Iranian Journal of Medical Ethics and History of Medicine

Lying to patients from benevolent motives

Hossein Atrak

Telling the truth to patients is a key issue in medical ethics. Today, most physicians hold that truth-telling to patients is crucial, and that lying to patients or withholding information from them is not acceptable. It seems, however, that absolute and unconditional truth-telling is not always possible, and it may not be feasible to tell some patients certain truths under some circumstances. Although truth-telling is a rudimentary principle in ethics, it is allowed to withhold truth or even to tell lies in some circumstances. From the point of view of reason and tradition, lying under certain circumstances is allowed for instance when one is disinclined to tell the truth, or in emergencies where truth-telling might lead to loss of life, property or someone's reputation, and when truth may involve two adequately unpleasant situations. In my opinion, it is necessary to tell the truth, regardless of possible harms, when continuation of treatment, or the patient's cooperation and consent depend on it, and also when the truth which needs to be told to a patient is the incurability of his disease and therefore his inevitable death,. In other cases, however, when there are truths such as severity of disease, death of others in the accident, family problems outside the hospital, predicted survival time, and other possible diagnoses, the truth can be withheld and the patient can even be lied to if there is any risk of harm to the patient.

An ethical critique on the national guidelines for pediatric research

Akram Alsadat Sadat Hosseini

Pediatric research is a complicated and sensitive field of research that involves specific legal, ethical, and even philosophical aspects therefore the guideline of pediatric research is considered one of the important ethical guidelines in research. Although this ethical guideline has been used for some years, a need for its revision is always felt with the passing of time. Accordingly this study was carried out through library search, aiming to present a critical ethical review of the national guidelines for pediatric research. One important ethical issue is obtaining informed consent from children of various age groups, and the performance of the ethical committee in case of conflict between the child and his parent(s) or guardian. Recent studies show that getting informed consent needs to be revised and a new guideline must be developed for each age group. Another important issue is the unlawfulness of monetary incentives in pediatric research, which is nowadays being questioned. Among the topics discussed in ethical codes is the beneficence and non maleficence of the research for children, while the ruling philosophy in pediatric research has posed great challenges in the process. This has caused some research to lack quality and researchers are reluctant to do pediatric research. In terms of information dissemination and confidentiality, there seems to be a lot of debate regarding the child's age, and therefore these issues should be taken into account for revision. Hence we propose that in order to improve the quality of research, the present ethical guideline be revised and based on past experiences, legal and ethics professionals as well as philosophers and lecturers be involved in the process.

The role and consequences of trust in physician-patient relationship

Amirahmad Shojaee

Trust is a key element in the physician-patient relationship. Imam Jafar Sadiq (A.S.) stated that the proficient and trusted physician is in equal level of a just jurisprudent. Ancient ethical texts put much emphasis on physicians to be trusted. Nowadays, trust is a component of social health we believe that in the physician-patient relationship, trust has a significant impact on the practice, and increases the effectiveness of treatment and the satisfaction of patient and physician? also patient autonomy is preserved, health is positively reinforced, and patients will be more serious and less negligent with expenses, treatment, and follow up. This paper is a review/analytical article, and aims at classifying trust and examining its role in communication between physician and patient. If limited to practice, trust in the physician - patient relationship is divided into two types:

1- Unconditional trust, which means full confidence with no autonomy

2- Conditional trust, which entails maintaining autonomy.

In the first type, where patient's autonomy is foregone, both patient and physician can be blamed. The patient is to blame due to an absence of self confidence and lack of participation in decision making and treatment, and the physician might in his place have the tendency to patronize. In this article we emphasize the importance of trust and warn against paternalism and conclude that if doctors truly comprehend the meaning of trust, they will try to avoid paternalism.

A review of the models of physician-patient relationship and its challenges

Omid Asemani

Medicine is known as a combination of science and art. Besides knowledge, a good physician should be equipped with the art of establishing communication with patients. The keystone of any efficient relationship like a therapeutic one is trust, and its deterioration makes the relationship deficient and based on mere need. Therefore, establishing an efficient relationship brings about positive results in treatment. In the last two decades, the trend in the physician-patient relationship has greatly changed, so that patient-centered care is now in focus. In this kind of relationship, physicians recognize patients as respectable human beings with their unique beliefs, attitudes, and concerns, etc. In this paper we intend to provide a brief introduction to the concept of physician-patient relationship and its chronological changes. Also, common models of physician-patient relationships (e.g. paternalistic, etc) are introduced, compared, and their most obvious strengths and weak points are analyzed. At the end, a succinct analysis on the dominant model(s) of physician-patient relationship in Iran&aposs medical settings has been provided, and the necessity of compiling a model based on Islamic values is proposed.

