Iranian Journal of Medical Ethics and History of Medicine

The criminal responsibility of physicians and assistants is a complex area of ​​medical law. The purpose of this study was to investigate the responsibility of medical residents and medical students in performing diagnostic and therapeutic measures with case study of forensic medical files in Fars province from 2012 to 2017. In this study, 63 plaintiffs' cases were assessed, including 33 males (52.4%) and 30 females (47.6%). Most of the complainants were illiterate and under-graduate, and the least frequent was at doctoral level. Regarding the physical condition of the plaintiff (patient), the highest frequency was related to death ( 73%). Most of the complaints were from treatment group (95.2%) and physicians (4.8%). In terms of field of study, the field of obstetrics and gynecology (44.4%) included more complaints than other fields. In total, 26 (41.3%) cases were finally acquitted and 37 (58.7%) were convicted. The most common type of failure was neglect (91.9%). In this study, the highest frequency of associate education was related to senior resident (11.1%). Based on the results of the present study, medical errors were made by trainees (interns) and residents, specifying the criminal responsibilities of medical students and residents for errors and omissions and explaining their findings. Educational materials in each course are of particular importance. Additionally holding forensic courses and defining the legal and criminal responsibility for medical students are important for the improvement of treatment quality
 

A study on the adaptability of the patient's admission process with ethical standards has a significant role in reducing the misconduct of the medical staff and increasing the satisfaction of patients. Hence, by the study of the patient's admission process in the Neurosurgery ICU and the identification of its personnel faults; we are going to provide a platform for excellent service to patients. This study is a qualitative study. It had done with the In-depth interviewing with 28 staff of the Neurosurgery ICU of Loghman Hospital during the winter of 1396 (December2017- March 2018). The data is collected and analyzed with triple coding: open, selective, and axial. "The lack of ethical sensitivity to nursing profession and its importance" is a general tag for seven categories of functional status of ICU staff: the use of staff with insufficient professional competence, the impact of staff tastes in professional relationships, irrational expectations, lack of communication skills, the inability to admission new patients and work in other health centers. Accordingly, "the lack of moral sensitivity to the profession and its importance" in the ICU staff is a central phenomenon that results from neglect of the importance of developing transparent processes for various activities in the ICU, as well as the lack of professional training. This will make the ICU staff ignore the implementation of the defined standards, and subsequently  the decline in the quality of health care services in ICU.
 

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

The possibility of mistakes, negligence, injuries and damages in medical activities could give rise to a civil or criminal case. In such cases, resorting to experts’ opinion is necessary. Forensic medicine organization has important role in such cases. Therefore, understanding of the criteria used by experts of this organization is important and could give rise to awareness of doctors and reduce their professional failures. This is a practical research with a descriptive and analytical method and its necessary information are collected by documentary studies. This investigation shows that medics normally try to have correct medical diagnosis and select appropriate process, and treat patients through reasonable methods to reduce their suffering and pains. It is possible that medics make a mistake in their diagnosis and treatment. Although the result of medical treatment are not guaranteed always, they have to do their treatment and operation according to reasonable and scientific standards and any recklessness and negligence causes criminal or civil responsibility. Reflection on the medical cases shows that the reasons of medic’s conviction can be divided into two categories including pre-treatment and post-treatment factors. Pre- treatment indices contain errors related to diagnosis or choice of treatment.

Increased patient satisfaction can promote patient’s compliance with prescribed treatments and improve patients’ health. The aim of this study was to determine the patients’ satisfaction with nurses in surgical departments of Imam, Razi, and Golestan hospitals of Ahvaz city in 2018. In this descriptive-analytic study, patients over 18 years of age with at least 3 days of hospitalization were studied. Data including age, sex, marriage status, level of education, type of illness, hospitalization time, number of hospital admissions, and health status were collected through a demographic form. Patients’ satisfaction with nurses was obtained by the satisfaction questionnaire of nursing services. Chi-square, one-way analysis of variance, Kruskal-Wallis analysis, Mann-Whitney test, and Spearman correlation coefficient were used to analyze by SPSS software. Patients’ satisfaction in Imam, Razi and Golestan hospitals were 78.25±12.09, 68.30±11.24, and 58.09±17.42, respectively. Highest level of patients’ satisfaction was with Razi hospital nurses (P-value<0.05).There were no significant difference between patients of different hospitals regarding age, marriage status, place of residence, hospitalization history, and education level (P-value>0.05).With increasing age, having a history of admission, an increase in the duration of hospitalization, the patients’ satisfaction score decreased significantly (P-value<0.05), but there was no significant difference between the patients’ satisfaction by marriage status, place of residence and level of education (P-value>0.05). It is suggested that effective strategies for increasing patients’ satisfaction be applied through more care and attention of more sensitive people. Also, increasing awareness of  the community about the duties of patients, nurses, and medical staff is recommended.

