Iranian Journal of Medical Ethics and History of Medicine

Assessing Responsiveness to Non-Medical Needs of Inpatients in Educational-Therapeutic Hospitals in Gorgan, 2022

Alireza Heidari

Addressing patients’ non-medical needs reflects the desires of patients and their families to engage more actively in decision-making and treatment processes. The present study aimed to assess the level of responsiveness to the non-medical needs of hospitalized patients. This was a cross-sectional study conducted using a descriptive-analytical approach. A total of 392 patients hospitalized in Shahid Sayad Shirazi and 5 Azar educational-therapeutic hospitals, affiliated with Golestan University of Medical Sciences in Gorgan, were included in the study. Participants were selected through systematic random sampling. Data were collected using the validated and reliable responsiveness questionnaire developed by the World Health Organization (WHO). The mean (±SD) age of participants was (45.17 ±16.92) years, with 55.1% being male. The mean (±SD) overall score for the importance of responsiveness was (33.37 ±4.45), which was above the average. The majority of patients (over 65%) rated all dimensions of responsiveness as very important or extremely important. The most important dimension from the patients' perspective was the quality of the surrounding environment (95.9%), while the least important was the confidentiality of personal information (34.7%). The mean (±SD) overall score for responsiveness performance was 54.54 (0.70 ± 8), which was above the average. The overall score of the responsiveness performance and importance in Sayad Shirazi and 5 Azar educational hospitals was above average. Dimensions deemed important by patients but with weaker performance should be prioritized, and educational and therapeutic centers should pay more attention to patients’ non-clinical expectations.

An Ethical Audit of Pharmaceutical Laws and Regulations in Iran

Pooneh Salari

Ethical challenges related to pharmaceutical laws and regulations are among the most significant challenges for pharmacists in fulfilling their professional duties. Therefore, identifying these challenges and conducting an ethical audit is a novel and effective approach for amending related laws and regulations. The ethical challenges faced by pharmacists in providing pharmacy services were explored through conducting a qualitative content analysis study entitled "Exploring the Ethical Challenges in Providing Pharmacy Services". The identified challenges were classified into various categories, one of which was challenges related to pharmaceutical laws and regulations. The challenges were extracted from a book entitled "Laws and Regulations of Iran’s Pharmaceutical Affairs", analyzed, and divided into three categories, including outdated laws and regulations, lack of proper implementation, and insufficient control and supervision over implementation. These rules and regulations were reviewed and analyzed in comparison with the Code of Ethics for the National Pharmaceutical System and an ethical audit was conducted. Raising awareness among officials and policymakers in the health sector, especially regarding pharmaceutical affairs, and taking necessary measures to improve laws and regulations can ultimately enhance the quality of medical and pharmaceutical services, ensuring that patients receive high-quality pharmaceutical and medical care.

The Experience of Moral Distress from the Perspective of Emergency Medicine Physicians and Nurses in the Emergency Department: A Qualitative Study

Amirahmad Shojaei

Moral distress constitutes a significant challenge for healthcare professionals, arising when individuals find themselves unable to act in accordance with their personal and professional values due to both internal and external pressures. Healthcare professionals may face scenarios that prompt them to question the ethical acceptability of their decisions and treatment practices, often feeling powerless in the face of perceived unethical changes. This study sought to explore the experiences of moral distress encountered by emergency medicine physicians and nurses in the emergency department. This study was conducted using qualitative content analysis. Data were collected through semi-structured interviews with 25 healthcare providers selected via purposive sampling. Data analysis was conducted using MAXQDA 2018 software. The results indicated that the experiences of moral distress among emergency medicine physicians and nurses in the emergency department can be classified into four primary categories including those related to: 1. patient rights, 2. medical staff and colleagues, 3. management, and 4. professionals. Notably, factors such as overcrowding, inadequate staffing, discrepancies between salaries and workloads, and poor management of human and physical resources emerge as significant contributors to moral distress in the emergency department of Imam Khomeini Hospital. To improve patient care quality, it is essential to implement strategies that enhance triage processes, prioritize human resources, align resources with patient needs, monitor patient attendance, and develop a comprehensive protocol for staff.