Errors, misconducts, improper hospital conditions, and whistle-blowing by nurses of Isfahan hospitals

Narjes Manjoghi

Errors occur commonly in hospitals and nurses are potential observers of these misconducts and they can prevent them by reporting. This research studies the types of errors, misconducts, and inappropriate situations in the nursing field, compares these errors in private and public hospitals and finally studies individuals' reactions to these errors (whistle-blowing and not whistle-blowing). Two hundred and forty five subjects were chosen out of 2260 nurses in Isfahan hospitals. In this study, a list of errors, misconducts and whistle-blowing criteria by McDonald instrument was used. Results showed that there is significant difference between error models in private and public hospitals, also between strategies used by whistle-blowers and non whistle-blowers when they observed errors, misconduct and inappropriate situations. Sixty-two percent of nurses revealed errors after observing them. Identifying the types of errors can help health decision makers to decrease them and will raise awareness of this issue. In addition, by decreasing the impediments of whistle-blowing, errors and organizational misconducts will be decreased.

Views of cancer patients on revealing diagnosis and information to them

Mohammadreza Lashkarizadeh

Disclosing the diagnosis of cancer to a patient could impact various aspects of their life. The present study was performed to evaluate the views of cancer patients about disclosure of the diagnosis of disease to them. The present study was conducted on 385 cancer patients in three teaching hospitals (Afzalipour, Shafa, and Bahonar) affiliated to Kerman University of Medical Sciences between 2010 and 2011. These patients were evaluated for their views on revealing the diagnosis to them using a questionnaire that included the type of cancer, demographic information and their preferred manner of being informed of the diagnosis. Out of 385 cancer patients, 155 patients (%40) were aware of the diagnosis of their disease. The majority of patients who were aware of their diagnosis (%89) said they would like to know the diagnosis before treatment. Almost all patients who knew the diagnosis preferred to be aware of the prognosis of the disease and the complications of treatment. The only significant demographic variable was sex men were more eager to know the diagnosis of the disease (P value< 0.05). This study showed that the majority of cancer patients would like to be aware of the diagnosis, even though most of them were unaware that they had cancer.

Euthanasia and care for dying patients: attitudes of ICU nurses

Maryam Momeni

Nurses play an important role in end-of-life care for dying patients. Based on the essence of the work environment, nurses are confronted with dying patients and their requests for euthanasia more than other care givers. However, little is known about their attitudes towards euthanasia. Hence, aim of present study was to determine nurses' attitudes toward euthanasia. In this descriptive-analytical study, 91 nurses who employed in intensive care units situated in educational and medical hospitals affiliated to Guilan University of Medical Sciences participated. Nurses attitudes evaluated by using Euthanasia Attitude Scale. Data analyzed by descriptive and inferential statistics (T-test, ANOVA and generalized linear models) by SPSS software version 16. Majority of nurses (83.5%) had negative attitude toward euthanasia. Univariate analysis showed no significant statistical relationship between demographic factors and nurses' attitude toward euthanasia, whilst age (P < 0.029) and employment status (P < 0.004) were related to nurses' attitude toward euthanasia in regression analysis.
Findings of the present study showed that majority of nurse's believe in care of dying patients for health maintenance and life continuance even in the end stage of life. They don't accept euthanasia at any condition. Perhaps, more accurate studies need to assess other confounding factors such as nurses' knowledge, practice and role.

Posthumous assisted reproduction: patients’ rights and Islamic view

Leila Alizadeh

Rapid development in assisted reproductive techniques has brought hope to many childless couples, while it has created new social, ethical and legal dilemmas. Stored frozen gametes and embryos have led to situations where the surviving spouse wants to create offspring after the person's death. Also, the possibility of sperm retrieval even after 36 hours of death, and getting oocytes from aborted fetus or brain dead people has brought a new term: "posthumous assisted reproduction". Posthumous assisted reproduction is the most challenging, difficult, and sensitive issue to be discussed ethically and religiously. In this paper, the acceptability of the posthumous reproduction in Islamic context was evaluated. In Islamic societies where infertility is viewed as a problem of families, posthumous assisted reproduction seems unacceptable. Major concerns such as consent and ownership of the gametes after death, family, marriage and welfare of the child are discussed together with some legal issues. Based on infertility as a disease of family, posthumous assisted reproduction is unacceptable even with previously frozen gametes or embryos. Also, Islamic vision to marriage, consent and welfare of the child confirms the unacceptability. There must be law or guideline to ban this procedure in Islamic contexts.