Iranian Journal of Medical Ethics and History of Medicine

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Abortion of the disabled fetus is among the challenges of medical ethics, and decision-making in this respect is subject to a major controversy between Islam and Western philosophies. One reason is skepticism about the continued existence and evolution of the human soul after death, which has resulted in legitimacy of abortion of disabled fetuses in the West. Islam and Islamic philosophers, however, attribute great importance to the soul and its evolution, and therefore in decisions related to such embryos all aspects of the body and soul are considered, with more emphasis on the latter. Some issues that are raised in the Islamic worldview include: What is the reason behind embryonic defects? And does a disabled fetus also suffer from a defect in the soul?The present paper is a descriptive-analytical non-systematic review that uses a data collection approach. Regardless of the issue of ensoulment, the study intends to examine the evolution of the spirit (nafs) in the fetus during various stages of life (vegetative, animal and human) based on Mulla Sadra and Imam Khomeini's perspectives. It also aims to conduct a philosophical investigation into defects in creation and to find the answer to the important question of whether the soul of a disabled fetus is also imperfect. Findings of this study show that based on Mulla Sadra’s views, all living things have been created in the best and most perfect form. The disabled fetus is not an exception and therefore has a perfect soul, but the appearance of the soul in a malformed body is defective. The imperfection may have two causes: first, a wrong choice made by the soul of the disabled fetus in the world before this one, i.e. the Zar world, although the concept is among the unfolded mysteries of creation unfathomable by human knowledge second, effect of the genes and/or the environment, regardless of the choice made by the soul of the disabled fetus in the world of Zar.However, since decision making regarding abortion of disabled fetuses is still a matter of controversy in medical ethics, further studies from the perspective of Islamic philosophy seem necessary to help resolve the issue and provide ethical guidelines based on Islamic principles.

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It is universally acknowledged that death is a complex concept and different factors such as complicated philosophical ideas, contradictory descriptive approaches, and diversity in interpretations add to this complexity. Although a thorough understanding of the notion of death is important for everyone, this concept is of crucial importance to health care providers as they face enormous ethical challenges in the course of their careers. A few instances are controversial issues such as brain death, euthanasia and end-of-life care, where it seems essential to define a set of robust criteria for death. On the other hand, it can be argued that death is not a scientific concept and only different branches of medicine can provide a framework to clarify the subject of death. Therefore, it could be argued that theological approaches may shed some light on this concept. In this article, we aim to extract ontologic components of death mentioned in the Holy Quran, and will move on to propose a set of 12 criteria for death. This may help provide a clear understanding of the concept from the point of view of the Holy Quran, although more research is warranted to further illuminate this complex subject.

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Abortion has remained a subject of intense controversy in medical ethics, particularly in the case of malformed fetuses. Review of the existing literature on the issue indicates that there are two main challenges in this regard: firstly, the question as to whether a malformed fetus has the right to live, and secondly, the fate of the soul (vegetative and animal) after induced abortion.This descriptive research presents different viewpoints in order to investigate the aforementioned questions in Mulla Sadra’s philosophy with a focus on the “right to live”. The results of the study demonstrate that according to Mulla Sadra’s theory, all fetuses possess potential human souls even if they are extremely malformed or disfigured. He considers the fetus a vegetable with the potential to convert into a human. Based on this ideology, which encompasses both creation and resurrection, the malformed fetus has the right to live. The assumption is founded upon Mulla Sadra’s Theory of Substantial Motion, which implies that abortion may influence the evolution of the soul in the limbo period (intermediate state) after abortion and might even affect its resurrection. It can be concluded that in the Iranian society, which has an Islamic background, theological views should be considered in decisions about abortion. It should be mentioned, however, that philosophical approaches alone cannot be relied on for decision-making regarding the abortion of a malformed fetus. Furthermore, interdisciplinary contributions are indispensable to a thorough analysis of this controversial issue so that the ethical challenges surrounding abortion in such cases can be overcome.

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The climate of clinical settings is one of the effective factors on the quality of clinical education and students' attitude toward their field of study. This research aims to determine the relationship between the ethical climate of operating rooms and the students’ attitude toward their field of study in hospitals of Tabriz University of Medical Sciences.All medical students in the operating rooms of Tabriz University of Medical Sciences in their second semester during the academic year 2013 - 2014 were entered into this analytic study. In addition to the demographic questionnaire, Olson’s Hospital Ethical Climate Survey and a student attitude questionnaire were used to collect the information. Data were analyzed by the SPSS 18 software using descriptive and analytical statistics methods including chi-square test and Spearman's ordinal correlation coefficient.Most of the students were female (61.4%) and single (86.8%) and the mean of their age was 20.87 ± 1.54. Additionally, 64.9% of the students had a negative perception of the ethical climate in operating rooms, while 51.8% had a positive attitude toward their field of study. Moreover, a significant relationship was found between the ethical climate and attitude of operating room students toward their field of study (P ≤ 0.001, r = 0.56). Despite the negative ethical climate of operating rooms, most of the students had a positive attitude toward their field of study. In view of the direct relationship between these two variables, improvements in the ethical climate of operating rooms and students’ attitude toward their field of study can positively affect their future career.

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Despite all recent advancements in medical sciences and the related technologies, the concept of death still remains obscure. It can be asserted that as death includes both physical and spiritual dimensions, medicine alone is not capable of fully illuminating its different features. Therefore, inter-disciplinary collaboration between different branches of science such as Quranic studies, humanities, and philosophy seems necessary in order to shed some light on this hitherto undiscovered subject. Through description of what the soul experiences before and during death, such collaborations may even enrich the knowledge and broaden the minds of physicians who are capable of the analysis of physical changes caused by death. This insight can promote the ethical decision-making process as well as the provision of end-of-life care and spiritual support in different stages of death. The current research, as a library literature review, endeavors to provide a descriptive view of death from a medical perspective, and then, a Quranic depiction of its different stages through an analysis of verses and quotations from the holy Quran and Islamic scriptures whose primary focus is the process of dying. The final discussion section presents some similarities and differences observed between viewpoints and raises questions which can be considered as being of great practical importance in terms of provision of necessary end-of-life spiritual support. We hope that further research in this field can better clarify the issues raised in this article so that practical measures aiming at the provision of Quran-based spiritual end-of-life care are designed and implemented.