The purpose of this research is to investigate association between social influence, productivity, and performance among researchers of medical ethics field.  This research was done using common methods in scientometric studies with the method of co-author and network analysis. The statistical population of the study consists of all articles published in journals in the field of medical ethics, which were indexed in the database of web of science in the period of 1978-2017. A total of 14,231 articles and 20,845 researchers were surveyed. Data analysis was done using UciNet and SPSS softwares. Research findings based on the social influence that calculated for each researcher. The study of relationship between social influence and performance showed that there is positive correlation between performance and degree centrality. However, there is a negative correlation between performance and closeness and betweenness centrality. Also, the relation between social influence and productivity showed that there is a positive and significant correlation between social influence and productivity indices. The results showed that the researcher who have a good status in terms of performance, have a high social impact. In addition, researchers who have a high degree centrality are in a favorable position in terms of productivity and performance.

The first definition of sexual harassment which comes to mind is a behavior with force and violence. But is sexual harassment restricted to these behaviors? Apparently, sexual harassment comprises of a wide range; a range with rape on its one side (article 224 of the Criminal Code) and using offensive words (article 619 of the Ta’zirat part of the Criminal Code) containing sexual concept on the other. The conduct and talk which causes harm to someone just because of his/her sex. This concept is consistent with the spirit and purpose of the tort law which is for protection of victims. Moreover, this concept makes our legal system in line with other legal systems’ movement. However, Sexual harassment usually happens without the consent of the victim and by the use of force. But sometimes despite the consent of the victim, this consent is considered null and void since it is the result of duress, fraud, or pressure. Sexual harassment causes different types of damages such as physical or mental which have to be compensated in accordance with the “no harm” principle. In our legal system, blood money and the sum of money which is paid for the loss of virginity and the criminal relish are considered as different kinds of compensation. Also, mental and moral damage is awarded according to article 1 and 9 of the Iranian Civil Liability Code, and 14 of Iranian Criminal Procedure Code. Knowing legal aspects of this issue leads to respecting of moral aspects. Additionally, in this article, the sexual harassment as well as its related damages and compensations under Iranian law are investigated.

In recent decades, the concepts of healthy lifestyle and healthcare choices have been the subject of focus by healthcare policymakers. Together with financial, mental, and ethical reasons for citizens to have a free hand as far as their healthcare, numerous arguments based on the social aspects of healthcare have also been made by proponents of the necessity to limit these options by government, believing that in addition to personal consequences, an individual's healthcare choices have social ramifications as well. On the other hand, the definitions of the concept of freedom along with the impressionability factor of the individual's healthcare choices to government and society are other parameters that affect government policy in this area. By looking at the meaning of freedom from both the functional and opportunity creating standpoints, we have attempted to demonstrate that the optimal definition of freedom in the healthcare system is a responsibility based freedom in which it is although limited by the government, a person still maintains his individuality. According to the findings of this study, without establishing the necessary prerequisites by government and society, the freedom and equality of individuals in healthcare choices is meaningless. In this context, the special role of government is to create a balance between the individual rights and public interest as well as to cultivate responsible and well-informed citizens to protect themselves and others, building a society that would not allow the withdrawal or disregards of the right to freedom.

