethical culture and job commitment among nurses. Enhancing ethical culture within healthcare settings through effective leadership, clear ethical guidelines, and open communication channels can significantly improve job satisfaction and, ultimately, patient care. Further research is needed to explore the specific factors that contribute to ethical culture within different healthcare contexts.

Barriers to Equitable Healthcare Access Among People Living with HIV

Heshmatolah Heydari

Acquired Immunodeficiency Syndrome (AIDS) is a disease that occurs in the final stage of infection with the Human Immunodeficiency Virus (HIV). According to the World Health Organization (WHO), approximately 39.9 million people were living with HIV worldwide in 2024, with an incidence rate of 1.3 million and a mortality rate of 630,000 globally. In Iran, the prevalence and incidence rates of HIV were reported as 54,000 and 2,400 people, respectively, with a mortality rate of 3,200 annually. Access to healthcare is considered one of the key goals of a health system. The Universal Declaration of Human Rights recognizes the right to health services as a common standard. People living with HIV, as a vulnerable group, may face barriers to accessing healthcare services. This study aims to explore the challenges faced by people living with HIV in accessing equitable healthcare. This qualitative study was conducted using a conventional content analysis approach between April and September 2024 in Iran. Participants included people living with HIV and healthcare providers, who were recruited through purposive sampling. Data were collected through 10 face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. From the data analysis, 406 initial codes were extracted. These codes were then grouped based on similarities and differences into three main categories:
1.Factors related to clients (with subcategories: fear of transmitting the disease to others, poverty, physical problems, unfamiliarity with their rights, and non-adherence to treatment regimens)
2.Factors related to the healthcare system (with subcategories: discrimination in accessing healthcare services, contemptuous attitudes of healthcare providers, incompetency of healthcare providers, fear of infection by the virus, disclosure of patient information, negligence by medical centers in identifying infected individuals, and failure to conduct premarital testing)
3.Cultural factors (with subcategories: non-acceptance of infected individuals in society, stigma, and discrimination in marriage and childbearing).
The right to access healthcare services, confidentiality of information, the right to marry, financial protection, and active participation in society should be prioritized for people living with HIV.

The Heart of Healing: How Narrative Medicine Deepens Nursing – A Systematic Review of Clinical Trials

Negin Farid

Narrative medicine has emerged as a transformative model in healthcare, emphasizing the role of patient stories in enhancing the quality of care. By recognizing the individuality of each patient's narrative—shaped by personal experiences and cultural contexts—this approach fosters deeper connections between caregivers and patients. Despite its growing recognition, narrative medicine remains underutilized in nursing, where the psychological and emotional dimensions of care are often overlooked. This systematic review examines clinical trials that investigate the integration of narrative practices into nursing education and care delivery, with the aim of assessing their clinical and educational impact. A comprehensive literature search was conducted across international and national databases including PubMed, Scopus, Web of Science, SID, Noor, Magiran, Irandoc, and Google Scholar, using relevant English and Persian keywords. Eligible studies were clinical trials published in English or Persian. After removing duplicates and applying inclusion criteria, eight studies were included for analysis. Selection and data extraction were conducted independently by two researchers, with discrepancies resolved by a third reviewer. The review adhered to PRISMA guidelines and ethical standards were maintained throughout. The studies, published between 2018 and 2024, involved nursing students (mean age 17.96–21.5 years), patients with lung tumors (mean age 49.31 years), and elderly patients (aged 61–89 years) with complex fractures. Findings were synthesized into three main domains. First, narrative-based education significantly enhanced empathy and academic performance among nursing students. Second, the implementation of narrative approaches led to measurable reductions in anxiety and depression among patients, particularly those with lung tumors. Third, improvements were observed in overall quality of life, pain management, and cognitive function, especially in elderly patients. These findings suggest that narrative education plays a critical role in improving both clinical and psychological outcomes. Narrative-based interventions enhance the empathetic capacity of nurses and contribute to higher standards of patient care. Incorporating narrative approaches into nursing curricula and clinical practice is recommended as a strategy to foster more holistic and human-centered care.

Factors Affecting Compassion Fatigue in Critical Care Nurses: A Systematic Review

Mobina Abedinpour

Compassion fatigue refers to the physical and emotional exhaustion experienced by healthcare professionals due to prolonged exposure to job-related stress and the emotional demands of caring for others. Compassionate care is vital for achieving better patient outcomes, but various factors during healthcare delivery can compromise it. This study examines the factors influencing compassion fatigue among critical care nurses. This systematic review was conducted by searching databases including SID, Magiran, Irandoc, Iranmedex, Civilica, Science Direct, Web of Science, Embase, PubMed, Scopus, ProQuest, and Google Scholar. Keywords used in the search included “compassion fatigue,” “critical care,” “intensive care,” “nurses,” “compassion satisfaction,” and “burnout.” After removing duplicates, studies were screened based on inclusion and exclusion criteria, and their quality was assessed using the Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Ultimately, 23 studies met the criteria and were included in the systematic review (qualitative synthesis). The studies included in this review were conducted between 2012 and 2024, with a total of 5,820 participants. The review found that both workplace structural factors and demographic characteristics of nurses, such as age, sex, marital status, nationality, educational level, resilience, length of shifts, experience in critical care settings, place of work, position within the unit, and nurse-to-patient ratios, are causes and predictors of compassion fatigue. Leadership and administrative support in clinical settings, as well as the coping strategies employed by nurses, were identified as factors that mitigate the impact of compassion fatigue among critical care nurses. This systematic review highlights the profound impact of compassion fatigue on nurses and emphasizes the roles of workplace environment and demographic factors in its development. The findings underscore the importance of supportive leadership and effective coping strategies in reducing compassion fatigue and enhancing compassion satisfaction among critical care nurses. By addressing these factors, healthcare organizations can reduce burnout, improve nurse well-being, and enhance patient care and clinical outcomes.

A Review of the Ethical Challenges Surrounding Abortion and Related Perspectives in Islamic Societies

Mohammad Chahkandi

Induced abortion remains a significant global health concern, with an estimated 73 million procedures performed annually. While legal and medical frameworks vary across countries, many Islamic societies grapple with ethical dilemmas surrounding abortion. This review examines the ethical challenges surrounding abortion within the context of Islamic perspectives. A comprehensive literature search was conducted using the keywords "abortion," "Islam," and "ethics" in combination with Boolean operators (AND, OR) within PubMed, SID, Google Scholar, and other relevant databases. The search was conducted by three independent researchers. Inclusion criteria included articles published between 2014 and 2024 with the keywords appearing in the title, abstract, or keywords, and full-text availability. After removing duplicates, 11 articles met the inclusion criteria. The decision to undergo elective abortion is influenced by various factors, including the desire for pregnancy, maternal and fetal health status, family dynamics, social stigma, and legal and religious regulations. While Islam generally prohibits abortion, ongoing debates arise from challenges related to access to safe abortion methods and the protection of women's rights. Despite the religious prohibition of abortion, restrictions on access to safe abortion services do not eliminate the practice but rather drive women towards unsafe methods, leading to significant physical and psychological harm, particularly among vulnerable populations. Moreover, limitations on prenatal screenings can result in the birth of infants with genetic defects. These factors raise important questions about the effectiveness and ethical implications of restrictive abortion policies in Islamic societies. Ensuring access to safe and legal abortion services, along with comprehensive sexual and reproductive health education, is crucial for improving maternal health outcomes and upholding women's rights within these contexts.

