Iranian Journal of Medical Ethics and History of Medicine

Science of medicine is affected by metaphysics and non-experimental foundation, although it proves its issues by experimental methods. Nowadays, lots of evidence confirm the effects of metaphysical assumptions in experimental sciences including medicine. These assumptions are not experimental but have serious impact on determining the methods, structures, and orientation of science. In comparison with other experimental sciences, medicine is more affected because it concerns with one of human dimensions; which means the body. Each medical school, desirable or nondesirable, has a special viewpoint about the human and when it studies the body, issues like existence of soul and divine aspect of the man has a particular standpoint that cause change the in some of medicine’s directions. Then, study the metaphysical foundations in medicine is necessary. From which, we concerned the anthropological basis in this study that include: 1.Positivistic approach to man 2.Biological concept of man 3. Neglect of human’s spirituality 4.Mechanical viewpoint 5.Partailism approach 6.A purely material view of death. This article, criticizes these approaches. In conclusion, modern medicine has defaced metaphysical foundations which must be revised. As these foundations have influenced medicine’s methods and directions, evaluation of the aforementioned influence on medicine seems necessary.
 

Penetrative injury is one of the injuries which the legislator has mentioned in the fourth book of the Punishment Code: ''it's an injury which occurs by sinking of a tool like spear or bullet in hand or leg; the blood money for men is one tenth of a complete blood money and for women there is a “Arsh". Interestingly, the legislator has determined the sanction of this blood money as a complete blood money while in women it is just an Arsh. The foundation of this view is based upon some of the jurisprudents; however, contemplation in jurisprudential references shows that a group of other jurisprudents believe that blood money of penetrative injury is same for men and women. This essay examines the arguments of the two sides by a descriptive-analytic method. Then, it tries to prove the weaknesses of the view believing in an Arsh for women, it shows that the focus of the Islamic law is on the point that the blood money of penetrative injury is equal for men and women (both one tenth).

Involving children in their own treatment decision-making improves their abilities. Factors such as the ability to reason, previous children's experiences in relation to the subject as well as information, and their general understanding of the subject affect the child's ability to make decisions. The current laws of informed consent in children allow alternate decision makers to decide on their own. Our goal in this study was to examine the current conditions for the informed consent of children in to provide appropriate guidelines in this regard. In this qualitative study, participants were selected through targeted sampling. The data were collected by semi-structured interview with open questions. Coding and classification was carried out using continuous comparative analysis. Participants included 6 admitted children, 15 parents of children, and 4 pediatricians. Three general categories of "satisfaction culture", "environmental conditions", and "child world" were extracted. Parents and children were not clear about the purpose of obtaining consent. The gender of children was not significantly affected by the process of obtaining formal consent in medical settings. The existing conditions have created a non-appropriate balance in the expectations of parents regarding the treatment decisions and giving vital information and treating the child by doctors disregarding child’s competency. This defective balance can, in the meantime, cause instability and harm to human dignity and autonomy of parents and children, waste of resources, challenging the sense of trust in the community towards doctors and the lack of growth in child’s decision-making power.
 

Moral intelligence as a dimension of intelligence can provide a framework for the proper functioning of human. This function can be effective in the clinical environment such as dentistry. Therefore, the present study examined ethical intelligence of the first and sixth year dental students in the Tehran University of Medical Sciences. The present cross-sectional study was conducted in 2018 among 106 of the first and sixth year dental students. The students were selected by census sampeling and the Lennic & Kiel's Ethical Intelligence Questionnaire were used for data collection. The variables were analyzed by SPSS-Ver.22 software using descriptive and analytical statistical tests. Findings of the study indicate that there is no significant relationship between the ethical intelligence of the first and sixth year dental students. Also, in the first year students, only the indirect relationship between ethical intelligence and mother's education (P value = 0.026) and the level of household economic condition (P- value = 0.009) were found. In the sixth year students', only the direct relationship between ethical intelligence and the level of household economic condition was found (P -value = 0.015). This study showed that the ethical intelligence of dental students during education was not significantly improved, which indicates that the educational system not effecient on for promoting ethical intelligence of dental students.

