Iranian Journal of Medical Ethics and History of Medicine

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New antiviral remedies have greatly improved the prognosis of patients infected with AIDS, as well as their life expectancy and quality of life, and assisted reproductive techniques have made it possible for many HIV positive patients to have healthy children. Nevertheless, most assisted reproduction centers continue to reject these couples, and this is a factor that contributes to their isolation from the society. The present study was performed through document and library research, and the results were investigated from the viewpoints of the infected couple, their future children, and health care staff. Social and legal issues were evaluated through consultation and collaboration of experts, and related articles, guidelines and accessible material were examined for this purpose. Every individual has the right to reproduction. If it is possible for HIV positive couples to have children with the help of fertility lab techniques, and provided that throughout the process there is no danger of disease transmission to others and particularly the embryo, ART centers should not reject HIV positive couples. Rejection of these couples is against the principles of medical ethics and in violation of the current effective laws of the country. On the other hand, acceptance of patients infected with Hepatitis type C, advanced cancers, mental diseases, and so on is further proof that rejecting HIV positive couples is a form of discrimination and unethical. The word HIV itself is synonymous with the stigma of social deviance, and it seems children of infected parents are not in the ideal position from the public point of view. One step that needs to be taken is for the society to try to remove this stigma and provide support for all chronically ill patients. There is no valid justification for rejecting HIV positive couples in ART centers, and it appears to be unethical and a violation of human rights to deny these couples the right to have healthy children through modern technology.

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Animal cloning is one of the animal biotechnology branches. Although this method has been used since 1950, but many have paid attention to cloning by birth of Dally. Because the way of Dolly production was completely different from other existed methods in cloning.
This new-found and unprecedented method has been called "Somatic Cell Nuclear Transfer" (SCNT), so scientists have eagerly paid attention to many profitable abilities such as, duplicating valued animals traits, preventing endangered animal species from extinction or even restoration of extinct animals, producing high quality food and drug by using cloning as a way for propagating transgenic animals.
Even though all these instances sound good and encourage use of SCNT, in fact, none of them has practically become feasible so far. The main reason for this claim is that in spite of whole attempts taken for producing cloned animals, the method still is under debate and the hit-rates of this method has been kept considerably low and disappointing.
Because of several reasons, we cannot ignore this recognized obstacle as low efficiency. Along with this issue, there are various sub-effects, which put human and animals life at risk. Not only the High rates of miscarriages or birth of genetically abnormal animals, causes many different health-oriented problems for human and animals, but also it can directly and indirectly endanger human and animals welfare. Nowadays hordes of legal and ethical criticism around SCNT in reaction to these portentous signs, invite scientists to be more scrupulous and patient in its broad enforcement.
Taken together, although at first glance SCNT seems to be promising, it's usefulness has been diminished because of difficulties in its application in broad spectrum. Therefore SCNT should be kept under surveillance and use of it must be just limited to very important and critical cases such as medical purposes, as long as all due observations and cautions take into account before implementing.

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Generally, when moral values and ethical principles are concerned, human beings are considered as the sole subject of these fields. It is then concluded that the only living creatures with some privileges and obligation towards their own bodies and also, towards their other human counterparts are humans. An emerging issue, particularly in the past recent three decades, has been the expansion of the ethical community to be inclusive of other living creatures, namely animals. Novel branches of science such as animal ethic are increasingly challenging the traditional view of ethics and aim to include animals in ethical community. In this article, a descriptive study and systematic review of literate was carried out on different aspects of animal ethics and the specific codes applicable to animals was studied in order to shed some light on the animal ethics and on what basis they are subjects to ethical considerations. As animals are proven to have the ability of perception and demonstrated to be able to feel and differentiate good and bad experiences, they are considered as being the subject of ethical considerations. Therefore, human beings should be responsible for their behavior towards animals in different aspects.

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For some infertile couples, egg donation is the only option. In egg sharing programs, patients share half of their eggs with another couple in exchange for a discount on assisted reproductive technology. In many countries, using this method is legally discussed. Iran is the only Islamic country in which donation programs are practiced, so, we designed this study to compare egg sharing to ordinary egg donation from ethical, legal, and religious aspects.A complete review of ethical issues and debates about egg donation and sharing was done. For religious issues, we consulted clergies, Islamic texts, and current decrees (fatwas). Social issues and legal problems were examined by consulting expert opinion and jurists. Also a complete review of literature was done. Egg donation and egg sharing are both religiously accepted in Iran by the Shiite clergies as they are considered completely similar. Egg sharing has some religious (seeing and touching the female genitalia) and social (preventing repetitive donation) advantages to egg donation as well as avoiding complications of fertility drugs and procedures, financial and trading issues, advertisement and brokers. However, there are some disadvantages with egg sharing, such as reduced likelihood of conception by donating half of the eggs, challenges related to donor health, and emotional stress of failure for the donor and success for the recipient, which can be prevented by careful case selection, psychology and genetics consultation, and  practicing anonymity. As a result, egg sharing is ethically and religiously more acceptable than commercial egg donation.   

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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.

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Recently larger numbers of women of advanced age are referring to fertility centers. Although there may be no age restriction for women who are naturally able to and want to be pregnant, using assisted reproductive techniques for women of advanced age is medically and ethically disputed, and this question is always raised: "Should there be an age limit for accessing assisted reproductive techniques for women?" This study was a review of ethical, legal and religious issues regarding pregnancy and reproduction in advanced age for women. We tried to cover codes, legislations and articles on the subject. There is no national legislation about age limit for women seeking assisted reproduction. In this regard, fertility clinics follow their own protocols. Most centers do not accept women older than 45 unless there is a specific clinical situation confirmed by a physician. In any case, the safety of the mother and her child must be the first concern of the physician, and all the treatment protocols should be determined accordingly. Obviously, age alone cannot be a suitable criterion for rejecting the infertile patient. Therefore, regardless of the patient's persistence and their ability to afford treatment, physicians should consider mother's safety and the welfare of the child before admission. Pursuing an all-inclusive legislation and guideline seems to be of great importance in Iran.  