The Relationship Between Moral Courage and Occupational Stress in Nurses: A Cross-Sectional Study in Urmia, Iran

Haleh Ghavami

Due to the inherently demanding nature of their profession, nurses face significant job-related stress that can adversely affect their lives and the quality of nursing care. Moral courage may serve as a key factor influencing occupational stress among nurses. Accordingly, this study aimed to examine the relationship between moral courage and occupational stress among nurses. This descriptive-analytical cross-sectional study was conducted in 2024 with 120 nurses from emergency departments of educational and therapeutic hospitals in Urmia, Iran, who were selected via two-stage sampling. Data were collected through a demographic information form, Sekerka’s Moral Courage Scale, and Gray-Toft and Anderson’s Nursing Stress Scale. Data were analyzed using Pearson correlation coefficient, multiple linear regression, independent t-test, and one-way ANOVA in SPSS software version 23. The results showed the mean scores for professional moral courage and occupational stress were 85.93 ± 15.68 and 10.77 ± 0.23, respectively. Moreover, there was a significant negative relationship between moral courage and occupational stress in nurses (r = -0.33 and P< 0.05). Specific dimensions of moral courage, such as moral factor, threat tolerance, and moral purpose, had a significant negative effect on occupational stress (P< 0.05). These findings suggested that moral courage plays a significant role in mitigating occupational stress among nurses, which can influence their performance and, consequently, the quality of nursing care. Therefore, by fostering an environment that promotes moral courage, nursing managers can play a vital role in decreasing and mitigating the occupational stress experienced by nurses as well as enhancing the quality of care.

Methods of Teaching Medical Sciences in Iran until the End of the Safavid Era

Hamid Kavyani Pooya

Education in Iran, as in the rest of the world, has a long history, and with the foundation of inclusive national governments, due to the interaction of civilizations and adaptation of scientific achievements, education and educational institutions and centers have undergone major changes and transformations. Accordingly, this study aimed to examine different methods of teaching medical sciences and transferring medical achievements to scholars and those interested in this profession in the history of Iran until the end of the Safavid era through a library-based method. Data were collected from original medical resources, travelogues, and reliable historical documents and evidence in Arabic, Persian, and English. Data were then described and analyzed using domestic databanks. The findings indicated that throughout the history of Iran, particularly in the Islamic civilization, medical education and sciences have been transferred both theoretically and practically. In modern terms, this involved lectures (theory) and clinical training (practice). Nevertheless, there have been differing opinions regarding the importance and priority of each method, and the period under study witnessed significant evolution and changes in improving the ways medical concepts have been conveyed to scholars.

Domestic Violence: Ethical Challenges and Considerations - A Case Report

Soudabeh Mehdizadeh

Domestic violence and abuse against women, particularly intimate partner violence, is a widespread public health problem. Domestic violence is associated with a wide range of physical and mental health issues and negatively impacts the health and well-being of the affected individual. Women who experience violence need support to mitigate the negative impacts of these violent acts. In this regard, health institutions play a critical role in providing comprehensive healthcare to women affected by domestic violence. Physicians' encounters with women experiencing domestic violence, especially in countries like Iran, where there are no clear guidelines on this matter, lead to challenges and ethical issues. This study explored some of these ethical issues and challenges by presenting a case study.

Design and Psychometric Evaluation of a Questionnaire on Factors Associated with Unethical Research Practices among Faculty Members and Researchers in the Ministry of Health

