http://ijme.tums.ac.ir Iranian Journal of Medical Ethics and History of Medicine - Journal articles for year 2011, Volume 4, Number 4 Yektaweb Collection - https://yektaweb.com en 2011/7/10 http://journals.tums.ac.ir/ijme/browse.php?a_id=161&sid=1&slc_lang=en With the development of professionalism in modern-day nursing, concepts such as accountability and civil responsibility have found a special place in nursing, since responsibility is an intrinsic part of this profession. Accountability typically brings civil responsibility, which means an individual can be held legally responsible for injury they have caused to another person. Due to the autonomy that nurses enjoy in their practice, they have legal responsibilities, which in turn expose them to complaints and lawsuits on grounds of negligence more often than in the past. The objective of this paper was to familiarize nurses with the concept of civil responsibility, and to help them prevent the damages arising from it, as well as to ensure patients’ safety and rights. This was an analytical study that examined the concept of nurses’ civil responsibility based on books and articles on the subject. The study will first explicate the general definition of civil responsibility, and then proceed to explain its application to the nursing profession, and the more common stages of litigation, prosecution and defense. The nursing profession today can benefit from a modern outlook on civil responsibility and nursing errors in order to improve teaching methods in providing better patient care and reduce errors. This can eventually enhance the quality of care, and lead to a decrease in nurses’ civil responsibilities and prevention of a waste of public resources. Khadijeh Yazdi http://journals.tums.ac.ir/ijme/browse.php?a_id=162&sid=1&slc_lang=en New antiviral remedies have greatly improved the prognosis of patients infected with AIDS, as well as their life expectancy and quality of life, and assisted reproductive techniques have made it possible for many HIV positive patients to have healthy children. Nevertheless, most assisted reproduction centers continue to reject these couples, and this is a factor that contributes to their isolation from the society. The present study was performed through document and library research, and the results were investigated from the viewpoints of the infected couple, their future children, and health care staff. Social and legal issues were evaluated through consultation and collaboration of experts, and related articles, guidelines and accessible material were examined for this purpose. Every individual has the right to reproduction. If it is possible for HIV positive couples to have children with the help of fertility lab techniques, and provided that throughout the process there is no danger of disease transmission to others and particularly the embryo, ART centers should not reject HIV positive couples. Rejection of these couples is against the principles of medical ethics and in violation of the current effective laws of the country. On the other hand, acceptance of patients infected with Hepatitis type C, advanced cancers, mental diseases, and so on is further proof that rejecting HIV positive couples is a form of discrimination and unethical. The word HIV itself is synonymous with the stigma of social deviance, and it seems children of infected parents are not in the ideal position from the public point of view. One step that needs to be taken is for the society to try to remove this stigma and provide support for all chronically ill patients. There is no valid justification for rejecting HIV positive couples in ART centers, and it appears to be unethical and a violation of human rights to deny these couples the right to have healthy children through modern technology. Mona Oodi http://journals.tums.ac.ir/ijme/browse.php?a_id=163&sid=1&slc_lang=en In the past generations and throughout the history of dentistry, horrific and deadly epidemics of the diseases transmitted through blood have not been a concern for those in the dental care profession. This has been due to the success of this profession in maintaining the oral health of patients. Questions such as whether dental treatments can potentially spread HIV and AIDS have therefore not been discussed extensively, and there seems to be a shortage of reference for dentists to find comprehensive and accurate answers to these questions. As a matter of fact, several generations of dentists, and health care providers in general, have continued to perform their duties despite the possibility that they could be exposing their patients to a deadly infection, and have not even apprehended a fatal pandemic. Consequently, it is not surprising that the professional norms that today’s dentists were educated on during their training years should fail to give clear answers to their questions regarding AIDS and HIV nowadays. The present paper will cover this issue in connection to HIV positive patients from the ethical and professional point of view. Mahdi Tabrizizadeh http://journals.tums.ac.ir/ijme/browse.php?a_id=164&sid=1&slc_lang=en Duty-based or deontological ethics is among much discussed, major schools of thought in philosophy of medical ethics that can provide additional solutions to various ethical challenges in modern medicine. Duty-based ethics generally refers to a set of principles according to which the criteria for determining whether an action is right or wrong is the action itself and its properties, regardless of its benefits or consequences in other words, proponents of duty-based ethics believe that performing ethical acts in spite of their consequences is an obligation which lies in the acts themselves rather than the ends they bring, as is the belief of the proponents of results-oriented ethics. Advocates of results-oriented ethics are concerned with the consequences of their actions, and advocates of duty-based ethics with their duties. The present paper offers an overview of the latter and its two main subdivisions: act- and rule deontological theories, in order to evaluate and analyze duty-based ethics. In ethical philosophy, duty-based theories have received less criticism in general compared to results-oriented theories, as they are more difficult to criticize. Mohammad Javad Movahhedi http://journals.tums.ac.ir/ijme/browse.php?a_id=165&sid=1&slc_lang=en A review of the history of the Patient’s Bill of Rights reveals the universal significance of this subject in health systems management. There is a long history of attempts to raise respect for patient’s rights and setting the legal