Iranian Journal of Medical Ethics and History of Medicine

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Although there is no more propensity for measuring patient's satisfaction as an important qualitative scale of health services, the thing which is slightly seems to be forgotten is the attention towards the concept and expansion of theory framework. The purpose of this study is to remark the meaning of satisfaction and to offer a qualitative definition for that. This research is a qualitative study and content analysis. During the study period  fifteen patients who were hospitalized in Semnan hospitals (2009) were selected. The data were gathered by half-structured interview and analyzed. The results of this study shows four two major themes and four subthemes including feeling of satisfaction and the reception of nurses by patients. Accordingly, satisfaction is a calm sense that the patient feels it after the emotional and logical reception of nurses. The feeling will be sensed by intelligent and sometimes emotional feeling of patient towards the nurse in his/her care unit environment. The results of this study indicate the real and basic meaning of patient's satisfaction from nurses' views. This meaning is even beyond the imagination of experts and managers. These results can be put into work for designing suitable tools to measure the scale of patients' satisfaction of nurses based on their real perception.

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Surrogacy is considered as one of the selective methods for infertile women especially those who don't have womb. As this method is controversial and the sides should be analyzed both ethically and legally, the purpose of this study is to scrutinize the attitude of infertile women who visit Hazrat Masoumeh Infertility Centre in Qom for surrogacy.
This cross-sectional study  conducted on  300 infertile women. The information were gathered from a two part questionnaire which in one part there was personal information and the other part was for phrases related to attitudes. The earned data were analyzed by descriptive test analysis and P<0.05 was considered significant.
The results showed that 61.3% of infertile women were in favor of surrogacy and 38.7% were against it. The highest priority in terms of attitude was the fear of an emotional relationship between the surrogate mother and the baby, and also the problems of delivering the baby from surrogate mother to the applicant couple. There was a logical statistical relation between the infertile women's attitude  and age, educational level of the woman, educational level, the educational level of infertile women's partners, years of infertility and income of the bread winner( P<0.05).
As the attitude of vast majority of the study samples  was positive and as it is important to know about opinions and preferences of families to make this action lawful, wider investigations in this field in more variable groups is recommended.

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The appearance and the way a doctor is dressed has a very influential effect on the physician-patient relationship. Interns and trainees of medicine must follow the principles of professional behavior as they play a crucial role during their education. The aim of this research is to analyze the interns and trainee's point of view towards dress code.
In this study, after preparing a questionnaire and assessing its validity and reliability, it was sent to 337 interns and trainees of universities of medical sciences, at Shariati, Imam Khomaini and Sina hospitals, which are selected by portion method, after ward their viewpoints were analyzed from 5 dimensions.
One hundred and seventy seven students (52.5%) and seventy students (20.8%) got mean score and high score of physical features respectively.. Two hundred and sixteen students (64.1%) and fifty four students (16%) got mean and high score of dress code respectively. One hundred and eighty eight students (55.8%) and seventy five students (22.3%) got mean and high marks in make up respectively. Two hundred and twenty three students (66.2%)were completely in favor of observing personal hygiene while one hundred and fourteen students (33.8%) just agreed with this issue. Finally, in the total physical features and dress code, 210 students (62.3%) got the average mark and 58 students (17.2%) earned high mark. Interns and trainee's viewpoints about the physical features had a significant correlation with age, sex, and educational level (P<0.05).
The results of this study shows that teaching the importance of physical feature and professional dress code is the most important action to boost the level of compliance about appearance by interns and trainees. Compiling the professional dress code can help getting this aim come true.

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The most basic research in the area of human science is the research about human beings and people, while the first introduction to the immense concept of people is facing independence towards defining this concept because we feel the instances of it every day. Lack of attention in human recognition can prevent us from reaching generalized results and therefore, will lead us to transient decisions. But in fact there are some trembling parts towards human recognition, like getting far from the definition of concept, the inseparability of living species from each other up to dismissing the reality of specie's existence, a quick glance to the challenges of extraverts, ambiguity of biological definitions (morphological, fertilization, genetical and behavioral) and also lack of logical definitions.
From our point of view, there is no pervasive criterion about humanistic living therefore, the rights and characteristics which we consider for human beings are related to the humanistic living from a philosophical view point. To attach this expansion, the philosophical human beings and its differences are incorporated into the minimal human. It is clear that there is no incorporation the same as this rule and we should overcome some steps about them, if not, this incorporation will get beyond the philosophical control of human. In a steady view, what makes a difference from human beings and other creatures is not the biological definition of them, while in the approval view sometimes this definition is the only tool to separate the people. Autonomy and free choice are the exact criterion for this recognition.

