Iranian Journal of Medical Ethics and History of Medicine

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.

The physicians of the Bukhtishu dynasty first entered the Abbasi court with the aim of practicing medicine; but soon after, thanks to their medical knowledge and skills, they gained a lot of power and wealth and became involved in power relations at court. Although they were able to gain a high position in the Abbasid court; but their position was constantly unstable, and sometimes they were at the peak of power and sometimes at the bottom of humiliation. Therefore, the present study, with a historical method and a descriptive-analytical approach, seeks to answer the question: what factors have been effective on the relationship between the physicians of the Bukhtishu dynasty and the Abbasid Caliphate? The claim of the research is that the need of the caliphs for treatment provided the background for the entry of the doctors of Bukhtishu dynasty to the caliphate system and strengthened their presence in the court. Factors such as the success of these physicians in medicine, the power of the caliphs in supporting them; other threats from courtiers also fluctuated the status of these physicians. The findings of the study indicate that physicians with the benefit of medical knowledge had such an effect on the caliphs that they were considered as one of the main actors in politics, so they play an important role in the removal and installation of caliphs, poisoning and killing of them. They could pave the way for their conditioned person to come to power by abandoning their treatment; they were also degraded, imprisoned, and sometimes exiled or even killed. 

The health system needs nursing managers with moral reasoning ability to increase the quality of care in the system by adopting an effective leadership style. The aim of this study was to investigate the relationship between moral reasoning ability and leadership style of nursing managers of medical centers affiliated to Jiroft University of Medical Sciences. The present study was a descriptive- correlation cross-sectional study that was conducted in 2020. The population of study was all employed nursing managers, among whom 124 participants with a bachelor's degree in nursing and higher were included in the study by census sampling method. Data collection tools were demographic questionnaires, “Cherisham moral reasoning” and “Hershey and Blanchard leadership style”. Descriptive and inferential statistics and SPSS software version 19 were used to analyze the data. The results of the study showed that the mean score of moral reasoning of nursing managers is (48.10 ±7.04) which is higher than the mean score of the test. Also, the dominant leadership style of managers was selling leadership style 59.68%. The highest average of ethical reasoning of nursing managers was related to participating leadership style (48.44±7.35). There was no significant relationship between moral reasoning ability and leadership style of nursing managers (P >0.05). According to the results of the study, it is recommended to strengthen nursing managers 'efforts to strengthen transformational leadership styles in their managerial behaviors in order to improve leadership effectiveness and increase nurses' job satisfaction and observe ethical decision making.

The National Medical Ethics Film & Photo Festival was held in February 2020 and ended with the registration of 487 works which 80 films and 36 photographs of them were finally selected and peer reviewed. The present article focuses on the films of this festival and tries to explain the experience of attracting, selecting, and judging films through the design and holding a festival by using action research method. The article, also, tries to analyze the selected films (50 documentaries, 20 short films, and 10 unspecified films) from medical ethics point of view. In this way, the thematic adaptation of the selected films with 16 topics declared by the festival has been used. One of the obvious findings of this study is the difference between the views of filmmakers and experts on medical ethics. This difference becomes more significant when we see that the number of films related to the 16 topics declared by the experts is one less than the number of the films that the filmmakers made and submitted to the festival on the 7 topics neglected in the text of the call. It seems that the camera of filmmakers in the field of medical ethics mainly focuses on the commitment of professionals and the vulnerability of patients. On the other hand, considering the number and variety of films in the festival, another finding of this study can be considered as the possibility of using short and documentary films to teach some concepts of medical ethics to medical students. 

Evaluating clinical performance of nursing students as a resource to determine educational needs and decision-making is essential to change the educational environment and improve the quality of education. The aim of this study was to evaluate the professional behavior of nursing students in the clinical environment with the Small Scale Professional Assessment Tool (P-MEX). This descriptive cross-sectional study was conducted with the participation of 86 nursing interns of Ahvaz University of Medical Sciences in 2019. Data collection tools were demographic information questionnaire and P-MEX Cruess evaluation form. The validity and reliability of this instrument was evaluated by observers and was determined with Cronbach's alpha coefficient of 76%. Data were analyzed using SPSS software version 20 and descriptive statistics, independent t-test, analysis of variance, and post hoc test. In professional skills, most participants in the first stage were 51.2% at the average and expected level and 48.8% above the expected level, and in the second stage, most were 84.9% at the average and expected level and 15.1% higher than they were as expected. In this study, based on the evaluation scores in two stages, although the average total clinical skills scores of most students were within the expected range of the 4-point Likert scale, the skill scores were lower in the special wards. Therefore, for the full development of professional skills, it is necessary to develop appropriate methods of planning and training in the field of professional behaviors.

