Iranian Journal of Medical Ethics and History of Medicine

Nursing role development was created to response to the challenge of balancing supply and demand in healthcare system. The aim of this study is to examine the evolution in nursing role development and subsequent experience in dealing with the challenges in the world. In this study, electronic resources were searched till to 2015 by English keywords contain 'Role development' and 'Nursing role' in combination and individually. Data were extracted from articles that were more relevant. This study found two approaches regarding nursing role development. First, the role extension that relates to progressing in the field of medicine and the traditional functions of physicians, and the role expansion that implies any enlargement of the nurse's role within the boundaries of nursing education, theory and practice. In many countries that seek to expansion/extension of the nurses’ role. However, despite the shortage that exist in nursing and also because of the increased workload of nurses, caused employment of workers with lower skills and in result multiple significantly challenges have been experienced.  In our country, nursing role development has not considerable progress. The current situation does not provide enough infrastructures such as the licensing professional qualification and data-based decision-making from monitoring the effect of changes on the quality of care. Therefore, decision-making about the implementation of any changes in the nursing profession and its role development, must be accomplished very prudential with regard to all aspects of the professional Ethics.
 

Several definitions for medical futility has been proposed in the literature. Medical futility is defined as the condition in which an intervention, either for diagnosis, prevention, treatment, rehabilitation or other medical goals, has no benefit for the individual patient. This critical review aimed to increase the understanding of physicians and other healthcare providers on the issue of futility in complementary and alternative medicine (CAM). Our comprehensive search resulted in more than 1000 studies; unrelated studies were excluded by title and abstract screening, then 219 full-texts were read and finally, 118 studies were included. The conclusion concerning whether or not it is morally acceptable to provide a futile treatment in CAM, becomes a controversial issue based on different approaches. Using futile treatments is not acceptable according to the duty-based approach, and the principle of justice. In contrast, the case-based approach  and the principle of autonomy of the patient, hold that such treatments could be morally acceptable. Based on utilitarianism, only evidence-based treatments can be morally discussed, and those CAM therapies that have been shown to be futile, should be prohibited; thus health care providers must not offer them to patients since it would be a kind of deceit. We suggest that more comprehensive studies should be performed to clarify the boundary between placebo, nocebo, and futility.