This research reviews the scientific productions of the field of biomedical ethics based on articles published in Iranian scientific journals in Farsi (Persian language). The findings showed that from 2003 to 2017, researchers have published 1238 Persian articles in this field. The average annual growth rate of published articles is 23.17 percent, but this growth has been declining since 2013. The citation rate of articles (0.4 per article) suggests a small impact. Shahid Beheshti University of Medical Sciences and Tehran University of Medical Sciences with the publication of 36% and 33% had the largest share in the publication of articles, respectively. Biomedical ethics research was interdisciplinary and researchers from the medical, nursing, and law sciences played a major role in compiling and publishing them. The topics such as medical ethics, medical education, and Islamic ethics were, repetitive subjects in articles, respectively. Only 22% of these articles referred directly to funding provided by universities and research centers.

David Benatar, influenced by Nietzsche and Schopenhauer, sees the life of this world full of pain and suffering, and believes that not being in this world is preferred to be. The purpose of this article is to challenge Benatar's approach in an analytical and citation way. Benatar expresses two arguments for his claim. One is the argument of asymmetry and the other is the quality of life argument. In this paper, both of his arguments are explained and criticized. In the first argument, Benatar provides ample of evidence for his claim that he does not provide the preference for the pain and suffering which humankind experiences in this world. In the second argument, while ignoring the element of individual satisfaction and the independence of the personality of human beings, their judgments regarding their lives are considered to be due to optimism, and believes that humans, because of their ability to get accustomed to the conditions believe that their being is preferred to not being. By this statement, instead of solving the problem of suffering, he cleansed the principle of the problem and preferred not being. The morality of abortion, the immorality of reproduction and marriage, the validity of non-voluntary euthanasia, and the belief in the extinction of the human race are consequences of Benatar's approach, which are untenable.
 

Professional nurse should be familiar with the principles of biomedical ethics and how to deal with situations of moral conflict. Nurses encounter a variety of ethical conflicts in their work environments, which, if not properly educated for that, may be destructive. One of the first steps to recognize and help resolve moral conflicts seems to be a better understanding of the underlying causes of these conflicts. For this purpose, this study compared the exposure of pre-hospital emergency staff and nurses of the ophthalmologic departments in Isfahan with ethical conflicts in their careers. This descriptive-analytic study was performed on 44 pre-hospital emergency personnel and 42 nurses in ophthalmic and postgraduate degrees. Data were collected using Falco's moral conflict questionnaire. The results were analyzed using descriptive statistics such as frequency distribution tables, dispersion indexes, and mean and analytical statistics such as T test and ANOVA. Data were analyzed using SPSS software version 8. The results of this study showed that the prevalence of ethical conflicts among pre-hospital emergency personnel with a mean of 61.65 was higher than nurses in ophthalmic departments with an average of 40.23. Therefore, according to the results of this study, the degree of exposure to ethical conflict situations for pre-hospital emergency personnel more common in comparison with the staff of the elective hospital units in more stressful situations. The degree of exposure to ethical conflict situations is also more significant for pre-hospital emergency personnel than nurses in the ophthalmic departments.

Patients’ satisfaction of treatment centers is one of the most important indicators for the quality of care and treatment services. Taking care of patients’ satisfaction has essential role in managing programs of health services. The aim of study was to evaluate patients' satisfaction with the quality of services provided in Shahid Beheshti Hospital in Qorveh in 2015. The research method was cross-sectional and descriptive-analytic. The statistical population of the study consisted of 384 patients selected in one stage cluster sampling from different parts of hospital. Patient satisfaction was evaluated by means of questionnaire that its validity and reliability was confirmed. Information was analyzed by statistical software SPSS 20 and t-test. The results showed that most of satisfaction was related to the emergency department and the lowest levels of satisfaction was related to ICU. Overall satisfaction from health services of Shahid Beheshti hospital was 72%. In this study, the satisfaction and habitat of patient had meaningful relationship, but other factors had not significant relationship with patient statisfaction. In recent years, patient satisfaction had an acceptable level due to dramatic improvements in health system. Nevertheless, the problems and weaknesses in the health care field also should be concerned and resolved and we have to improve the quality of services.
 