Moral sensitivity is the first step in making a moral decision and taking a moral judgment. An effort to promote nurses' moral sensitivity, education of ethical concepts, and using appropriate approaches to teaching ethics is still under discussion. Thus, this study was conducted to determine the effect of virtual teaching of ethical principles through narrative method on the ethical sensitivity of critical care nurses. In this quasi-experimental study, 60 critical care nurses were studied in two groups of test and control in 2 hospitals. The experimental group was taught ethical principles through virtual narrative method. Demographic information and Latezen moral sensitivity questionnaire were completed by nurses on three occasions (before, immediately after and two months after virtual education). Data were analyzed by SPSS 20 software. Results showed that the mean and standard deviation of nurses' moral sensitivity were 61.53 ± 9.24 before intervention and (60.60 ± 7.76 for the control group, and the association was not statistically significant (p> 0.05). However, there was a significant difference between the experimental group (77.50 ± 6.05) and the control group (60.83 ± 8.07 in the first post-test. In addition, there was a significant difference between the experimental and control groups (p <0.05) in the second post-test. Repeated measure analysis showed a significant difference between the ethical sensitivity scores in the experimental group, but no significant difference in the control group. According to the findings, the nurses' moral sensitivity was moderate at the beginning of the study, but after the intervention, the test group was at a high level and the control group was still at a moderate level. Thus, it is necessary to motivate nurses for recording and sharing their ethical challenges. Accordingly, they can promote their own ethical performance. Furthermore, their narratives can be used for education of other nurses and students of nursing.

Jundishapur was built during the Sassanid Shapur era to house Roman prisoners, and a scientific school, especially in the field of medicine was established there. Jundishapur's urban and scientific identity are intertwined with three concepts of Medical knowledge, Syriac, and Christian Christianity. In this research, the establishment of the Nestorian dynasty in Jundishapur, as well as the distinguished position of these physicians in the flourishing of Islamic civilization, has been studied and recognized. Therefore, this issue will be explained and highlighted by analytical descriptive method and relying on library resources. After the rise of Islam and the conquest of Iran, the medical elites of Syriac and Nestorian Jundishapuri; in particular, the Bakhtishoo, Masouyeh, and Maserjuyeh families continued to incorporate the medical traditions of various nations and the translation of Greek medical texts into other languages at Jundishapur Hospital. With the employment of prominent people of these dynasties in the Abbasid Caliphate of Baghdad, human resources, academic, and clinical achievements and the results of centuries of experience of Jundishapur Hospital Medical Center in compiling and translating medical texts have transferred to Islamic civilization by them.

The "Legal language" has provided a strong supportive argument for right to health advocacy. In such a way that, human rights rules has been established as the most important globalized political value at the heart of the theory and practice of public health discourse. Its power of enforceability guaranties fair distribution of health resources in each country. At the same time, the right to health, the “Right-claim” which has been identified by international and national documents  requires preconditions that will not come true without the proper cultural, social, economic, and political infrastructures, in general the factors shaping the "context of people's lives”. In other words, a legal reasoning for right to health can be followed by an argument for the right to health determinants. Therefore, by adopting an epistemological approach, this paper presents a legal narrative of “governance for health”. This paper creates a new perspective on the "right to health" debates. Additionally, it provides powerful arguments that health policy should be based on a perception of factors with major impacts on the people health and what have being described as "health hazard", "health protector", and "health promoter". However, this claim for right to health as an "individual enforceable right" is criticized, and there may be theoretical and practical obstacles to the full realization of this human right.

Undesirable experience as “moral distress” is one of the major issues faced by nurses when making moral decisions. The spiritual dimension is one of the dimensions that influences their moral distress; therefore, this study was conducted with the aim of determining the relationship between spiritual health and the moral distress of nurses working in the emergency departments. In this descriptive-analytic study, 140 nurses working in the emergency departments of the educational and medical centers of Hamedan participated by census sampling. Data were collected through a three-part questionnaire, including demographic information, Paloutzian and Ellison spiritual health questionnaires and Corly moral distress questionnaire. The data was analyzed by Chi-square test and Pearson correlation coefficients using SPSS software, version 16. The mean age of participants was 31.9 ± 7.31 years. The spiritual health score and moral distress of most nurses were moderate. A negative and significant correlation was observed between spiritual health and the severity of nurses' moral distress, (r = -0.200, p = 0.05), meaning that the higher the nurse's spiritual health score, the lower their moral distress. The results indicate that spiritual health is an effective parameter in reducing moral distress in nurses, so it is suggested to pay attention to spiritual’s dimension in promotion of nurses' health.