Rahele Samouei

Faculty members and researchers bear the greatest responsibility for producing scientific research outputs due to the nature of their profession and mission. Given the role of ethical principles in ensuring evidence-based research, their impact on research utilization in society, and the importance of scientific evaluations, this study was conducted to design and psychometrically evaluate a questionnaire on factors related to unethical research practices among researchers. This cross-sectional study was conducted in 2024 among faculty members and researchers at medical sciences universities in Iran. Based on a preliminary qualitative study, 40 items were initially generated for the questionnaire. The validity of the questionnaire was assessed through face validity, content validity (CVR, CVI), and criterion validity (divergent and convergent). Besides, exploratory factor analysis (EFA) and reliability testing (Cronbach's alpha) were performed. Data were analyzed using descriptive statistics, Pearson correlation coefficient, and Student's t-test. During the content validity assessment, 11 researchers evaluated the items. Applying cutoff scores of 0.59 for CVR and 0.79 and above for CVI, 16 out of 40 items were removed, retaining 24 items. Exploratory factor analysis revealed five key factors, including “researchers’ irresponsible and unprofessional behaviors and beliefs”, “inefficient basis for competition and career advancement among researchers”, “lack of awareness and up-to-date knowledge among researchers”, “inefficient organizational culture and policies”, and “lack of supervision over researchers and research”. Descriptive findings indicated significant differences in the mean scores of factors associated with unethical research practices of researchers by gender (P=0.002) and organizational position (P=0.004), but not by education level. The findings from this study confirmed the strong psychometric properties of the questionnaire on factors related to unethical research practices.

Quantitative Evaluation of the Content of Theses in the Field of History of Medical Sciences in Iranian Universities (2013-2022)

Seyed Abdollah Mahmood

Evaluating and analyzing scientific productions play a crucial role in enhancing the quality of research and effectively managing research resources. This study aimed to quantitatively assess the content of theses in the field of the history of medical sciences in Iranian universities from 2013 to 2022. This applied study was conducted using the quantitative content analysis method. The findings revealed that the highest number of theses were completed in 2022 (19.2%), with topics related to traditional medicine and traditional pharmacy being the most prevalent. Descriptive and descriptive-analytical studies were the most common research methods. Moreover, the most frequent keywords included “Medical History”, “Traditional Medicine”, and “Iranian Medicine” and their Persian equivalents. Regarding historical periods, the Islamic period (from the emergence of Islam to the early Safavid era) accounted for the highest number of theses, while the contemporary period had the lowest. The results indicated a research focus on traditional medicine and the Islamic period, highlighting the need for further exploration of other historical periods and the use of qualitative methods to deepen understanding of historical complexities.

The Relationship Between Moral Injury and Moral Courage in Nurses Working in Intensive Care Units

Fatemeh Etemadinia

Nurses working in intensive care units are frequently exposed to complex ethical issues and difficult decision-making, placing them at high risk for moral injury. Such injury can negatively affect their professional performance and mental health. Accordingly, this study aimed to explore the relationship between moral injury and moral courage among nurses working in intensive care units. This descriptive cross-sectional study was conducted in 2024. The study population consisted of 150 nurses working in intensive care units. Data were collected through Sekerka’s Moral Courage Questionnaire and the Moral Injury Symptom Scale for Health Professionals. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient, and the independent samples t-test via SPSS software version 22. The findings revealed a significant inverse relationship between moral injury and moral courage (r = -0.64, p < 0.001). Moreover, moral courage levels were higher among registered nurses compared to nurses in the compulsory service program. Besides, a direct relationship was observed between age and moral courage, suggesting that moral courage increases with age. The results of this study highlight the importance of designing and implementing effective educational programs to reduce moral injury and promote moral courage among this group of nurses.

The Effect of An Intervention Based on the Knowledge-to-Action Model on Moral Distress in Critical Care Nurses

Maasoumeh Barkhordari-Sharifabad

Identifying an effective coping strategy for moral distress, as an important and common phenomenon among intensive care unit nurses, seems essential. The knowledge-to-action model aims to identify effective methods for implementing evidence into clinical practice. The present study sought to determine the effect of an intervention based on the knowledge-to-action model on moral distress among nurses working in intensive care units. This was an experimental study, and the statistical population included nurses working in the intensive care units of Namazi Hospital in Shiraz, Iran. A total of 100 eligible nurses were selected through convenience sampling and then randomly assigned to intervention and control groups. For the intervention group, the knowledge-to-action model was implemented. Data were collected using the Hamric Moral Distress Scale before and one month after the intervention. Both groups completed the questionnaire at these time points. Data were analyzed using descriptive and inferential statistics with SPSS version 19. The findings showed that the two groups were similar in terms of demographic characteristics and mean moral distress scores before the intervention. After the intervention, the mean scores of moral distress in the intervention group were significantly reduced in the frequency dimension (2.12±0.34) and severity dimension (2.32±0.46) compared to the control group (frequency: 2.51±0.43; severity: 2.57±0.55) (p<0.001). The results indicated that implementing the knowledge-to-action model reduces moral distress in intensive care unit nurses. Therefore, it is recommended that nursing managers adopt this model to improve the quality of care.

