Iranian Journal of Medical Ethics and History of Medicine

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Nurses play an important role in end-of-life care for dying patients. Based on the essence of the work environment, nurses are confronted with dying patients and their requests for euthanasia more than other care givers. However, little is known about their attitudes towards euthanasia. Hence, aim of present study was to determine nurses' attitudes toward euthanasia. In this descriptive-analytical study, 91 nurses who employed in intensive care units situated in educational and medical hospitals affiliated to Guilan University of Medical Sciences participated. Nurses attitudes evaluated by using Euthanasia Attitude Scale. Data analyzed by descriptive and inferential statistics (T-test, ANOVA and generalized linear models) by SPSS software version 16. Majority of nurses (83.5%) had negative attitude toward euthanasia. Univariate analysis showed no significant statistical relationship between demographic factors and nurses' attitude toward euthanasia, whilst age (P < 0.029) and employment status (P < 0.004) were related to nurses' attitude toward euthanasia in regression analysis.     
Findings of the present study showed that majority of nurse's believe in care of dying patients for health maintenance and life continuance even in the end stage of life. They don't accept euthanasia at any condition. Perhaps, more accurate studies need to assess other confounding factors such as nurses' knowledge, practice and role.

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Documentation of accepted ethical behavior in special settings is one of the strategies employed to foster ethics in organizations. Such documents, known as codes of ethics, vary in different societies according to their cultural and ideological differences. Medical educators have dual professional roles (as physicians and teachers) that sometimes seem ethically incompatible. Therefore, having codes of ethics is essential in this profession. The aim of this study was to develop codes of ethics for clinical medicine educators with an Islamic-Iranian approach. This was a three stage developmental research. First, a comprehensive literature review was conducted. Using content analysis method, the first draft of a code of ethics for clinical medicine educators was prepared. Second, the draft was thoroughly and critically reviewed and revised in experts’ focus group discussion and the 2nd draft was devised. This was further reviewed by a group of 24 experts at the national level (validated) and revised according to their comments, and thus the 3rd draft was prepared to be presented for formal approval process. The final document includes 55 codes of ethics in 18 topics (conscientiousness, accountability, respectfulness, scientific excellence, respect for others’ freedom, equity, patience, religious commitment, modesty, trustworthiness, humility, contentment, relationship with coworkers, attentiveness toward patients, attentiveness toward learners, kindness, confidentiality, and discipline). It seems that extracting ethical concepts from the rich Islamic-Iranian cultural resources is feasible, and provides an appropriate basis for the development of ethical codes for medical educators. Compared to Western codes, such codes may be better accepted in Iranian contexts and will be implemented more readily if the organizational settings are prepared simultaneously.

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In order to achieve teamwork-based and integrated care, one of the issues in health care is the implementation of ethics and values in teamwork. The aim of this study is to develop the interprofessional collaborative ethics framework.This cross sectional study was conducted in two phases. In phase one, core competencies of the interprofessional collaborative ethics were determined by literature review. In phase two, Delphi rounds of experts were undertaken to validate the competencies and calculate content validity indexes through Content Validity Ratio (CVR) and Content Validity Index (CVI).The interviews and Delphi rounds identified 12 competencies categorized in three core themes including patient-centered values, interprofessional collaborative ethics, and team-based values. In phase two, based on the mean scores of importance, utility, and clarity, patient center value (4.9), interprofessional ethics competencies (4.6), and team-based values (4.5) were determined as essential themes.In conclusion, the validation of the inter-professional ethics framework was found to be acceptable in the Iranian context. Therefore, the framework for teaching and evaluating inter-professional ethical competencies is an applicable tool in the Iranian context.

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With the progress of science, organ transplantation emerged as one of the modern innovations of the medical science. Like other innovations, organ transplantation brings individuals in the society some disadvantages alongside numerous advantages. Legislators have therefore adopted rules and regulations for the mutual support of society members and their rights.In this article the researchers will examine the current regulations on organ transplantation in Iran. Legal sources in Iran, especially the constitution, Islamic criminal law, health and sanitary regulations, moral codes and so on will be referred to in this respect.In the constitution (as epigraph of all laws and regulations within the country), articles 14, 29, 43, 167 will be examined, and in Islamic criminal law articles 159, 372, 495, 497 and 724 will be discussed as the most significant existing articles on organ transplantation. In relation to the moral codes and medical and sanitary regulations we studied the following: Organ transplantation act of April 5, 2000 about the deceased or patients whose brain death has been confirmed the protocol on confirmation of brain death, established 2000 executive regulations for transplant from the deceased or patients whose brain death has been confirmed, adopted May 15, 2002 act of renal transplantation and donation from living donors passed on October 20, 2008 executive regulation 13101 approved on April 29, 2006 about living donors (with the exception of transplantation from a living donor to a foreign citizen) and the charter of patient’s rights ratified in 2009. Lastly, it should be mentioned that transplantation laws and regulations that presently exist in Iran appear to be inadequate for the purpose of resolving the current challenges and problems.

