Iranian Journal of Medical Ethics and History of Medicine

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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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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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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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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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Healthy volunteers are the first group who take part in experimental studies on the efficacy of new drugs. Parallel with expanding the boundaries of medical science, medical research has shown rapid growth which has caused new and critical ethical challenges in medical research.A clinical trial is one of the essential methods in clinical research and a very challenging method from the ethical viewpoint.Recruiting healthy volunteer participants is necessary in clinical trials of drugs, and it requires special and careful ethical considerations. Although recruiting healthy volunteers is not limited to clinical trials, we have focused our discussion on ethical issues of research on healthy volunteers in this kind of study. In this paper, ethical challenges of involving healthy volunteers in clinical trials have been discussed in four domains of risk-benefit assessment, fair subject recruitment, incentives, and informed consent. The authors believe and argue that using the daily life risks standard as the acceptable risk for healthy volunteers is impractical. We suggest defining a reasonable risk that is acceptable to the research ethics committee. The ethical committee, as a jury, can then evaluate the public acceptance of the risks.

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In many countries around the world, we find important evidence about violation of ethics in medical research. In the United States, the history of unethical or even inhuman experiments on human subjects dates back to the time of slavery, and unfortunately, most subjects of these experiments were poor or black people, slaves, prisoners and physical/mentally ill patients. For instance, we refer to the Tuskegee study that was done on black people. Other examples are tormenting experiments on American or Nazi prisoners. In this paper, we will review some infamous unethical experiments and researches in terms of neglecting human dignity and the validity of the research. On the other hand, in response to these dreadful events, some ethical codes and guidelines have been established which we shall review. For instance, the Belmont Report and the Nuremberg Code which were developed in response to the Tuskegee study and Nazi experiments on human subjects, respectively. The medical history of our country, Iran, is free of such troubling acts however, this does not mean that ethical standards in medical research are fully observed. Therefore, in addition to items that have been enacted so far, to prevent such faults, it is necessary to enact professional codes and guidelines or legislated laws and regulations too.

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The astonishing advances in medical sciences, owing to research in recent decades, have brought about endless advantages for humans, including improved level of health, prevention of communicable disease, and curative treatments. This trend, despite its great benefits, may undermine the principle of respect for human vulnerability and personal integrity, and expose certain risks to target populations or those excluded from investigations. Therefore, the principle of respect for human vulnerability and personal integrity has received attention by policy makers, law makers, human rights activists, and international organizations. It is necessary to cite the important question that arises here is there any contradiction between international documents' demands such as the Universal Declaration on the Human Genome and Human Rights and the legal actions of some countries on the principle and merits of Islamic teaching? If not, what type of activity should be undertaken by legislators in Islamic countries in general, and the Iranian Parliament in particular? An in-depth discussion of the issue reveals the fact that there is no contradiction between Islamic law and the principle of respect for human vulnerability and personal integrity. Therefore, there is room for the national legislative body to take legal actions in order to achieve the objectives of the principle of respect for human vulnerability and personal integrity in medical research and practice as articulated by international instruments such as the Universal Declaration on Bioethics and Human Rights in particular.

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Research ethics, as one of the main issues of modern bioethics, has attracted the interest of scientists and ethicists in various areas of science and technology around the world. Research Ethics Committees (RECs) have been established to improve putting ethics into practice in the field of research. RECs, fortunately, have received a great deal of attention in different countries, and their mission, goals, and tasks have been described in many national and international guidelines. Ethical guidelines for biomedical research and RECs administrative regulations have been developed in Iran too. The need for special training courses for capacitating members has been emphasized in both international guides and our national administrative regulations for RECs. In this brief article, we present suggestions concerning course presentation and contents, which are provided by international assemblies. In view of the fact that many RECs in our country do not have specific plans for their members' primary training and continuing education, there seems to be a need for fundamental changes in the educational prerequisites for membership in this important organization.

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In this paper, different definitions of moral conflict and moral dilemma at two levels of recognition and observing moral duties are taken into consideration and some instances of usage of conflict in physiology (conflict of stimulant and goals) and sociology(conflict of roles and norms)are mentioned. Also concepts and constraints used in the moral dilemma, especially the concept of "ought to" and the concept of "Inescapable of wrongdoing" are surveyed in a logical analysis. If in definition of moral dilemma, the concept of “ought to” and “duties” being transformable to “commensurable reasons” and their justificatory values, many of apparent moral dilemmas will be solvable and only if the values contained in the duties, being incommensurable and non-infringement, moral wrongdoing will be inevitable. In this research, it will become clear that why and how proponents of the possibility of moral dilemmas under pressure of logical argument against the possibility of moral dilemmas and criticisms of opponents, in order to provide the necessary features for a genuine dilemma have suggested variety and supplementary definitions of moral dilemmas such as: natural, disjunctive, two shape and prohibition definitions. Natural definition of moral dilemma represents a situation in which the agent sees himself as both a moral duty, while he can't do it well. In disjunctive definition agent is required to perform either task. In two shape definition (consisting of the "ought to" and "ought not to"), on the one hand the agent ought to do and on the other hand ought not to do the same. In prohibition definition, the agent should not perform any of the two while he has no choice but to do one.