Superior ethics badge (NAB plan), that is election of most moral person, best nursing and midwifery in a university is a kind of professional ethics. The purpose of this study was to investigate the effect of the implementation of the NAB plan on the professional ethics of nursing staff in Baharloo Hospital. This semi-experimental study was done in before and after design. A 360-degree questionnaire as a data collection tool was used to assess ethical nursing staff in a checklist consisting of 5-4 questions. The five-choice Likert scale was used to describe the data from the central indices and in the inferential part, the t-test, for independent and dependent variables, repeated measure ANOVA and ANOVA were used. The results of the present study showed that the implementation of the NAB plan has a significant effect on the ethics of the nursing staff from the general viewpoint of the evaluators (P <0.001). Also gender, age (30-20 years old were more than 30 years old), education, employment status (formal, covenant, etc.), marriage status and work experience in implementation of the NAB plan had a significant effect on professional ethics of nursing staff but the interactive effect of participants' demographic characteristics was not significant. The results of current study showed that the implementation of the NAB design (superiority of ethics) in Baharloo Hospital promoted the professional ethics of the nursing staff.

Spiritual intelligence is a set of personal capacities that helps to adaptation and problem solving. The aim of this study was determining domains and construct validity of cultural and religious context of spiritual intelligence scale in Iranian students. In this mixed methodological study, we assessed the existing scales, and selected 62 items. Then we interviewed with 67 students and derived 42 items. We determined the scale construct validity by exploratory factor analysis with 1000 students' samples that were selected by stratified random sampling from universities. The ethics permission of study was obtained from ethical committee of Tehran university. Factor analysis reduced items number from 104 to 39. Among 10 dimensions in theoretical model, 7 dimensions explained the 60.21% of scale total variance. These dimensions were meaning perception and religious works effect; perception and extension of consciousness; perception of extraordinary phenomena superior than material being; existential critical thinking; personal meaning production ability; problem solving by using spiritual resources, and spiritual adaptation in interpersonal relationship. Inter items’ reliability was determined by internal consistency as 0.731 to 0.906 and the scale total reliability was 0.945. A 39 items’ spiritual intelligence scale with optimal psychometric properties and acceptable structural model based on Iranian religious and cultural practices can be used as a valid and reliable scale in community of Iranian students.
 

The most important conditions necessitating Hajj are financial affordability, physical, and psychological capacity. Most persons who become bound to make the Hajj ignore the psychological capacity. Each year many persons lacking psychological capacity, go on Hajj and cause other mentally qualified people deprived of travel. A number of these pilgrims undergo medical treatment or are hospitalized during their travel and some of them are returned back to the country. No study has been carried out so far on these special conditions, psychological capacity, of Hajj. In quantitative part of this study, information of all records existing in the medical center of Hajj during 2012-2015 was extracted. The information was analyzed by assistant psychiatrist, professor, and physicians based on DSM-IV-TR standards. In qualitative part, systematic information was extracted from authorities of Hajj organization. From studied records related to psychiatric disorders, cases of schizophrenia and psychotic disorders were identified as lacking mental and psychological capacity. The results of this study showed that about 16% of the people with mental disorders such as schizophrenia and psychotic disorders, and that their dispatch to Hajj's journey was in contradiction with the principles of jurisprudence and ethics. This study can be regarded as a religious and ethical guide for identifying the examples of people who have been deprived, to help policy makers of the Hajj system to apply more strict monitoring of the dispatch of pilgrims, eliminating the time spent by other pilgrims and defusing national pride, and helping to replace eligible people instead of those who are not qualified for Hajj.

Today, health care providers are moving toward becoming professionals, so only academic knowledge and skills are not enough in complex medical environments, morality is an integral part of medical decision making and paying no attention to it may have adverse effects on quality of care. This Research investigated the moral intelligence and its relative demographic factors between medical and nursing students. In this descriptive cross-sectional study, 214 students were selected by census sampling. Data were collected by using Kiel & lennik questionnaire which its reliability is reported as r=0.94 and has been validated in previous studies. The mean age of students was 21.79±2.82 years. The moral intelligence mean scores in medical and nurse students were 76.44±7.10 and 74.07±8.26, respectively. There was no significant relation between demographic factors and moral intelligence scores but there was significant difference among nursing and medical (p=0.025) and the first and last year students (p=0.002). Trustworthy domain was significantly higher in medical students (p=0.003). Although the results indicate that the students' moral intelligence score is in good condition, this situation can be upgraded to be very good and excellent. The significant difference in the score of moral intelligence in first and last year students shows the effect of educational curriculum. There was significant difference in the scores of medical and nursing groups. So, the educational climate and curriculums can effect on moral intelligence development. Therefore, considering the proven effect of moral intelligence on the quality of professional performance, ethical dimensions, and professionalism in clinical education should be emphasized, evaluated, and monitored more than ever.