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By the ever-increasing discovery of pharmaceutical and chemical substances, their  adverse effects  will be considered too. To evaluate adverse effects, animals are used, and factors like standardization of species and breed, storage condition and biochemical system will be effective for animal selection. In Islamic education, animal issues are important. The principles of keeping animals, using them and prohibition of animal abuse are mentioned in this article. The information were gathered from electronic and non-electronic resources including articles and books. Based on this, the following issues need specific attention:

• 1- Infrastructure of rights: In Hajj and Nahl chapters of Quran (verses 18 and 49) it is mentioned that animals will bow down to God. This is the basis of animal rights.
• 2- Animal rights for keeping them: For this case Sheikh Tousi and martyr Saani mentioned that it is necessary for the owners to feed and water the animals enough.
• 3- The exploitation rights: In the Holy Quran, it is said that the power and the hygiene of the animals must be considered and it is major to exploitation.
• 4- Rights of animal's damages: It is advised to keep and defend the animal species and human beings are forbidden to harm and kill animals. Therefore, from Islam point of view, although animals lack the speech power, they must be treated emotionally and their owners have some responsibilities, too.

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The medical Arjuze is one of the less known works of Avicenna, a great Iranian scientist and physician, which is written didactically in Arabic. In this book, Avicenna has composed 1326 lines about a complete cycle of traditional medicine of Iran in Arabic in the form of battle cry. Didactic poetry is one of the poetry forms which its main purpose is to provide educational aims and to convey scientific terms both in literature and poetical way. Avicenna's poetry in Arjuze is simple and fluent. The medical topics are overviewed in a sketchy way and not in full details in this book. In this book, theoretical and practical medicines are explained in two specific parts.
The existence of French and English translations of Arjuze shows the value of this work for Europeans as a complete outline about medicine in that time, but there is no Persian translation of this work, available. Traditional Medicine and History of Medicine Research Centre of Shiraz University of Medical Sciences has started the translation of medical Arjuze with the aim of introducing this precious work which shows the educational pattern of traditional Iranian scientists in using didactic poetry.
The purpose of this article is to introduce the characteristics of Avicenna's Arjuze with an overview of his position in modern traditional medicine.

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The first step in battling against prevention and control of a social phenomenon is to distinguish it completely and clearly. Designing the information system of substance abuse, with the aim of converting data into information and knowledge, consists a great share in prevention and control of addiction, but it is faced with challenges and problems which have unpleasant and inappropriate consequences on consumer abusers. Therefore, this article is written with the purpose of studying the medical ethics challenges of information system of substance abuse.
The present research is a review of studies. The needed information is gathered form Medline, Ovid, Elsevier, Google and Pubmed search engines and also from Police Information and Statistic Centre, Ministry of Health, and Medical Education, Welfare Organization and National drug Studies centre.
Substance abuse information system has several legal and ethical problems that if they occur, abusers will show no zest for receiving any consulting and medical services and also participating in epidemiological studies.
World Health Organization has provided a special framework in eight compasses including respect for human dignity, secrecy and privacy policy, to respond to the health information system.
Before arranging the schedule, designers and programmers of  substance abuse information system should provide and codify the rules, regulations and necessary instructions to clarify and determine the legal status, in order to guarantee the secrecy and privacy policy of information.

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Theologians describe the difference between active and passive euthanasia as in the former, we kill hopeless patients terribly suffering from an incurable disease and in the latter, and we let them die. The present research aimed at exploring for a solution to an ethical dilemma by which the difference between foundational concepts of the two types of euthanasia can be examined. Another objective of the study was to assess personal characteristics regarding this judgment. One hundred and five students were recruited, and in addition to reading the trolley problem and answering the related questions, they responded to a six-point scale self-assessment on morality and a short 20-point scale questionnaire on the five principle personality factors. Results showed that 83.8% of respondents found it immoral to kill one person in order to save 5 lives. Respondents' gender, religiousness and personality had no significant effect on their responses regarding the footbridge dilemma (P<0.05). Nonetheless, extroversion had an almost significant relationship (P=0.056, r=0.19). According to the results of the present study, the difference between "killing" and "letting die" is clear to most people, and they do not prefer killing even when there is more benefit than loss. Responses to the trolley problem were independent of personal characteristics, nonetheless, the quality of extroversion is suggested a as a potential determinant of agreement with active euthanasia.

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Decision making by a surrogate on behalf of incompetent patients is based on the ethical principle of "respect for autonomy". The increase in advanced health services has lead to more instances of decision making for incompetent patients receiving such services, and the treatment team usually asks a family member to serve for this purpose without being aware of the patient's preference. This study was conducted to assess patients' wishes and preferences regarding surrogate decision makers and determinants of such preferences.The study was cross-sectional, and samples were selected randomly from patients presenting at Farabi Eye Hospital clinics who were 18 years of age or older. Questionnaires were completed through interviews. Two hundred patients between 18 and 83 years old were interviewed. About 52% (n=105) were men, and 73% (n=77) were married. Among the married, the spouse was chosen as the surrogate decision maker in only 51% of cases. Among singles, boys preferred their father in 36% (n=9) of cases, while girls chose their father in 5.6% (n=1) of cases and the most frequent choice was other unmentioned people (33.3%, n=6). Most patients (93.5%) wished to be asked about their surrogate decision maker upon admission.Results of this study demonstrated that the people we usually consult for decisions concerning patient treatment are significantly different from patients' preferred surrogate decision makers. We suggest leaving the choice of surrogate decision maker to the patient while they are conscious.

