Iranian Journal of Medical Ethics and History of Medicine

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Despite advances in science and technology, human is not yet capable to produce a material or solution to compensate blood loss or act as blood this vital material of the body. Blood loss is only recovered through transfusion of blood prepared from donors.
Blood safety widely depends on the information obtained from voluntary blood donor. It is his/her ethical responsibility to provide valid information. On the other hand, some ethical issues about the donor and the recipients right should be considered. For this reason, the International Society of Blood Transfusion (ISBT), in 1980, in Montreal, approved the code of Ethics for Blood Transfusion. This code emphasizes on access to safe blood, free blood without need to be substituted, informed consent for blood transfusion, the right not to accept the blood and the right to be informed if they have been harmed. This article attempts to highlight some of the important points in blood transfusion medicine, and ethical aspects of blood transfusion according to the Islamic principles and Iran laws.

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Evaluation of the factors related to the patients&apos complaints against medical staff, especially doctors and efforts towards its reduction affects patients&apos satisfaction of health care system.  The main purpose of the present study was to determine the factors related to the patient`s complaint against doctors with the verdict of Medical Council of Kerman.
This study was a descriptive, analytical and practical evaluation, assessing 250 documents related to the patients&apos complaints of doctors in Kerman Medical Council during 2004-2009.
 The most reasons of complaints (%73.2) were carelessness and disrespecting scientific and legal standards, and obtaining funds out of legal standards (%9.3) respectively. In the case of issuing vote, the most opinions (%31.7) were innocence and suspended and barred from prosecuting (%22.9) respectively. Most complaints were of ophthalmologists and private hospitals.  There were significant relationship between the reason of complaint and issued out (P<0.01, c²= 53.706) and the reason of complaints and field practitioners (P=0.026, c²= 49.27). No significant relationship between issued out and the type of hospital was found.
Regarding the results, respecting scientific, and legal standards, and decreasing financial relationships between doctors and patients is an effective way in reducing patients&apos complaints of physicians. Improvement in physicians&apos patients&apos relationship by explaining the disease condition, its risks and treatment options to patients are effective in reducing patient&aposs complaint against physicians.

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Caring for dying patient is one of the painful events and a tough experience for nurses. Care of dying patient according to his/her cultural norms is one of the principles of nurse's professionalism. Therefore identifying and explaining the daily experiences of nurses in cultural care of dying patients would help in determining caring standards. Due to the lack of such studies, the aim of this study was to explain the nurses' experiences in the care of dying patients.
This study is a qualitative investigation with content analysis method. Eighteen nurses working in teaching hospitals of Tehran were selected by purposeful sampling method from 2010 to 2011. Data were collected through semi-structured face to face interviews. Content of the interviews were transcribed and analyzed by content analysis.  
The findings were classified into two themes of cultural exposure and cultural skills.  Understanding of family presence and family bereavement were two sub-themes of cultural exposure.  Cultural skills consist of 3 sub-themes i.e., preparation for telling bad news, facilitating facing death and solacing family members. 
Regarding our results, in order to meet patients and their families expectations in a respectful manner, nurses awareness of cultural norms of the dying patient and his/her family seems to be necessary. It would be an important step in reforming and improving nursing performance and professional development.

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The aim of this study was to explore experiences of family members of patients confronting brain death diagnosis and the request for organ donation.
A qualitative study was designed focusing on content analysis. Data collection process included 38 unstructured in- depth interviews with relatives of 26 brain death patients who were candidate for organ donation and field notes. Sampling method began as purposive and continued as theoretical until saturation.
Five main themes were extracted from the current dataset that indicated family experiences and perceptions of brain death concept while being informed. The themes were included internal conflict, internal barriers against external realities, imminent sense of loss and grief, surrender and acceptance.
The results showed that facing the diagnosis of brain death for relatives and family members is a condition surrounded by many challenges, ambiguities and conflicts that is become more complicated when emotional responses related to grieving and defensive psychological reactions emerge. So it is recommended before any organ request, at first medical team provide conditions for brain death acceptance. Respecting family members experiences and their perceptions about the situation will resolve their internal ambiguities and conflicts. At this situation requesting organ donation seems to be rational.

