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Ethical Considerations in Decision-Making for an Elderly Alzheimer's Patient: A Case Report
Maryam Modabber, Mojtaba Parsa, Shiva Khaleghparast,
Volume 17, Issue 1 (3-2024)
Abstract
In the current era, the alarming increase in the number of patients with Alzheimer's disease has led to greater attention to issues related to care and alternative decision-making for this special group in society. The four ethical principles of "beneficence", "non-maleficence", "respect for autonomy", and "justice" serve as fundamental guidelines in medical decision-making. This study presents a case report of an elderly Alzheimer's patient and the ethical issues related to medical decision-making in the absence of a substitute decision-maker. Typically, for individuals lacking decision-making capacity, decisions are made by a substitute decision-maker and, in some countries, an advance care directive. In the absence of these, the medical team may make decisions in the best interest of the patient, considering the individual's cultural and social conditions, while taking into account the aforementioned ethical principles.

Assessing Responsiveness to Non-Medical Needs of Inpatients in Educational-Therapeutic Hospitals in Gorgan, 2022
Alireza Heidari, Seyed Hamed Atashi, Farideh Kouchak, Zahra Khatirnamani,
Volume 18, Issue 1 (3-2025)
Abstract
Addressing patients’ non-medical needs reflects the desires of patients and their families to engage more actively in decision-making and treatment processes. The present study aimed to assess the level of responsiveness to the non-medical needs of hospitalized patients. This was a cross-sectional study conducted using a descriptive-analytical approach. A total of 392 patients hospitalized in Shahid Sayad Shirazi and 5 Azar educational-therapeutic hospitals, affiliated with Golestan University of Medical Sciences in Gorgan, were included in the study. Participants were selected through systematic random sampling. Data were collected using the validated and reliable responsiveness questionnaire developed by the World Health Organization (WHO). The mean (±SD) age of participants was (45.17 ±16.92) years, with 55.1% being male. The mean (±SD) overall score for the importance of responsiveness was (33.37 ±4.45), which was above the average. The majority of patients (over 65%) rated all dimensions of responsiveness as very important or extremely important. The most important dimension from the patients' perspective was the quality of the surrounding environment (95.9%), while the least important was the confidentiality of personal information (34.7%). The mean (±SD) overall score for responsiveness performance was 54.54 (0.70 ± 8), which was above the average. The overall score of the responsiveness performance and importance in Sayad Shirazi and 5 Azar educational hospitals was above average. Dimensions deemed important by patients but with weaker performance should be prioritized, and educational and therapeutic centers should pay more attention to patients’ non-clinical expectations.

Comparing the Effectiveness of Professional Ethics Education Via Mobile Application and Webinar on Maintaining Patient Dignity from the Perspective of Nursing Students
Mohsen Shahriari, Maryam Sadat Hashemi, Arash Najimi, Mohammad Zare Reshkoieh,
Volume 18, Issue 1 (3-2025)
Abstract
The fundamental nature of nursing care lies in maintaining patients’ human dignity. Protecting the dignity and high value of humanity is the focus of the nursing profession. This study aimed to compare the effectiveness of mobile application-based and webinar-based professional ethics education on maintaining patient dignity among nursing students. This was a quasi-experimental study with a two-group pretest-posttest design involving 90 undergraduate nursing students. One group received professional ethics education via webinars, while the other received training through a mobile application-based program. Data were collected using a demographic information form and a questionnaire assessing nursing students’ views on maintaining patient dignity. The findings showed that before training, the mean total scores for human dignity were 99.96 ± 17.43 in the webinar group and 99.59 ± 16.28 in the mobile application group, with no statistically significant difference (p=0.62). After training, the mean human dignity score was significantly higher in the mobile application group (111.15±14.69) than in the webinar group (104.34 ± 15.38), and this difference was statistically significant (p=0.02). The findings indicated that professional ethics education delivered via a mobile application was associated with a greater improvement in nursing students’ views on patient dignity compared to webinar-based education. Mobile-based education offers a self-directed, flexible learning method, enabling students to have continuous access to educational content without time or place restrictions. It is recommended that medical universities in Iran consider developing and integrating educational applications into their curricula.

Explaining Perceptions of Discharge Against Medical Advice as a Patient’s Legal Right: A Qualitative Study
Hossein Motaarefi, Shahriar Sakhaei, Amin Soheili, Hassan Ebrahimpour Sadagheyani,
Volume 18, Issue 1 (3-2025)
Abstract
 Patients’ perceptions of healthcare service quality and satisfaction with their legal rights constitute the primary objective of the care team and should be considered a criterion for accreditation evaluation. In this regard, a thorough examination of healthcare providers’ and patients’ perceptions, emotions, and experiences regarding the reasons for ‘Discharge Against Medical Advice’—as a patient’s legal right—can help identify hidden factors influenced by temporal and spatial conditions. This qualitative study employed a conventional content analysis approach, involving semi-structured interviews with 24  healthcare providers and patients selected purposively. Researchers repeatedly reviewed recorded content and notes to code the data. Subsequently, key codes and themes were clustered, categorized into specific topics, and labeled. Finally, an interpretation of the obtained data reflecting the study’s approach was presented. Through conventional content analysis, 203 codes were extracted. After categorization, four subthemes, including human factors, processes, facilities, and environment, were identified under the core theme of “uncertainty and distrust” as reasons for discharge against medical advice. Discharge against medical advice is recognized as both a challenge for hospital accreditation and an adverse outcome for patients. Addressing uncertainty-related issues and fostering public trust through team collaboration and implementing novel policies can mitigate discharge against medical advice.

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