The increasing number of social and individual problems caused by occupational stress have been indicative of the ineffectiveness of the previous models despite many attempts. This article is intended to measure the current status of organizations in order to correct and reduce staff stress. After obtaining the reliability and validity of the model derived from the review of literature and interviews and the questionnaire of expert opinion, the model test required a field study, so a researcher-made questionnaire was developed with the allocation of 90 items. The questionnaire was prepared for distribution in the high-stress zone of six hospitals including public, military, and private hospitals. After receiving the opinions of the employees in the high-stress zones and analyzing the findings of the statistical population, the conceptual model of occupational stress management from the point view of Islam was obtained and it was based on "God-belief, continuity of life after death and centrality of ethics". Considering that hospitals are one of the most important occupational organizations, the model test was used in the high-stress zones of hospitals' and proved the researchers’ hypothesis. So, the obligation to strengthen religious beliefs was explained in these organizations and the model of occupational stress management of employees from the Islamic point of view was confirmed by assessing the status of organizations. The indicators, components, and dimensions of the above model can be used by authorities of health policy such as Iranian medical council, the ministry of health and medical education, and medical sciences’ universities.

Capacity, positive attitude, and proper nurses' function in dealing with death are greatly influenced by their religious beliefs. An important religious variable, the type of internal religious orientation (Implementing religious beliefs in all behaviors and practices) and the external (Using Religious Beliefs to Achieve Material Objectives). The purpose of this study was to investigate the relationship between religious orientation and nursing students' attitude towards death. The study had a cross-sectional correlational design, where 202 students from all nursing students were selected by random sampling in the academic year of 2017-2018. Data were collected via Allport Religious Orientation Questionnaire and the Standard Scale of Attitude toward Death (DAP-R) which were completed by participants after confirmation of validity and reliability and obtaining written consent from participants. Data were analyzed by SPSS version 18 software and independent t-test and Pearson correlation coefficient. Participants included 51.5% females, the average age was 21.7 years, 89.6% single, 95.5% undergraduates, 53% resident of the dormitory, 94.6% Shiite, and 50.5% had experience of seeing death. The average score of internal religious orientation was higher than that of the outside; and it was the same in both sexes. The difference between the mean score of internal orientation and the active acceptance of death was a positive correlation (P <0.001) and with avoidance of death, it had a significant negative inverse correlation (p= 0.01/0.17); Exterior orientation with fear of death and acceptance by escape had a significant positive correlation (P <0.001); the difference in mean score of both religious orientations was not significant in terms of gender, marital status, and religion (P>0.001). The difference between fear of death and avoidance of death and acceptance by escape based on gender, and in terms of admission or escape, having experience of seeing death, had a meaningful relationship (p=0.01). While there was no significant relationship between attitude toward death and family death experience (P>0.001). Findings show the type of religious orientation of nursing students and its relationship with people’s attitudes toward admission or escape from death; as the effective factor affecting the health of individuals and the quality of providing care for dying patients.

How can we determine that death has occurred? To answer this question, two points should be noted. First, in order to determine the incidence of death, there should be a standard for determining the occurrence of death; secondly, we need to determine certain clinical tests to determine whether the criterion has been met. In this article, we first introduce different criteria that are presented in different definitions of death, and then offered arguments against each of them. Cardiopulmonary and brain criteria are also introduced and criticized. The basic objection in these definitions is that they see death as an event. At the end, it will be argued that biological death, contrary to conventional wisdom, is a process, not an event. Based on this understanding of death, we provide a definition that addresses the problems of other criteria and shed new light to some issues related to death such as euthanasia and brain death.

It is a widely held belief that "health care" is an old concept. As one of the most important institutions dealing with this issue, the hospital has been treating human beings throughout human civilization. But historical studies show that, in the pre-modern era, the hospital was not for the treatment of patients. Its function was as a nursing home for the poor and patients. In this article, we attempt to examine the reasons for this in two ways. We first examine the socioeconomic conditions that led to this function for hospitals in the middle ages. We then show that the treatment of patients at that time was based on humorism and classification medicine, which was not only considered the hospital as a place of treatment but also considered it as a barrier to treatment. Therefore, the hospital served as a hospice for the elderly and disabled, and veterans.
 