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By the end of the nineteenth century some countries that had trade relations with Iran established a quarantine stations at the southern ports. This was due to the spreading of cholera and pestilence especially in those regions as well as to a significant number of casualties. Later quarantines were adapted as a tool of colonial influence in order to pressurize the Iranian government.
In fact the quarantine was placed in critical frontiers caused a lot of problem for both the governments and people scattering quarrels in frontier quarantines and excessive letters between Iran and England.
In this review we aimed at surveying documents and papers remained from the past. Also in this review more attention has been paid to some issues which involve reasons of setting up quarantine stations in Iran and the resulted problems for government, frontiersman and pilgrims.

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Human cloning is one of the most controversial issues in ethics. This paper, with analytic-descriptive method, deals with Kant&aposs principle of ends and permission or prohibition of human cloning from its point of view. According to Kant&aposs principle of ends, any action in which humanity is taken as a means, not as an end, is prohibited. There are different interpretations of taking humanity as an end: to do without one&aposs awareness anything, to respect human&aposs freedom and autonomy, to help his happiness and to respect the humanity of others. According to the Kant&aposs principle of ends our review shows any human cloning in which human being is taken as a means to other ends, is prohibited. Thus human cloning in order to produce many groups of humans with the same genetics and using them in war or excruciating work, to reproduce geniuses, politicians, soldiers, scientists..., produce children with ideal genotype and to replace recently died family, is prohibited. But human cloning in which humanity of produced people is taken as an end is permissible, such as cloning at the purpose of human happiness without limiting their freedom and autonomy, therapeutic cloning for producing tissue and transplant organs, for helping infertile couples and for giving birth to healthy newborns without genetic disorders.

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The definition of disaster is diverse but certainly the similarity between disaster and normal condition is negligible. The most important characteristic of critical condition is the number of human victims. Therefore each critical condition needs medical intervention and the presence of health care providers is necessary.
Health care services are divided into two categories one in normal situation and the other in the critical condition so the ethical considerations and responsibilities of the health care providers will differ accordingly.
Our approach for explaining medical ethics or ethics in health care n critical conditions is two dimensional including the responsibilities of health care providers and ethical problem solving. The second dimension needs systematic approach which is not possible in this article. In the case of the responsibilities of health care providers we may focus on individualized viewpoint or systematic and strategic view point however the later is more complete and acceptable.
From systematic viewpoint three important issues should be considered ethical principles, ethical codes and multi dimensional ethical charter of each organization.
In this review we aimed at describing some ethical principles and codes of conduct and the ethical principles of Red Cross and Red Crescent as well.
In conclusion, critical conditions are far wider and there are full range of special situations in which no unique solution can be followed. It is necessary to determine the diverse fields affecting the condition and solve the resultant ethical issues in a problem oriented manner.  In addition medical ethics should be considered as one of the most important priorities of the Ministry of Health and other related organizations.

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Breaking bad news to the patients does not back to a long history and is a controversial issue between patients and physicians. Many physicians are reluctant to breaking bad news to patients and this is not desirable for most patients. For example, in Northern European countries and United States, most physicians usually break bad news to the patients, while in Southern and Eastern European countries or many Asian countries they would not do so. In Iran, physicians prefer to break bad news to patient's family rather than the patient. Cultural differences also influence people's viewpoints about breaking bad news. In Western countries, most people agree with breaking bad news to patients while it is not common in the other populations. Nowadays, the dominant view in the most countries is that it is the duty of the physicians to break bad news to patients. Some advantages of breaking bad news to patients including strengthening the trust between physician and patient, preventing non - maleficience, increasing patients satisfaction and reducing legal action against the doctors. There are some exceptions to breaking bad news the most important is serious psychological damage to the patient. Quality and quantity of information that should be released depends on situation of each patient. Breaking bad news needs specific communication skills and physicians must be trained for this purpose.

