Iranian Journal of Medical Ethics and History of Medicine

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Pharmacy, from the earliest time has been closely related to health and well-being of the people and its own code of ethics. In recent decades there has been a shift in the pharmacist role from traditionally dispensing to patient oriented health care management. Nowadays, the philosophy of pharmacy practice is that a pharmacist is an individual who provide his knowledge and skills in patient counseling regarding ethical principles. Recent advances in the science and technology and emerging new horizons of medical therapy, drug delivery and pharmacy practice put forth new concepts such as professionalism and professional code of ethics for health care providers. In this respect, rights of patient, patient autonomy and consent, consumerism, and commercialism put forth the importance of the study of pharmacy practice pathology and implementation of the code of ethics. These constrain has not put into consideration in Iran, it seems necessary to study how effective are code of ethics with these factors as well as others such as lack of knowledge and skills, economical, cultural, and socio-cultural constrains.

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Backgrounds: Nowadays one of the major problems in research ethics, especially in medical researches, is how to make bioethics codes practical and how to oblige researchers to perform them. In this essay, we have tried to suggest all detailed activities of different management sides which have a role in different phases of performing a research project, to make codes more practical. Materials and Methods: In order to provide a practical guideline in medial research ethics issue from different points of view, a workshop was held by the presence of some representatives from type1 medical universities, 9 research centers, Pasteur Institute, molecular research and stem cells networks, and members of national research ethics committee. Results: Participants were divided into 5 groups based on their proficiency and management scopes and edited the task's descriptions. These groups included: 1) task's description for ethics committee of universities 2) task's description for research executive managers and research deputies of universities and research centers 3) task's description for professors, executors, managers, research deputies of departments and research council's department 4) task's description for international relationship committees of universities 5) task's description for publishing committees. These 5 groups were chosen deliberatively. Conclusion: Considering importance of bioethics, interference of environmental and sociological factors, local area culture and existence of executive facilities, providing practical codes of ethics needs group assistance and researchers' national impetus, research affairs accomplishment and massive country management.

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Based on the definition offered by ancient scholars and philosophers, the term “ethics” refers to a certain set of qualities and character traits, and an ethical person is one who possesses those qualities. This definition is still accepted, although it does not undertake the actions of an ethical person, and does not clarify the stance regarding an ethical person who happens to commit an unethical act. While supporting the definition above, this paper will investigate people’s behaviors individually through an analytical approach, logical arguments, and by applying falsification criticism. It will then proceed to define the term “piety” and provide a comprehensive exposition of an ethical person. The above-mentioned exposition is offered in this paper for the first time and presents a fresh approach to defining morality. It combines the terms piety and ethics to argue that an ethical person is a pious individual who not only possesses ethical characteristics, but also is sensitive to each one of his/her behaviors.

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Making decisions for recipients of health care while offering clinical care is an important part of nurses’ responsibilities. In order to ensure patient satisfaction, nurses are obligated to observe ethical standards in the decision-making process. This paper aimed to determine the effect of teaching professional ethical principles on ethical sensitivity in nurses’ decision-making. In this semi-empirical study, 80 Social Security nurses were selected through purposive sampling and were then randomly placed in two groups of 40 each, the intervention group and the control group. Research tool was the Ethical Sensitivity Scale Questionnaire for decision-making, the validity of which was assessed using content validity, and whose reliability was confirmed with a Cronbach’s alpha coefficient of 0.83 for internal consistency. At first the ethical sensitivity in decision-making was evaluated in both groups, and then an educational workshop on nursing ethics was held for the intervention group every other week the workshop consisted of 4 three-hour sessions, and upon completion of this workshop, both groups filled in the questionnaire once more, and data were analyzed using SPSS software. There was no significant difference between the average ethical sensitivity in decision-making of the two groups before the intervention after the intervention, however, the difference was meaningful (P = 0.001). Moreover, the average ethical sensitivity in decision-making of the intervention group was significantly different after the intervention (P = 0.001). Based on the findings of this study, teaching nursing ethical principles has a positive effect on nurses’ ethical sensitivity in decision-making. It is therefore recommended that this educational program be offered to nursing students and health care staff.

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The definition of disaster is diverse but certainly the similarity between disaster and normal condition is negligible. The most important characteristic of critical condition is the number of human victims. Therefore each critical condition needs medical intervention and the presence of health care providers is necessary.
Health care services are divided into two categories one in normal situation and the other in the critical condition so the ethical considerations and responsibilities of the health care providers will differ accordingly.
Our approach for explaining medical ethics or ethics in health care n critical conditions is two dimensional including the responsibilities of health care providers and ethical problem solving. The second dimension needs systematic approach which is not possible in this article. In the case of the responsibilities of health care providers we may focus on individualized viewpoint or systematic and strategic view point however the later is more complete and acceptable.
From systematic viewpoint three important issues should be considered ethical principles, ethical codes and multi dimensional ethical charter of each organization.
In this review we aimed at describing some ethical principles and codes of conduct and the ethical principles of Red Cross and Red Crescent as well.
In conclusion, critical conditions are far wider and there are full range of special situations in which no unique solution can be followed. It is necessary to determine the diverse fields affecting the condition and solve the resultant ethical issues in a problem oriented manner.  In addition medical ethics should be considered as one of the most important priorities of the Ministry of Health and other related organizations.

