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Mojtaba Norouzi , Ali Akbar Haghdoost , Mina Mobasher,
Volume 16, Issue 1 (3-2023)
Volume 16, Issue 1 (3-2023)
Abstract
Scientists now believe that precision medicine, which employs complicated technology and information derived from omics, can treat complex diseases and provide justice in health. Implementation of precision medicine will face new ethical challenges, considering the principles of medical ethics. With respect to philosophical principles, this study addressed the issue of justice and some ethical challenges of precision medicine. Because, in order to gain the benefits of precision medicine, a proper ethical framework must be developed while considering the challenges. The manner in which precision medicine information is shared and accessed can have an impact on people’s future careers, marriage choices, and type of health insurance. Furthermore, preserving people’s privacy and autonomy are important ethical concerns in precision medicine since there will be no perfect guarantee about data security and access. Although in the short and medium term, due to the design of studies and expensive and complex technologies, precision medicine will be limited to certain groups and will intensify the inequality in justice, in the long run, with the easy access and inexpensive cost of precision medicine technologies, the accumulation of medical expenses will decrease throughout life, and justice will be established between and within countries.
Arman Latifi, Seyyed Sadegh Hosseini, Sara Rahimi, Vahid Rahmani, Atefeh Esfandiari, Hedayat Salari,
Volume 16, Issue 1 (3-2023)
Volume 16, Issue 1 (3-2023)
Abstract
Professional commitment is described as a set of attitudes, values, behaviors, and relationships that serve as the foundation of a health professional's contract with society. The present study was conducted with the aim of determining the attitude of medical students of Bushehr University of Medical Sciences towards professional commitment in 2022. The research population of this descriptive study included 254 students of the last 3 years of the Faculty of Medicine of Bushehr University of Medical Sciences who were included in the study by census. The standard questionnaire of attitude towards the professional commitment of doctors was used for data gathering. Data were analyzed using SPSS software version 25. Descriptive tests, Spearman's correlation test, linear regression and Mann-Whitney test were used to analyze the data. The mean and standard deviation of the age of the students participating in the study was 24.69±2.25 years. The mean and standard deviation of the attitude score towards professional commitment were 67.12±12.72 out of 100. There was a statistically significant relationship between the variables of age, academic semester and experience of participating in training courses related to professional ethics with the mean attitude score (p < 0.05), but there was no relationship between gender and the attitude score towards professional commitment. There was no statistical significance (p > 0.05). Educational centers and its professors, as the most influential force on the formation of students' morals, should revise and implement the educational program well in the field of medical professionalism, considering professional needs
Mojtaba Parsa,
Volume 16, Issue 1 (3-2023)
Volume 16, Issue 1 (3-2023)
Abstract
Physician self-referral is the referral of a patient to a medical facility in which the referring physician has a financial interest. This can take two forms: internal referrals within the same office and external referrals, often involving joint ventures. Many claims, positive or negative, have been made regarding self-referral. Proponents claim that self referral causes, reduction of costs by fostering a competitive environment, encourage investment in health facilities particularly in underserved areas, financial benefits for both the doctor and the patient via cost reduction, and inhance the quality and accessibility of health services. Conversly, opponents, citing multiple studies, argue that self- referral may result in excessive and unnecessary utilization of healthcare services, leading to increased healthcare costs, low quality of services provided, and jeopardise patient safety. In certain countries, such as the United States and the Islamic Republic of Iran, ethical codes address self-referral. These guidelines either deem it unethical or require disclosure, accompnied by regulations to govern this practice.
