Iranian Journal of Medical Ethics and History of Medicine

---

Medicine is known as a combination of science and art. Besides knowledge, a good physician should be equipped with the art of establishing communication with patients. The keystone of any efficient relationship like a therapeutic one is trust, and its deterioration makes the relationship deficient and based on mere need. Therefore, establishing an efficient relationship brings about positive results in treatment. In the last two decades, the trend in the physician-patient relationship has greatly changed, so that patient-centered care is now in focus. In this kind of relationship, physicians recognize patients as respectable human beings with their unique beliefs, attitudes, and concerns, etc. In this paper we intend to provide a brief introduction to the concept of physician-patient relationship and its chronological changes. Also, common models of physician-patient relationships (e.g. paternalistic, etc) are introduced, compared, and their most obvious strengths and weak points are analyzed. At the end, a succinct analysis on the dominant model(s) of physician-patient relationship in Iran&aposs medical settings has been provided, and the necessity of compiling a model based on Islamic values is proposed.

---

Birth of a poor prognosis neonate (premature and/or congenitally affected) may potentially burden the family and/or society with many ethical, social, legal, etc challenges. Most of the decision making criteria used in handling the care of these neonates, such as disability, quality of life, etc., are multidimensional and heavily ethical bearing. In this study, we have tried to explore and present a perfect view on the existing challenges and different dimensions of the discussed criteria. In the end, the prominent standpoint of the Islamic school in confronting a severely disabled newborn has been introduced and analyzed. Most related discussions boil down to some fundamental and unanswered questions, for instance whether human beings should be permitted to make decisions about the life of severely diseased neonates, the decision making criteria themselves and their appropriateness, etc. Even though many scientists have theorized on the subject, a multilateral explanation of life and death criterion has not been presented yet. One thing is for certain and that is, in answering the basic questions of the subject, our present knowledge and experience is limited and insufficient. The authors have tried to show that despite many western views, decision making about the life of a neonate has no place in Islamic teachings, since it could be considered an unauthorized human action. Instead, it is proposed that any attempt to provide an ethical rationale, while utilizing today's science and technology, be in compliance with God's commandments.

---

In this article, we aim to discuss one of the essential concepts of medicine. As a rule, such studies attempt to clarify the philosophical principals of medicine, whereby the act of medic can be regulated based on his clear perceptions of the principles of his knowledge. In this article, we will evaluate the concept of causation in medicine from a philosophical point of view and through historical review, and we aim to clarify the significance of such concepts in clinical decisions. Medicine is an academic discipline dedicated to learning about illnesses and their causes, curing ailments and promoting social as well as individual health. There are four general paradigms in the world of medicine, and accordingly four definitions of causation. Along the line of these thaughts are the views of modern philosophers such as rationalists, empiricists and post-modern philosophers. In this article we will look at these four medical paradigms and consequently the four definitions of causation. Hippocratic paradigm, with reprsentatives such as Hippocrates, Ibn Sina and Galen, was the first paradigm in medicine to presuppose a rationalistic and realisitc view about causation.Biomedical paradigm aquires an attitude similar to logical positivism, seeing causation as a real concept that is true and is provable not through intelect, but by experience. Within this paradigm, a critical clinical approach is specially noticable according to which causation is not a real and necessary concept, but a mental, unprovable concept that is abtained through symmetry-based association, repetition and statistics. Finally, in the post-modern hermenutical paradigm, discussions of scientific causation and biological and mechanistic topics are replaced by ethical discussions about humans thus the causation is marginalized and loses its relevance.

---

Abortion is a challenging issue. It is proposed as a problem in medical philosophy and medical ethics texts. In dealing with abortion, graduate medical students may be influenced by different situations, or make a decision according to their conscience. Therefore they should acquire a satisfactory level of ethical development to deal with these issues during their years of education.Some things that are important for education on abortion are law, religious and moral reasoning, understanding the moral reasoning of people who request an elective abortion and related ethical philosophies. If health providers want to make the right decision and manage the patient suitably, they should be aware of the moral reasoning of the abortion applicant, religious moral reasoning, legal issues, and the ethical philosophies related to elective abortion, so they can do the best thing when dealing with abortion applicants. Sometimes the abortion applicant or the health provider thinks that abortion is an ethical action, but according to religion and the philosophy of ethics it is not. Therefore supporting health may be warranted by educating medical students on ethics as well as religious rules and legal issues.