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Breaking bad news is one of the most difficult tasks an emergency physician has to perform and unfortunately it is not well studied. Almost all of the original studies for compilation of the guidelines of breaking bad news have been conducted in a non-emergent situation and were physician-oriented. In this study and by reviewing related articles in medical databases, the authors try to show the necessity of adapting these guidelines into the situation of the emergency departments and indigenizing them for non-Western countries. This can be the first step to design a guideline for the emergency department.The different nature of bad news and the chaotic situation in the emergency departments are the two most important points that may prevent using these guidelines in the emergency departments. On the other hand, breaking bad news guidelines are designed based on Western cultures and their application in a non-Western country may decrease their effectiveness.To the best of our knowledge, there is no national guideline for breaking bad news in Iran. There is a long way to go before we can suggest a national guideline for emergency departments, so we recommend using one of the Western guidelines and indigenizing it according to the Iranian culture and emergency situations.

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Empathy and communication between dentists and patients are among the major concerns of dental health educators. The present study aimed to evaluate the empathy levels of dentistry students with their patients in the city of Tehran during 2014.In this descriptive cross-sectional study, 410 dentistry students of various universities throughout Tehran were selected randomly. Data were collected using the questionnaire of demographic data and Interpersonal Reactivity Index to assess dispositional empathy. Data analysis was performed using SPSS 16 statistical software.The students had a mean empathy score of 53.06 (SD = ± 1.03), with the highest level pertaining to the imagination dimension (14.41 ± 4.65). Age, gender, and educational level had significant relationships with empathy (P < 0.01). Female students reported higher emotional empathy (P < 0.01), but no significant relationship was found between empathy and the university of attendance.Empathy scores of undergraduate dentistry students were lower than ideal and acceptable levels. Therefore it seems necessary to design proper educational programs to improve empathy among dentistry students.

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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.

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In the past decades, the need for organ donation has increased while consent rate continues to remain inadequate. One of the most important limiting factors in organ donation is families’ refusal to grant consent, and therefore it is important to determine the circumstances influencing the phenomenon. The aim of this study was to investigate the factors affecting consent to organ donation in families of brain death patients in hospitals affiliated with Shahrekord University of Medical Sciences. For this purpose, a self-made questionnaire was distributed among 54 family members of brain death patients admitted in hospitals affiliated with Shahrekord University of Medical Sciences between 2003 and 2013. The data were reported as mean, frequency and percentage using the SPSS16 software. The average age of the deceased was 31.38 ± 13.72 years, and car accidents were the most frequent cause of brain death (59.3%) in this study. In addition, 72.2% of the deceased were male and 90.7% of them lived in or around the city of Shahrekord. About 37% of the families consented to organ donation. The average age of the family members who participated in the study was 42.15 ± 8.9 years. The most frequent reasons affecting families’ consent to organ donation were religious rewards (100%), confidence in the medical team and staff (100%), and confidence in physician diagnosis (100%).The findings of the study show that religion, faith and family ties affect the willingness for organ donation, and therefore specific attention should be given to these factors in educational programs. In the present study, religious beliefs and confidence in the performance of health care workers were highlighted as the most effective factors in consent to organ donation in brain dead patients' families. Consequently, in order to increase organ donation rate, special attention to these factors and proper planning is necessary.

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Emphasis on the organizational commitment of employees is a soft management technique to enhance performance and efficiency. This study aimed to determine the relationship between organizational commitment in the employees of Tehran University of Medical Sciences (TUMS) and their tendency to display non-ethical behavior.

This study was a descriptive analytical and cross-sectional research conducted on the headquarters employees of Tehran University of Medical Sciences during 2013 and 2014. A sample size of 150 employees was determined using the Cochran formula. Research tools consisted of a researcher-made questionnaire measuring non-ethical behavior, and Allen & Meyer’s Organizational Commitment Scale. The validity and reliability of both questionnaires were confirmed. The response rate was 85%. Data were collected using the SPSS software, and Pearson’s statistical methods were applied.

The average organizational commitment of the employees in this study was 62.32, which is considered as moderate. It should be added that the majority of the employees did not demonstrate a tendency for non-ethical behavior.

Although the average organizational commitment was not high in TUMS employees, it was not correlated to their non-ethical behavior tendency. It seems that the organizational commitment of TUMS employees is influenced by other factors such as supervisor and organizational ethics, which can be the subject of future studies.

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Pharmacists serve as members of both the society and the health care team, which may involve them in activities that could be the subject of ethical query. They can face issues and problems in the workplace that may raise questions as to whether their acts are appropriate, right, just or legal.

