Iranian Journal of Medical Ethics and History of Medicine

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Pediatric research is a complicated and sensitive field of research that involves specific legal, ethical, and even philosophical aspects therefore the guideline of pediatric research is considered one of the important ethical guidelines in research. Although this ethical guideline has been used for some years, a need for its revision is always felt with the passing of time. Accordingly this study was carried out through library search, aiming to present a critical ethical review of the national guidelines for pediatric research. One important ethical issue is obtaining informed consent from children of various age groups, and the performance of the ethical committee in case of conflict between the child and his parent(s) or guardian. Recent studies show that getting informed consent needs to be revised and a new guideline must be developed for each age group. Another important issue is the unlawfulness of monetary incentives in pediatric research, which is nowadays being questioned. Among the topics discussed in ethical codes is the beneficence and non maleficence of the research for children, while the ruling philosophy in pediatric research has posed great challenges in the process. This has caused some research to lack quality and researchers are reluctant to do pediatric research. In terms of information dissemination and confidentiality, there seems to be a lot of debate regarding the child's age, and therefore these issues should be taken into account for revision. Hence we propose that in order to improve the quality of research, the present ethical guideline be revised and based on past experiences, legal and ethics professionals as well as philosophers and lecturers be involved in the process.

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Telling the truth to patients is a key issue in medical ethics. Today, most physicians hold that truth-telling to patients is crucial, and that lying to patients or withholding information from them is not acceptable. It seems, however, that absolute and unconditional truth-telling is not always possible, and it may not be feasible to tell some patients certain truths under some circumstances. Although truth-telling is a rudimentary principle in ethics, it is allowed to withhold truth or even to tell lies in some circumstances. From the point of view of reason and tradition, lying under certain circumstances is allowed for instance when one is disinclined to tell the truth, or in emergencies where truth-telling might lead to loss of life, property or someone's reputation, and when truth may involve two adequately unpleasant situations. In my opinion, it is necessary to tell the truth, regardless of possible harms, when continuation of treatment, or the patient's cooperation and consent depend on it, and also when the truth which needs to be told to a patient is the incurability of his disease and therefore his inevitable death,. In other cases, however, when there are truths such as severity of disease, death of others in the accident, family problems outside the hospital, predicted survival time, and other possible diagnoses, the truth can be withheld and the patient can even be lied to if there is any risk of harm to the patient.

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The most important element in physician-patient relationship is trust which has a major effect on treatment and satisfaction of both patient and physician. To be able to realize the trust between patients and physicians, at first we should find an appropriate definition of trust so in this article we study the criteria of trust and it's realization to be adapted between patient and physician.We reviewed the literatures investigating the perspective of scientists of sociology and ethics. Afterwards the issue was discussed in focus groups, and the contents were analyzed to reach to a proposed model including several criteria.We believe that trust has two sides, the trust (patients) and the trustee (physicians) and for trust fulfillment both sides should be involved. So some criteria are related to the individual patients, such as patient's needs and desire to trust. Some are related to patients and are considered as respect to patients, awareness of physicians characters, such as his/her knowledge and experiences of physician.The other two criteria are related to physician's characteristics, such as his/her commitment and appearance, and physician-patient relationship, such as communication skills of physician.

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Avicenna wrote many great books and articles such as Canon of Medicine which is his most important medical work. This study has been conducted in order to provide the necessary information on Avicenna's adherence to ethical principles and ethical norms in Canon. Three aspects including his medical practice, researches and philosophical attitude have been studied. Avicenna offers some valuable guidelines on the ethics in medicine in Canon. The first necessary condition for the practice of medicine is to comprehend medicine. Congruently, Avicenna emphasizes in his book that the doctor must be masterful. The use of scientific resources and valid information with citation to the references is one of the ethical subjects that are highlighted in this book. Avicenna has put much emphasis on ethical principles as a religious issue in medical practice. He believed in Islam and Islamic ethics and felt responsible toward God and his creations including humans Although in Canon there is no chapter specifically devoted to medical ethics, there are numerous ethical references that focus on humans as the main target of medical activities. It offers recommendations regarding ethical issues such as how to treat patients and minimize hazards. In brief, the book of Canon represents many humanistic ideas.