---

Confidentiality is an inevitable pillar of the history of the physician-patient relationship. Misunderstanding of this principle not only causes harm to sanctity of the medical profession, but also can damage the quality of the therapeutic relationship, and more broadly public health. The keystone of this negative effect is the potential harm to the patients’ trust and confidence. Generally, the Western school tends to agree that respecting patient confidentiality is essentially desirable. Islam also respects and emphasizes confidentiality, and has general and some specific recommendations about the importance of secrecy and concealment of people’s secrets. Overall, despite strong agreement about the importance of the principle, some ethical theories do not insist on maintaining confidentiality under any circumstance. This paper is an attempt to describe the importance of confidentiality in the medical profession considering the approach of both absolutists and relativists in practice.Absolutists believe that the intrinsic desirability of implementing the principle of confidentiality in all cases is the same and without any exception, but the issue is about not giving just priority to other conflicting moral values.Additionally, the absolutists believe that breaching this principle in practice cannot be permissible due to some serious long-term and mostly hidden complications such as patients’ failure or delay to seek medical assistance or advice and/or withholding important information and so forth. Overall, according to empirical evidence and rational considerations, adherence to absolute confidentiality seems more desirable to absolutists. Unlike absolutists, in relativists’ concept of confidentiality, insisting on maintaining the secret will not be allowed in certain cases, and those cases are considered exceptions of the rule of confidentiality.The most important reasons for falling into the wrong orientation of relative confidentiality seem to be precipitance to attain the desired result, poor communication skills, ignorance of the consequences, and being headstrong.

---

---

The present study is an overview of the causes of patient complaints against physicians and the medical staff in Imam Khomeini Hospital Complex, and strategies to reduce the complaints. For this purpose, complaints that had been filed with the clinical governance office of Imam Khomeini Hospital Complex in 2012 and 2013 were investigated. The information in the forms included age and sex of the plaintiffs, their level of education, type of complaint and similar details. Of the 309 complaints, 174 had been recorded in 2012 and 135 in 2013. The plaintiffs were males with a mean age of 50.5, and 69.6% of them had high school diplomas or lower. Most (16.2%) of the complaints pertained to the emergency department, while 48.5% and 22.7% of the complaints were related to doctors and nurses respectively. In 62.5% of the cases, the accused had been acquitted and 34% had been convicted. The main cause of complaint involved treatment and care at 40.1% and 36.6% respectively. In general, the most common causes of complaints were treatment and care for doctors, and lack of respect for nurses and others. Thus, more attention should be paid to the continuous education of medical students and residents during training years in order to increase the knowledge and skills of physicians. Other measures that can reduce complaints are: providing sufficient information to patients before diagnostic or therapeutic procedures improving the equipment in health centers educating the society and raising public awareness of the treatment process offering the necessary information during medical procedures obtaining informed consent careful choice of the medical team and assigning them to the right position and holding communication skills workshops.

---

Medical laboratory is one of the health service providers that intensely responsible for the life of patient / client. With an increase in the number and variety of laboratory tests in recent years, the role of laboratory science in identifying and assessing the cause of disease has been more recognized. Performing the laboratory tests with the utmost accuracy, precision and speed using up to date methods as well as protecting the rights, integrity and respecting human dignity and also the establishment of priorities and the requisites for quality management systems can have a significant impact on patient satisfaction and quality which are the characteristics of a good medical laboratory. The principle concept of doing good and not doing bad is the essence of every code of medical ethics. Therefore, in laboratory medicine like other areas of medical sciences, there are ethical questions that have become more complex with the development of diagnostic tests. Medical laboratory practitioners usually deal with issues of confidentiality of patient information, as well as issues related to research ethics, professional ethics and business ethics.This study has collected important and common topics of medical ethics in laboratory medicine which leads to increase readers’ and practitioners’ information in this field. It is hoped that such information could be effective and practical to improve the laboratorial services for patients.

---

In recent years, there has been a significant increase in the rate of cesarean section in Iran. Physicians can have an active role in controlling this rate as they are truthfully consulted and followed by the general public. The Iranian Ministry of Health and Medical Education has also adopted new policies to control the national cesarean rate. The present study aims to determine the knowledge and attitude of medical residents towards elective cesarean section versus normal vaginal delivery (NVD) in 2015.

