Iranian Journal of Medical Ethics and History of Medicine

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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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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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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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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.

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Human germ cell engineering is a modern technology researched with the aim of studying perennial hereditary mutations in herbaceous, animal and human generations. It has led to abundant arguments and discords among ethics and law experts. Possible changes in the human genome that are identified - according to deceleration of human genome and human rights - as the heritage of humanity and the fundamental unity of all members of the human family lead to questions about the relations between this technology and the normal process of creation. At first glance it seems that human germ cell engineering may lead to innovations in the ordinary institution of creation and the old customs of reproduction. Pursuing the contrasting viewpoints on human germ cell engineering, we can observe an essential and material concern about "changing God's creation" or "interference in the will of God"."Changing God's creation" is a current term in Islamic juridical and moral literature. It performs the main role in the legal destiny of genetically engineered creations so the assertion of this phrase about a being can lead to its natural prohibition. The majority of Moslem interpreters maintain that creation bears upon man's Godly disposition, which is unchangeable. In this research, adopting a dominant approach, the author thinks that the process of human germ cell engineering is not exclusively a sample for the term "changing God's creation". In this article we will try to analyze the potentials of the subject of change in genetic engineering of the human germ cell while taking into consideration the holy religion of Islam.

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Political behaviors are a group of practices that are not essential in organizations, but can impact organizational resources and their reward systems. Employees and managers try to demonstrate political behavior to gain power. Today, most organizational behavior researchers have focused on the perception of political behaviors and how these behaviors are presented with regard to ethical considerations. Therefore, this review is aimed to study the goals, reasons, outcomes, and morality or immorality of political behaviors and power in organizations. The current paper is the result of a literature review that was conducted by using Medline, Ovid, Elsevier, Google, Pub Med, Scopus, Springer, and Cochran library search engines and through selection of 5 key words and 110 references out of which 41 references were ultimately chosen. Most political behaviors are the consequences of employees' personal differences and organizational specifications. Some employees follow moral political behaviors and the rest prefer immoral ones, although it seems difficult to establish which political behaviors are moral and which ones are not. We believe that political behaviors that are based on ethical considerations should be consistent with organizational interests. Seeing as political behaviors are a fundamental component of organizational conduct, they cannot be eliminated therefore, managers should believe in the political nature of their organizations and determine their political strategies and try to employ these strategies to the advantage of their organizations.

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Biotechnology is a high technology that is bound to play an important role in the future world due to its wide range of applications in different parts of industry, agriculture, medicine, environment and so on. In our country special attention has been paid to biotechnology as a strategic technology. While the production and consumption of genetically modified organisms (GMO) products is witnessing an upsurge in the world on account of the value of cultivation and production, Iran does not have a noticeable share in this field. Food and agriculture organization (FAO) has predicted that food preparation for the 9.1 billion world population in 2050 will require a 70 percent increase in food production throughout the world and a 100 percent increase in food production in developing countries. Report of the International Service for the Acquisition of Agri-biotech Applications (ISAAA) indicates that biotechnology can be a key solution to the growing demand for food in the world. The development and operation of targeted biotechnology in compliance with all aspects of biosafety and bioethics will cause food production and productivity to increase. Naturally, this depends on culture making, production and commercialization of GMO products and changing the society’s consumption pattern. Jurisprudential views of consumption of GMO products, however, will lead us to bioethics-related issues and proper use of such products. In this study the views of grand jurisprudents were pursued about various aspects of direct and indirect consumption of GMO products in the form of four questions. All of the grand jurisprudents permit consumption of GMO products, and some do so with reservations: that they do not entail losses in the present and future, and that product information be truthfully disclosed to customers. This paper reports the responses received, and discusses the bioethical aspects of the views of grand ayatollahs.

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Documentation of accepted ethical behavior in special settings is one of the strategies employed to foster ethics in organizations. Such documents, known as codes of ethics, vary in different societies according to their cultural and ideological differences. Medical educators have dual professional roles (as physicians and teachers) that sometimes seem ethically incompatible. Therefore, having codes of ethics is essential in this profession. The aim of this study was to develop codes of ethics for clinical medicine educators with an Islamic-Iranian approach. This was a three stage developmental research. First, a comprehensive literature review was conducted. Using content analysis method, the first draft of a code of ethics for clinical medicine educators was prepared. Second, the draft was thoroughly and critically reviewed and revised in experts’ focus group discussion and the 2nd draft was devised. This was further reviewed by a group of 24 experts at the national level (validated) and revised according to their comments, and thus the 3rd draft was prepared to be presented for formal approval process. The final document includes 55 codes of ethics in 18 topics (conscientiousness, accountability, respectfulness, scientific excellence, respect for others’ freedom, equity, patience, religious commitment, modesty, trustworthiness, humility, contentment, relationship with coworkers, attentiveness toward patients, attentiveness toward learners, kindness, confidentiality, and discipline). It seems that extracting ethical concepts from the rich Islamic-Iranian cultural resources is feasible, and provides an appropriate basis for the development of ethical codes for medical educators. Compared to Western codes, such codes may be better accepted in Iranian contexts and will be implemented more readily if the organizational settings are prepared simultaneously.

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Nurses encounter challenging ethical issues in practice that can make decision making tough for them. The purpose of this study was to determine the moral sensitivity of critical care nurses in clinical decision making and its correlation with their caring behavior in teaching hospitals of Bandar Abbas in 2012.This research is a descriptive analytic study with intensive care unit nurses as its participants. A demographic and background questionnaire, a standard questionnaire of the nurses’ moral sensitivity, and a caring behavior questionnaire were used to collect information. Data were analyzed using SPSS16 software, descriptive statistics, Mann-Whitney U test, Kruskal-Wallis, and Spearman’s correlation.The mean score of the nurses’ moral sensitivity was 70.15 ± 6.90 (maximum score was 96 and minimum score was 49) that was moderate in 85.6% of the nurses. The mean score of the nurses’ caring behavior was 108.90 ± 10.62 (maximum score was 120 and minimum score was 69). There was no significant correlation between moral sensitivity and caring behavior scores, but both scores were significantly associated with the place where the nurses were working. The dimension of respect for patient autonomy had a significant relationship with participation in medical ethics seminars or workshops.The moral sensitivity of the nurses in this study was moderate and did not have a significant correlation with caring behavior scores. In view of the fact that nurses deal with serious situations in patient care that call for adequate ethical abilities for decision-making as well as good performance, it is necessary for them to be familiar with and sensitive to ethical issues related to their profession.