The Relationship Between Ethical Courage and Moral Distress in Nursing Students of Mashhad University of Medical Sciences in 2023

Sepide Ghavidel

Moral distress is a common topic in medical ethics, referring to a state where individuals, despite possessing knowledge and the ability to act ethically, are unable to perform the right ethical actions due to external constraints. Ethical courage is a crucial virtue for conscientious performance by healthcare providers, particularly nurses and nursing students. It facilitates the delivery of nursing care and is especially important in today’s healthcare environment, where factors such as increased patient awareness, evolving health needs, social justice issues, and access to healthcare services have contributed to heightened levels of moral distress among nurses and nursing students. This study aims to investigate the relationship between ethical courage and moral distress in nursing students. This descriptive, cross-sectional study was conducted in 2023 in Mashhad, Iran. The study population consisted of third-semester nursing students at Mashhad University of Medical Sciences. A total of 40 third-semester nursing students, both male and female, participated in the study. Data were collected using two questionnaires: the Moral Distress Scale (Corley) and the Ethical Courage Questionnaire (designed by Sekerka and colleagues). The data were analyzed using SPSS version 25, employing descriptive statistics and Pearson correlation tests. The majority of the students were female (51.2%), while 36.6% were male. The average age of the participants was 21.14 years. Among the students, 75.6% were single, and 4.9% were married. The findings revealed a weak, non-significant negative correlation between moral distress and ethical courage (r = -0.055, p > 0.05). The average moral distress score was 75.34 ± 10.81 (range: 12–16), while the average ethical courage score was 85 ± 9.33 (range: 60–103). The study found a weak, non-significant negative correlation between moral distress and ethical courage among nursing students. Based on these findings, it is recommended to implement workshops focused on ethical motivation and educational programs designed to reduce moral distress and enhance ethical courage among nursing students. Additionally, the non-significant correlation may be attributed to the small sample size. Therefore, future studies with larger sample sizes are suggested to validate these findings.

Educational Strategies to Enhance Moral Sensitivity in Nursing Students: A Systematic Review

Pooriya Samadzadehshahri

Nursing students, as future healthcare professionals, must develop not only clinical competencies but also ethical competencies to deliver appropriate and professional care. Moral sensitivity is a critical aspect of professional competence, enabling nurses to recognize and respond sensitively to ethical situations as patient advocates. Consequently, fostering moral sensitivity should be prioritized from the beginning of nursing education to ensure quality care. This study aimed to examine the characteristics and effectiveness of educational interventions designed to improve the moral sensitivity of nursing students. In this systematic review, articles were retrieved using Persian and English keywords from international databases, including PubMed, Web of Science, and Scopus, as well as Persian databases such as SID and Magiran, from inception until October 2024. Keywords used in the search included "moral sensitivity," "ethical sensitivity," "nursing students," "ethics," and "moral sensitivity in nursing students." A total of 2,321 articles were identified in the initial search. References for each study were also manually reviewed. Based on inclusion criteria, experimental and quasi-experimental studies published in Persian and English focusing on effective interventions to improve the moral sensitivity of undergraduate nursing students were selected for analysis. Ultimately, six articles met the criteria for thorough review, and relevant data were extracted. Two researchers independently extracted the data and assessed the quality of the studies using the Joanna Briggs Institute (JBI) checklist. A total of 190 nursing students from six selected studies participated in the research, with 60% in intervention groups. The six educational interventions identified included:

Two studies on nursing ethics workshops.
A nursing ethics workshop conducted through a seminar.
A motivational ethical education program.
A virtual narrative ethics workshop.
Problem-based learning.

However, the nursing ethics workshop conducted through a seminar was not effective in improving the moral sensitivity of nursing students. Evidence suggests that while the positive effects of educational interventions on the moral sensitivity of nursing students are limited, they are nonetheless encouraging. This review highlights various approaches to ethics education and moral sensitivity development. The findings can be utilized to enhance students' preparedness and ability to navigate ethically challenging work situations. However, further research is necessary to confirm the effectiveness of these interventions in fostering moral sensitivity among nursing students.

Investigating the Factors Influencing Moral Courage in Nurses: A Systematic Review

Negin Farid

Moral courage, encompassing the ability to act ethically in the face of adversity and uphold ethical principles, is crucial for nurses. This systematic review aimed to investigate the factors influencing moral courage among nurses. A comprehensive literature search was conducted using keywords such as "moral courage," "ethics," "nurses," and "courage" in major databases, including PubMed/Medline, Web of Science Core Collection, Scopus, Google Scholar, Irandoc, SID, and Magiran. The search included publications in both English and Persian with no time limitations. After excluding duplicates and screening the initial 2577 studies, 21 studies met the inclusion criteria. The review adhered to the PRISMA guidelines for reporting systematic reviews, ensuring ethical considerations were maintained throughout the selection, extraction, and analysis processes. The review revealed that moral courage in nurses is influenced by a multifaceted array of factors. Individual factors such as age, gender, work experience, and type of employment (e.g., permanent vs. temporary) were found to influence moral courage. Higher education, particularly possessing a master's degree or higher, and participation in medical ethics training were significantly associated with increased moral courage. Ethical sensitivity, defined as the ability to recognize and appreciate ethical dilemmas, was a significant facilitator of moral courage. A supportive work environment, characterized by factors such as strong ethical leadership, open communication, and adequate resources, was found to positively influence moral courage. Conversely, ethical distress experienced in challenging clinical situations can negatively impact moral courage. This review demonstrates that moral courage among nurses is influenced by a complex interplay of individual, professional, and environmental factors. Enhancing moral courage requires a multi-pronged approach, including strengthening nursing education with a robust emphasis on ethics training, fostering a supportive and ethically sound work environment, and implementing strategies to mitigate ethical distress. These interventions can significantly contribute to improved clinical practice and enhanced patient care.

Investigating the Effects of Spiritual Care on Death Anxiety: A Systematic Review

Negin Farid

Death anxiety, characterized by persistent fear of death, is a significant psychological burden. Spiritual care, encompassing compassionate listening, fostering trust, and addressing spiritual and existential concerns, has the potential to alleviate this anxiety. This systematic review aimed to investigate the impact of spiritual care interventions on death anxiety in various patient populations. A comprehensive literature search was conducted using keywords such as "spiritual care," "death anxiety," "spirituality," and "patients" in major databases, including Web of Science Core Collection, PubMed/Medline, Scopus, Irandoc, SID, Magiran, and Google Scholar. The search included publications in English and Persian with no time limitations. After screening and removing duplicates, eight studies met the inclusion criteria. Ethical considerations, including minimizing bias in the selection, extraction, and analysis of evidence, were adhered to throughout the review process. The review followed the PRISMA guidelines for reporting systematic reviews. The findings suggest a potential positive impact of spiritual care on reducing death anxiety. Studies conducted among patients with chronic kidney disease, multiple sclerosis, and stroke demonstrated that spiritual care interventions, including individual counseling and group support, can effectively alleviate death anxiety and improve overall well-being. However, some studies, particularly those involving patients with cardiac problems and gastrointestinal cancer, did not show a significant reduction in death anxiety. Furthermore, research conducted during the COVID-19 pandemic highlighted the potential effectiveness of tele-nursing interventions for providing spiritual care and alleviating death anxiety in older adults. This review provides evidence suggesting that spiritual care interventions may be effective in reducing death anxiety in certain patient populations. Further research is warranted to investigate the effectiveness of different spiritual care modalities across diverse patient groups, including those with chronic illnesses, terminal diseases, and those facing end-of-life care.