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End stage patient control and autonomy are core principles in human bio-medical ethics and key components of end-of-life (EOL) care. Albeit, according to modern medical ethics principles the centrality of the patient as decision maker may not be relevant to culturally diverse groups of end stage people. The purpose of this article is to present results of a literature review of end stage patient control and their family position within the context of end of life support. The review revealed that the interaction between medical control and ethical values in end of life support is multifaceted and unpredictable. According to the recommendations of American College of Physicians/American Society of Internal Medicine End-of-Life Consensus Panel and some other world class medical and ethical societies, culturally effective end of life support includes the following essential elements • acceptance of and respect for cultural differences among all end stage patients • willingness to negotiate and compromise when world views differ • understanding of one's own values and biases • contact and communication skills that enhance empathy • information of the cultural practices of patient groups should be seen on a regular basis and • attention that all patients are individuals and may not share the same views as others within their own ethnic group According to the above description, applicants identified five domains of quality end of life support: 1. receiving adequate pain control 2. avoiding inappropriate prolongation of the dying process 3. achieving a sense of control 4. relieving burden on loved ones and 5. strengthening relationships We emphasize that, despite above mentioned points and advices maintaining a sense of control is an essential element in the end of life support for some individuals, further study of the interplay between ethnicity, desire for control, and achieving a good death is needed.

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Medical ethics is an interdisciplinary knowledge which increasingly developed during the last 30 years, and nowadays it becomes a part of medical student’s curriculum. Although, the quality of medical education has improved in Iran, but medical ethics teaching has not accomplished effective alteration yet. For deeper and more actual recognition of the challenges of medical ethics curriculum, we interviewed medical ethics instructors in a qualitative study. The data was collected by semi-structured interview with fourteen medical ethics instructors of Tehran University of Medical Sciences in 1389 and analyzed by Mairing content analyzing approach. Results of this study shows weaknesses and challenges in medical ethics curriculum which presented under five themes: comprehensiveness of goals, composing organization, proportion of content, active teaching method, and comprehensive system of evaluation. According to this the existing weaknesses and challenges of medical ethics curriculum can be considered as important obstacles in moral development of students. Considering those challenges, can develop medical ethics curriculum and introduce new models for medical ethics teaching.

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Spiritual care includes assistance in performing religious rituals to support those seeking connection to the spiritual world. It forms an essential part of holistic care and helps finding answers to issues concerning life, pain, and death. This study was conducted to understand cancer patients' perception of spiritual care.A qualitative content analysis approach was applied to conduct the study. Semi-structured interviews were undertaken with convenience sampling of 17 cancer patients and their family members in oncology wards of a hospital in Tehran and Behnam Daheshpor Charity Organization. The recorded interviews were transcribed verbatim. For data reduction, data were labeled and coded before content analysis.The following themes were identified: characteristics and duties of nurses with a spiritual approach in religious and non religious domains, care with a spiritual approach in religious and non religious domains (emotional, communicational, functional), barriers to spiritual care.According to our findings, nurses do not satisfy all spiritual needs of the participants, because the characteristics and practices of nurses do not meet the expectations of patients and their family members, and ward environment does not support such care.

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For some infertile couples, egg donation is the only option. In egg sharing programs, patients share half of their eggs with another couple in exchange for a discount on assisted reproductive technology. In many countries, using this method is legally discussed. Iran is the only Islamic country in which donation programs are practiced, so, we designed this study to compare egg sharing to ordinary egg donation from ethical, legal, and religious aspects.A complete review of ethical issues and debates about egg donation and sharing was done. For religious issues, we consulted clergies, Islamic texts, and current decrees (fatwas). Social issues and legal problems were examined by consulting expert opinion and jurists. Also a complete review of literature was done. Egg donation and egg sharing are both religiously accepted in Iran by the Shiite clergies as they are considered completely similar. Egg sharing has some religious (seeing and touching the female genitalia) and social (preventing repetitive donation) advantages to egg donation as well as avoiding complications of fertility drugs and procedures, financial and trading issues, advertisement and brokers. However, there are some disadvantages with egg sharing, such as reduced likelihood of conception by donating half of the eggs, challenges related to donor health, and emotional stress of failure for the donor and success for the recipient, which can be prevented by careful case selection, psychology and genetics consultation, and  practicing anonymity. As a result, egg sharing is ethically and religiously more acceptable than commercial egg donation.   

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Disclosing the diagnosis of cancer to a patient could impact various aspects of their life. The present study was performed to evaluate the views of cancer patients about disclosure of the diagnosis of disease to them. The present study was conducted on 385 cancer patients in three teaching hospitals (Afzalipour, Shafa, and Bahonar) affiliated to Kerman University of Medical Sciences between 2010 and 2011. These patients were evaluated for their views on revealing the diagnosis to them using a questionnaire that included the type of cancer, demographic information and their preferred manner of being informed of the diagnosis. Out of 385 cancer patients, 155 patients (%40) were aware of the diagnosis of their disease. The majority of patients who were aware of their diagnosis (%89) said they would like to know the diagnosis before treatment. Almost all patients who knew the diagnosis preferred to be aware of the prognosis of the disease and the complications of treatment. The only significant demographic variable was sex men were more eager to know the diagnosis of the disease (P value< 0.05). This study showed that the majority of cancer patients would like to be aware of the diagnosis, even though most of them were unaware that they had cancer.

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Medicine is known as a combination of science and art. Besides knowledge, a good physician should be equipped with the art of establishing communication with patients. The keystone of any efficient relationship like a therapeutic one is trust, and its deterioration makes the relationship deficient and based on mere need. Therefore, establishing an efficient relationship brings about positive results in treatment. In the last two decades, the trend in the physician-patient relationship has greatly changed, so that patient-centered care is now in focus. In this kind of relationship, physicians recognize patients as respectable human beings with their unique beliefs, attitudes, and concerns, etc. In this paper we intend to provide a brief introduction to the concept of physician-patient relationship and its chronological changes. Also, common models of physician-patient relationships (e.g. paternalistic, etc) are introduced, compared, and their most obvious strengths and weak points are analyzed. At the end, a succinct analysis on the dominant model(s) of physician-patient relationship in Iran&aposs medical settings has been provided, and the necessity of compiling a model based on Islamic values is proposed.

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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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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.