Iranian Journal of Medical Ethics and History of Medicine

Medical professionalism has recently received attention in Iran, so we aimed to assess it in a single specialty educational hospital.In the present study, we evaluated observation of medical ethics principles from the viewpoints of physicians, nurses and patients. Eight principles of medical ethics were evaluated in these three groups through modified questionnaires containing 43 questions for physicians, 42 questions for nurses, and 25 questions for patients. The mean scores of those principles are as: enhancing professional efficiency (68.7 ± 23), confidentiality (67.9 ± 21), maintaining an appropriate relationship with the patients (61.7 ± 21), improving access to services (59.6 ± 21), distributing limited resources fairly (60.2 ± 25), knowledge production (61.4 ± 23), promotion of trust through management of conflicts of interests (64.8 ± 23), and perform professional responsibilities (59.6 ± 23). There were significant differences in the two parameters of “enhancing professional efficiency” and “confidentiality” between the viewpoints of the patients and the viewpoints of physicians and nurses (P < 0.0001). The difference in “maintaining an appropriate relationship with the patients”, “improving access to services”, and “distributing limited resources fairly” was significant between the viewpoints of the nurses and that of the patients and physicians. The viewpoints of the nurses and patients were significantly different only in “knowledge production”, “promotion of trust through management of conflicts of interest”, and “perform professional responsibilities” (P < 0.0001). With respect to these significant differences, the nurses’ viewpoint regarding “enhancing professional efficiency” may be more dependable due to their more accurate knowledge of the physicians’ performance and more extensive contact with them. This has also resulted in significant differences between nurses and patients or physicians in other principles as well.

Ethics is important in all professions, particularly in nursing, since morality and commitment in nurses can play a significant role in improving patients’ health and recovery. The nursing profession is therefore rooted in ethics, and the observance of nursing ethics is more important than other aspects of health care. This study aimed to determine patient's views on standards of professional ethics in nursing practice in Imam Hussain Hospital during 2015.

This was a cross-sectional study conducted on 575 patients in different wards of Imam Hussein Hospital in Shahroud. Research instrument was a 22-item questionnaire designed by the researchers to evaluate nurses’ observance of professional ethics in the three dimensions of accountability, improvement of care quality, and respect for patients. Data analysis was performed using SPSS 20 software.

The mean age of participants in this study was 51.32 (± 19.03), and 299 participants (52%) were male. The mean total score of professionalism was 18.38 (± 2.74), and the relationship between age and observance of professional ethics was statistically significant (P = 0.006).

According to the subjects of this study, the nurses’ observance of professional ethics was relatively good and at a desirable level. It is recommended to utilize a variety of learning styles and employ the services of professors of nursing ethics in order to enhance the quality of nursing education with respect to professional ethics.

As a result of the changes made in health care systems, nurses nowadays are faced with more complicated ethical dilemmas. Therefore, they need to be familiar with ethical decision-making procedures and have the ability to perform ethical reasoning. The present study aimed to evaluate this ability in nurses and investigate its relationship with demographic characteristics in a subspecialized hospital in Tehran during 2015. This was a descriptive-analytical study, and the research population consisted of 245 qualified nurses selected by census. A demographic questionnaire and Crisham’s Nursing Dilemma Test were used to collect the data. Descriptive-analytical tests and SPSS software version 22 were used for data analysis. Based on the, the mean value of the nurses’ ethical reasoning was 40.81 ± 6.72, which is lower than the average score of the test. Furthermore, increased work experience led to a reduction in the mean value of ethical reasoning (P ≤ 0.05). Overall, single subjects scored higher in the mean ethical reasoning than those who were married (P ≤ 0.05), but no significant relationship was observed between other demographic characteristics and the mean of ethical reasoning. Due to the nurses’ low ability to perform ethical reasoning, further studies will need to be conducted on proper training methods to promote ethical decision-making in nurses. As regards the reduced ethical reasoning ability in nurses with more work experience, it is necessary to identify the reasons and devise appropriate solutions with the help of nursing managers and hospital ethics committees.