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Providing sufficient information for patients and other healthcare clients is necessary to protect their rights in health systems. In this realm, medical librarians, especially in hospital libraries, can play an important role in supporting patients' rights. Professional national and international associations have compiled and promulgated some codes and guidelines in some countries however, there are many shortcomings in this area in our country. This paper aims to review the status of patients' and other healthcare clients' rights in professional codes of ethics of library and information sciences and professional standards of hospital libraries. We hope the results can provide us with an approach for a more strict observance of patients' rights in our country. This paper reviews professional codes of ethics of library and information sciences and professional standards of hospital libraries. We will contemplate on the articles related to patients' and other healthcare receivers' rights. The findings show that providing patients with information is a pivotal element in professional codes of ethics of library and information sciences and professional standards of hospital libraries. Interactive and knowledge-based information (KBI) that is based on improvement of performance and finding clinical solutions (not just education without practical impact) have aided clinical librarians in protection of patients' rights in some countries.Considering the roles of libraries and information centers in collecting, organizing and making accessible the information for their users, librarians and information scientist should make effective utilization of information possible for healthcare clients, while taking into account their specific needs. Therefore, it is essential to compile professional codes of ethics containing the appropriate approach to disseminate information to patients and other healthcare clients, and to define specific roles for clinical librarians in hospitals and medical clinics.

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Birth of a poor prognosis neonate (premature and/or congenitally affected) may potentially burden the family and/or society with many ethical, social, legal, etc challenges. Most of the decision making criteria used in handling the care of these neonates, such as disability, quality of life, etc., are multidimensional and heavily ethical bearing. In this study, we have tried to explore and present a perfect view on the existing challenges and different dimensions of the discussed criteria. In the end, the prominent standpoint of the Islamic school in confronting a severely disabled newborn has been introduced and analyzed. Most related discussions boil down to some fundamental and unanswered questions, for instance whether human beings should be permitted to make decisions about the life of severely diseased neonates, the decision making criteria themselves and their appropriateness, etc. Even though many scientists have theorized on the subject, a multilateral explanation of life and death criterion has not been presented yet. One thing is for certain and that is, in answering the basic questions of the subject, our present knowledge and experience is limited and insufficient. The authors have tried to show that despite many western views, decision making about the life of a neonate has no place in Islamic teachings, since it could be considered an unauthorized human action. Instead, it is proposed that any attempt to provide an ethical rationale, while utilizing today's science and technology, be in compliance with God's commandments.

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By the late 1960s, there seems to be a growing number of articles in medical journals on the subject of the distress that many terminally ill patients declared they had gone through due to repeated resuscitations that only prolonged their suffering. This demonstrates that standard protocols of resuscitating any patient who is undergoing a cardiopulmonary arrest may bring about new problems. A review of studies shows that dealing with patients who are in the last days or hours of their life has been a major challenge for healthcare professionals, and making decisions on therapeutic approach is one of the most fundamental skills for healthcare staff. The scientific, ethical, religious and legal dilemmas in this field make decision-making difficult in some cases. In this paper, we reviewed articles published during the past 30 years, through which the views of health care providers including physicians and nurses on the issue of do not resuscitate (DNR) orders in different societies had been studied. The Islamic perspectives have also been discussed in brief. Moreover, DNR guidelines prepared by various countries such as America, Britain and Saudi Arabia have been assessed. For searching the related studies, we used authentic electronic databases and many reliable websites. Some articles were obtained through hand searching of the references of searched articles.The results showed that despite substantial studies, caring teams are still facing the challenge of DNR in different societies. In Iran, considering the religious values and beliefs, the matter needs more deliberation to help the caring teams to deal with the clinical issues. The religious and cultural background call for a national guideline to be adopted based on Iranian-Islamic culture. Education and awareness rising of different groups including patients, general public, healthcare staff, and health policy makers is crucial in all countries all over the world, and particularly in Iran.

