Iranian Journal of Medical Ethics and History of Medicine

Obtaining informed consent is for protection of patients' rights. The aim of informed consent is not decreasing physicians' responsibility.Informed consent assists the patient in making a decision concerning their care, improve their satisfaction, and decrease legal litigations. This study examined patients' attitude toward the quality of informed consent and its challenges in educational -clinical settings. Current qualitative research was simple content analysis. Semi-structured interviews were conducted with 15 hospitalized patients who were selected by purposeful sampling method considering type and severity of the disease, gender, age, and satisfaction or dissatisfaction from the management. The data was analyzed using MAXQDA 2007 software. Primary codes and categories were extracted then the findings were presented based on the main. Five themes were extracted from the data: "meaning, importance and status of consent in medicine", "consequences of obtaining consent", "the role of patient and therapist in the process of informed consent", "challenges of making informed consents" and "facilitators in the process of informed consent"; all could define and compile the main theme “doctor, patient, and procedural elements, three pillars of informed consent”. Inadequate explanation to the patient, signing the form prior to read it, lack of trust to the practitioner, disregarding patients' psychologic needs and stress and obtaining the consent by someone other than the physician was among the main reported challenges of informed consent. Correction and standardization of obtaining informed consent's culture requires knowledge about current situation followed by training, enforcement, supervision, encouragement, and punishment.  Collaboration of health care team needs comprehension of necessity and importance of this issue and its consequences.

One of the main issues in hospitals is evaluation of efficiency and effectiveness. For this purpose, several indicators are presented, which are known as functional indicators. If the performance of hospitals depends on the patient's demographic characteristics, overlooking effect of hospital indicators, as an effective factor at a higher level on the patient rights, may lead to inaccurate conclusions about these relationships. In such cases, where the data are intrinsically multilevel, the use of multi-level statistical models for this type of data is useful. Samples were collected from eight hospitals of Tehran University of Medical Sciences during 2013 in a two stage cluster. Data on patient rights and demographic information were collected from 375 patients by a questionnaire. The patient's rights rate was measured by multivariate statistical analysis and factor analysis. Two-level linear regression models were used to examine the relationship between patients' rights and some demographic information. The first level was demographic factors and the second level was hospital factors. The results showed that rate of considering patients' rights in hospitals were in moderate level. About 16% of the variance of the dependent variable of patient's rights, which was significant, is due to variations at the higher level of the hospital and other variations at the individual level. Furthermore, variables of bed occupancy, complaint rate, and hospital escape rate at the higher level (Hospital) have a significant impact on the patient's rights.

The purpose of this study was to perform a narrative review and documentary research in the history of community medicine specialty formation and the needs for its existence in health systems. We searched and reviewed related literature and documents in English and or Farsi (printed or online). Data was extracted and findings were categorized, summarized, and reported. About a century ago community medicine specialty was formed to respond to major health challenges of that time such as neglecting the effects of social determinants on populations’ health and total separation between clinical care and public health. Community medicine professionals are able to address many of the current health problems such as inequalities in health, fair financing problems, increasing demands and costs and disease-based health system approaches. They can be the leading advocates to emphasize the importance of social determinants in health of populations. They can promote communications with influencing institutions outside the health system to improve the health of the communities. This discipline can pave the way for the health systems to tackle the most important contemporary health challenges. Lack of attention to this discipline may hinder the achievement of sustainable development goals and health promotion of the communities. More support from officials and utilizing the skills of community medicine specialists can help health systems not only to better respond to the health needs of the society but also to facilitate the achievement of their main goals.

Human is spiritual dimensions that has legal status in health and disease. The purpose of this study was to evaluate the knowledge of nursing and midwifery students about patient rights in Iran Universities of Medical Sciences teaching hospitals’ in 2017. This study was a descriptive cross-sectional study in 2017 with convenience sampling method. Data was collected by a three-part questionnaire including demographic information, Knowledge about the Patient Rights Charter, and strategies for student information to deal with patient rights. Mann-Whitney and Spearman tests were used for data analysis. A total of 1219 undergraduate students participated in this study. The mean score of students' awareness of the Patient Rights Charter was 13.54±4.45 out of 29 points. 1007 students (82.61%) reported that education about patient right was sufficient. Direct correlation was between patient knowledge awareness score with pre-internship training (r = 0.461) and learning from instructor information (r = 0.512) and there was a negative correlation between self-education (r = -0.151) and other methods of information acquisition (r = -0.067). Given that most students did not consider the educational content taught in the field of patient rights to be effective, it can be concluded that these methods were ineffective and failed to convey the correct information. Therefore, revising of the Patient Rights Curriculum for Nursing and Midwifery students is recommended

Televisits offer significant potential for enhancing healthcare accessibility, reducing costs, and improving patient satisfaction. However, their effective implementation requires careful consideration of ethical principles to ensure patient safety, privacy, and quality of care. This paper examines key ethical considerations for televisit implementation across three stages: pre-visit, during-visit, and post-visit. Pre-visit considerations include careful patient selection to ensure suitability for remote care, establishing a strong physician-patient relationship based on trust and obtaining informed consent, and demonstrating cultural sensitivity and inter-professional coordination. During the televisit, optimal technical conditions are critical, including reliable internet connectivity, high-quality audio-visual equipment, and a conducive physical environment. Comprehensive and transparent documentation of the televisit encounter is essential. Post-visit considerations include evaluating patient experiences, addressing any identified issues, and ensuring timely follow-up for continuous quality improvement. Ethical considerations extend beyond the clinical encounter. Addressing technical challenges such as data security, privacy breaches, and equitable access for all populations, including those with disabilities, is crucial. Transparent reimbursement mechanisms and ongoing education for both patients and healthcare providers are essential for successful televisit integration. The successful implementation of televisits requires a multi-faceted approach that addresses ethical considerations at all stages. Developing comprehensive guidelines, adhering to international standards, and establishing robust oversight mechanisms are essential for ensuring the safe, effective, and equitable utilization of this innovative technology in healthcare delivery.