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Showing 5 results for Khaleghparast
Perspectives of doctors, nurses and patients on physicians’ observance of professional ethics
Ali Vasheghani Farahani, Majid Maleki, Reza Golpira, Hooman Bakhshandeh, Mojtaba Parsa, Mahnaz Mayel Afshar, Sima Kashanian Fard, Shiva Khaleghparast, Mohsen Rezaei, Seyed Ahmad Rezaei,
Volume 8, Issue 1 (5-2015)
Abstract

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.


Exploring Advance Directives and End-of-Life Preferences in Heart Failure Patients: A Systematic Review and Meta-Analysis
Aydin Feyzi, Amirali Soheili, Samira Chaibakhsh, Fidan Shabani, Shiva Khaleghparast,
Volume 17, Issue 0 (Supplement of 11th Annual Iranian Congress of Medical Ethics 2024)
Abstract
Advance directives (ADs) are legal instruments that enable individuals to express their healthcare preferences in anticipation of a future loss of decision-making capacity. These directives are particularly important in the context of chronic conditions such as heart failure (HF), a disease marked by progressive functional decline and unpredictable medical crises. ADs help safeguard patient autonomy by ensuring that care aligns with personal values and preferences, especially at the end of life. This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines to examine the preferences of patients with heart failure regarding life-sustaining treatments and end-of-life decision-making. A comprehensive literature search was performed across PubMed, Scopus, and Web of Science databases, covering publications up to March 2024. Search terms included "advance directive," "advance care planning," "heart failure," and "end-of-life decision-making." Studies were included if they were original, peer-reviewed, full-text articles focusing on HF patients aged 18 and older. Non-peer-reviewed works and inaccessible full texts were excluded. A total of 25 eligible studies were identified and appraised using the NIH quality assessment tool. Extracted data included demographic characteristics, preferences for treatment, surrogate decision-making, and educational interventions. Findings from the reviewed literature reveal consistently low levels of awareness and completion of ADs among HF patients. Completion rates varied significantly across studies, reflecting potential cultural and systemic influences. Preferences for surrogate decision-makers overwhelmingly favored family members over healthcare professionals. A notable finding from Jawahri et al. (2016) indicated that patients who received video-based education were significantly less inclined to choose cardiopulmonary resuscitation (CPR) or mechanical ventilation compared to those receiving only verbal information. Additional qualitative insights, such as those from Formiga et al. (2004), showed that patients prioritized maintaining dignity, independence, and meaningful relationships over merely extending life. These patterns highlight the necessity of aligning care with patients’ broader goals and values. Across the 25 studies included, a total of 4,091 heart failure patients were analyzed, with a mean age of 68.22 years. Meta-analytic findings demonstrated diverse preferences regarding life-sustaining interventions: approximately 53.73% of patients favored such treatments, while 45.37% declined CPR. These statistics underscore a substantial variability in end-of-life preferences, further reinforcing the need for individualized care planning. In conclusion, patients with heart failure display heterogeneous preferences concerning end-of-life care, shaped by cultural context, personal values, and the type of information provided. Despite the established importance of ADs, significant deficits in awareness, understanding, and documentation persist. These findings point to a critical need for tailored educational interventions, improved provider-patient communication, and culturally sensitive approaches to advance care planning. Future research should focus on designing and integrating standardized AD facilitation tools into routine clinical practice to support truly patient-centered care.