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Narrative ethics is an approach that is well known for ethical education and moral development.  In narrative ethics, by using a story, its components and characters, ethical knowledge and awareness can be achieved. This approach is very useful in medical ethics education and is helpful in dealing with ethical dilemmas. In fact, part of ethical development, in addition to moral judgment, is to reinforce the ethical sensitivity in which narrative ethics can play a significant role for this purpose.This approach has been widely used for teaching morality in Persian literature and history telling, such as Mathnavi. Narrative ethics can be applied by telling stories about patients' life and their experience of illness. It can also be used to criticize and analyze the clinical situation and explore ethical challenges that healthcare providers face in their daily practice. Thus, it can help to prevent ethical conflicts by establishing interaction between ethical principles and patients' values. This paper emphasizes the application of this method in medical ethics education and ethical decision-making.    

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Medicine is a branch of health science with the purpose of maintaining health and health promotion, diagnosis, treatment and prevention of diseases, and rehabilitation of patients. In addition to possessing academic qualifications and legal training, physicians and service providers should be familiar with moral and jurisprudential considerations in their profession, as is rationally and logically expected.Respect for moral values ​​and legal principles is important since on the one hand it gives the service provider a feeling of fulfillment, and on the other hand it causes the patient to feel satisfied with the service offered.Islamic laws must be observed in all aspects of life in our country and medical practices are not an exception. Therefore it is necessary for all practices to be approved by jurists and to comply with the principles of Islamic jurisprudence and ethics. Consequently, practitioners need a thorough understanding of Islamic laws and ethics in order to be considered qualified. In this regard it should be remembered that Islamic jurisprudence, or Sharia refers to a set of laws and rules of life defined by the Quran and its interpretation and explanation by the great Prophet of Islam (SAW) and Imams (AS). In Islamic culture, law and medicine are closely related to each other. Many physicians are staunch followers of the Islamic jurisprudence and try to observe them in their diagnostic and therapeutic approaches, and in cases where they have dilemmas and are not certain what course of action to take, religious standpoint is what guides them to make the right decision. In recent decades, physicians have tried to apply Islamic laws in the context of medical or jurisprudential problems. This article investigates the realm of medical jurisprudence and medical ethics.

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Prevalence of epidemic diseases including cholera and plague was among the most common causes of death during the Qajar era, and the necessity of fighting such diseases was one of the priorities of the government. Acquiring medicinal and pharmaceutical knowledge from Europe and promotion of general hygiene were among the efficient ways of preventing outbreaks and epidemics. The process was started by Abbas Mirza through sending students to Europe and continued by Amir Kabir through the establishment of Darolfonun (the Polytechnic School). Modern medicine and pharmacy were introduced in Iran by European professors of the Darolfonun however, their development faced oppositions in the traditional society of the era. In this research, we are going to explain the process of development and promotion of the modern medicine and drugstores, based on the present references, and then proceed to examine the impediments in this regard.

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Moral intelligence is the capacity of understanding right from wrong, choosing what's right and then behaving morally. This research was aimed to determine the moral intelligence status of the faculty and staff of the Shahid Sadoughi University of Medical Sciences.This descriptive/analytical research was done through cross-sectional method in 2011. Research population was comprised of the faculty and staff of public health and paramedical schools of Shahid Sadoughi University of Medical Sciences. Sample size was 100 people who were obtained by using stratified-random sampling method. Required data was gathered by a Lennick and Kiel valid questionnaire. Data analysis was done through the SPSS16 software.Research findings indicated that both faculty and staff have "very good" status in integrity, forgiveness and responsibility. Also, faculty members and staff have "very good" and "good" status in compassion respectively. The status of moral intelligence in faculty members and staff is "very good". There is a statistical meaningful relationship between age and moral intelligence status (P=0.04) but there is no relationship between other demographic variables and emotional intelligence.Moral intelligence status of faculty and staff can help the university to conduct its role in moral development of students effectively.

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Considering the professional position of physicians, ethics is of great significance in medical society and being among medical sciences, dentistry is not an exception. This research evaluates the Shiraz dentists' knowledge of professional ethics especially in regard to patients' rights, which is recommended by American Dentists Association. This research is of descriptive/observational and cross-sectional type. The society studied in this research included all dentists in Shiraz who owned an office, out of which 97 individuals were selected through simple random sampling. To collect the data, a 20-question questionnaire was used. The reliability and validity of this questionnaire was approved, and collected data was analyzed by SPSS software. ANOVA test was used as a method of gaining correlation of age and knowledge, and T-test was used to gain correlation of gender and knowledge. Results revealed that the score of dentists' knowledge was 61%, which is equal to 11 out of 18 scores. There was no relationship between knowledge and age (P=0.67) or gender (P=0.68). Dentists must be aware of patients' rights, and reviewing ethical education in the faculty of dentistry is essential, and reaching this goal requires public participation and proper planning for training on this issue in Iran.