Comparing the Perspectives of Patients and Staff in Obstetrics and Gynecology Operating Rooms on Patient Privacy

Fatemeh Esmaelzadeh

Maintaining patient privacy is a fundamental right of patients and an ethical duty of healthcare professionals. The present descriptive, cross-sectional study was conducted in 2022 to compare the perspectives of patients and staff in obstetrics and gynecology operating rooms in Mashhad, Iran, on the extent to which patient privacy was preserved. Patients were selected using random sampling in the operating rooms of hospitals affiliated with Mashhad University of Medical Sciences. Data were collected through a demographic information form and a standardized questionnaire to assess hospitalized patients’ privacy. Data were analyzed via SPSS-22, utilizing descriptive and inferential statistics, with a significance level of P<0.05. The mean ages of patients and staff participating in this study were 39.07±12.56 and 31.65±8.42 years, respectively. The mean score of preserving privacy from the patients' perspective was 38.92±22.41, whereas from the staff's perspective, it was 64.26±8.02, and the difference was statistically significant (p=0.0001). The lowest scores in both groups for personal privacy were 4.97±8.77 for patients and 13.37±2.66 for staff. Results indicated that the staff perceived the level of preserving patient privacy to be above average, while patients considered it below average. Therefore, given the patients’ specific conditions, high stress levels, and physical and mental limitations to support themselves, it is essential to implement targeted training and take necessary measures to encourage the staff to pay more attention to patient privacy and raise patient awareness in this regard.

Explaining Perceptions of Discharge Against Medical Advice as a Patient’s Legal Right: A Qualitative Study

Hassan Ebrahimpour Sadagheyani

Patients’ perceptions of healthcare service quality and satisfaction with their legal rights constitute the primary objective of the care team and should be considered a criterion for accreditation evaluation. In this regard, a thorough examination of healthcare providers’ and patients’ perceptions, emotions, and experiences regarding the reasons for ‘Discharge Against Medical Advice’—as a patient’s legal right—can help identify hidden factors influenced by temporal and spatial conditions. This qualitative study employed a conventional content analysis approach, involving semi-structured interviews with 24 healthcare providers and patients selected purposively. Researchers repeatedly reviewed recorded content and notes to code the data. Subsequently, key codes and themes were clustered, categorized into specific topics, and labeled. Finally, an interpretation of the obtained data reflecting the study’s approach was presented. Through conventional content analysis, 203 codes were extracted. After categorization, four subthemes, including human factors, processes, facilities, and environment, were identified under the core theme of “uncertainty and distrust” as reasons for discharge against medical advice. Discharge against medical advice is recognized as both a challenge for hospital accreditation and an adverse outcome for patients. Addressing uncertainty-related issues and fostering public trust through team collaboration and implementing novel policies can mitigate discharge against medical advice.

Elucidation of Ethical Components in Education at Mazandaran University of Medical Sciences: A Qualitative Study

Roya Malekzadeh

Adherence to ethical principles in medical universities, which play a vital role in training the next generation of healthcare professionals, is of significant importance. These principles can serve as a guide to achieving educational goals and improving performance in various academic fields. This study aimed to explain the components of ethics in education at the Mazandaran University of Medical Sciences. The study was conducted in 2023 using a qualitative Hybrid Thematic Analysis approach. Participants included 17 educational managers, faculty members, and students from the university. The study was carried out in three phases: a comprehensive literature review, interviews with experts, and the formation of a specialized panel. Data were collected through semi-structured interviews using purposive and snowball sampling, and the process continued until data saturation was achieved. The interviews were transcribed, coded, classified, and analyzed using thematic analysis. The analysis revealed eight main themes, including ethics, justice, responsibility, duty, respect for others, adherence to dress codes, accountability, and spiritual health, along with 55 subthemes. Focusing on ethical components can enhance transparency, create a fair educational environment, strengthen responsibility among faculty members and students, and improve the quality of learning, thereby playing a crucial role in fostering interactions between professors and students. Adhering to ethical components in academic education not only requires understanding ethical concepts but must also align with appropriate implementation mechanisms. Therefore, organizing training workshops to raise awareness among faculty members, students, and staff, and incorporating ethical indicators into recruitment and promotion processes for faculty members are recommended.