Investigating the Relationship Between Moral Intelligence and Clinical Competence of Nurses and Nursing Students: A Systematic Review

Negin Farid

Moral intelligence encompasses an individual's ability to discern right from wrong, possess ethical values, and demonstrate ethical behavior in practice. Clinical competence, a crucial aspect of nursing practice, encompasses a combination of knowledge, skills, and attitudes, including adherence to ethical principles. This systematic review aimed to investigate the relationship between moral intelligence and clinical competence among nurses and nursing students. A comprehensive literature search was conducted using keywords related to "moral intelligence," "clinical competence," "nurses," and "nursing students" in major international databases, including Web of Science Core Collection, PubMed/Medline, Scopus, and Google Scholar, as well as national databases such as Irandoc, SID, and Magiran. The search included publications in Persian and English with no time limitations. After removing duplicates and screening the initial 150 identified studies, five studies met the inclusion criteria. Ethical considerations, including minimizing bias in the selection, extraction, and analysis of evidence, were adhered to throughout the review process. The abstract adheres to PRISMA guidelines for reporting systematic reviews. The review revealed a significant positive correlation between moral intelligence and clinical competence across various dimensions. Studies demonstrated that higher levels of moral intelligence were associated with improved clinical competence, including ethical reasoning and clinical self-efficacy. Factors such as age, work experience, educational status, and individual rank were found to influence this relationship. Additionally, some studies indicated that moral intelligence could predict clinical competence scores, while others demonstrated that it could be a significant predictor of clinical competence alongside other factors such as Grade Point Average (GPA). This systematic review provides evidence for a significant positive relationship between moral intelligence and clinical competence among nurses and nursing students. Enhancing moral intelligence through targeted educational interventions can contribute to improved clinical competence and ultimately enhance the quality of patient care. Future research should focus on developing and evaluating educational programs designed to enhance moral intelligence in nursing education and practice.

Scientometric Analysis of Studies in the Field of Ethics and Artificial Intelligence

Rasha Atlasi

Artificial intelligence (AI) ethics encompasses principles and standards guiding the design and application of AI, ensuring privacy, security, and fairness. This study aims to conduct a scientometric analysis of research in this field, identifying key features and emerging trends. A search was conducted in the PubMed database using the Medical Subject Headings (MeSH) terms "artificial intelligence" and "ethics." All indexed documents from inception to September 1, 2024, were retrieved and analyzed. Scientometric analysis and data visualization were performed using R, with results presented through tables, graphs, and scientific maps. A total of 534 papers were published in this domain from 1986 to 2024, with the highest number (n=70) in 2024. The American Journal of Bioethics had the most publications (n=30), and Melissa D. McCradden (University of Toronto) was the most prolific author with five articles. The University of Oxford (n=24) and Stanford University School of Medicine (n=21) were the leading institutions in this field. The most active countries were the USA (n=236), Germany (n=91), and France (n=52). In 2024, the top trending topics included "research personnel," "informed consent/ethics," and "artificial intelligence/ethics/trends," while in 2023, "privacy," "biomedical research," and "medical education" were predominant. The field of AI ethics has seen exponential growth in scientific output, paralleling the rapid advancements in AI applications across disciplines and daily life. Addressing ethical concerns and fostering international research collaboration will be essential for maximizing benefits while mitigating challenges in this evolving domain.

The Role of Ethics in Emergency Care for the Elderly

Soolmaz Moosavi

The elderly population is rapidly increasing, and as a result, the demand for emergency services for this age group is also growing. Due to their specific physical and mental conditions, the elderly are exposed to numerous ethical issues and challenges when receiving emergency services. These issues are significant because their physical and mental conditions can prevent them from making decisions independently and achieving informed consent. The aim of this article is to examine the ethical challenges associated with the care of the elderly in the emergency department and to provide suggestions for improving this care. This educational narrative review article examines and analyzes ethical challenges in elderly care in the emergency department using reliable sources and articles between 2005 and 2024. Keywords included "medical ethics," "elderly care," and "emergency," and sources were extracted from reliable scientific databases such as PubMed, Scopus, and Google Scholar. Ethical challenges in elderly care in the emergency department include maintaining the independence of the elderly, obtaining informed consent, ensuring privacy and confidentiality, decision-making at the end of life, observing justice and fairness, maintaining honesty, providing psychological and emotional support, offering compassion and empathy, upholding professional principles of education and awareness, communicating effectively with the family, managing pain, and ensuring patient comfort. Although developed countries have long faced the issue of aging, in recent years, the growth rate of aging in developing countries has accelerated. These countries face major challenges in elderly care due to inadequate infrastructure and rapid demographic changes. Ethical challenges in caring for elderly patients in emergency rooms are among the most important issues that healthcare teams face. These challenges are exacerbated by the physical and mental sensitivity of the elderly, the complexities of treatment, and the need for rapid decision-making. Adherence to ethical principles, along with ongoing education of caregivers, can improve the quality of care for the elderly in emergency situations and prevent physical and mental harm. Therefore, in addition to knowledge and skills, caring for the elderly requires adherence to ethical principles and humane behavior. By following these principles, a sense of trust and peace can be fostered in the elderly. Some suggested solutions include educating and raising awareness among healthcare teams, strengthening communication with family and legal representatives, using ethical standards, encouraging the elderly to prepare a medical will, and utilizing psychological and physical assessments.

Modern Care and Ethical Challenges: Emerging Needs and Considerations

Soolmaz Moosavi

Scientific advancements and emerging technologies in healthcare - such as Artificial Intelligence (AI), the Internet of Things (IoT), and telemedicine -have created unprecedented opportunities to enhance the quality of care. These innovations enable physicians and patients to achieve faster and more accurate methods in diagnosis, treatment, and monitoring. However, they also introduce new ethical challenges that require careful analysis and appropriate solutions. This study was conducted as a Scoping Review aimed at exploring and elucidating various dimensions of modern care. The methodological framework proposed by Arksey and O'Malley, along with its enhancements by Levac et al., was employed. The main steps included:

1. Research Questions

The review focused on the following key questions:
What is modern care, and what are its main dimensions?
What factors and evidence influence the design and delivery of modern care?
What are the major challenges associated with modern care?
What are the potential strategies to address these challenges?

2. Search Strategy Development

Reputable scientific databases including PubMed, Scopus, Web of Science, and Google Scholar were searched using relevant keywords such as “modern care,” “contemporary healthcare,” “innovative care,” and “advanced patient care.” Boolean operators were applied to refine the search strategy.