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Moral distress is a psychological phenomenon whose effects on people’s functions can be considered as a subject of study. Although moral distress exists in numerous professions, research dedicated to this phenomenon has proved that due to the nature of the nursing profession, it is a familiar source of stress for most nurses. Nurses are more often than not faced with moral dilemmas in the workplace, and suffer moral distress as a result. The present paper aimed to study the history of moral distress, its definitions, consequences and coping strategies through library and online research, and although it attempted to investigate the phenomenon of moral distress in general, its focus has mainly been on moral distress in the nursing profession. A thorough understanding of moral distress and its negative and positive aspects is believed to raise awareness and lead to improvements in nurses, and educate them on appropriate coping strategies to help reduce their emotional suffering.

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Ethical research and theories assign great importance to the role of intention in passing moral judgments about individuals’ actions. The doctrine of double effect is among ethical disciplines that differentiate between controversial medical situations such as end of life care or abortion, and intentional, premeditated damage, in that they consider the former impermissible and the latter permissible under specific circumstances. The present paper was conducted to investigate the role of intention in judging a person’s actions, and to provide empirical evidence for the doctrine of double effect. 200 students were asked to evaluate the morality of two situations: in the first situation, one person needs to be killed so that five other persons can be saved. In the second, the killing of one person is the side effect of saving five others. Data analysis was performed based on frequency, averages and ANOVAs using SPSS statistical software version 16. The analysis indicated completely different responses to these two situations: in the first situation most respondents (62.3%) considered the act of killing the one person unethical, while in the second situation the majority of respondents (60.6%) considered the act that would result in the one person getting killed as ethical. The findings of the present paper highlighted the role of intention in passing moral judgments and provided empirical evidence in support of the doctrine of double effect. This research also demonstrated that the attitude of theorists about the role of intention in moral judgments is consistent with the moral sense of ordinary people.

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Admitting medical errors is one of the professional obligations of physicians that unfortunately involves numerous challenges. The present paper aimed to investigate the attitude of surgery faculty and residents towards medical error disclosure and factors affecting it. In this cross-sectional descriptive and analytic study, a self-administered questionnaire was distributed among all faculty and residents of the department of general surgery of the teaching hospitals of the Tehran University of Medical Sciences. The response rate was 84.1% (53 out of a total of 63). Tendency to make minor and major errors among the respondents was 39.6% and 49.1% respectively, and 71.7% declared that the most significant factor hindering error disclosure was fear of litigation. Only 16.7% (8) had disclosed their most recent medical errors to their patients, 25% (2) of whom had to face legal action. There seems to be a clear distinction between the doctors’ inclination to disclose their medical errors and what actually happens in their practice, the most important reason being their professed fear of litigation. Considering the need in the majority of physicians for appropriate training on the subject of medical errors and communication strategies, it seems that in order to resolve this issue, changes need to be made in the current system for error management so as to provide professional support for physicians who make medical errors, and doctors should receive the necessary training on ethical principles and patient communication strategies.

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Nurses' ability to communicate with patients is essential for the effectiveness of the nursing process. This factor is more significant in the case of adolescent patients. Appropriate communication between adolescent patients and health care staff is crucial, since it contributes to the patients disclosing important personal information, and helps nurses communicate necessary information, viewpoints or skills through health promotion measures. The present study aimed to draw a comparison between nurses’ and hospitalized adolescents’ understanding of the significance of the nurse-patient relationship and the observance thereof. In this cross-sectional study, 175 nurses and 180 hospitalized adolescents (12-18 years of age) were selected through simple random sampling respectively, all of whom met the criteria necessary to enter the study. The data was collected from children’s hospitals affiliated with the Tehran University of Medical Sciences, and the data collection tools were self-report questionnaires. Data analysis was performed using the SPSS statistical software. Findings of this study showed that there was a significant statistical difference between the understanding of nurses and hospitalized adolescents regarding the importance of the nurse-patient relationship (P=0.019) and its observance (P0.001), and the nurses scored a better understanding than adolescent patients in both cases. This paper also investigated the priorities of each group regarding the significance and observance of the nurse-patient relationship. The results showed that nurses viewed explaining the necessary follow-up care after discharge as the most important part, while adolescent patients believed that proper verbal communication and being listened to patiently were of great significance. Both groups seemed to observe proper verbal and non-verbal communication according to the results of this paper. The findings of this research proved that nurses can be directed to achieve the less observed objectives that are viewed by adolescent patients as significant in order to eliminate the obstacles in proper nurse-patient relationship.