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In recent years, vaccination programs have advanced significantly due to the progress in molecular biology and biotechnology. Research on plant-made vaccines has become a very tempting subject and transgenic plant technology to produce human or animal vaccines has attracted much attention. Numerous advantages have been reported for vaccine production in transgenic plants such as low cost, ease of maintenance, lack of infection, and high compatibility with the immune system. So far, many of these vaccines are being produced in various plants. The present paper attempts to introduce plant made-vaccines and at the same time discuss the ethical aspects related to the production and clinical testing of these vaccines from three aspects: production of edible vaccines in transgenic plants, clinical tests on plant-made vaccines and plant-made vaccines and global health. Although many aspects of the ethical issues related to plant made vaccines are those that have been reported in transgenic plants, new problems have risen for ethicists and policy makers. Furthermore, the hope of the widespread use of these types of vaccines in developing countries without considering the possibility of plant surveys is unrealistic. Therefore, commercial feasibility for the development of plant-made vaccines in developing countries is very important as a solution to global health problems.

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Every organization has ethical codes and behavioral standards suited to its professional structure that are referred to as professional ethics. Higher education is a professional system and the faculty should be aware of ethical standards of teaching considering their role in developing students and their obligation to them. Applying professional ethics in education ensures the right teaching-learning process in higher education institutions and can result in more commitment to students' needs.The aim of this review article, which is based on literature and related books and articles, is to examine the professional ethics of faculty as teachers and their role in the education and moral development of their students in view of ethical standards. In order to do this, samples of Islamic ethical issues related to the subject and some educational ethical rules of other countries have been investigated. Based on the professional ethics of teaching, teachers should pledge to ethical principles in two dimensions: firstly, they should behave decently considering their role in the students' moral development, and should be aware that the most effective method to characterize positive values in students is being actual role models. Secondly, because of the teachers' responsibility in meeting the educational needs of their students, they should have maximal commitment to ethical principles to perform professional tasks in the best way possible.

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One of the important issues in the field of medical ethics is the patient's consent to treatment. This issue has also been addressed in the law, and Islamic legislators have clarified the conditions of gaining patient's consent and approached questions such as legitimacy of treatments or surgical operations, capacity of the person giving consent and so on. In medical ethics, there are different types of consent including expressed, implied and informed consent, while the Islamic Criminal Act concerns itself only with the expression of consent and it is unclear which type of consent the legislators are referring to. The importance of this issue lies in the fact that gaining the patient's consent without meeting the specified legal conditions causes liability for the physician. This article attempts to clarify the legal conditions for gaining patient's consent and at the same time answer questions such as whether the consent mentioned in the Islamic Criminal Act includes various types in medical ethics or not, how failure to meet the legal conditions for gaining consent should be penalized, what the liabilities are in the event that the patient's consent is not gained, and other questions related to the issue

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Recently larger numbers of women of advanced age are referring to fertility centers. Although there may be no age restriction for women who are naturally able to and want to be pregnant, using assisted reproductive techniques for women of advanced age is medically and ethically disputed, and this question is always raised: "Should there be an age limit for accessing assisted reproductive techniques for women?" This study was a review of ethical, legal and religious issues regarding pregnancy and reproduction in advanced age for women. We tried to cover codes, legislations and articles on the subject. There is no national legislation about age limit for women seeking assisted reproduction. In this regard, fertility clinics follow their own protocols. Most centers do not accept women older than 45 unless there is a specific clinical situation confirmed by a physician. In any case, the safety of the mother and her child must be the first concern of the physician, and all the treatment protocols should be determined accordingly. Obviously, age alone cannot be a suitable criterion for rejecting the infertile patient. Therefore, regardless of the patient's persistence and their ability to afford treatment, physicians should consider mother's safety and the welfare of the child before admission. Pursuing an all-inclusive legislation and guideline seems to be of great importance in Iran.  