Military psychologists and mental health professionals live and work alongside their potential patients. For the most important concerns of military psychologists are multiple relationships, confidentiality, sudden role shifts and avoiding harm. The purpose of this study was to explore experiences of the military psychologists regarding ethical challenges in the counseling centers of one of the Iranian military forces. This qualitative and content analysis study was performed on 31 military psychologists during 2019. Participants had a master's degree in one of the psychology majors and 5-15 years of work experience. Data were collected by electronic questionnaire, due to access difficulty. The most important challenges of professional ethics mentioned by the participants included boundaries of competence, confidentiality, multiple relationships, and sudden role shifts. The results of this study showed that one of the problems affecting the performance of military psychologists is ethics’ issues and its challenges. Thus, according to this study, to better manage possible ethical challenges for military psychologists, they are suggested to participate in workshops and become acquainted with important ethical decisions and ethical conflicts inherent to military settings, be active in obtaining consultation and supervisions, and involve themselves in self-monitoring programs to consistently make good ethical decisions.

The aim of the present study was to determine the relationship between sensory processing sensitivity and cognitive-emotional self-regulation by mediating moral characters among students. The study participants were 293 students of different fields and levels of Shiraz University (Medical Sciences and the Ministry of Science) who were studying in the academic year 2018-2019. To measure the variables of study, three high personal sensitivity scales (sensory processing) of HSPS, ethical sources and CERQ-P cognitive adjustment scale were used and to evaluate the proposed research model, structural equation modeling (SEM) was applied by using AMOS software; intermediate relationships were also tested using the Bootstrap method. The results of the structural equation model showed that Cognitive aesthetic sensitivity directly (p <0.01, β = 0.67) and also through positive moral characters (p <0.01, β = 0.26), predict cognitive self-regulation, positive emotion. In other words, people who better understand the subtle differences in the environment try to change the amount and type of emotional experiences; they are also more successful at doing so. On the other hand, the ease of direct and positive stimulation (β = 0.31, β = 0.33) and the mediation of negative moral characters (0 = 0.01, β = 0.12) can predict cognitive-emotional and negative emotional self-regulation; in fact, people with low sensory thresholds are less likely to cope with stressful situations and misbehaviors, and use inconsistent emotional strategies. Finally, positive moral sources directly predict positive cognitive-emotional self-regulation (p <0.01, β = 0.30), and negative moral sources directly predict negative cognitive-emotional self-regulation (p <0.01, β = 0.38).

The observance of professional ethics standards’ is inherent nature of nursing profession. Observance of ethical standards by them will be an effective factor in improving performance of patient care and affecting the quality of health care. This study was conducted to determine the facilitating and Inhibitory factors of professional ethics from the perspective of nurses. This cross-sectional descriptive study with the participation of 367 nurses in Masjed-e-Soliman hospitals was performed in 2019. The data collection tool was a questionnaire of facilitating factors in the three dimensions of management, individual, and patients and inhibitory factors in three dimensions of management, environmental, and individual care; design, validity, and reliability of the questionnaire was reported by Dehghani. Data analysis was analyzed using SPSS version 22 and statistical tests. From the nurses' point of view, facilitating factors to follow ethics were: sufficient personnel in proportion to the number of patients (64.6%) in the managerial dimension, proper interpersonal relationship between colleagues and other treatment teams (60.3%) in the individual dimension;. appropriate treatment of patients with nursing staff (59.1%) in the patient dimension. The most important inhibitory factors were: lack of attention to the ability and skills of personnel during the division of labor (71.2%) in the managerial dimension; crowded and busy wards in environmental dimension  (69.6%); shortage of time in the individual and care dimension (66.4%). In this research, most important facilitating and inhibitory factors for following professional ethics standards in nurses was evaluated. Due to the necessity of observing the standards of professional ethics in nursing performance, the managers of health care organizations can observe the current situation by conducting periodic studies in the field of professional ethics from the perspective of nurses and patients.