Comparing the Effectiveness of Professional Ethics Education Via Mobile Application and Webinar on Maintaining Patient Dignity from the Perspective of Nursing Students

Mohammad Zare Reshkoieh

The fundamental nature of nursing care lies in maintaining patients’ human dignity. Protecting the dignity and high value of humanity is the focus of the nursing profession. This study aimed to compare the effectiveness of mobile application-based and webinar-based professional ethics education on maintaining patient dignity among nursing students. This was a quasi-experimental study with a two-group pretest-posttest design involving 90 undergraduate nursing students. One group received professional ethics education via webinars, while the other received training through a mobile application-based program. Data were collected using a demographic information form and a questionnaire assessing nursing students’ views on maintaining patient dignity. The findings showed that before training, the mean total scores for human dignity were 99.96 ± 17.43 in the webinar group and 99.59 ± 16.28 in the mobile application group, with no statistically significant difference (p=0.62). After training, the mean human dignity score was significantly higher in the mobile application group (111.15±14.69) than in the webinar group (104.34 ± 15.38), and this difference was statistically significant (p=0.02). The findings indicated that professional ethics education delivered via a mobile application was associated with a greater improvement in nursing students’ views on patient dignity compared to webinar-based education. Mobile-based education offers a self-directed, flexible learning method, enabling students to have continuous access to educational content without time or place restrictions. It is recommended that medical universities in Iran consider developing and integrating educational applications into their curricula.

Is the Use of Video Recording Important in the Intensive Care Unit?

Zahra Torkashvand

One of the key ethical-legal concerns in the medical profession is patients’ trust in the quality of care and adherence to professional standards. This viewpoint explored the ethical-legal dimensions of using surveillance cameras in Intensive Care Units (ICUs), focusing on a specific legal-ethical case. In this scenario, the patients’ family caregivers express doubt about the quality of care and request access to recorded footage. From an ethical-legal perspective, documenting events by the medical team—provided that privacy, data protection regulations, and visual monitoring standards are respected—can help safeguard patients’ rights, clarify staff performance, and prevent legal misunderstandings. While acknowledging the potential benefits, this study also outlined legal considerations, such as patient notification, access limitations, and data management protocols. The key conclusion is that the use of cameras in ICUs, if aligned with legal and institutional requirements, can enhance trust, demonstrate ethical compliance, and reduce legal complaints.

Nursing Professional Ethics in Clinical Services: A Review of Studies in Iran

Parvaneh Aghajari

Improving the quality of nursing services and enhancing ethical decision-making in clinical settings require greater attention to professional ethics. This study aimed to review and synthesize existing research on professional ethics in nursing in Iran, to organize, plan, and establish knowledge- and evidence-based decision-making, and also provide strategies for ethics-centered nursing in Iran. Iranian studies on ethics were reviewed without time limitations until June 22, 2023. Database search was conducted using keywords including "Nurse", "Nursing", "Ethics", "Professional ethics", "Nursing Care", "Codes of Ethics", "Patient Rights", "Conscience", and "Iran", as well as their Persian equivalents, combined with "AND" or "OR" operators. The included studies were analyzed utilizing the five-stage integrative review method proposed by Whittemore and Knafl. A total of 103 Persian and 59 English articles were reviewed. The results were organized into two main categories: achievements of professional ethics (encompassing knowledge, attitudes, and professional performance of nurses; nurses’ experiences with ethical care; positive outcomes of professional nursing ethics education; and the convergence of spiritual health with adherence to professional ethics and the need for an Islamic approach) and factors influencing ethical performance (including facilitators of ethical performance and barriers to adherence to professional ethics). Based on the findings, it is recommended that nursing care protocols and standards be developed, and various educational programs be conducted, including those on ethical care in emergencies and disasters, emotional and spiritual intelligence, training for clinical nursing managers, and the application of creative strategies for teaching clinical professional ethics.