frameworks associated with those rights in the health care of many countries. The present study aimed to evaluate observance of the Patient’s Bill of Rights according to patients in the teaching hospitals of the Mazandaran University of Medical Sciences. This descriptive cross-sectional study was carried out in 2009 in all 4 teaching hospitals of the Mazandaran University of Medical Sciences on 200 patients who were either hospitalized or about to be discharged at the time. Data were collected through interviews, using a fifteen-item Likert type questionnaire based on the Patient’s Bill of Rights, and its validity and reliability had been confirmed. Data analysis was performed through ANOVAs and t-tests, using SPSS version 17 software. The results showed that according to the population under study, the patients’ rights were respected in 14.59% of the cases based on the overall score of the Patient’s Bill of Rights. This figure was 16.63% for respect for patients, their privacy and, patient non-discrimination, 14.17% for patient information availability right, 14.15% for the right to make choices and decisions freely, and 13.20% regarding complaints. There was no meaningful relationship between patients’ views on observance of their rights and their sex (P = 0.106), education level (P = 0.723), marital status (P =0.260) and place of residence (P = 0.101). Based on the findings of this study, observance of the Patient’s Bill of Rights was not satisfactory according to the population under study and from their viewpoint. It is therefore recommended that measures be taken to eliminate any obstacles preventing observance of patients’ rights and to improve the present conditions of hospitals in this respect. Mohammad Khademloo http://journals.tums.ac.ir/ijme/browse.php?a_id=166&sid=1&slc_lang=en Nurses are confronted with numerous situations calling for moral decision-making in their workplace every day. Nursing students should therefore attain a satisfactory level of moral development during their university years. The present study was conducted to determine nursing students’ level of moral development, as there seems to be a shortage of similar studies throughout the country. This descriptive, correlational research was performed in 2010 study samples were 115 junior and senior students of the Department of Nursing and Midwifery of Tabriz University of Medical University who were selected by census. These students’ level of moral development was evaluated through the Nursing Dilemma Test (NDT), which has been created based on Kohlberg’s theory of ethical development. NDT assesses nurses’ moral development in three levels: pre-conventional, conventional and post-conventional, and evaluates their observance of clinical considerations at the same time. A number of the participants’ sociodemographic characteristics were also collected through a questionnaire. Data analysis was performed using SPSS statistical software, and descriptive and inferential statistics. According to the findings of this study, 13 students (11.3%) were in the pre-conventional, 33 (28.7%) in the conventional, and 55 (47.8%) in the post-conventional level, and 14 (12.1%) took clinical considerations into account more than others. There seemed to be no meaningful statistical relationship between the students’ moral development and their age (P = 0.49), sex (P = 0.21), marital status (P = 0.79), place of education (P = 0.32), and year of education (P = 0.92). These results showed that although approximately half of the students under study were in the post-conventional level, which is an acceptable level of moral development, a great percentage were still in the lower levels. This means that those in administrative positions in nursing departments need to pay more attention to the moral education of nursing students. Azad Rahmani http://journals.tums.ac.ir/ijme/browse.php?a_id=167&sid=1&slc_lang=en Nurses have to cope with various forms of tension in the workplace on a daily basis. One of the factors affecting the moral distress experienced by nurses is the ethical climate prevalent in clinical environments. The present study aimed to establish the relationship between moral distress and nurses’ ethical work environment. This was a cross-sectional, correlational study on 210 nurses in select departments of medical/educational centers of the Tehran University of Medical Sciences in 2009. Data collection tools included a demographic questionnaire, Corley’s Moral Distress Scale, and Olson's Ethical Climate Questionnaire. Data analysis was performed using SPSS version 14. Findings confirmed that the nurses under study were tolerating an average amount of moral distress, although they did not perceive the frequency of morally stressful situations to be particularly high. There was no significant relationship between the moral distress of the nurses under study and their evaluation of the ethical climate of their workplace. Of the five factors affecting the ethical climate, there was a meaningful indirect relationship between managers and frequency of moral distress (P ≤ 0.04), and patients and frequency and intensity of moral distress (P = 0.001). The results obtained through this research indicated a need for authorities to pay more attention to medical/educational centers and devise various strategies in order to make work environments more ethical, so that nurses can continue to offer health care services in more relaxed environments and with less stress. Hamidreza Jalili http://journals.tums.ac.ir/ijme/browse.php?a_id=168&sid=1&slc_lang=en Based on the definition offered by ancient scholars and philosophers, the term “ethics” refers to a certain set of qualities and character traits, and an ethical person is one who possesses those qualities. This definition is still accepted, although it does not undertake the actions of an ethical person, and does not clarify the stance regarding an ethical person who happens to commit an unethical act. While supporting the definition above, this paper will investigate people’s behaviors individually through an analytical approach, logical arguments, and by applying falsification criticism. It will then proceed to define the term “piety” and provide a comprehensive exposition of an ethical person. The above-mentioned exposition is offered in this paper for the first time and presents a fresh approach to defining morality. It combines the terms piety and ethics to argue that an ethical person is a pious individual who not only possesses ethical characteristics, but also is sensitive to each one of his/her behaviors. Amirahmad Shojaee