Iranian Journal of Medical Ethics and History of Medicine

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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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Confidentiality has long been protected in criminal law as an important ethical principle. With regard to the issue of sexually transmitted diseases, however, health care providers are faced with certain challenges. On the one hand, it is their obligation and duty to respect patient confidentiality, and on the other hand, the possibility of transmission of infection to sexual partners is a rather significant phenomenon. Therefore, health care providers have a crucial role in terms of the conflict of interests and legal duties with respect to sexually transmitted diseases.Medical mandatory reporting to state authorities accompanied by personally identifiable information of the infected person is another controversial issue in the field of confidentiality, which will be discussed in this article by studying various trends in statutes and precedents. It seems that throughout the world, there are two major trends in this respect: in some states, principles of confidentiality are observed even if the patient is infected by sexually transmitted diseases, unless it is inevitable for the safety of third parties such as sexual partners in a narrow implementation of Acts. States like Iran, France and Thailand are examples of such governments. In some countries, however, partner notification and compulsory notification by personally identifiable information of patients are mandatory for epidemiologic reasons. The United States, Australia and Ukraine are some of the countries that fall within this category. In Iranian legal system, the duty to respect confidentiality is emphasized and partner notification cannot be considered as a legal duty and therefore it is not legally permitted. Merely in emergency condition and under a narrow interpretation of law and by resort to patients informed consent, necessity and explicit law permission, breaching of confidentiality is justified.

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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.

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