Ethical Challenges in Elderly Care: A Narrative Review

Samaneh Fallah-Karimi

With increasing life expectancy and a growing elderly population worldwide, elder care has become a major priority for health systems. These care services are accompanied by numerous ethical challenges, and neglecting them can negatively affect the dignity, rights, and quality of life of older adults. This study aimed to address the question: “What ethical challenges are faced in elder care?” Accordingly, a systematic review was conducted guided by PRISMA guidelines. To identify relevant studies, PubMed, Scopus, Web of Science, SID, and Google Scholar were searched for the period 2013–2025, using the keywords “Ethical Challenges”, “Elderly Care”, “Nursing”, and their Persian equivalents. Inclusion criteria were original articles (qualitative, quantitative, experimental, or quasi-experimental) with a direct focus on ethical challenges in elder care, written in Persian or English, and with full-text availability. Exclusion criteria included letters to the editor and conference abstracts. The quality of the studies was assessed using the appraisal tool proposed by Gifford. In total, 31 eligible articles were included in the final analysis. The results indicated that ethical challenges in elder care can be classified into four main categories, including autonomy, justice, beneficence, and non-maleficence. Subthemes included privacy preservation, shared decision-making, end-of-life care, equitable resource allocation, and the prevention of physical and psychological harm. The findings underscored the necessity of strengthening ethics education and informing policymaking in elder care.

Investigating the Impact of the Bombay Plague (1896 AD / 1314 AH) on Muslim Pilgrimage (Hajj)

Reza Taghi Zade Naieni

The plague of 1896 AD/1314 AH was one of the most devastating epidemics in history that occurred in Bombay, India. This disease had a profound impact on human societies, particularly Islamic societies, and on the pilgrimage of Muslims between 1896 and 1899. This historical review study analyzed the consequences of the plague outbreak in Bombay, India, in 1896 AD/1314 AH on the pilgrimage process of Muslims in the mentioned year and the following years. This study also examined the type of exposure of Muslims to this disease and the restrictions imposed by the governments of the time. Data were collected from historical resources such as reports in Hajj travelogues, historical documents, Arabic press news, recent research by Western researchers, and scientific articles. The findings indicated that the ruling governments attempted to prevent the spread of the disease and reduce casualties by establishing and developing quarantine facilities, dispatching medical teams, shortening the permitted duration of pilgrims’ stay in Saudi Arabia, and persuading Muslims to forgo the Hajj pilgrimage. The success of these preventive measures hinged on two main factors: first, the necessary executive power to enforce restrictions, and second, the mitigation of economic insecurity for communities simultaneously affected by illness and pilgrimage. Furthermore, the acceptance of these limitations was significantly influenced by Muslim perceptions of the restrictions and their cultural and religious backgrounds.

A Critical Analysis of the 2024 Revision of the Declaration of Helsinki: Effective Revisions and Adaptive Requirements in the Research Ethics System Involving Human Participants

Ehsan Shamsi Gooshki

The Declaration of Helsinki, as a fundamental document of ethics in medical research involving human participants, has been periodically revised since its adoption in accordance with theoretical and scientific advancements, emerging ethical issues in research, and the experiences gained over time. In the latest revision completed in 2024, significant changes and amendments have been made. This study examined the changes and revisions made in the latest version of the declaration in comparison to its previous version from 2013. Fundamental revisions in the recent update include a requirement for adherence to ethical principles in research not only by physicians but also by other researchers, the replacement of “subject” with “participant,” and the emphasis on the voluntary nature of informed consent. Attention to environmental sustainability, precise design to prevent research waste, and a focus on scientific integrity are among the other amendments in the new revision of this declaration. Other modifications and revisions made in the recent edition include the promotion of individual and public health as the ultimate purpose of research, the provision of sufficient resources for research ethics committees and strengthening their independence, the importance of local ethical review, consideration of the preferences and values of participants who are unable to provide voluntary and informed consent, and the necessity of adhering to the ethical principles of the declaration during public health crises and emergencies. Given the changes made, it is recommended that the national ethical guidelines for medical research involving human participants in Iran be revised based on the 2024 revisions.