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Documentation of accepted ethical behavior in special settings is one of the strategies employed to foster ethics in organizations. Such documents, known as codes of ethics, vary in different societies according to their cultural and ideological differences. Medical educators have dual professional roles (as physicians and teachers) that sometimes seem ethically incompatible. Therefore, having codes of ethics is essential in this profession. The aim of this study was to develop codes of ethics for clinical medicine educators with an Islamic-Iranian approach. This was a three stage developmental research. First, a comprehensive literature review was conducted. Using content analysis method, the first draft of a code of ethics for clinical medicine educators was prepared. Second, the draft was thoroughly and critically reviewed and revised in experts’ focus group discussion and the 2nd draft was devised. This was further reviewed by a group of 24 experts at the national level (validated) and revised according to their comments, and thus the 3rd draft was prepared to be presented for formal approval process. The final document includes 55 codes of ethics in 18 topics (conscientiousness, accountability, respectfulness, scientific excellence, respect for others’ freedom, equity, patience, religious commitment, modesty, trustworthiness, humility, contentment, relationship with coworkers, attentiveness toward patients, attentiveness toward learners, kindness, confidentiality, and discipline). It seems that extracting ethical concepts from the rich Islamic-Iranian cultural resources is feasible, and provides an appropriate basis for the development of ethical codes for medical educators. Compared to Western codes, such codes may be better accepted in Iranian contexts and will be implemented more readily if the organizational settings are prepared simultaneously.

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Any contract in the Iranian legal system contains features that need to be explained in order to better understand the exact terms of agreement. Some such features are related to whether the contract is irrevocable or voidable, gratuitous or with considerations, and may bear upon accountability and suspension, formality or contentment, and so on. In surrogacy, the sperm and egg of an infertile couple are fertilized and then transferred to another woman's uterus to carry till birth, when the child is delivered to the owners of the sperm and egg. The specific features and uncertain nature of surrogacy specify the standing of this type of contract among others. The present article is aimed to examine the features of surrogacy agreements from ethical and legal perspectives

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Confidentiality has long been protected in criminal law as an important ethical principle. With regard to the issue of sexually transmitted diseases, however, health care providers are faced with certain challenges. On the one hand, it is their obligation and duty to respect patient confidentiality, and on the other hand, the possibility of transmission of infection to sexual partners is a rather significant phenomenon. Therefore, health care providers have a crucial role in terms of the conflict of interests and legal duties with respect to sexually transmitted diseases.Medical mandatory reporting to state authorities accompanied by personally identifiable information of the infected person is another controversial issue in the field of confidentiality, which will be discussed in this article by studying various trends in statutes and precedents. It seems that throughout the world, there are two major trends in this respect: in some states, principles of confidentiality are observed even if the patient is infected by sexually transmitted diseases, unless it is inevitable for the safety of third parties such as sexual partners in a narrow implementation of Acts. States like Iran, France and Thailand are examples of such governments. In some countries, however, partner notification and compulsory notification by personally identifiable information of patients are mandatory for epidemiologic reasons. The United States, Australia and Ukraine are some of the countries that fall within this category. In Iranian legal system, the duty to respect confidentiality is emphasized and partner notification cannot be considered as a legal duty and therefore it is not legally permitted. Merely in emergency condition and under a narrow interpretation of law and by resort to patients informed consent, necessity and explicit law permission, breaching of confidentiality is justified.

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In the Iranian Civil Code, article 190 and the following articles specify a series of conditions that each party of a contract should possess in order to be able to enter into the contract. The above-mentioned article states that in order for a contract to be valid, both parties must be of age, must be in full possession of their senses, and must have reached puberty. In addition to these conditions, the intended parents must meet a number of other criteria as well; for instance, they should be infertile and must be physically and mentally healthy. As regards the surrogate mother, she needs to be married and in good physical and mental health, and she should have previously conceived a child. She must also be of an age suitable for pregnancy, and it needs to be ascertained that she will come to no harm due to pregnancy. These terms, however, are not ordained by the Iranian law and are only observed by some institutions at the moment. Therefore it is recommended that legislators focus on the issue of surrogacy and oversee the observance of the above-mentioned terms by institutions that are involved in the process.

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Cryopreserved embryos are considered as abandoned embryos in two situations. The first situation is when the embryo`s owners have no definite domicile and no written guideline has been provided by the couple regarding the embryo`s status. The second one is when the owners of cryopreserved embryos explicitly state that they permit the freezing centers to decide about their embryos` fate. The aim of the present study was to determine the best possible decisions about cryopreserved embryos in case of their abandonment by couples.

This research was conducted through library and analytical research methods.

As the cryopreservation of embryos is expensive, cryopreservation centers must be exempted from preserving embryos after unsuccessful attempts at communication with the owners and passing of reasonable time.

Making decisions about the fate of abandoned cryopreserved embryos depends on the nature we attribute to them. If we consider abandoned cryopreserved embryos as humans, it is possible to destroy them according to the rule that necessities allow prohibitions. If we consider them as properties or quasi-properties, when there is no accessibility to their owners in order to determine their fate as properties, the governor is permitted to make decisions about their disposal or donation for researches.

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