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Trust is an important factor in the relationship between physician and patient. Trust between physician and patient is an important factor in improving patient and physician satisfaction, but it will not materialize unless we define trust and its criteria. Since trust fulfillment is dependent on its criteria, in this study we tried to define these criteria. First, we explicated the meaning and concept of trust through review articles, then we proceeded to content analysis, and lastly, the logical conclusion was obtained. In this article we have expressed scientific opinions and extracted 23 components from the cited opinions. We concluded that trust can be analyzed from three perspectives: the perspective of patients with 5 criteria, the physicians' view with 2 criteria and the perspective of an observer of the physician-patient relationship with 9 criteria.

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Moral distress is one of ICU nurses' major problems that can happen due to various reasons and may have several consequences. Considering that certain variables can be related to moral distress and turnover intention in nurses, this study was done to determine the correlation between ICU nurses' demographic characteristics and their moral distress and turnover. In this correlational study, 159 ICU nurses were selected from medical universities of Iran. Data collection instruments included a demographic questionnaire, ICU nurses' moral distress scale, and Hinshaw and Atwood's turnover scale. Data analysis was done by using SPSS 17_. The findings showed high level of moral distress and turnover in ICU nurses. The results revealed a positive statistical correlation among ICU nurses' age, their work experience, the ratio of nurses to ICU beds and their moral distress. However, there was no correlation among sex, marital status, educational degree, work shift and moral distress. Similarly, moral distress and intent to turnover did not have a statistical correlation.The results showed that increasing recruitment of young nurses and nursing staff, and diminishing ICU nurses' moral distress and turnover intention are essential.

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Nursing advocacy is an essential aspect of nursing professionals' ethics that promotes patients' autonomy, safety, and rights. It seems that nurses' attitudes toward nursing advocacy can affect their role as patients' advocates and improve the nurse-patient relationship. This study aimed to investigate nurses' attitudes toward patient advocacy in educational hospitals in Kerman.The data for this descriptive-analytical study was collected using a self-administered questionnaire by quota sampling among 385 nurses from four teaching hospitals of Kerman and analyzed using the SPSS software including descriptive and inferential statistics. Overall the nurses' attitude toward nursing advocacy was relatively positive. There was a significant relationship among nurses' attitude and age, sex, nursing experience and participation in workshops, while we could find no significant relationship between nurses' level of education and their attitude. The nurses' attitude in mental hospitals was more appropriate than others, and the majority of participants were confident that they were suited for the advocacy role.The cognitive aspect of nurses' attitude was stronger than the behavioral aspect. Despite the lack of significant effect of education, more nursing experience led to more willingness to play the advocacy role. In psychiatric hospitals, nurses with more independence and stronger relationships with the patients became more familiar with the needs of patients so these nurses made more effort to defend them. It seems Iranian nurses have felt morally obligated to defend their patients for many years. In order to support nurses' advocacy role in our country, we believe it is necessary to reinforce this attitude in nurses through holding ethical workshops.

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Confidentiality is one of the oldest principles of the medical profession that impacts on the relationship between physician and patient, the personal interests of patient and physician and consequently social welfare. While emphasizing the necessity of confidentiality, religious teachings consider disclosure of others' secrets a sin that deserves punishment thereafter. Nowadays, medical developments and the invention of new diagnostic and therapeutic procedures as well as the vastness of the informatics world make disclosure of patients' secrets easier than ever. This review article is the result of a descriptive study, and the information was collected using reliable library and internet resources. It will first expound the concepts and principles of confidentiality in medical ethics as well as Islamic ethics, and will then proceed to a comparative review of the similarities and differences in these two sets of­­­­ ethical views on the issue of confidentiality. In addition to the emphasis of medical ethics and Islamic ethics on the necessity of confidentiality in order to win public trust, both sets of teachings cover two areas of personal and public discretion, while in Islamic ethics, the issue extends to a third from, namely religious confidentiality. This makes Islamic ethics more comprehensive in the sense that based on Islamic teachings, the person who keeps someone's secret will also be rewarded in the Hereafter. Also, in medical ethics, only the behavior of the health staff is evaluated and their moods and motives are not taken into consideration, while Islamic ethics pays attention to human dispositions and therefore confidentiality is more stable and can maintain its efficiency without external supervision.