3. Study Selection

Inclusion and exclusion criteria were as follows:

Inclusion: Articles related to modern care, published within the last 10 years, in English or Persian, addressing challenges, strategies, or innovative care approaches.
Exclusion: Studies focused solely on traditional care or lacking full-text access.
Initial selection was based on titles and abstracts, followed by full-text screening

4. Data Extraction and Analysis
Key data were extracted using standardized forms, including study characteristics (year, location), definitions of modern care, focus areas, and main findings. A qualitative approach was used for data analysis, and core themes were identified. Findings were categorized into three major areas:

Types of Advanced Technologies and Applications in Care
Ethical Challenges in Modern Technology Use
Proposed Strategies for Addressing Ethical Challenges

1. Artificial Intelligence (AI)

AI algorithms assist in analyzing complex data, pattern recognition, and treatment outcome prediction. Their applications are significant in medical imaging, genetic data analysis, and patient outcome forecasting.

2. Internet of Things (IoT) in Healthcare

IoT enables real-time monitoring through connected devices, useful in remote monitoring and chronic disease management.

3. Telemedicine

Telemedicine provides patients in remote areas or at home with access to healthcare services, reducing the need for in-person visits and enhancing patient comfort.

Ethical Challenges in Modern Care

Privacy and Data Security
- Modern technologies, especially AI and IoT, require the collection and analysis of vast amounts of sensitive patient data, posing significant privacy risks and opportunities for unauthorized access.
- Solution: Employ advanced security systems, data encryption, and adherence to privacy regulations such as GDPR.
Automated Decision-Making by AI
- AI systems may suggest or even make treatment decisions, sometimes without human oversight. This could result in ethically inappropriate decisions that overlook human and emotional aspects.
- Solution: Ensure that AI-based decisions are supervised by medical professionals and account for human factors.
Accountability and Responsibility
- Determining responsibility in case of errors or failures in automated systems is complex. Is the medical team liable, or the technology provider?
- Solution: Develop clear guidelines and legal frameworks outlining responsibilities and oversight mechanisms.
Equity in Access to Advanced Services
- Advanced care may not be accessible to all, especially in low-income areas or developing countries, leading to healthcare and social inequalities.
- Solution: Plan for equitable access and provide support to underserved communities.
Use of Genetic Data and Personalized Medicine
- Although personalized medicine based on genetic profiling improves outcomes, it also raises concerns about genetic discrimination and privacy breaches.
- Solution: Establish strict laws and ethical standards for handling genetic data.
Changing Roles of Physicians and Patient Trust
- Automation may diminish the central role of physicians, potentially undermining patient trust.
- Solution: Reinforce the human element in care and ensure physicians maintain their role as primary decision-makers.

Proposed Strategies to Address Ethical Challenges

Education and Empowerment of Medical Teams and Patients
- Familiarity with new technologies and their ethical implications helps care teams make informed decisions. Patients should also be aware of their rights and data privacy issues.
Development of Comprehensive Regulations
- Clear and enforceable legal frameworks that uphold ethical standards and protect patient privacy are crucial.
International Collaboration and Knowledge Sharing
- Global standard development and sharing of best practices can enhance ethical use of medical technologies.
Establishment of Ethics Committees and Oversight Bodies
- Ethics committees in healthcare and research institutions can assess and manage emerging ethical concerns. Close monitoring of technology use is essential.
Assessment of Long-Term Impacts
- Longitudinal studies are needed to understand the long-term consequences of modern technologies, supporting better decision-making.

Modern healthcare technologies offer vast potential for improving quality of life. However, they also introduce new ethical challenges. Addressing these requires integrating ethical principles with scientific innovation and strategic planning. This article underscores the importance of comprehensive legislation, education, and maintaining the human role in medical processes to reduce these challenges and strengthen patient trust in modern care.

Investigating Ethical Considerations in the Use of Artificial Intelligence in the Field of Health: A Narrative Review

Reza Salehinia

Artificial intelligence (AI) represents a significant human advancement. The proliferation of AI technologies within the healthcare sector has led to substantial improvements in health outcomes and medical indicators. However, the application of AI in healthcare is accompanied by numerous ethical challenges. This study aimed to investigate the ethical considerations associated with the use of AI in the healthcare domain. This narrative review included articles published between February 2019 and November 2024. A comprehensive literature search was conducted across internal databases, including Magiran and SID, as well as external scientific databases such as PubMed, Web of Science, Medline, ScienceDirect, and Google Scholar. Keywords used for the search included "Ethics," "Artificial Intelligence," and "Health" in both Persian and English. After applying inclusion criteria and conducting quality assessments, nine studies were deemed eligible for inclusion in this review. The findings of previous studies demonstrate that the utilization of AI in healthcare has yielded significant benefits, including more accurate disease diagnoses, improved clinical predictions, more efficient hospital management, optimized resource allocation, enhanced patient care, streamlined clinical workflows, and advancements in medical research. These technologies have contributed to increased efficiency and quality within healthcare services. However, significant ethical challenges remain, including data privacy and security concerns, algorithmic bias, transparency issues, the need for robust clinical validation, and the importance of ensuring professional responsibility. Adherence to principles such as transparency, fairness, privacy protection, and equitable access is crucial for the responsible development and deployment of AI in healthcare. Ultimately, achieving a balance between technological advancements and human values is paramount for the sustainable and ethical utilization of AI in this domain. The findings of this review underscore the profound impact of AI on improving quality of life and enhancing services across various sectors, particularly healthcare, by providing innovative solutions. However, the optimal utilization of AI in healthcare necessitates a meticulous consideration of ethical implications, rigorous monitoring of AI systems, and proactive efforts to address the existing challenges.

Elucidating the Lived Experiences of Operating Room Nurses Regarding Moral Intelligence: A Hermeneutic Phenomenological Study

Masoomeh Salehi

The diversity of work environments, regulations, and prevailing atmospheres uniquely influence individuals' moral intelligence. Given the significant role of operating room nurses in patient care and the importance of moral intelligence in enhancing the quality of these services, this study aimed to elucidate the experiences of operating room nurses regarding moral intelligence at Hamadan University of Medical Sciences. A hermeneutic phenomenological study was conducted in hospitals affiliated with Hamadan University of Medical Sciences, Iran, from May to October 2023. Twelve operating room nurses were purposefully selected. Data was collected through in-depth semi-structured interviews and analyzed using van Manen's method. The study's rigor was ensured through four criteria: credibility, dependability, confirmability, and transferability. Three main themes related to moral intelligence were identified by examining the experiences of operating room nurses. These themes include: moral sensitivity (inner guidance, recognizing the rightness or wrongness of actions, having a work ethic), the ability to make sound decisions (ability to make sound judgments, moral courage), and ethical behavior towards patient interests (providing ethical care, preserving patient dignity, ability to work as a team). Operating room nurses with high moral intelligence are sensitive to the rightness or wrongness of actions, guided by inner ideals and professional commitment to doing what is right. They make sound judgments when faced with challenges and defend them courageously, making sound decisions. By providing ethical care, working as a team, and protecting human dignity, they demonstrate ethical behavior towards patient interests.