Moral distress has been identified in nursing literature as a major dilemma affecting nurses in all healthcare systems. It is viewed as an important factor threatening the integrity of nurses and ultimately the quality of patient care. The present study attempted to determine levels of moral distress among the nursing staff employed in hospitals across the city of Malayer. This was a descriptive and cross-sectional study conducted on 195 nurses of Malayer hospitals during 2015. Data were collected using a demographic questionnaire and the standard moral distress scale (MDS). Data analysis was performed by descriptive and analytical statistics using SPSS software version 18.

In this study, 88 nurses (45.1%) were found to be suffering from severe moral distress. The most important factors causing moral distress pertained to substandard care and treatment due to a shortage of health professionals and care providers (6.6±0.21), physician orders for unnecessary tests, treatments and care (6±0.12), and measures taken by staff who lacked clinical competency (5.9±0.22). Among the nurses’ demographic data, gender (P=0.001), job experience (P=0.001) and nursing ward (P=0.01) were significantly related to the level of moral distress experienced by the nursing staff. The results imply that in nursing, moral distress is a highly important and pertinent issue that requires greater consideration by health service managers, policymakers and nurse educators.

Moral intelligence is the ability to utilize principal criteria that can lead to effectiveness of individual reactions. The aim of this study was to determine the relationship between moral intelligence and communication skills among bachelor’s students in nursing at Tehran University of Medical Sciences, Iran, in 2016-2017. 

This was a descriptive-correlational study. The study population consisted of all nursing students studying at the School of Nursing and Midwifery of Tehran University of Medical Sciences. Among the study population, 204 subjects were selected through convenience sampling method and based on the inclusion criteria (direct acceptance in the field of nursing, absence of any illness, and willingness to participate). The data collection tools consisted of a demographic characteristic questionnaire, the Moral Intelligence Scale (Lennick & Kiel), and the Communication Skills Inventory (Jerabek). The validity and reliability of both instruments had been approved in similar studies in the country using Cronbach's alpha coefficient (α = 0.88 and α = 0.71, respectively). The reliability of the two questionnaires was calculated in the current research using Cronbach's alpha (α = 0.85 and α = 0.81, respectively). Data were analyzed using descriptive (average and standard deviation) and inferential statistics (t-test, Pearson correlation coefficient, and ANOVA test) in SPSS software. The mean moral intelligence score was 71.98±7.12 and ranged from 20 to 100 and mean communication skills score was 114.9±9.67 and ranged from 34 to 170. Pearson correlation coefficient revealed a significant and positive relation between moral intelligence and communication skills of nursing students (r=0.54, P ≤ 0.001). Thus, the communication skills of students can be improved by strengthening their moral intelligence. Therefore, it is suggested that the grounds for the strengthening of moral intelligence among nursing students be provided.

Physician-assisted suicide is an important, challenging issue in medical ethics, which the right to die is a central point in this issue. Physician-assisted suicide is offered to end intolerable pain and suffering. Although, it is a legal practice in some countries, still it is a challenging and controversial practice in ethical and legal perspectives. It has been argued that based on the principles of medical ethics, physicians should respect patient’s decision, however many ethicists and jurists believe that Physician-assisted suicide is unethical. It should be noted that the main reason for proponents and opponents is based on their interpretation about human dignity. This controversy can be resolved by reference to religious interpretation of human dignity in which asserts that Physician-assisted suicide is against human dignity and respect for human life.

Self-defence is everyone’s right. Based on this right, one can defend himself against any eminent threat, even if it cause the predator’s death. This ethical principle is an applicable principle in ethics in war. However, the principle of self-defence has been applied in other situation such as justification of abortion if mother’s life is threatened by her fetus. Judith Thompson is a philosopher who defend abortion by applying this principle, in her book, “ A Defence of Abortion”  Thompson categorized pregnancy into two types, wanted and unwanted pregnancy, argues that abortion is justified in wanted pregnancy if mother’s life is endanger. She also discusses the involvement of a third party in performing abortion. However, her argument has been criticised by her proponents as well as opponent. This article examines the principle of self-defence and its application in justifying abortion as well as   the involvement of a third party in Thompson’s perspective.