Conflict of Interest in Research
Shiva Khaleghparast, Samaneh Karimian,
Volume 17, Issue 0 (Supplement of 11th Annual Iranian Congress of Medical Ethics 2024)
Abstract
Conflict of interest refers to situations in which professional judgment or actions related to a primary interest are unduly influenced by secondary interests. In scientific communication, such conflicts can compromise professional decision-making and threaten the integrity of research outcomes. As educational, research, and clinical activities in the medical field expand, the prevalence of conflicts of interest across healthcare domains has increased. Despite the efforts of organizations such as the International Committee of Medical Journal Editors and the Committee on Publication Ethics, which have established guidelines for conflict of interest disclosure, there remains a significant gap in awareness and understanding among researchers. This highlights the urgent need for increased attention to this issue. The UK National Research Ethics Advisory Panel defines conflict of interest as situations where professional judgment concerning a primary interest, such as patient welfare or the credibility of research, is improperly influenced by a secondary interest, such as financial gain. In clinical research, therapeutic studies primarily aim to validate the safety and efficacy of new drugs or devices. This goal should take precedence over secondary concerns, such as economic benefits derived from pharmaceutical production. Good Clinical Practice (GCP) guidelines and the International Conference on Harmonization (ICH) stress that researchers have primary responsibility for the health and medical care of participants. Therefore, any conflict of interest represents a significant risk to participants, potentially compromising their welfare. To safeguard scientific integrity, institutions must enforce policies that uphold ethical principles, require researchers to disclose conflicts of interest to ethics committees, and implement measures to mitigate associated risks. Identifying and managing conflicts of interest based on their potential impact is crucial to preserving the credibility of clinical research. Members of ethics committees, like researchers, must disclose their conflicts of interest, as they significantly influence study processes. Transparency in research funding is essential to minimizing bias and managing conflicts of interest. Effective strategies for addressing conflicts of interest include the development of comprehensive policies and guidelines, the maintenance of an electronic database for conflict disclosure, and the promotion of regular training for ethics committee members and researchers on managing such conflicts. Collaborative learning initiatives and the ongoing refinement of institutional policies further enhance the management of conflicts of interest, ensuring the integrity of scientific research.

A Critical Review of the Ethical Aspects of the Electronic Health Record System (SPAS in Iran)
Shiva Khaleghparast, Saied Bagheri Faradanbeh, Samaneh Karimian, Fahimeh Khosrobeigi Bozchaloei, Seyed Ebrahim Hoseini Zargaz, Ehsan Shamsi Gooshki,
Volume 17, Issue 1 (3-2024)
Abstract
The electronic health record system (SPAS in Iran) records information related to the health of individuals in an electronic format. It is the center for collecting health information and data on outpatients and inpatients. This system records information such as the patient's full name, marital status, gender, date of admission, level of education, occupation, type of admission, and other relevant medical data. The core values and ethical requirements of SPAS include safeguarding citizens' rights, respecting individuals, observing justice and fairness, transparency, encouraging participation, and accountability. In this study, the ethical aspects of SPAS were evaluated using the model proposed by the World Health Organization (WHO) for ethical evaluation. This model emphasizes fundamental ethical principles such as human well-being and health, respecting individuals and communities, justice, and fairness. Concerning human well-being and health, SPAS can prevent unnecessary and redundant interventions and provide physicians with quick access to an accurate patient history. Furthermore, the system ensures the confidentiality of information, which is essential to respect individuals and communities. Regarding justice and fairness, the system can improve access to health services for disadvantaged and remote areas. Moreover, SPAS adheres to procedural ethical principles such as solidarity, transparency, participation, and accountability. Therefore, by critically examining the ethical dimensions of the electronic health record system (SPAS), the findings of the present study provide valuable insights for policymakers, health professionals, and regulatory organizations to ensure the ethical and efficient performance of electronic health record systems in Iran.

Ethical Considerations in Decision-Making for an Elderly Alzheimer's Patient: A Case Report
Maryam Modabber, Mojtaba Parsa, Shiva Khaleghparast,
Volume 17, Issue 1 (3-2024)
Abstract
In the current era, the alarming increase in the number of patients with Alzheimer's disease has led to greater attention to issues related to care and alternative decision-making for this special group in society. The four ethical principles of "beneficence", "non-maleficence", "respect for autonomy", and "justice" serve as fundamental guidelines in medical decision-making. This study presents a case report of an elderly Alzheimer's patient and the ethical issues related to medical decision-making in the absence of a substitute decision-maker. Typically, for individuals lacking decision-making capacity, decisions are made by a substitute decision-maker and, in some countries, an advance care directive. In the absence of these, the medical team may make decisions in the best interest of the patient, considering the individual's cultural and social conditions, while taking into account the aforementioned ethical principles.

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