Iranian Journal of Medical Ethics and History of Medicine

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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.

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Birth of a poor prognosis neonate (premature and/or congenitally affected) may potentially burden the family and/or society with many ethical, social, legal, etc challenges. Most of the decision making criteria used in handling the care of these neonates, such as disability, quality of life, etc., are multidimensional and heavily ethical bearing. In this study, we have tried to explore and present a perfect view on the existing challenges and different dimensions of the discussed criteria. In the end, the prominent standpoint of the Islamic school in confronting a severely disabled newborn has been introduced and analyzed. Most related discussions boil down to some fundamental and unanswered questions, for instance whether human beings should be permitted to make decisions about the life of severely diseased neonates, the decision making criteria themselves and their appropriateness, etc. Even though many scientists have theorized on the subject, a multilateral explanation of life and death criterion has not been presented yet. One thing is for certain and that is, in answering the basic questions of the subject, our present knowledge and experience is limited and insufficient. The authors have tried to show that despite many western views, decision making about the life of a neonate has no place in Islamic teachings, since it could be considered an unauthorized human action. Instead, it is proposed that any attempt to provide an ethical rationale, while utilizing today's science and technology, be in compliance with God's commandments.

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Confidentiality is an inevitable pillar of the history of the physician-patient relationship. Misunderstanding of this principle not only causes harm to sanctity of the medical profession, but also can damage the quality of the therapeutic relationship, and more broadly public health. The keystone of this negative effect is the potential harm to the patients’ trust and confidence. Generally, the Western school tends to agree that respecting patient confidentiality is essentially desirable. Islam also respects and emphasizes confidentiality, and has general and some specific recommendations about the importance of secrecy and concealment of people’s secrets. Overall, despite strong agreement about the importance of the principle, some ethical theories do not insist on maintaining confidentiality under any circumstance. This paper is an attempt to describe the importance of confidentiality in the medical profession considering the approach of both absolutists and relativists in practice.Absolutists believe that the intrinsic desirability of implementing the principle of confidentiality in all cases is the same and without any exception, but the issue is about not giving just priority to other conflicting moral values.Additionally, the absolutists believe that breaching this principle in practice cannot be permissible due to some serious long-term and mostly hidden complications such as patients’ failure or delay to seek medical assistance or advice and/or withholding important information and so forth. Overall, according to empirical evidence and rational considerations, adherence to absolute confidentiality seems more desirable to absolutists. Unlike absolutists, in relativists’ concept of confidentiality, insisting on maintaining the secret will not be allowed in certain cases, and those cases are considered exceptions of the rule of confidentiality.The most important reasons for falling into the wrong orientation of relative confidentiality seem to be precipitance to attain the desired result, poor communication skills, ignorance of the consequences, and being headstrong.

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In recent years, there has been a significant increase in the rate of cesarean section in Iran. Physicians can have an active role in controlling this rate as they are truthfully consulted and followed by the general public. The Iranian Ministry of Health and Medical Education has also adopted new policies to control the national cesarean rate. The present study aims to determine the knowledge and attitude of medical residents towards elective cesarean section versus normal vaginal delivery (NVD) in 2015.

In this cross-sectional study, residents of four major fields of specialty (obstetrics and gynecology, pediatrics, general surgery and internal medicine) were interviewed using a researcher-made questionnaire. The face and content validity and reliability of the instrument were determined, and data analysis was performed using SPSS version 21.

The Cronbach’s alpha coefficient was 0.77. A total of 108 residents with the mean age of 32.89 participated in the study. Of this number, 53 reported at least one personal experience of childbirth (their own or that of their wives) with a satisfaction rate of 9.5 and 6.3 out of 10 for NVD and cesarean respectively. The mean score of the domains of "knowledge", "attitude" and "function" were 3.5, 3.6 and 3.3 (out of 5) respectively. There was a meaningful correlation between the variable of "sex" and the domain of "knowledge", "specialty" and all three domains, and "methods of delivery" and the two domains of "attitude" and "function". 34.3% of the residents chose "mandatory public education of pregnant women" as the first step to decrease the cesarean rate.

It can be concluded that educating pregnant women should be the main strategy for decreasing the cesarean rate in Iran. Considering the significance of medical specialists’ "knowledge", "attitude" and "function” with regard to the method of delivery chosen by pregnant women, it is recommended to develop specialty educational programs in line with the policies of the Iranian Ministry of Health to decrease the cesarean rate

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Regarding how to make decisions on the revelation of medical errors done by colleagues, investigation of physicians' points of view particularly those in educational settings could help the improvement of circumstances to which we encounter medical errors and thus respecting patient's rights. This cross-sectional descriptive study was conducted through a researcher-made questionnaire after performing face and content validaty and determination of internal and external reliability. The viewpoint of 40 attending physicians and 112 medical residents from different specialties about their inclination to disclose errors, the results of disclosure, the factors influencing on nondisclosure, and the factors decreasing medical errors were asked. Data were analyzed using SPSS v.21. Mean scores of 15.2±1.3 for attending and 12.56±2.05 for residents regarding the dimension of "inclination to disclose others' medical error"; and mean scores of 7.55±0.677 for attending and 9.09±2.01 for residents in terms of "inclination to NOT disclose" were differed significantly (p<0.001). Participants declared the head of medical department/ward as the best authority for managing and dealing with medical errors as the best approach for disclosure of the errors through attendance of the senior physician accompanied by the physician who has made the error. Urban general physicians, nurses, and first-year residents were reported with the most frequency of the errors. The data can be used for the promotion of the patient's rights and the perspective of the medical team when encountering errors done by a colleague, rightfully, and protectively. Building cultural, legal, and social contexts will be the mission of the educational-medical settings aimed at making possible a scientific and skillful error disclosure.

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This article has no abstract.