Explaining Nursing Students’ Experiences of Professional Ethics in Relation to Psychiatric Clients: an Analysis Based on Narrative Writing-Reflection

Mina Gaeeni

Clinical education constitutes the cornerstone of nursing education. Enhancing students' theoretical and practical knowledge within the psychiatric department is crucial for improving their attitudes, acceptance, and delivery of care. The outcomes of effective clinical learning encompass the development and refinement of professional competencies, including communication and professional ethics, the cultivation of critical thinking for clinical judgment and decision-making, the enhancement of ethical sensitivity, and the fostering of effective team and group performance. Recognizing the significance of these factors, this study aimed to "explain the experiences of nursing students based on narrative writing-reflection during their first encounter with psychiatric clients." This qualitative study was conducted during the psychiatric nursing internship at the Faculty of Nursing, Qom University of Medical Sciences, over two consecutive semesters. Purposive sampling was employed, and data were collected through 10 semi-structured individual interviews and 2 face-to-face and virtual focus groups (n=5 per group). Data collection continued until data saturation was reached. Data analysis was conducted using a qualitative content analysis approach with the assistance of MAXQDA20 software. The clinical experiences of students during their initial psychiatric nursing training course, as reflected in their narrative writing-reflections, revealed a primary theme: "encouraging ethical and spiritual communication in nursing." This overarching theme encompassed four sub-themes: "enhancing empathetic communication," "enhancing ethical sensitivity," "respecting the dignity of clients," and "listening to the voice of clients' feelings." The experiences gained through the reflective method within the clinical education setting, particularly in specialized clinical environments such as psychiatric wards and during initial encounters with clients in these departments, can provide valuable insights into students' attitudes and perspectives towards these clients and their families. These rich experiences can be effectively utilized to cultivate and strengthen communication and professional ethics among medical science students.

No to Ageism in Older People: A Review Paper

Fatemeh Estebsari

While the concept of ageism has existed across centuries, countries, contexts, and cultures, the term itself is relatively new and lacks a universal equivalent in many languages. Ageism encompasses stereotypes (how we think), prejudice, and discrimination directed towards individuals based on their age. Given the recent emergence and growing attention to this concept, this study aims to establish a common and consistent understanding of ageism within scientific literature. This review examined the concept of ageism in older adults. A search of the PubMed, Scopus, Web of Science, and Embase databases was conducted using the keyword "Ageism" and "Older adult," yielding 18,945 English-language abstracts published between 2014 and 2024. Two researchers independently reviewed the articles in two stages. An initial review of titles and abstracts resulted in the selection of 77 relevant papers. A subsequent full-text review narrowed the selection to 34 papers, of which 17 were ultimately included after a quality assessment. The findings encompassed various aspects of ageism, including types of ageism, its effects, determining factors, and strategies recommended by the World Health Organization to mitigate ageism. Age discrimination significantly diminishes the quality of life for older adults, increasing social isolation and loneliness. Ageism has profound and widespread consequences for individuals' health, well-being, and human rights. For older adults, ageism is associated with shorter life expectancy, poorer physical and mental health, slower recovery from disability, and cognitive decline. Based on the findings of this study, it is recommended to implement policies and laws, integrate ageism education into curricula from elementary school to university and in both formal and informal settings, and invest in interventions that foster intergenerational contact to effectively reduce age discrimination.

Spirituality Components in the Nurses' Health Monitoring Website

Nasrin Rasoulzadeh

A crucial aspect of nurses' professional performance is adherence to ethical principles, which can significantly impact their spiritual health. Strengthening spiritual well-being contributes to improved physical and mental health for individuals and society as a whole. By prioritizing spiritual dimensions such as faith, purpose in life, and moral commitment, individuals can mitigate anxiety and its associated complications. Spiritual aspects of life foster greater tolerance for shortcomings and challenges, facilitating more appropriate interactions with others within society. To effectively monitor the health status of nurses, accurate and readily accessible online health information is essential. Therefore, this study aimed to determine the key spirituality components that should be incorporated into a nurses' health monitoring website. This research was conducted in two stages. The first stage employed a content analysis approach with 25 participants, followed by a Delphi approach involving 51 participants across four rounds. Purposive sampling was utilized, with participants including nurses and other relevant specialists. In the first stage, data were collected through semi-structured interviews and guiding questions related to nurses' health monitoring. In the second stage, a questionnaire with open-ended questions was administered to participants in four rounds. Items achieving consensus from more than 75% of experts were incorporated into the final statements defining the information structure of the health monitoring system. Qualitative data were analyzed using directed content analysis. In the first qualitative stage, analysis of participant statements within the category of "spiritual peace" revealed a primary focus on the stability of health monitoring pillars. Participants identified belief in God and service to humanity as key contributors to establishing inner peace. However, all participants did not initially recognize the necessity of assessing spiritual health within the health monitoring framework. They tended to equate religious behavior with spiritual health, considering it primarily an internal and personal category, likely influenced by the prevailing religious and cultural context. In the second Delphi stage, expert consensus emerged regarding the importance of assessing nurses' spiritual health. While nurses initially may not have explicitly identified the need to assess spiritual health, neglecting this aspect can potentially hinder their ability to identify and address the spiritual needs of their patients. Therefore, it is recommended that the implementation of the health monitoring system incorporate a component for assessing nurses' spiritual health, tailored to the specific cultural context of Iran, enabling users to evaluate their own spiritual well-being.

Moral Empowerment in Intensive Care Unit Nurses: A Scoping Review

Mansoureh Ashqli Farahani

The intensive care unit (ICU) environment presents numerous ethical challenges, contributing to significant levels of moral distress among ICU nurses. This distress negatively impacts their well-being and job satisfaction. Recognizing this critical issue, researchers have investigated the potential of moral empowerment programs to alleviate moral distress. This scoping review aimed to systematically synthesize existing literature on these programs and evaluate their efficacy in mitigating moral distress among ICU nurses. A comprehensive search of PubMed, Scopus, and CINAHL databases was conducted, utilizing keywords such as "moral empowerment," "moral distress," and "intensive care unit nurses." Fifteen articles meeting predefined inclusion criteria, including publication between 2010 and 2022 and a specific focus on moral empowerment programs for ICU nurses, were selected for analysis. The scoping review revealed that moral empowerment programs demonstrated positive outcomes in reducing moral distress among ICU nurses. These programs, encompassing workshops, case-based discussions, reflective exercises, and role-playing simulations, were designed to enhance moral reasoning, ethical decision-making, and moral resilience. Consistent findings indicated a significant decrease in moral distress among nurses who participated in these programs. Participants reported increased confidence in navigating ethical dilemmas, making sound clinical decisions, and effectively advocating for patients' rights. Moreover, moral empowerment programs fostered a sense of moral agency, empowering nurses to address ethical challenges proactively. Moral distress poses a significant challenge for ICU nurses, impacting their well-being and potentially compromising the quality of patient care. Moral empowerment programs offer a promising approach to mitigating this distress and enhancing ethical decision-making capabilities. The successful implementation of these programs requires a supportive work environment that fosters open dialogue and ethical reflection. Nurse leaders and educators play a crucial role in collaborating with ethics committees to develop and implement tailored interventions, including integrating moral empowerment modules into new nurse orientations and ongoing professional development programs. Continuous support through follow-up sessions, mentoring, and debriefing is essential to sustain the long-term benefits of these programs. Ethical consultation services and interprofessional collaboration further contribute to the ethical well-being of ICU nurses. While this review provides valuable insights, further research is warranted to investigate the long-term effects and broader implications of moral empowerment programs in the ICU setting.