Emotional intelligence and critical thinking are important factors affecting professional performance and mental health of health care professionals. In this research, the relationship between emotional intelligence and critical thinking is investigated. This is a descriptive-correlational study. The statistical population of this study was all nurses working in hospitals affiliated to one of medical universities located in Iran in 2016. The sampling method was random. Using Cochran formula, 174 subjects were obtained. The main tool for data collection was the Bar-On Inventory and California Critical Thinking Skills Questionnaire. The validity of the questionnaire was confirmed by the professors and reliability was calculated using Cronbach's alpha coefficient for emotional intelligence and critical thinking questionnaire 0.82 and 0.79 questionnaire. The mean scores of emotional intelligence in nurses working in studied hospitals were 3.46±0.78 of 5 and the average score of critical critical thinking nurses was 22.66 out of 34. Also, Pearson coefficient confirmed the significant correlation of all components of emotional intelligence with critical thinking. Among the components of emotional intelligence, social skills have the most positive and meaningful relationship with critical thinking. There is a positive and significant relationship between emotional intelligence and critical thinking of nurses working in studied Hospitals. Therefore, selecting students and employing nurses based on the measurement of emotional intelligence and critical thinking will improve the performance of nurses.

Patient rights is one of the essential rights that should be considered by the medical staff, checking and comparing the attitudes of first and last year medical students to inform the ethical points of service delivery is important. The aim of this study was to compare and evaluate of first and last year medical students' attitude about respecting patients' rights in hospitals of Bushehr University of Medical Sciences. The present study was a descriptive, cross-sectional study carried out by using a questionnaire derived from Patient Right Charter approved by the Ministry of Health. The study population included all the first and last year of medical students of Bushehr University of Medical Sciences. The sample size was 113 and the sampling method was census. By using independent t-test and Pearson correlation, data analysis was performed by SPSS19 software. The attitude of first year students' was 76.36 ± 13.90 and among seniors was 71.63 ± 8.08, which was statistically significant (p<0.05). %52 of first and %84 of last year medical students had respectively and relatively favorable attitude regarding patients' rights. There was not statistically significant relationship between students' attitude and demographic factors. First year students had a better attitude among patient rights than the last year students. Therefore, planning to improve the students' attitude of observing patients' rights during the years of study is recommended.
 

In this research, an intercultural comparison between medical students from Iran and England was made to investigate the potential impact of culture on empathy and the relationships between empathy and child birth order in the family. The population consisted of medical students of medical universities from three cities: Tehran (Iran), London and Sheffield (England). The sample consisted of 182 students from two countries (88 Iranian, 94 English) which was selected by convenience sampling method. Data was collected by scale of empathy- student version and researcher made demographic questionnaire. Data was analyzed by using student’s t- test, MANOVA and Scheffe post hoc test. Results showed that the physician empathy of Iranian medical students is significantly higher than English students (P <0.01). Also the results showed that birth order of students has a meaningful correlation with their empathy (F=2.96,P<0.05). The results of multivariate analysis of variance showed that in the empathy variable, empathic care and self-care is more than English students rather than the patient of Iranian students, but they do not differ in the component of adopting the view. The result of this study reveals the importance of cultural differences and family factors such as birth order on personality factors for instance the physician ability to empathize with patients.
 

Nowadays, transplantation is the final treatment for the patients with end-stage organ dysfunction. Considering the importance of the organ donation and the important role of teachers in raising the knowledge and attitude of a large group of people, the present study aimed to determine the level of knowledge and the attitudes of the teachers in Sanandaj regarding organ donation. This study was a descriptive-analytic (cross-sectional). A total of 250 teachers working in the first and second level of high school in Sanandaj city were selected by cluster sampling method in the academic year 2017-2018 and completed the questionnaire on knowledge and attitude towards organ donation. Data were analyzed by SPSS software version 20, independent t-test and ANOVA. The findings of this study showed that 152 (60.8%) had moderate knowledge and 92 (36.8%) had high knowledge about organ donation. 166 teachers (66.4%) had moderate attitude and 81 teachers (32.4%) had high attitude toward it. 90.8% of teachers lacked donation cards, while 144 (57.6%) were inclined to receive a donation card. According to the results, the knowledge and attitude of the majority of teachers were moderate and most of them did not have a donation card. Considering the importance of this effective group in raising the culture and knowledge of students and their families in the community toward organ donation, education and preparing appropriate background for receiving, raising knowledge, and attitudes toward organ donation for the teachers are required.