Modern infertility treatment methods, along with favorable results, sometimes bring about unfavorable consequences. Multiple pregnancy is one of those consequences that puts the health of mother and life of fetus in danger. Fetal reduction, namely removing one or more fetuses with aim of preserving pregnancy and also certain preventive measures such as transfer of fewer fetuses into uterus of mother in each cycle of In Vitro Fertilizations (IVF), is one of solutions to tackle this unfavorable consequence. In a number of legal systems, along with a permission to conduct fetal reduction, precise provisions on the number of transferable fetuses are enacted. A comparative study of fetal reduction in countries in which there is an experience of legal encounter with this issue shall open a horizon for the legislator and policy makers in the field of health in Iran, where there is no consistent laws or regulations in this context, so that they adopt an appropriate approach to the problem. It seems that a fetal reduction permission, limiting regulations on the number of transferable fetuses, and proper insurance coverage embody an appropriate legal system in the context of fetal reduction.

The necessity of governing ethics is desirable in the work environments and is universally accepted. Ethical performance is based on the ethical criteria that employees are expected to adhere to. The purpose of this study was to determine the relationship between ethical educational needs and ethical efficiency in health workers of Sistan province. This is a descriptive correlational study. Data of 377 healthcare providers of Sistan rural areas were collected through a multi-stage cluster sampling method.  Information was collected with a valid and reliable questionnaire. The data were analyzed by SPSS 19 software using descriptive correlation, independent t-test, one-way ANOVA, and Pearson correlation coefficient. The results showed mean score of the need for ethical education of health care providers was relatively high (with respect to the maximum of the score), and the ethical performance of health care workers was low. There was also a significant and inverse relationship between score of ethical educational needs and ethical performance of health care providers (P >0.05). Based on the results, there was a significant and inverse relationship between ethical educational needs and ethical performance of health care providers. Providers who had a higher level of information and less educational needs had higher ethical performance. So, implementation of educational programs based on ethical educational needs is recommended for increasing ethical performance of health care providers as they are first-line practitioners who interact with people and health care clients.

Muslims learned how to build a hospital using the experiences of physicians from other nations, especially Iranians, by modeling at Jundishapur Hospital, and this way set up many hospitals. In addition to building a variety of hospitals, Muslims created efficient structures and organized them based on bosses, deputies, stewards, supervisors, nurses, and the like, who served in different parts of hospitals. In Islamic hospitals, male and female physicians with various specialties treated patients regardless of religion or race. Using a descriptive-analytical approach based on library information, this research seeks to answer the question of how the structure and organization of hospitals in Islamic civilization have been. Findings of the present research verify that hospitals in Islamic civilization had a well-organized and efficient structure, and various medical departments. Findings also indicate that the structure and organization of Islamic hospitals have evolved over time.

The long-standing interaction of philosophy and medicine has assumed to be as follows: great physicians have been also philosophers, so there is a relationship between medicine and philosophy. In this paper, based on philosophical modeling, essentials of interaction for medicine and philosophy are presented. First, brief descriptions of two models of medicine-philosophy interaction are presented: Galen and Avicenna. Then, the distinct and innovative model of Fakhr Razi- that has been seriously neglected- will be descried. Galen believes “The best doctor is also a philosopher (logic and ethics)”. The logic helps physician to provide accurate diagnosis while the physician-patient relationship is regulated by ethics. Avicenna concerns more with the epistemological foundations of medicine, the position of medicine in the classification of knowledge and the importance of theory of medicine. He argues that philosophical debate on fundamental medical concepts is neither useful for medicine nor philosophy. Fakhr Razi's model can be described as Socratic Method, that is, understanding through dialogue based on questions and answers. His book called “Sharh Kulliyyat al-Qanun fi al-Tibb” (Commentary on Canon of Medicine) is philosophical reflection on basic concepts of medicine and It could be considered as of one of the first texts in medical philosophy. The main goal of his philosophical reflections seems to provide a deeper understanding of medical knowledge and its application in practice.