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In medical etiquette and ethics, benefit and harm assessment includes risk evaluation, rational risk, distinction between medical and non medical utilitarian considerations, individual and community benefit ratio, and issues of the like. This article explores philosophical foundations of this issue. In philosophy, benefit/harm reduces to pleasure/pain and good/bad. Pleasure (spiritual and non-spiritual) is considered a subjective criterion for benefit, whereas applied ethics needs an objective criterion. To achieve such a criterion, we need a specific model for casuistry evaluation and a holistic and organic approach. This article advocates the public sphere model and presumes it is the missing link of ethical confusions and the solution to ethics lack of quantifiability. Public sphere sits between public authority and private sphere, and supervises them impartially. Benefit/harm evaluation components in medical research requires such sphere for clarity and distinction.

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One of the most important factors for effective function in an organization is human factor. Social support is known as a psychocognitional factor in workplace that affects human productivity. The purpose of this study was to determine the rate of perceived social support at domain of emotional support   among hospital staff.
In this cross-sectional study, 120 hospital staff who worked at a selected hospital of Isfahan were included based on convenience sampling. Data was collected using social support and demographic data questionnaires. These questionnaires were developed by researcher. The validity of questionnaires was evaluated by content analysis and reliability of questionnaires was evaluated by test re-test and data were analyzed by descriptive and analytical statistics.
Our results show that perceived social support at the domain of emotional support from coworkers (mean ± SD=3.34±0.9)  was significantly more than perceived social support at domain of  emotional support  from managers (mean± SD =2.58±0.88).  Also, a significant association was found between perceived social support at the domain of emotional support and age and work experience (P<0.005).
In conclusion social support from personnel at the domain of emotional support is necessary for increasing human productivity and hospital managers can affect staff efficiency by developing their relationship with hospital personnel.

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Nurses face to a lot of different gender perspectives in their routine work. Cultural and social backgrounds influence gender stereotyping and it causes significant changes in nursing roles. This article reviews and analyzes the effect of gender on nursing. Gender perspective in nursing has affected services and quality of nursing practices. Although gender perspective affects health care system, its elimination is not beneficial. Because its elimination abducts nursing from its real spirit and disappoint women from exposing their emotional and mental abilities. Therefore gender stereotyping affects nursing from different dimensions and it will improve nursing profession by leading right way.

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Euthanasia, to end easily the life of a terminally ill patient, is one of the most controversial ethical issues which there are not enough information about it in Iranian society. Valid and reliable instruments can facilitate research in this issue. The current study aimed at assessing the rate of acceptance of euthanasia in a group of college students, and studying validity and reliability of the Euthanasia Attitude Scale (EAS). Four hundred and thirty seven students judged about morality of euthanasia (by accepting euthanasia scale), and then completed the EAS. To analyze the data, indices of descriptive and inferential statistics including factor analysis and convergent validity were used. The results show that only 27.9 percent of the participants agree with euthanasia. There was a strong correlation between euthanasia acceptance and ethical considerations. Factor analysis of the EAS confirmed a three factor structure.  Cronbach's alpha for the EAS was 0.88 and its correlation with euthanasia acceptance score was 0.54 which indicate internal consistency reliability and convergent validity of the EAS. According to these findings, most of the students are against euthanasia and their opposition to euthanasia mostly is due to Ethical Considerations within the domains of euthanasia attitude. Moreover, this study showed that the Persian version of the Euthanasia Attitude Scale is a valid instrument for assessing attitudes toward euthanasia.

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The main challenge in organ transplantation is the organ limitation. According to the law of organ donation, it's necessary to obtain family consent for organ donation from a brain-dead patient in addition to patient consent. In this research, we explored Tehran citizens' viewpoints regarding organ donation from beloved ones in case of brain death.
In this cross-sectional study, two interviewers selected 706 study participants by phone interview through random digit dialing during February to November 2010. Calls were made between 6 and 9pm on 5 workdays. Companies and organizations were excluded from the study. Only those over 18 year of age were enrolled in the study.
Of 1379 people who met the inclusion criteria, 706 subjects agreed to have the interview (response rate=51%). Of these, 83.3% (n=688) agreed with organ donation from family member if they had a donor card and suffered brain death. Agreement with organ donation was significantly associated with considering brain death to be real death (P=0.011) and considering it to be irreversible (P=0.028).
In conclusion it is necessary to design public education programs to change their misconceptions about brain death, and provide options to opt for organ donation in case of brain death on common cards such as drivers' license so that family members can make decisions about organ donation more easily when a beloved one suffers brain death.