Examination of Nursing Students' Moral Sensitivity and Its Relationship with Demographic Characteristics

Zahra Keshtkaran

Nurses, as the largest healthcare provider group, play a crucial role in patient care and treatment teams. To provide professional and appropriate care, nursing students must possess both clinical and moral competencies. Moral sensitivity, defined as the ability to recognize and understand moral situations, is paramount. It fosters trust and responsiveness to individual patient needs while equipping nurses to navigate ethical challenges within clinical settings. This study aimed to assess the moral sensitivity of nursing students and investigate its relationship with demographic characteristics. This descriptive-cross-sectional study involved 112 third- and fourth-year nursing students. Data were collected using demographic questionnaires and Lutzen's moral sensitivity scale. Data analysis was performed using SPSS version 23, employing descriptive and analytical statistical tests. The highest mean score for moral sensitivity was observed in the area of "honesty in decision-making" (14.71 ± 6.25), while the lowest mean was found in the area of "professional knowledge" (3.70 ± 2.12). The overall mean score for moral sensitivity was 15.87 ± 8.54, indicating a moderate level. Analysis of the relationship between demographic variables, including age, GPA, gender, marital status, living situation, current semester, family financial status, and parental education, revealed a significant positive correlation between moral sensitivity and family economic status only in the area of "experience with moral issues" (P=0.046). The findings of this study underscore the critical need for the development and implementation of structured programs designed to enhance the moral sensitivity of nursing students. Furthermore, this study highlights the importance of considering influential social factors, such as economic conditions, in fostering moral experiences and strengthening ethical sensitivity.

Defenders without a Defense: Factors Associated with Ethical Conflict in the Context of Nursing Care

Mohsen Shahriari

While ethical conflict is an internal and individual experience, it is significantly influenced by environmental factors and variables. It describes a situation characterized by a discrepancy or conflict between the ethical values of caregivers, between caregivers and patients, or within the individual caregiver regarding the morally right course of action, often leading to ambiguity regarding duties and obligations. This research aimed to elucidate the factors associated with ethical conflict within the nursing context. This qualitative study employed conventional content analysis. Participants included 27 nurses working in various clinical departments, including emergency, intensive care, internal medicine, and surgery. Data were collected through in-depth semi-structured individual interviews conducted after obtaining written informed consent. Data analysis was performed using MAXQDA version 20 software, adhering to Granheim and Lundman's approach. To enhance the rigor of the study, the criteria of credibility, confirmability, dependability, and transferability proposed by Lincoln and Guba were applied. Decision-making challenges within the context of care emerged as a central theme. Several factors were identified as contributing to ethical conflict in nursing care, including disrupted relationships, inefficient management systems, physician prioritization, conflicts of interest, legal constraints, a negative ethical climate, and insufficient resources. Nurses, as primary patient advocates, are consistently exposed to various ethical conflicts within their practice. This study highlights the critical importance of addressing decision-making challenges within the context of care for policymakers within the healthcare system. Reducing these conflicts is crucial for improving the quality of nursing care.

The Dignity of the Elderly: The Missing Link in the Search for Primary Health Care Services: A Qualitative Study

Mohaddeseh Mohsenpour

Societies that fail to adequately address the growing needs of the elderly and the consequences of aging will face significant challenges. A critical challenge in many countries involves ensuring the provision of accessible and affordable healthcare services for the elderly. The active engagement of older adults in seeking healthcare services and adhering to preventive care measures is crucial for reducing healthcare costs. This study aimed to elucidate the lived experiences of elderly individuals regarding the factors influencing their utilization of primary healthcare services in Mashhad, Iran. This qualitative study employed content analysis. Participants were recruited through snowball sampling from a list of elderly individuals registered with health centers in Mashhad, including those who regularly utilized services and those who had not visited in the past two years. Eighteen elderly individuals participated in the study. Data were collected through in-depth interviews using open-ended questions and subsequent probing. Interview transcripts were analyzed using Bernard's formal content analysis approach. A significant barrier to accessing healthcare services identified by elderly participants was a lack of dignity during their visits to health centers. This theme encompassed two subcategories: perceived dignity violation and observed dignity violation. The imposition of feelings of worthlessness on the elderly was recognized as a prevalent cultural issue within society. Factors contributing to a diminished sense of dignity included: inadequate physical space to accommodate the limitations of the elderly, informal and unprofessional behavior of healthcare providers, excessive waiting times, unsanitary and overcrowded health centers, a lack of appointment scheduling, disruptions in internet and software systems that prolonged the healthcare process, shared waiting spaces with infants and young people, and insufficient seating. Participants emphasized the detrimental impact of a lack of dignity in healthcare settings, expressing feelings of worthlessness. These findings corroborate those of previous studies highlighting the paramount importance of dignity in healthcare environments. The perception among elderly individuals that healthcare services prioritize administrative processes over patient-centered care may discourage them from seeking preventive services. This study underscores the critical need for a cultural shift within healthcare systems to prioritize the dignity and respect of elderly patients and foster a supportive environment that encourages preventive care.

Ethical Challenges in Nursing and Midwifery Schools from the Perspective of Faculty Members: A Qualitative Study

Negar Farajzadeh

Nursing and midwifery professors play a crucial role in transmitting societal norms, providing cultural experiences, shaping students' behavior, beliefs, and attitudes, and cultivating moral virtues. As significant influencers on students' moral development during their academic journey, careful attention to this aspect is essential. This study aimed to elucidate the ethical challenges encountered by faculty members within the Faculty of Nursing and Midwifery. This qualitative study employed content analysis. Purposive sampling was utilized to select 23 faculty members from the Faculty of Nursing and Midwifery at Isfahan University of Medical Sciences, with data collection spanning eight months. Data were collected through semi-structured interviews and analyzed using conventional qualitative content analysis. Continuous and comparative data analysis revealed three primary categories of ethical challenges perceived by faculty members: discrimination and injustice, low professional commitment, and unprofessional behavior.
· Discrimination and injustice: This category encompassed three subcategories: disparities in rule implementation across faculties and groups, unfair financial compensation, and inequitable distribution of academic units and points.
· Low professional commitment: This category included two subcategories: educational underselling and non-adherence to established rules by faculty members.
· Unprofessional behavior: This category comprised two subcategories: unhealthy competition among faculty members and inappropriate student evaluations.
The experiences of faculty members in this study highlighted the presence of numerous challenges, with ethical issues significantly impacting their performance and motivation. The identified ethical challenges primarily revolved around discrimination and injustice, low professional commitment, and unprofessional behavior. Given the pivotal role of faculty members in teaching ethical principles and actively addressing ethical challenges, it is imperative for administrators and officials to acknowledge these concerns and implement strategies to mitigate these issues.

