Iranian Journal of Medical Ethics and History of Medicine

Moral necessities in the field of children’s cancer are among the most important issues in medical services. The present study was conducted to explore this issue based on a case discussed during the medical ethics round in Tehran Children's Medical Center. A 13 year-old girl diagnosed with left ovarian cancer 5 years ago stated that she had not been informed about the disease and the type of surgery by her family, doctors and the medical staff. The family even denied the child’s disease, but she was struggling to adapt to the situation and eventually recovered after chemotherapy and surgery. Findings of the present study showed that through observance of moral necessities, health workers can assist children suffering from cancer and their families to better adapt to the situation. This is possible by providing supportive resources to these children as well as their families

Severe combined immunodeficiency (SCID) is an inherited primary immunodeficiency syndrome characterized by a profound deficiency in T-lymphocytes and variable defects in the B-lymphocyte number. The present study aimed to evaluate the ethical aspects of the clinical management of children with SCID. This report is based on the case of a 6-month-old male infant with SCID diagnosis presented during the Medical Ethics Grand Rounds in the Children's Medical Center in Tehran, Iran.

The patient had a positive history of recurrent infections and frequent hospitalization. His parents were consanguineous and came from a low socioeconomic level of the community. He was the fourth child of the family. The first and second children were healthy girls, while the third child was a boy with a history of numerous problems post vaccination who had eventually died of widespread infections. The physician had recommended bone marrow transplant, but the parents had been directed by a neighbor to visit a religious healer.

Timely management of severe combined immunodeficiency can reduce complications and improve the patients’ quality of life. The need for early screening tests is therefore ethically justified, although ethical issues surrounding the subject should not be overlooked. Instances of these issues include: neglecting the scientific criteria necessary to conduct the tests the economic burden imposed on the family of the child failure to provide sufficient information to parents and ignoring their consent to conduct testing and treatment lack of equitable access to diagnostic and treatment facilities and lack of attention to the child’s autonomy. It should, however, be noted that in certain cases, healthcare providers could perform their management activities with an ethical and supportive approach, taking into account all physical and psychological needs of infants with severe combined immunodeficiency, as well as those of their families

Chronic renal failure in infants is a life-threatening condition that can also severely affect their families. Patients and their families are under great physical, mental and social pressure, and therefore require medical, palliative and supportive care. Moreover, ethics has an important role in care for these infants and their families. The purpose of this study was to identify an ethical approach to providing medical, supportive and palliative services for infants with chronic renal failure and their families. The study was based on a case report in the Medical Ethics Grand Rounds of the Children's Medical Center in Tehran, Iran. The case pertained to a male newborn infant with diagnosis of renal failure. Assessments indicated severe bilateral hydronephrosis and multicystic dysplastic kidneys accompanied by high creatinine levels. The patient underwent surgery but further evaluations revealed a low glomerular filtration rate accompanied by elevated blood pressure. The physicians suggested insertion of a catheter for CAPD (continuous ambulatory peritoneal dialysis) after the initial peritoneal dialysis until a kidney transplant was performed. The proposal, however, was rejected by the parents and the patient was discharged by their consent. A few weeks later, the infant expired at home. It seems that health professionals need effective ethical strategies to offer medical, supportive and palliative services for infants with chronic renal failure and their families

Errors in health care services may cause irreversible harm in some cases. Medical errors are a threat to the welfare and health of the patient and their family and should be prevented. The majority of medical errors have little impact on human health, but some of them cause huge losses. This report describes a case of laboratory error in amniocentesis during pregnancy in which uncertain test result caused anxiety and lots of concern for the family. Inappropriate approach to medical error causes more errors to happen. Studies have shown that appropriate reporting and shift from traditional to systematic approach are important factors in reducing the frequency of medical errors.

One of the most important patient rights is to respect the patients’ autonomy and their participation in the process of treatment decision-making. This is of particular importance for the patients in the emergency department, who require due care in differential diagnosis leading to illness and death. However, the problem arises when this right is negligently ignored and despite the fact that it seems a simple matter, it is difficult to manage and control. Accordingly, this study aimed to investigate this issue through the case report of a patient diagnosed with acute abdomen. Moreover, an attempt was made to briefly review how negligence occurs, its causes and consequences, as well as its management strategies. In this report, the results highlighted the importance of patient participation, obtaining informed consent from the patient in the entire treatment process (diagnosis, treatment, rehabilitation, and prevention), and maintaining privacy and confidentiality regarding all medical and non-medical information of patients that are provided to the treatment staff in verbal, written, partial, and even electronic forms, especially in sensitive and stigmatizing cases. It seems that there are certain strategies to manage such negligence including timely detection, investigation of the causes and consequences, compensation for the damage, enhancing the cultural competence of the treatment staff, developing relevant local guidelines and instructions, having an efficient system with the support of the organization for handling it, and strengthening communication skills and teamwork.