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Because of complications of medical treatments, informing patients about the rate of treatment success, potential risks, and side- effects, is considered as an indispensable part of treatment contracts. Patients' deprivation of this information can be considered as a major obstacle in obtaining informed consent. Clearly treatment without patients' or their legal guardians informed consent may lead to civil and penal liability for the physicians.
Consenting without getting enough information about the disease, and its treatment is the most important issue in this regard. Now can such consent be valid and legalize the treatment or not? In this article informed consent and the physicians duty of informing patients are compared in three legal systems of Iran, England and France and then the physicians' duty of notification will be analyzed and some suggestions for safeguarding patients rights will be offered.

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Animal cloning is one of the animal biotechnology branches. Although this method has been used since 1950, but many have paid attention to cloning by birth of Dally. Because the way of Dolly production was completely different from other existed methods in cloning.
This new-found and unprecedented method has been called "Somatic Cell Nuclear Transfer" (SCNT), so scientists have eagerly paid attention to many profitable abilities such as, duplicating valued animals traits, preventing endangered animal species from extinction or even restoration of extinct animals, producing high quality food and drug by using cloning as a way for propagating transgenic animals.
Even though all these instances sound good and encourage use of SCNT, in fact, none of them has practically become feasible so far. The main reason for this claim is that in spite of whole attempts taken for producing cloned animals, the method still is under debate and the hit-rates of this method has been kept considerably low and disappointing.
Because of several reasons, we cannot ignore this recognized obstacle as low efficiency. Along with this issue, there are various sub-effects, which put human and animals life at risk. Not only the High rates of miscarriages or birth of genetically abnormal animals, causes many different health-oriented problems for human and animals, but also it can directly and indirectly endanger human and animals welfare. Nowadays hordes of legal and ethical criticism around SCNT in reaction to these portentous signs, invite scientists to be more scrupulous and patient in its broad enforcement.
Taken together, although at first glance SCNT seems to be promising, it's usefulness has been diminished because of difficulties in its application in broad spectrum. Therefore SCNT should be kept under surveillance and use of it must be just limited to very important and critical cases such as medical purposes, as long as all due observations and cautions take into account before implementing.

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Quality of nursing care services directly influences individuals' health status. Compiling codes of ethics according to the religion and culture of each population could be an appropriate approach in improving quality of health care services especially nursing care. Hence, the most important priority in our national health system is developing ethical guidelines.
For this purpose a task force has been established in collaboration with nurses, physicians, lawyers and clergymen who were expert in the field of medical ethics. The code of ethics for Iranian nurses was drafted in 2010. The draft that included 12 values and 71 regulations of professional ethics were finally approved in the second session of the Ethics Supreme Council of the Ministry of Health and Medical Education on 6 March, 2010.
The values consist of concepts such as maintaining human dignity, adherence to professional obligations, accountability and responsibility, patient privacy, promotion of scientific and practical competence and respect to individual's autonomy.
Also, 71 regulations of professional ethics divided to five sections including "Nurse and Community" consisting of 9 items, "Nurse and Professional Commitments" with 14 items, "Nurse and Clinical Services" with 23 items, "The Nurse and Other Healthcare Providers in Medical Team" with 15 items, and also "Nurse, Education and Research" including 10 items.