The Effectiveness of Character Education on Wisdom, Academic Hope, and Prosocial Behavior in Students

Farhad Khormaei

This study aimed to investigate the effectiveness of character education on wisdom, academic hope, and prosocial behavior among university students. The study employed a quasi-experimental design with a post-test and a control group. Participants included two groups of students from Shiraz University who were randomly assigned to experimental and control groups. The experimental group participated in a twelve-session program focused on developing etiquette-based professional conduct, and at the end, both groups completed the questionnaires on wisdom, academic hope, and prosocial behavior. The validity and reliability of these instruments for use in Iranian culture have been found to be satisfactory. The results of multivariate analysis of variance (MANOVA) revealed that etiquette-based character education had a significant effect on all three variables of wisdom, academic hope, and prosocial behavior. A key implication of these findings is the importance of paying attention to character education in educational settings.

A Critique of Blackshaw’s Ethical Argument Against Procreation

Amir Rastin Toroghi

Recent decades have witnessed a decline in birth rates and a growing trend toward voluntary childlessness, phenomena reflected in emerging ethical theories such as antinatalism. This study critically analyzed one of the most prominent arguments in this domain—Bruce Blackshaw’s “Applying Pascal’s Wager to Procreation.” Inspired by Pascal’s Wager and McMahan’s Asymmetry Principle, Blackshaw argues that since a child may one day lose faith and face eternal torture, procreation is morally impermissible, regardless of the low probability of such an outcome. He concludes that moral responsibility requires individuals to avoid reproduction altogether, either through celibacy or sterilization. This study critiqued Blackshaw’s argument from three perspectives: (1) its implausible implications, such as generalizing to all moral decisions and disruption of everyday life; (2) foundational critiques by moral philosophers who reject asymmetry principle; and (3) incompatibility with theological foundations, particularly within the Islamic tradition, such as the neglect of key considerations including the moral responsibility of children, the educational role of parents, and the diverse interpretations of eternal damnation. From an Islamic perspective, procreation is not a hazard but rather part of the prophetic tradition, human nature, and the wise design of creation. Birth is seen as a gateway to development, choice, and proximity to God.

Comparison of Adherence to Professional Ethics Principles among Operating Room Students and Personnel

Zahra Nouri Khaneghah

Professional ethics, as a critical aspect of medical ethics, holds significant importance in healthcare professions that directly involve human lives. Accordingly, this study aimed to compare adherence to professional ethics principles among operating room (OR) students and staff in selected teaching hospitals affiliated with Iran University of Medical Sciences during 2021–2022. This cross-sectional descriptive study included 200 OR staff from six hospitals (selected via stratified quota sampling) and 60 OR students (recruited via convenience sampling). Data were collected using a demographic questionnaire and Kadushin’s Professional Ethics Questionnaire (2002) and analyzed in SPSS-24 using descriptive statistics (median and interquartile range) and inferential tests (Chi-square and Mann-Whitney U tests). Results indicated strong professional ethics in 98.4% of students and 75% of staff. Students scored significantly higher in loyalty and accountability (median score, P < 0.0001), while staff outperformed in honesty (median score, P = 0.003). No significant differences were observed in other dimensions. Overall, both groups demonstrated favorable professional ethics. These findings can guide educational interventions and developmental programs to further enhance professional ethics in these populations.