Is Elder Infantilization Ethical? An Analysis of the Concept of Elder Infantilization

Farzaneh Mokhtary

Infantilization is a behavioral pattern where an autonomous individual is treated as a child. This behavior manifests in various forms, such as the use of inappropriate or exaggerated vocabulary, thereby disregarding the social status and dignity of the elderly. Ethics, as a branch of philosophy, guides values related to appropriate and inappropriate human behavior. This article aims to enhance our understanding of elder infantilization and consequently facilitate the avoidance of such behaviors through a thorough analysis of the concept. This concept analysis study employed Walker and Avant's eight-step approach. A comprehensive literature search was conducted, encompassing both Persian and English databases, including Magiran, SID, PubMed, Scopus, Web of Science, and Google Scholar, with no time limitations. Keywords used for evidence retrieval included "infantilization," "elderspeak," "elderly," and "older people" in both Persian and English. A total of seven selected articles were reviewed in full text, and attributes, antecedents, and consequences related to the concept of elder infantilization were extracted. Antecedents of elder infantilization include functional impairment and observable disabilities, cognitive impairment, age over 70 years, and non-age-related factors such as lower education, less credible professional backgrounds, and care provided by younger caregivers. Infantilization is more prevalent in patients with delirium and those experiencing prolonged hospital stays. Environmental factors contributing to infantilization include the use of childish decorations in elderly care facilities. Activity-related manifestations encompass the lack of elderly participation in decision-making, inappropriate grooming of elderly women, loss of privacy and independence, reprimands, punishments, confinement, suppression of sexual expression, engagement in childish games, and the use of nicknames without the elderly person's consent.Linguistic manifestations include the use of childish terms and phrases, short sentences, simplified language, slow or exaggerated speech, and addressing elderly individuals by diminutive names without their permission. Consequences of elder infantilization encompass negative impacts on behavior, well-being, personal identity, relationship formation, social interaction, diminished abstract thinking abilities, limited problem-solving skills, decreased self-esteem, and increased resistance to care in individuals with cognitive impairment. Fostering autonomy is an ethical imperative in the care of the elderly across all service-providing settings. The occurrence of infantilizing behaviors towards the elderly stems from a failure to adopt a person-centered approach to care. It is crucial to prevent such behaviors by ensuring the provision of age-appropriate services for the elderly, even when they experience physical or cognitive disabilities.

Ethical Considerations in Providing Healthcare Services to the Elderly in Iran: A scoping review

Alireza Hajizadeh

As one of the countries with the fastest growing aging population, it is predicted that more than 20% of the Iran’s total population will be elderly in 2040. It is important to address ethical considerations in providing healthcare services to aged population. This study aimed to review the evidence related to ethical considerations in providing healthcare services to the elderly in Iran. This study was a scoping review conducted using the six-step protocol of Arksey and O’Malley. The English-language, Persian-language databases and Google Scholar, were searched without time limitation. After selecting studies and extraction the data, the narrative analysis was used to analyze the data. Providing comprehensive healthcare including, preventive, diagnostic, treatment, and rehabilitation services to the elderly needs to be based on humane-Islamic principles and values accepted by society. The most important ethical considerations required are: Maintaining the dignity and eminence of the elderly in all situations, considering ethics in communication with the elderly, ensuring autonomy and independence of the elderly in relevant decision-making, paying attention to the principles of justice and benefit in healthcare interventions, empathy and cheerfulness among healthcare providers, ensuring confidentiality and privacy and protecting information, paying attention to privacy, obtaining informed consent in healthcare centers, paying attention to religious and Islamic rules in caring for the elderly, the responsibility of government and non-government institutions in preventing stigma and discrimination against the elderly, carrying out timely and ethically-based care actions, healthcare providers' adherence to teamwork and scientific and professional behaviors, supporting the elderly as a vulnerable population group in prioritizing health services, preventing conflicts of interest in elderly care, and using safe, affordable, reliable, and evidence-based healthcare services for the elderly. It is necessary to pay attention to the ethical considerations identified in this study in providing healthcare services to the elderly. So, it is recommended that policymakers, managers, and healthcare providers take actions at the levels of the ministry of health, medical universities, and healthcare centers providing services to the elderly to promote humane-Islamic principles and values.

Ethical Challenges in ICU

Atefe Salimi Akinabadi

The intensive care unit (ICU) is a complex environment where diverse healthcare professionals collaborate to care for critically ill patients. Evidence suggests that ethical issues or conflicts are prevalent and can negatively impact ICU care. This research aimed to investigate the ethical challenges encountered by critical care nurses in clinical practice. Using the PRISMA guideline, relevant studies were identified through searches of the PubMed, Scopus, and Web of Science databases from 2015-2024 using the following MeSH terms: "ethics," "ethical challenges," "nursing," and "intensive care unit." Only English-language manuscripts were included. Ethical challenges in the ICU were categorized as follows:
1. Internal Constraints: Lack of self-confidence, fear, maladaptive coping mechanisms, religious conflicts, and spiritual conflicts.
2. External Constraints: Lack of collegiality, hierarchical structures, poor communication, inadequate staffing, restrictive policies, shortages of full-time critical care physicians and nurses, and working with incompetent staff.
3. Clinical Situations: Futile treatment, inappropriate care, inadequate pain relief, hastening death, providing false hope, end-of-life care decisions, decisions about life-sustaining treatments, and the use of physical restraints.
Recognizing ethical challenges in the ICU is crucial. It enables the implementation of measures to minimize ethical conflict, design effective strategies for preventing ethical dilemmas, and improve the nursing work environment.

Nurses’ Attitudes About Euthanasia: A Systematic Review

Shabnam Rasoulpoor

Euthanasia, defined as the intentional ending of a patient's life to relieve intractable suffering, presents complex ethical, legal, and emotional challenges for healthcare professionals, particularly nurses. Nurses play a pivotal role in end-of-life care, making their attitudes toward euthanasia crucial for understanding its implications in clinical practice. This review aims to synthesize existing literature on nurses' attitudes about euthanasia to identify key influencing factors and areas requiring further exploration. This study was conducted using the PRISMA 2020 guideline with no time limitation (by December 2024). Eligible articles were selected following a search in various databases (Scopus, Web of Science, PubMed, ScienceDirect, Embase, and Google Scholar) using keywords and operators of “AND” & “OR.” The search strategy included “Perceptions” OR “Attitudes” OR “Nurse” AND “Euthanasia.” Data extraction and risk-of-bias assessment were performed independently by two reviewers (SR and NT). Studies were evaluated with the Appraisal Tool for Cross-Sectional Studies (AXIS Tool). A total of 21 studies were included in the review. The review revealed that nurses’ attitudes toward euthanasia vary widely depending on legal frameworks, cultural norms, religious beliefs, and personal values. In countries where euthanasia is legalized, such as Belgium and the Netherlands, nurses often report greater acceptance and willingness to participate in the process, emphasizing their role in ensuring patient autonomy and dignity. Conversely, in regions where euthanasia is illegal, nurses frequently express ethical concerns, moral distress, and reluctance to support the practice. Common themes include the need for clear guidelines, ethical training, and emotional support systems for nurses dealing with euthanasia-related situations. Nurses’ attitudes about euthanasia are influenced by a complex interplay of cultural, legal, and personal factors. While some nurses view euthanasia as an extension of compassionate care, others experience ethical dilemmas and professional conflict. This highlights the need for robust ethical frameworks, specialized training, and supportive resources to help nurses navigate the challenges associated with euthanasia in their practice.