This study aims to explore ethical issues from the perspective of pharmacists and to examine their reasoning processes regarding social phenomena such as ethical challenges. Moreover, it explores the ethical decision-making strategies that pharmacists employ when dealing with such problems in pharmacies and in their interactions with people.

This was a qualitative content analysis study. The participants were chosen using purposeful sampling from community pharmacists and the academic staff of the School of Pharmacy at Shiraz University of Medical Sciences. The data were obtained through semi-structured interviews with 20 individuals and analyzed using content analysis approach.

Analysis of the interviews led to extraction of the following six categories: pharmacists' understanding of key ethical concepts; pharmacists' experiences and duties; relationship with other health professionals; the pharmacy as a commercial setting; the difference between the practice of ethics in pharmacy, medicine and nursing from the perspective of pharmacists; and the actual response of pharmacists in confronting ethical problems.  Each of the above-mentioned categories were further divided into sub-classifications describing specific ethical challenges in pharmacy practice

Awareness of ethical issues and professional guidelines is a fundamental part of the education of health care professionals and provides a structure that will enable them to assess ethical problems and make appropriate, justifiable decisions. The findings of this study indicate the need for implementation of professional guidelines and codes of ethics in pharmacy practice to cover all ethical issues

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It is an undeniable fact that nurses have an important role in the provision of health services. The psychological well-being of nurses is associated with an improvement in their job performance. The aim of this research was to survey the relationship between spiritual and moral intelligence and the psychological well-being of nurses.

This was a descriptive-correlational study conducted on 128 nurses working in hospitals of Bojnourd during 2013. The subjects were selected through availability sampling and responded to King’s Spiritual Intelligence Self-Report Inventory, Lennick and Kiel’s Moral Competency Inventory and Ryff’s Scales of Psychological Well-being. The collected data were analyzed by Pearson’s correlation coefficient and regression analysis using SPSS software version 18.

The results indicated a positive and significant relationship between spiritual and moral intelligence and psychological well-being (P<0.01). The regression analysis showed that spiritual and moral intelligence could significantly predict 26 percent of the variance of psychological well-being (P<0.01).

Based on the positive relationship between spiritual and moral intelligence and the psychological well-being of nurses, it is recommended that these factors be taken into consideration in programs designed to promote nurses’ mental health

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Moral distress has been identified in nursing literature as a major dilemma affecting nurses in all healthcare systems. It is viewed as an important factor threatening the integrity of nurses and ultimately the quality of patient care. The present study attempted to determine levels of moral distress among the nursing staff employed in hospitals across the city of Malayer. This was a descriptive and cross-sectional study conducted on 195 nurses of Malayer hospitals during 2015. Data were collected using a demographic questionnaire and the standard moral distress scale (MDS). Data analysis was performed by descriptive and analytical statistics using SPSS software version 18.

In this study, 88 nurses (45.1%) were found to be suffering from severe moral distress. The most important factors causing moral distress pertained to substandard care and treatment due to a shortage of health professionals and care providers (6.6±0.21), physician orders for unnecessary tests, treatments and care (6±0.12), and measures taken by staff who lacked clinical competency (5.9±0.22). Among the nurses’ demographic data, gender (P=0.001), job experience (P=0.001) and nursing ward (P=0.01) were significantly related to the level of moral distress experienced by the nursing staff. The results imply that in nursing, moral distress is a highly important and pertinent issue that requires greater consideration by health service managers, policymakers and nurse educators.

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Job stress is rather common in the nursing profession and affects many areas of nurses’ personal lives such as physical, psychological, social and family aspects. Considering the important role of nurses in the society, it is necessary to identify factors that influence their professional and domestic life, and take preventive measures. The aim of this study was to investigate the impact of job stress on marital stress and subjective well-being of nurses.

This was a descriptive correlation research. Study population consisted of 120 nurses employed in the city of Ardabil during 2013 and 2014 selected through available sampling. To collect data, Job Stress Questionnaire (Tufts and Gary Anderson), a subjective well-being questionnaire, and Stockholm-Tehran Marital Stress Scale (STMSS) were used. Data analysis was performed by Pearson’s correlation coefficient and regression analysis.

The results of Pearson’s correlation coefficient demonstrated a negative correlation between job stress and subjective well-being in nurses. Moreover, a positive correlation was discovered between job stress and marital stress. Additionally, regression analysis showed that nursing job stress could predict 25 percent of variance of subjective well-being, 27 percent of variance of marital stress and 29 percent of variance of empathy.

It can be concluded that due to the nature of the nursing profession, nurses’ physical, mental and personal lives are influenced by the stress of the workplace. This will in turn lead to increased marital stress and reduced subjective well-being, which may intensify the risk of developing psychological problems and marital issues in the long run.