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The Declaration of Helsinki, the most creditable ethical guideline for medical research on human subjects, has been updated 8 times since its establishment and the last revision was in 2008. Researchers, medical research subjects, authors, members of ethics committees, and editors of medical journals must be informed of the tenets of the Helsinki declaration in order to improve achievements of medical research and respect the rights of participants in medical research. In this study, the evolution of the Helsinki declaration is examined, and the provisions of the last version are compared with the previous version (2004). Finally, we made a practical interpretation of the last version, and discussed its differences from previous version. There are seven new paragraphs in the last version of the declaration. Four new paragraphs concern informed consent in areas of its being written and voluntary, renewed consent for using human materials, participants' right to revoke the consent, and exceptions from informed consent requirements. The other three new paragraphs focus on the research subjects’ right to being informed of the declarations' provisions, vulnerable groups gaining benefit from research, and registration of randomized clinical trials. It is important for researchers to recognize international guidelines such as the Declaration of Helsinki, because it enables them to use correct scientific and ethical standards in medical research. In the last version of the Helsinki Declaration more emphasis was placed on informed consent and vulnerable groups than previous versions.

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Conflict of interest is a real situation in which a person as a decision maker simultaneously has two positions, one in private and the other in the public. In public role he or she has to pay attention to the society`s best interests and follows his or her best ones as private role. Conflict of interest is a common challenge of health system among both real and legal persons in all courses such as education, treatment, and researches.
The most causes of conflict of interest are named as deferent goals, lack of resources, authorities malfunction, health marketing and etc.
We aimed at discussing conflict of interest and its relation to law, its management, conflict of interest in pharmacy and pharmaceutical companies and also Iranian legal system viewpoint. In conclusion it seems that conflict of interest should be included in the law and the provisions to achieve the least conflict of interests in health system should be revised.

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Although we have diverse methods in laboratory studies, such as cellular and molecular sciences, understanding many issues related to human health requires research on animals. An ethical duty of every researcher is to respect animal rights. In our country, educational and research activities are carried out frequently on animals. Therefore, guidelines for ethical use of animals in Iran were developed in 2004 after a review of international resources and considering the needs of researchers working with animals. This guideline was written in four sections, including animal transportation, facilities, animal care personnel, and research users. However, some studies show that researchers need comprehensive and easy to use instructions on the ethical use of laboratory animals. On the other hand, inadequate knowledge about ethics principles in research on laboratory animals have revealed the need to update guideline to be more practical, applicable, and in line with researchers' requirements. In this study, the above mentioned guideline was revised and completed in five parts, including transportation, facilities, animal care personnel, research users, and the use of animals in experimental procedures. In the first section, points on transport of animals and facilities, including location, cage, ventilation, humidity, light, temperature, noise, water and food are presented. The new revision, contains additional paragraphs, and some previous paragraphs are split. Another part of the findings is presented in terms of fundamental duties and ethical performance of persons who work in laboratory animals' houses and researchers working with animals. The final section of the findings is related to the use of animals in laboratory processes which are not presented in the previous formulation of the guideline, and includes basic ethical issues in regard to categorizing, anesthesia, surgery, and euthanasia. Therefore, the guideline was revised to be much more practical, more applicable, and should lead to some form of researchers' training in this field.

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The Declaration of Helsinki, the most creditable ethical guideline for medical research on human subjects, has been updated 8 times since its establishment and the last revision was in 2008. Researchers, medical research subjects, authors, members of ethics committees, and editors of medical journals must be informed of the tenets of the Helsinki declaration in order to improve achievements of medical research and respect the rights of participants in medical research. In this study, the evolution of the Helsinki declaration is examined, and the provisions of the last version are compared with the previous version (2004). Finally, we made a practical interpretation of the last version, and discussed its differences from previous version. There are seven new paragraphs in the last version of the declaration. Four new paragraphs concern informed consent in areas of its being written and voluntary, renewed consent for using human materials, participants' right to revoke the consent, and exceptions from informed consent requirements. The other three new paragraphs focus on the research subjects' right to being informed of the declarations' provisions, vulnerable groups gaining benefit from research, and registration of randomized clinical trials. It is important for researchers to recognize international guidelines such as the Declaration of Helsinki, because it enables them to use correct scientific and ethical standards in medical research. In the last version of the Helsinki Declaration more emphasis was placed on informed consent and vulnerable groups than previous versions.