In this cross-sectional study, residents of four major fields of specialty (obstetrics and gynecology, pediatrics, general surgery and internal medicine) were interviewed using a researcher-made questionnaire. The face and content validity and reliability of the instrument were determined, and data analysis was performed using SPSS version 21.

The Cronbach’s alpha coefficient was 0.77. A total of 108 residents with the mean age of 32.89 participated in the study. Of this number, 53 reported at least one personal experience of childbirth (their own or that of their wives) with a satisfaction rate of 9.5 and 6.3 out of 10 for NVD and cesarean respectively. The mean score of the domains of "knowledge", "attitude" and "function" were 3.5, 3.6 and 3.3 (out of 5) respectively. There was a meaningful correlation between the variable of "sex" and the domain of "knowledge", "specialty" and all three domains, and "methods of delivery" and the two domains of "attitude" and "function". 34.3% of the residents chose "mandatory public education of pregnant women" as the first step to decrease the cesarean rate.

It can be concluded that educating pregnant women should be the main strategy for decreasing the cesarean rate in Iran. Considering the significance of medical specialists’ "knowledge", "attitude" and "function” with regard to the method of delivery chosen by pregnant women, it is recommended to develop specialty educational programs in line with the policies of the Iranian Ministry of Health to decrease the cesarean rate

---

Ethics is elemental in all lines of work, but more so in the nursing profession, since the ethical and responsible conduct of nurses can have an important role in promoting patient recovery. As members of a large group in the field of medical science, nurses need to be equipped with sound professional ethics in their interactions with others.

The present study was a descriptive survey of the relationship between professional ethics and the efficiency of nurses. Study population consisted of the nurses employed in Imam Hospital and Mostafa Khomeini Hospital in Ilam. Sample size was determined at 134 using the Cochran formula, and 126 completed the professional ethics and efficiency questionnaire. The validity of the questionnaire was confirmed by experts, and its reliability was established by Cronbach's alpha test. Subsequently, the main hypothesis and the eight sub-hypotheses were examined.

The subjects consisted of 89 males and 37 females, of which 50 percent were aged between 20 and 35, 42% between 36 and 50, and 6% between 51 and 60 years. In terms of education level, 7 subjects had high school diplomas, 18 associate degrees, 42 were undergraduate and 59 graduate students and higher. The findings showed a significant correlation (0.002) between professional ethics and the efficiency of nurses. Results of the Pearson’s correlation test confirmed the relationship between accountability, honesty, fairness, loyalty, respect for others, and the efficiency of the nurses employed in Imam ​​and Mostafa Khomeini Hospitals, Ilam. No significant correlation was found, however, between the components of superiority and sympathy in nurses and their efficiency.

Considering the relationship between professional ethics and the efficiency of the nurses in these two hospitals, it is recommended to improve their performance through continuous training and promotion of nursing ethics.

---

---

---

---

---

Regarding how to make decisions on the revelation of medical errors done by colleagues, investigation of physicians' points of view particularly those in educational settings could help the improvement of circumstances to which we encounter medical errors and thus respecting patient's rights. This cross-sectional descriptive study was conducted through a researcher-made questionnaire after performing face and content validaty and determination of internal and external reliability. The viewpoint of 40 attending physicians and 112 medical residents from different specialties about their inclination to disclose errors, the results of disclosure, the factors influencing on nondisclosure, and the factors decreasing medical errors were asked. Data were analyzed using SPSS v.21. Mean scores of 15.2±1.3 for attending and 12.56±2.05 for residents regarding the dimension of "inclination to disclose others' medical error"; and mean scores of 7.55±0.677 for attending and 9.09±2.01 for residents in terms of "inclination to NOT disclose" were differed significantly (p<0.001). Participants declared the head of medical department/ward as the best authority for managing and dealing with medical errors as the best approach for disclosure of the errors through attendance of the senior physician accompanied by the physician who has made the error. Urban general physicians, nurses, and first-year residents were reported with the most frequency of the errors. The data can be used for the promotion of the patient's rights and the perspective of the medical team when encountering errors done by a colleague, rightfully, and protectively. Building cultural, legal, and social contexts will be the mission of the educational-medical settings aimed at making possible a scientific and skillful error disclosure.

---

This article has no abstract.

---