Moral Sensitivity Among Pre-Hospital Emergency Personnel: A Cross-Sectional Multicenter Study

Mostafa Ghasempour

Moral sensitivity is a crucial attribute for pre-hospital emergency personnel, significantly impacting their ethical decision-making and patient care in urgent and often complex situations. Defined as the capacity to recognize ethical dilemmas and comprehend their implications, moral sensitivity empowers personnel to navigate challenges such as resource limitations, critical patient conditions, and the imperative for rapid, independent decision-making. This study aimed to evaluate the level of moral sensitivity among Emergency Medical Technicians (EMTs) and identify key influencing factors. A cross-sectional study was conducted in 2023, encompassing 245 EMTs selected through cluster random sampling. Data were collected using the Moral Sensitivity Questionnaire (MSQ) and analyzed employing correlation tests and regression analysis. The findings revealed a mean moral sensitivity score of (39.45 ± 7.13) among participants, indicating a moderate-to-high level of ethical awareness. A significant correlation was observed between moral sensitivity and specific demographic and professional characteristics. Notably, work experience emerged as a key determinant (P < 0.001). Regression analysis further emphasized work experience (β = 0.08, P < 0.001) as a strong predictor, demonstrating that increased exposure to clinical and ethical challenges over time enhances moral sensitivity. Enhancing ethical sensitivity among pre-hospital emergency personnel is paramount to improving their ability to identify and address complex ethical challenges and deliver high-quality patient care. Given the unique demands of emergency situations, including time constraints, resource limitations, and the need for immediate action, it is crucial to equip personnel with the tools necessary to recognize and navigate ethical dilemmas. Implementing comprehensive training programs that emphasize ethical awareness and reasoning can empower EMTs to make more informed and empathetic decisions. Furthermore, cultivating a supportive organizational culture that prioritizes ethical performance and provides ongoing training can further enhance their confidence and competence in managing ethically sensitive situations.

Ethics and Health Chatbots

Masoud Amanzadeh

Health chatbots, powered by artificial intelligence (AI), are revolutionizing healthcare by providing accessible, personalized, and efficient health-related assistance. These tools have found applications in symptom checking, mental health support, and even aiding in clinical decision-making. While their potential to enhance healthcare efficiency is significant, the use of medical chatbots raises significant ethical considerations that must be considered and addressed. The aim of this study is to investigate the ethical challenges and considerations of health chatbots. In this article, we reviewed the literature on the ethical considerations of health chatbots. PubMed, Scopus, Web of Science, and Google Scholar were searched using related keywords such as "Chatbot," "conversational agent," "ethics," "medical," and "healthcare." Relevant studies were selected and reviewed based on specified inclusion/exclusion criteria. The review identified several ethical concerns associated with health chatbots: 1) Privacy and Data Security: Patient data collected by chatbots are vulnerable to breaches, raising concerns about confidentiality and misuse. 2) Accuracy and Reliability: Errors in chatbot responses can lead to misdiagnoses or inappropriate advice, potentially harming patients. 3) Bias and Equity: AI algorithms may perpetuate biases present in training datasets, leading to unequal care for certain demographic groups. 4) Accountability and Responsibility: Unclear legal frameworks complicate the allocation of responsibility in cases of harm. 5) Autonomy and Trust: Overreliance on chatbots may diminish the human element of care, affecting trust and patient autonomy in decision-making. While health chatbots offer substantial benefits in accessibility and efficiency, addressing their ethical challenges is imperative. A robust ethical framework emphasizing privacy, transparency, fairness, and accountability is needed to mitigate risks. Continuous monitoring, user education, and adherence to evolving AI regulations can ensure safe and equitable integration of chatbots in healthcare.

Ethical Considerations of Using Electronic Health Records by Healthcare Providers

Hamid Moghaddasi

The ethical use of patient medical records by healthcare providers is fundamentally guided by the patient's right to privacy and confidentiality, enshrined in patient rights charters. Users of patient medical records are categorized as authorized (e.g., clinicians directly involved in patient care) and unauthorized (e.g., administrative staff, external entities). This categorization informs both internal and external information disclosure policies. Authorized users access patient records based on the "need to know" principle, ensuring confidentiality while adhering to internal disclosure protocols. Unauthorized users have limited access, primarily governed by external disclosure policies that restrict access to personally identifiable information.
The transition from paper-based to electronic health records (EHRs) significantly alters the ethical landscape for healthcare providers. While paper records primarily raised concerns about physical security, EHRs present unique ethical challenges in three key areas:
1. Respect for Patient Information: Proper use of patient data requires a deep understanding of the ethical implications of accessing and utilizing sensitive information.
2. Privacy and Confidentiality: Maintaining patient privacy and confidentiality in the digital age requires robust security measures and a commitment to data protection best practices.
3. Data Integrity and Accessibility: Ensuring the accuracy, completeness, and accessibility of EHR data while maintaining patient privacy presents a complex challenge.
Healthcare providers, particularly physicians and nurses with extensive EHR access, must prioritize patient privacy and data confidentiality when utilizing information technology in patient care. This includes proactively mitigating threats to data security and adhering to strict ethical guidelines for data access and use.

Exploring Advance Directives and End-of-Life Preferences in Heart Failure Patients: A Systematic Review and Meta-Analysis

Shiva Khaleghparast

Advance directives (ADs) are legal instruments that enable individuals to express their healthcare preferences in anticipation of a future loss of decision-making capacity. These directives are particularly important in the context of chronic conditions such as heart failure (HF), a disease marked by progressive functional decline and unpredictable medical crises. ADs help safeguard patient autonomy by ensuring that care aligns with personal values and preferences, especially at the end of life. This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines to examine the preferences of patients with heart failure regarding life-sustaining treatments and end-of-life decision-making. A comprehensive literature search was performed across PubMed, Scopus, and Web of Science databases, covering publications up to March 2024. Search terms included "advance directive," "advance care planning," "heart failure," and "end-of-life decision-making." Studies were included if they were original, peer-reviewed, full-text articles focusing on HF patients aged 18 and older. Non-peer-reviewed works and inaccessible full texts were excluded. A total of 25 eligible studies were identified and appraised using the NIH quality assessment tool. Extracted data included demographic characteristics, preferences for treatment, surrogate decision-making, and educational interventions. Findings from the reviewed literature reveal consistently low levels of awareness and completion of ADs among HF patients. Completion rates varied significantly across studies, reflecting potential cultural and systemic influences. Preferences for surrogate decision-makers overwhelmingly favored family members over healthcare professionals. A notable finding from Jawahri et al. (2016) indicated that patients who received video-based education were significantly less inclined to choose cardiopulmonary resuscitation (CPR) or mechanical ventilation compared to those receiving only verbal information. Additional qualitative insights, such as those from Formiga et al. (2004), showed that patients prioritized maintaining dignity, independence, and meaningful relationships over merely extending life. These patterns highlight the necessity of aligning care with patients’ broader goals and values. Across the 25 studies included, a total of 4,091 heart failure patients were analyzed, with a mean age of 68.22 years. Meta-analytic findings demonstrated diverse preferences regarding life-sustaining interventions: approximately 53.73% of patients favored such treatments, while 45.37% declined CPR. These statistics underscore a substantial variability in end-of-life preferences, further reinforcing the need for individualized care planning. In conclusion, patients with heart failure display heterogeneous preferences concerning end-of-life care, shaped by cultural context, personal values, and the type of information provided. Despite the established importance of ADs, significant deficits in awareness, understanding, and documentation persist. These findings point to a critical need for tailored educational interventions, improved provider-patient communication, and culturally sensitive approaches to advance care planning. Future research should focus on designing and integrating standardized AD facilitation tools into routine clinical practice to support truly patient-centered care.