A Critique of the Jurisprudential-Ethical Foundations of Applying the Term “Death” to the Vegetative State

Jannat Mashayekhi

The vegetative state is a condition in contemporary medicine that raises numerous ethical, jurisprudential, and legal challenges. The most fundamental question when confronting this condition concerns whether individuals in such a state are considered alive or deceased, as subsequent rulings and implications are typically contingent upon the answer to this question. Some contemporary Islamic jurists, drawing upon the jurisprudential division of life into “stable life” and “unstable life”, have deemed individuals in a vegetative state to be deceased, given their lack of volition and consciousness. This study argues that the concept of “unstable life” does not apply to these individuals, particularly in cases of persistent and chronic vegetative states where the possibility of regaining consciousness, however remote, exists. Furthermore, the continued function of the brainstem and the non-fulfillment of the medical and legal criteria for brain death in many systems affirm that the designation of “deceased” is incorrect. From an Islamic perspective, the definitive separation of the soul from the body, which is the condition for the occurrence of death, cannot be ascertained in the vegetative state. Ultimately, in circumstances of doubt regarding the life or death of a person in a vegetative state, this uncertainty constitutes a “case-specific doubt”, and by applying the legal principle of “presumption of continued life”, the individual must be deemed alive and all the corresponding legal and religious consequences of life must be accorded to them.

The Necessity of Spiritual Health Education in Iranian Universities of Medical Sciences: A Qualitative Study

Ali Mohammad Mosadeqrad

Spiritual health refers to having purpose and meaning in life and a sense of belonging to something beyond the self, which strengthens inner peace, satisfaction, and happiness. This qualitative study was conducted in 2024 using an interpretive phenomenological approach. Through semi-structured interviews with 47 policymakers, managers, faculty members, staff, and students, a total of 183 benefits of spiritual health education in universities of medical sciences were identified. These benefits were categorized into six groups: benefits for faculty members, students, staff, patients, society, and the university. For faculty members, spirituality education leads to enhanced ethical awareness, increased motivation, job satisfaction, professional commitment, and improved quality of education. Students, by strengthening spirituality, gain greater communication and empathy skills, experience reduced stress and anxiety, and demonstrate improved professional competencies. Healthcare staff benefit from reduced medical errors, increased resilience, improved social relationships, and enhanced quality of care. Patients receiving spiritual care experience lower levels of stress and depression, improved mental health and quality of life, and a more rapid course of treatment and recovery. At the societal level, spiritual health education contributes to more positive social behaviors and the development of a healthier community. Furthermore, universities implementing such education can design more comprehensive curricula, promote interdisciplinary research, strengthen professional ethics, and train holistically oriented healthcare professionals, thereby increasing their credibility and productivity. Spiritual health education in Iranian universities of medical sciences, by exerting positive effects on faculty members, students, staff, patients, society, and the university itself, results in the improvement of psychological and professional well-being, the enhancement of educational quality, and the increased productivity and credibility of the higher education health system of the country.

A Comment on: "Is It Possible to Apply an Advance Directive in Iran’s Health System?"

Fatemeh Fallah Tafti

This Article has no Abstract.

Quantitative Evaluation of Scientific Articles in the Thematic Field of “History of Medicine in the Safavid Period” in Iran (2001-2024)

Morteza Mojahedi

The history of medicine during the Safavid period (907-1135 AH) in Iran, as one of the important periods, has always been the focus of researchers. The main objective of this study was to conduct a quantitative evaluation of articles related to the “history of medicine in the Safavid period” in Iran. This descriptive-analytical, applied study was conducted using a quantitative approach. The statistical population of the study comprised all scientific productions on the history of medicine in the Safavid period indexed in domestic and international scientific databases over 22 years, from 2001 to March 2024. During the period under review, a total of 247 articles in the field of the history of medicine in the Safavid period were published with the participation of 542 authors. In terms of thematic orientation, 18.2% of the published works were on the biographies of physicians, while research, translation, and editing of medical manuscripts ranked next with 16.1%. Among universities and scientific centers, Tehran University of Medical Sciences and Islamic Azad University ranked first. Male participation accounted for approximately 60%, exceeding that of female authors, and about 68% of the works were the result of collaborative research. The Journal of Islamic and Iranian Traditional Medicine published the highest number of articles. The most common type of publication was original research articles. Content analysis showed that, despite significant growth in this research field, an excessive concentration on specific topics, such as physicians’ biographies, has limited scholarly attention to other dimensions of medical history in this period, highlighting the need for broader and more balanced research perspectives.