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End stage patient control and autonomy are core principles in human bio-medical ethics and key components of end-of-life (EOL) care. Albeit, according to modern medical ethics principles the centrality of the patient as decision maker may not be relevant to culturally diverse groups of end stage people. The purpose of this article is to present results of a literature review of end stage patient control and their family position within the context of end of life support. The review revealed that the interaction between medical control and ethical values in end of life support is multifaceted and unpredictable. According to the recommendations of American College of Physicians/American Society of Internal Medicine End-of-Life Consensus Panel and some other world class medical and ethical societies, culturally effective end of life support includes the following essential elements • acceptance of and respect for cultural differences among all end stage patients • willingness to negotiate and compromise when world views differ • understanding of one's own values and biases • contact and communication skills that enhance empathy • information of the cultural practices of patient groups should be seen on a regular basis and • attention that all patients are individuals and may not share the same views as others within their own ethnic group According to the above description, applicants identified five domains of quality end of life support: 1. receiving adequate pain control 2. avoiding inappropriate prolongation of the dying process 3. achieving a sense of control 4. relieving burden on loved ones and 5. strengthening relationships We emphasize that, despite above mentioned points and advices maintaining a sense of control is an essential element in the end of life support for some individuals, further study of the interplay between ethnicity, desire for control, and achieving a good death is needed.

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Trust is a key element in the physician-patient relationship. Imam Jafar Sadiq (A.S.) stated that the proficient and trusted physician is in equal level of a just jurisprudent. Ancient ethical texts put much emphasis on physicians to be trusted. Nowadays, trust is a component of social health we believe that in the physician-patient relationship, trust has a significant impact on the practice, and increases the effectiveness of treatment and the satisfaction of patient and physician? also patient autonomy is preserved, health is positively reinforced, and patients will be more serious and less negligent with expenses, treatment, and follow up. This paper is a review/analytical article, and aims at classifying trust and examining its role in communication between physician and patient. If limited to practice, trust in the physician - patient relationship is divided into two types:

1- Unconditional trust, which means full confidence with no autonomy

2- Conditional trust, which entails maintaining autonomy.

 In the first type, where patient's autonomy is foregone, both patient and physician can be blamed. The patient is to blame due to an absence of self confidence and lack of participation in decision making and treatment, and the physician might in his place have the tendency to patronize. In this article we emphasize the importance of trust and warn against paternalism and conclude that if doctors truly comprehend the meaning of trust, they will try to avoid paternalism.

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Medicine is a branch of health science with the purpose of maintaining health and health promotion, diagnosis, treatment and prevention of diseases, and rehabilitation of patients. In addition to possessing academic qualifications and legal training, physicians and service providers should be familiar with moral and jurisprudential considerations in their profession, as is rationally and logically expected.Respect for moral values ​​and legal principles is important since on the one hand it gives the service provider a feeling of fulfillment, and on the other hand it causes the patient to feel satisfied with the service offered.Islamic laws must be observed in all aspects of life in our country and medical practices are not an exception. Therefore it is necessary for all practices to be approved by jurists and to comply with the principles of Islamic jurisprudence and ethics. Consequently, practitioners need a thorough understanding of Islamic laws and ethics in order to be considered qualified. In this regard it should be remembered that Islamic jurisprudence, or Sharia refers to a set of laws and rules of life defined by the Quran and its interpretation and explanation by the great Prophet of Islam (SAW) and Imams (AS). In Islamic culture, law and medicine are closely related to each other. Many physicians are staunch followers of the Islamic jurisprudence and try to observe them in their diagnostic and therapeutic approaches, and in cases where they have dilemmas and are not certain what course of action to take, religious standpoint is what guides them to make the right decision. In recent decades, physicians have tried to apply Islamic laws in the context of medical or jurisprudential problems. This article investigates the realm of medical jurisprudence and medical ethics.

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One of the most important issues in nursing ethics is moral distress, which is a severe psychological problem among nurses. The purpose of this study was to determine the nurses’ moral distress in the hospitals of the northwest of Iran.This was a cross-sectional study in which 418 nurses were selected by randomized multistep sampling method in the northwest of Iran in 2012. Data collection was done using the moral distress standard scale with high reliability and validity. In order to analyze data, descriptive (mean, standard deviation, frequency and percent) and inferential statistics (independent t-test and one way ANOVA) were used.The mean score of nurses’ moral distress was 148.49 ± 32.93, and 222 nurses (53%) suffered from severe moral distress. Of the three provinces under study, Zanjan (152.46 ± 35.88) and intensive care units (152.72 ± 33.36) had the highest moral distress scores. Among the respondents’ demographic characteristics, province (P < 0.01), education (P < 0.05), type of shift (P < 0.05) and job status (P < 0.05) were significantly related to the level of moral distress experienced by the nurses.Due to the high level of moral distress in the nursing profession, dealing with it requires a lot of attention. Studies on casual and predictive factors in different wards and teaching coping strategies to nurses appear to be necessary in order to address this issue.

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Genes are considered as “green gold” in this era of biotechnology. Currently, multinational companies and governments search continents to find this valuable asset in the hope to discover people with unique genetic characteristics that can be converted into capital and marketed in the future. Modern economy provides the framework to analyze any new technology from the advantage perspective and has vastly transformed the concept of capital and market thus, humans or any organism with specific genetic characteristics can be converted to capital and offered in profitable markets. Patenting and ownership of genetic resources without consideration for principles of inherent human rights will impact the society and result in a violation of these rights, especially those of vulnerable individuals and groups. In spite of the numerous benefits of biotechnology for individuals and the society, the risks to human dignity, equality, health, autonomy and research, as well as the possibility of information abuse should not be ignored, especially considering the alliance between technology and economy. Biotechnology can make claims to ownership of human life and desired genetic traits, and this is a problem caused by the biotechnology revolution in developing countries and consequently, indigenous peoples of these countries have shown different reactions to such issues. This article will discuss “human commodification”, which is a serious concern in the field of biotechnology in our world today

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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.

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