Iranian Journal of Medical Ethics and History of Medicine

Mohsen Savaee

Executive management of bioethics in medical researches: The results of a workshop

Mostafa Ghanei

Backgrounds: Nowadays one of the major problems in research ethics, especially in medical researches, is how to make bioethics codes practical and how to oblige researchers to perform them. In this essay, we have tried to suggest all detailed activities of different management sides which have a role in different phases of performing a research project, to make codes more practical. Materials and Methods: In order to provide a practical guideline in medial research ethics issue from different points of view, a workshop was held by the presence of some representatives from type1 medical universities, 9 research centers, Pasteur Institute, molecular research and stem cells networks, and members of national research ethics committee. Results: Participants were divided into 5 groups based on their proficiency and management scopes and edited the task's descriptions. These groups included: 1) task's description for ethics committee of universities 2) task's description for research executive managers and research deputies of universities and research centers 3) task's description for professors, executors, managers, research deputies of departments and research council's department 4) task's description for international relationship committees of universities 5) task's description for publishing committees. These 5 groups were chosen deliberatively. Conclusion: Considering importance of bioethics, interference of environmental and sociological factors, local area culture and existence of executive facilities, providing practical codes of ethics needs group assistance and researchers' national impetus, research affairs accomplishment and massive country management.

Legal and ethical critisim to lobotomy

Alireza Ismailabadi

Background: The first experimental lobotomy was performed in psychiatric patients at 1930. At the beginning, the purpose of such experiments was the treatment of certain patients such as psychotics, sexual offenders and schizophernics, but during the years, the unpredictable results and harms appeared. Nowadays the treatment is limited to medical treatment and psychosurgery which includes two new forms of lobotomy named cingulotomy and capsulotomy. Previously physicians were performing dangerous surgery on a wide rage of patients irrespective of their consent and objections. In fact they treated them in the favor of “patients’ and public (social) interests” and some claims have risen against it. In this regard some legislators such as Canadian legislator enacted or amended their regulations and these regulations criticized.
Method: We selected the most related articles and books among the related resources. For completing this article, we searched by the keywords of Lobotomy, enforced offender to treatment, ethics.
Results & Conclusion: Studying some known cases demonstrated harmful effects of this special surgery and regarding to the ethical and legal points of view, operating patients only for the interest of patients or public, irrespective of their consent is not legitimate.

A philosophical assessment of the implications of the issue of human dignity for medical researches

Ali Paya

Philosophers of ethics and those who are involved in the debates concerning Medical Ethics have discussed the issue of human dignity and its cluster of meaning from different angles and have suggested many interesting points in this respect. However, a cursory glance at the published works in this field reveals that most of those writers who have contributed to this issue have either based their arguments on notions such as rights or justice, or have used theological doctrines, or have conducted their debates within the frameworks of pragmatic or particularistic ethics. In the present paper, I shall approach the issue from a new viewpoint which is mostly inspired and informed by the ideas of some analytic philosophers. The main argument of the paper revolves around the pivotal notion of “value of life”. All those who take positions vis-à-vis stem-cell researches and the morality or otherwise of using embryos for such investigations, or those who form opinions concerning the ethicality or otherwise of abortion, or those who try to find satisfactory solutions for the vexing issue of the allocation of limited medical resources, maintain, at least in an intuitive way, that the life of a human organism, in whatever shape or form, has intrinsic value. The life of such an organism whether it is a newly conceived egg or an embryo ready to be implanted in the womb or a foetus whose neurological system has just emerged, or a morally fallen adult, is intrinsically valuable. The idea that some things or events are valuable in themselves, namely, we respect them not because they serve our interests but because they are intrinsically valuable, is a familiar intuition. We have developed this ‘intuition’ through our long existential experiences. Now if we reflect upon this very intuition we will be able to discover further layers of meaning in it. For example, we realize that from the belief that ‘human’s life is intrinsically valuable’ one cannot conclude that one should multiply human life as much as possible. On the contrary, some of our other intuitions would inform us that at least some parts of the world would be better off if less populated than crowded. Thus the question arises that if the intrinsic value of human life does not mean its multiplication, then how the continuation of human life, once it has appeared, can have intrinsic value? In the present paper I shall try to use the apparatus of analytic philosophy to explore the ways of reconciliation between the two seemingly contradictory notions of ‘the intrinsic value of life’ and ‘the morality of sacrificing life under particular circumstances’.

