Iranian Journal of Medical Ethics and History of Medicine

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Breaking bad news to the patients does not back to a long history and is a controversial issue between patients and physicians. Many physicians are reluctant to breaking bad news to patients and this is not desirable for most patients. For example, in Northern European countries and United States, most physicians usually break bad news to the patients, while in Southern and Eastern European countries or many Asian countries they would not do so. In Iran, physicians prefer to break bad news to patient's family rather than the patient. Cultural differences also influence people's viewpoints about breaking bad news. In Western countries, most people agree with breaking bad news to patients while it is not common in the other populations. Nowadays, the dominant view in the most countries is that it is the duty of the physicians to break bad news to patients. Some advantages of breaking bad news to patients including strengthening the trust between physician and patient, preventing non - maleficience, increasing patients satisfaction and reducing legal action against the doctors. There are some exceptions to breaking bad news the most important is serious psychological damage to the patient. Quality and quantity of information that should be released depends on situation of each patient. Breaking bad news needs specific communication skills and physicians must be trained for this purpose.

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Although we have diverse methods in laboratory studies, such as cellular and molecular sciences, understanding many issues related to human health requires research on animals. An ethical duty of every researcher is to respect animal rights. In our country, educational and research activities are carried out frequently on animals. Therefore, guidelines for ethical use of animals in Iran were developed in 2004 after a review of international resources and considering the needs of researchers working with animals. This guideline was written in four sections, including animal transportation, facilities, animal care personnel, and research users. However, some studies show that researchers need comprehensive and easy to use instructions on the ethical use of laboratory animals. On the other hand, inadequate knowledge about ethics principles in research on laboratory animals have revealed the need to update guideline to be more practical, applicable, and in line with researchers' requirements. In this study, the above mentioned guideline was revised and completed in five parts, including transportation, facilities, animal care personnel, research users, and the use of animals in experimental procedures. In the first section, points on transport of animals and facilities, including location, cage, ventilation, humidity, light, temperature, noise, water and food are presented. The new revision, contains additional paragraphs, and some previous paragraphs are split. Another part of the findings is presented in terms of fundamental duties and ethical performance of persons who work in laboratory animals' houses and researchers working with animals. The final section of the findings is related to the use of animals in laboratory processes which are not presented in the previous formulation of the guideline, and includes basic ethical issues in regard to categorizing, anesthesia, surgery, and euthanasia. Therefore, the guideline was revised to be much more practical, more applicable, and should lead to some form of researchers' training in this field.

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In many countries around the world, we find important evidence about violation of ethics in medical research. In the United States, the history of unethical or even inhuman experiments on human subjects dates back to the time of slavery, and unfortunately, most subjects of these experiments were poor or black people, slaves, prisoners and physical/mentally ill patients. For instance, we refer to the Tuskegee study that was done on black people. Other examples are tormenting experiments on American or Nazi prisoners. In this paper, we will review some infamous unethical experiments and researches in terms of neglecting human dignity and the validity of the research. On the other hand, in response to these dreadful events, some ethical codes and guidelines have been established which we shall review. For instance, the Belmont Report and the Nuremberg Code which were developed in response to the Tuskegee study and Nazi experiments on human subjects, respectively. The medical history of our country, Iran, is free of such troubling acts however, this does not mean that ethical standards in medical research are fully observed. Therefore, in addition to items that have been enacted so far, to prevent such faults, it is necessary to enact professional codes and guidelines or legislated laws and regulations too.

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Research ethics, as one of the main issues of modern bioethics, has attracted the interest of scientists and ethicists in various areas of science and technology around the world. Research Ethics Committees (RECs) have been established to improve putting ethics into practice in the field of research. RECs, fortunately, have received a great deal of attention in different countries, and their mission, goals, and tasks have been described in many national and international guidelines. Ethical guidelines for biomedical research and RECs administrative regulations have been developed in Iran too. The need for special training courses for capacitating members has been emphasized in both international guides and our national administrative regulations for RECs. In this brief article, we present suggestions concerning course presentation and contents, which are provided by international assemblies. In view of the fact that many RECs in our country do not have specific plans for their members' primary training and continuing education, there seems to be a need for fundamental changes in the educational prerequisites for membership in this important organization.

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Quality of nursing care services directly influences individuals' health status. Compiling codes of ethics according to the religion and culture of each population could be an appropriate approach in improving quality of health care services especially nursing care. Hence, the most important priority in our national health system is developing ethical guidelines.
For this purpose a task force has been established in collaboration with nurses, physicians, lawyers and clergymen who were expert in the field of medical ethics. The code of ethics for Iranian nurses was drafted in 2010. The draft that included 12 values and 71 regulations of professional ethics were finally approved in the second session of the Ethics Supreme Council of the Ministry of Health and Medical Education on 6 March, 2010.
The values consist of concepts such as maintaining human dignity, adherence to professional obligations, accountability and responsibility, patient privacy, promotion of scientific and practical competence and respect to individual's autonomy.
Also, 71 regulations of professional ethics divided to five sections including "Nurse and Community" consisting of 9 items, "Nurse and Professional Commitments" with 14 items, "Nurse and Clinical Services" with 23 items, "The Nurse and Other Healthcare Providers in Medical Team" with 15 items, and also "Nurse, Education and Research" including 10 items.

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Conflict of interest is a real situation in which a person as a decision maker simultaneously has two positions, one in private and the other in the public. In public role he or she has to pay attention to the society`s best interests and follows his or her best ones as private role. Conflict of interest is a common challenge of health system among both real and legal persons in all courses such as education, treatment, and researches.
The most causes of conflict of interest are named as deferent goals, lack of resources, authorities malfunction, health marketing and etc.
We aimed at discussing conflict of interest and its relation to law, its management, conflict of interest in pharmacy and pharmaceutical companies and also Iranian legal system viewpoint. In conclusion it seems that conflict of interest should be included in the law and the provisions to achieve the least conflict of interests in health system should be revised.

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By the late 1960s, there seems to be a growing number of articles in medical journals on the subject of the distress that many terminally ill patients declared they had gone through due to repeated resuscitations that only prolonged their suffering. This demonstrates that standard protocols of resuscitating any patient who is undergoing a cardiopulmonary arrest may bring about new problems. A review of studies shows that dealing with patients who are in the last days or hours of their life has been a major challenge for healthcare professionals, and making decisions on therapeutic approach is one of the most fundamental skills for healthcare staff. The scientific, ethical, religious and legal dilemmas in this field make decision-making difficult in some cases. In this paper, we reviewed articles published during the past 30 years, through which the views of health care providers including physicians and nurses on the issue of do not resuscitate (DNR) orders in different societies had been studied. The Islamic perspectives have also been discussed in brief. Moreover, DNR guidelines prepared by various countries such as America, Britain and Saudi Arabia have been assessed. For searching the related studies, we used authentic electronic databases and many reliable websites. Some articles were obtained through hand searching of the references of searched articles.The results showed that despite substantial studies, caring teams are still facing the challenge of DNR in different societies. In Iran, considering the religious values and beliefs, the matter needs more deliberation to help the caring teams to deal with the clinical issues. The religious and cultural background call for a national guideline to be adopted based on Iranian-Islamic culture. Education and awareness rising of different groups including patients, general public, healthcare staff, and health policy makers is crucial in all countries all over the world, and particularly in Iran.