Turnover and moral distress are considered as one of the challenges in health care systems. Nursing leaders are one of the factors influencing the thoughts and behaviors of nurses in organizational environments. The aim of this study was to determine the relationship between ethical leadership, moral distress and the turnover intention of nurses working in hospitals affiliated to Kerman University of Medical Sciences in 2019-2020. The research method was descriptive-correlation. A total of 130 participants were enrolled by stratified sampling method from 3 hospitals. Data were collected using demographic information questionnaires, Ethical Leadership in Nursing, moral distress, and turnover intention. Then data were analyzed using descriptive and inferential statistics by SPSS software version 16. The results showed that ethical leadership and all its components were at the desired level. Also, moral distress and intention to leave were moderate. There was a significant negative correlation between ethical leadership and all its dimensions with the turnover intention and moral distress. Also, there was a significant positive correlation between the variables of turnover intention and the moral distress. Therefore, considering the significant relationship between ethical leadership, moral distress, and the turnover, by adopting this type of leadership approach by nursing managers, moral distress and the turnover intention among nurses can be reduced.

Good and healthy communication between physician and patient is cornerstone of a complete medical care that has long been considered in sociology. From the classical point of view, the physician-patient relationship as a unique relationship encompasses a wide range of cultural and social influences. Electronic health record not only has facilitated the treatment and diagnosis process, but also has promoted the health care system by organizing patient records; however, it alters the physician-patient relationship process culturally and it will create new ethical challenges. Based on current findings and analyses Opinions of health experts about the cultural and communication dimensions of this technology, the electronic health record, despite its effectiveness, easy and convenient diagnosis, awareness of other physicians' diagnosis, earlier and better treatment, has cultural obstacles such as security, reduction of emotional and face-to-face actions, and fear of social stigma. Having a suitable cultural context and information and awareness can affect development of health technology. The results of this study, which have identified the role of culture on physician-patient relationships in context of using electronic health record, shows that building trust in patients and changing cultural conditions through education and improving system security can increase the efficiency of this system in health care processes.

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.

Medicine is a profession in which emotional and moral intelligence play an effective role in improving the quality of medical care for patients, mental health, and increasing job satisfaction. The aim of the present study was to investigate emotional and moral intelligence among different physicians. This study was conducted as a descriptive study. The statistical population consisted of all physicians in Mashhad in 2019. Among them, 213 physicians were selected by convenience sampling method and completed questionnaires. The data collection tools were the Bar-On Emotional Quotient Inventory (EQ-i) and the Moral Intelligent Questionnaire. Data were analyzed by Analysis of Variance (ANOVA) and independent t-test. The results showed that among physicians, female physicians, married, over 60 years old, and with a work experience of 30 years and more had more emotional intelligence. The results also showed that physicians over 60 years and a work experience of 30 years and more had higher moral intelligence. Therefore, it can be concluded that educating and selecting medical students and physicians based on measuring emotional and moral intelligence can give them better ability to solve problems and be more resilient when exposing to crises and difficult situations

One of the most important and influential events in the interaction between Islamic civilization and the West was the Crusades, which lasted for nearly two centuries and extended from Europe to the Levant and Egypt. The main reasons for these wars, apparently, were the religious zeal of the Christians to seize Jerusalem from the Muslims and, in fact, the territorial expansion and influx of the surplus population of Europe to the east. The present study aims to explore the role of the Crusades in the transfer of medicine to Europe. The present research uses a descriptive-analytical method and library resources to explain the process of transferring Islamic and Eastern medical science to the world, affected by religious wars. Referring to texts, honesty and trustworthiness, citation of used texts, avoidance of bias in inference from texts or analyzes have been observed. The results of the research show that during the Crusades, Europeans, observing the scientific progress of Muslims, decided to translate the works of Islamic physicians and transfer them to Europe. This led to the advancement of medical knowledge and the development of health in Europe's Renaissance. Thus, he most important consequence of the Crusades was facilitation of the transfer of the cultural and civilizational foundations of the Islamic world, including the reserves of Islamic and Persian medicine to Europe