Assessing the ethical climate of Kerman teaching hospitals

Mina Mobasher

Background: The ethical climate (organizational culture) of an organization as perceived by a group of its workers is believed to affect ethical practices, job satisfaction and quality of care. Objectives: To assess the ethical climate of teaching hospitals of Kerman city according to nursing staffs’ views.
Methods: A 26-items questionnaire was translated to Persian which its content validity was acceptable according to the literature review. Its reliability was in an acceptable range according to Cronbach’s alpha (0.92). It was distributed between a convenient sample of 350 nursing staff who worked in the four teaching hospitals of Kerman city. Three hundred and two subjects completed the inventory. All questionnaires were anonymous.
Results: The majority of them (76%) were female. The mean (±SD) age of the individuals were 32.4 (± 8.5). Subscription to the expression “always” was mostly seen for the item “my manager is someone I respect” and it was seldom observed for the item “nurses are supported and respected in this hospital”. There was no significant difference in the total score of the inventory according to background variables (i.e. age, sex, educational level, employment status and hospitals).
Conclusion: According to the great impact of organizational culture on nurses’ practices it seems that some aspects of organizational culture of teaching hospital especially the aspects that are related to physicians and top level managers need to be improved

Medical ethics challenges in the information societies

Farzaneh Aminpour

Information is the symbol of the present age due to the significant development in accessing, processing, storage and transferring information. Information societies have been formed by the widespread utilization of information and communication technologies in human social life and generally focus on the computer systems and information networks. Nowadays, various technologies of medical informatics comprise an important component of the management infrastructures of health care systems. Medical informatics is the development and assessment of specific methods and systems for acquisition, processing and analyzing patients' data with the help of knowledge and information from scientific researches. Moreover, it intends to increase access, improve quality and decrease the costs of care through decreasing chronological and geographical limitations. On the other hand, ethics have been always considered as a basic component of these systems. The increasing development of digital technologies and their application in health information management provides numerous benefits however, it encounters health care managers with new challenges in the information societies. These challenges may has been mainly caused by the conflicts among ethical principles by themselves or disregarding them in the field of medical informatics. Therefore, careful consideration of info ethics as well as beneficence, autonomy, fidelity and justice is essential to overcome those conflicts in the information societies.

The pathology of pharmacy ethics

Hassan Farsam

Pharmacy, from the earliest time has been closely related to health and well-being of the people and its own code of ethics. In recent decades there has been a shift in the pharmacist role from traditionally dispensing to patient oriented health care management. Nowadays, the philosophy of pharmacy practice is that a pharmacist is an individual who provide his knowledge and skills in patient counseling regarding ethical principles. Recent advances in the science and technology and emerging new horizons of medical therapy, drug delivery and pharmacy practice put forth new concepts such as professionalism and professional code of ethics for health care providers. In this respect, rights of patient, patient autonomy and consent, consumerism, and commercialism put forth the importance of the study of pharmacy practice pathology and implementation of the code of ethics. These constrain has not put into consideration in Iran, it seems necessary to study how effective are code of ethics with these factors as well as others such as lack of knowledge and skills, economical, cultural, and socio-cultural constrains.

Ethical assessment of confidentiality in gamete and embryo donation

Kiarash Aramesh

Confidentiality is anonymity of gamete or embryo donors to the recipients and resulted children and Vice Versa. In this article, I formulated the question about confidentiality through two main questions: 1- Ethically speaking, should the information about the characteristics and identity of donors be kept in specific organizations to be accessible for who considered having the right of access in the future? 2- Are receivers ethically obliged to inform their children about their biological origin? In this article, I assess the subject from Deontological, Utilitarianistic and Principalistic approaches and conclude that it is the right of such children to be informed about their biological origin. Of course in Iran, such ethical obligation should be suspended until the problems relating the heritage are solved.