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Research Misconduct Cases Reviewed by the National Committee for Ethics in Biomedical Research of Iran
Amirhossein Mardani, Maryam Nakhoda, Ehsan Shamsi Gooshki,
Volume 17, Issue 0 (12-2024)
Abstract
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 Considerations of Using Electronic Health Records by Healthcare Providers
Hamid Moghaddasi,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Reflection in Medical Education: A Strategy for Enhancing Professional Development
Homa Sadeghi Avval Shahr,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Ethical Considerations in the Use of Artificial Intelligence in Healthcare
Mohammad Shojaeinia ,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Ethical Dilemmas in Health Policymaking
Tahmine Salehi ,
Volume 17, Issue 0 (12-2024)
Abstract
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.

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,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Health Needs Assessment Based on Capabilities Theory
Reza Khadivi,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Challenges of Professional Commitment in the Digital Age
Saeedeh Saeedi Tehrani,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Avoidable Suffering at the End of Life
Mamak Tahmasebi,
Volume 17, Issue 0 (12-2024)
Abstract
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.
 

"The Other" and Public Health Ethics with Emphasis on the Views of Avicenna and Levinas
Abdollah Salavati ,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Ethical Challenges in Admission and Resource Allocation for Patients in Need of Rehabilitation Services
Mohammadjavad Hosseinabadi Farahani,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Ethics and Health Chatbots
Masoud Amanzadeh, Mahnaz Hamedan,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Ethics in Rehabilitation Research: A Review of Concerns, Challenges, and Ethical Principles
Shima Shirozhan ,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Conflict of Interest in Research
Shiva Khaleghparast, Samaneh Karimian,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Survey of COPE, ICMJE, CIOMS, and WAME Statements/Opinions on the Use of AI in Scientific Publications
Abdolhassan Kazemi,
Volume 17, Issue 0 (12-2024)
Abstract
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 Decision-Making in Pediatric Nursing: Managing Critical and Serious Conditions
Azam Khorshidian,
Volume 17, Issue 0 (12-2024)
Abstract

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.
 


Retracting or Discrediting Articles: Dos and Don'ts
Mina Mobasher,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Juridical, Legal, and Ethical Aspects of "Under-the-Table Payments " from the Perspective of Experts and Shia Grand Ayatollahs
Mojtaba Parsa,
Volume 17, Issue 0 (12-2024)
Abstract
"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.

COVID-19: An Opportunity to Restore Lost Trust? A Narrative Review of Trust Trends Before and After the Pandemic
Hanieh Karimi, Ali Farahmand Asil, Saeedeh Saeedi Tehrani,
Volume 17, Issue 0 (12-2024)
Abstract
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.

Challenges of Human Resource Allocation in the Health System
Kourosh Delpasand,
Volume 17, Issue 0 (12-2024)
Abstract
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.

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