In medical centers, compliance of personal and social behaviors with ethics and religious standards is very important and requires constant evaluations. Therefore, the present study was conducted to determine the compliance of medical affairs with the standards of the Holy Sharia from the perspective of patients and interns in the teaching hospitals of Jundishapur University of Medical Sciences in Ahvaz in 2020. This was a descriptive cross-sectional study and the statistical population consisted of 204 interns and 385 patients referred to the teaching hospitals of Jundishapur University of Medical Sciences in Ahvaz. Sampling was done randomly. Data were collected by data collection form and questionnaire from patients and interns which was collected by the researcher including 17 questions. Data were analyzed by SPSS version20 software and descriptive and inferential statistics. From the interns' point of view, there was a significant difference (P <0.05) between the compliance of medical affairs with the standards of holy sharia in different hospitals and gender, but there was no significant difference in different ages and marital status (P> 0.05). From the patients' point of view; There was no significant difference (P >0.05) between the compliance of medical affairs with the standards of the Holy Sharia based on gender, age, education, marital status, and hospital. From interns and patients point of view, compliance with Holy Sharia standards were 45.1% and 40.5%, respectively. According to the results of the present study, physical space and more medical staff in both genders are required to fully comply medical affairs with the standards of the Holy Sharia in all the examined hospitals.

The present study seeks to find an answer to this question, “how effective was the religious and moral advice on environmental health situation of cities under the territory of Al-Buwayh dynasty”? Findings indicate that in the first half of the Al-Buwayh era, following the increase in population and expansion of some cities, the need for health measures in various areas was felt, of which is considered a responsibility of environmental health authorities nowadays. In addition to the instructions and recommendations being embodied in some verses of Quran and hadiths being the basis of health laws, a number of rulers of this dynasty, like Azd al-Dawlah intervened in the health affairs of cities in various fields such as providing drinking water, constructing of medical and service centers, and appointing Sheriffs (Darougheh). A part of the mentioned actions was involved with the community health in the field of food hygiene, roads and public places, water hygiene as well as sewage disposal. In the present study, first, narrative, historical, medical and geographical books were indexed by using descriptive-analytical method and relying on library resources; second, the data in the most important areas related to environmental health was classified; and then, a conclusion was reached.

Nurses are among the members of the treatment team who have the most contact with Corona Virus Disease- 2019 (COVID-19) patients and their ethical decision-making is inevitable during patient care. On the other hand, nurses' motivation to implement end-of-life care is influenced by their attitude, awareness, and moral reasoning. The aim of this study was to investigate the level of ethical decision making of nurses and its relationship with the attitudes of end-of-life care of patients with COVID-19 in hospitals affiliated to Hamadan University of Medical Sciences in 2021. In this study, 180 nurses working in hospitals affiliated to Hamadan University of Medical Sciences were selected by convenience sampling method. Data collection tools included: demographic Information questionnaire, Nursing Dilemma Test (NDT) questionnaire, and Frommelt Attitudes towards End-of-Life Care questionnaire. According to the results, there is a direct relationship between nurses' ethical decisions and the attitude of end-of-life care (<0.05, r=0.819). The mean score of nurses' ethical decision-making indicates the low level of ethical decision-making (39.19 (5.3)) and the mean score of nurses' practical considerations (20.62(4.2)) showed that the process of nurses' ethical decision-making is relatively influenced by environmental factors. Also, the average score of nurses' exposure to moral challenges indicates that nurses are familiar with similar situations. The mean score of nurses' attitudes toward end-of-life care was reported at an undesirable level (81.58(7.8)). According to the results, by identifying the factors affecting nurses' ethical decision-making and educational planning to improve their decision-making level, it is possible to improve the quality of patients care while improving nurses' attitudes toward end-of-life care.