Homa Sadeghi Avval Shahr,
Volume 17, Issue 0 (12-2024)
Volume 17, Issue 0 (12-2024)
Abstract
Effective medical education requires the cultivation of essential professional attributes, including ethical reasoning, communication skills, empathy, and professionalism. Traditional teaching methods often fall short in adequately developing these crucial aspects. Reflection-based learning, with its emphasis on self-analysis and critical thinking, presents a promising pedagogical approach to address these limitations. This review study examined the literature on reflection in medical education. A comprehensive search of the Web of Science, PubMed, Scopus, and Google Scholar databases was conducted using keywords such as "education," "reflection," "professionalism," "professional behavior," and "medical students" from 2010 to 2024. Eighteen relevant articles were selected and analyzed for their type, focus, and conceptual implications. Different approaches to integrating reflection into professionalism education were then categorized and analyzed. The reviewed literature highlights a multifaceted approach to incorporating reflection into medical education. Key strategies include contextual reflection, linking reflections to specific clinical experiences; utilizing structured frameworks such as the Gibbs Cycle to guide the reflective process; fostering peer-to-peer learning through discussions, peer feedback, and mentorship; and seamlessly integrating reflection as an ongoing and assessed component of the medical curriculum. Findings suggest that an educational approach emphasizing practical application, experiential learning, and structured reflection opportunities can significantly enhance students' understanding of professional behavior. This approach is anticipated to lead to improvements in communication skills, ethical reasoning, empathy, and self-awareness, ultimately contributing to better patient care and a stronger medical workforce. Reflection-based learning offers a valuable strategy for developing professional competence in medical education. This approach necessitates the active integration of reflection into clinical learning activities, utilizing structured frameworks, and providing ample opportunities for peer and faculty support. Future research should rigorously investigate the impact of specific reflective activities on tangible improvements in clinical skills and behaviors.
Saeed Biroudian,
Volume 17, Issue 0 (12-2024)
Volume 17, Issue 0 (12-2024)
Abstract
Conflicts of interest, particularly financial ones, pose a significant ethical challenge in the medical field. They can compromise clinical decision-making, erode patient trust, and ultimately diminish the quality of healthcare. This study reviewed ethical documents and guidelines published by the Medical Council of the Islamic Republic of Iran, including the Charter of Rights for the Medical Community. A comprehensive review of relevant scientific literature on conflicts of interest in healthcare was also conducted. The analysis revealed that financial relationships between physicians and external entities, such as pharmaceutical companies, can create conflicts of interest that negatively impact patient care. These conflicts can erode patient trust and lead to suboptimal clinical decisions. The Medical Council's ethical guidelines address these concerns by emphasizing the importance of transparency regarding financial ties and relationships. They advocate for the disclosure of such relationships to patients and the implementation of educational programs to enhance physician awareness of ethical principles and conflict-of-interest management strategies. Adherence to the ethical guidelines established by the Medical Council of Iran is crucial for effectively managing conflicts of interest in the physician-patient relationship. By prioritizing transparency, disclosure, and ongoing education, healthcare professionals can mitigate potential conflicts and maintain the highest standards of ethical conduct in patient care.
Mostafa Ghasempour, Abbas Dadashzadeh, Majid Purabdollah, Fezeh Hoseini Lilab,
Volume 17, Issue 0 (12-2024)
Volume 17, Issue 0 (12-2024)
Abstract
Moral sensitivity is a crucial attribute for pre-hospital emergency personnel, significantly impacting their ethical decision-making and patient care in urgent and often complex situations. Defined as the capacity to recognize ethical dilemmas and comprehend their implications, moral sensitivity empowers personnel to navigate challenges such as resource limitations, critical patient conditions, and the imperative for rapid, independent decision-making. This study aimed to evaluate the level of moral sensitivity among Emergency Medical Technicians (EMTs) and identify key influencing factors. A cross-sectional study was conducted in 2023, encompassing 245 EMTs selected through cluster random sampling. Data were collected using the Moral Sensitivity Questionnaire (MSQ) and analyzed employing correlation tests and regression analysis. The findings revealed a mean moral sensitivity score of (39.45 ± 7.13) among participants, indicating a moderate-to-high level of ethical awareness. A significant correlation was observed between moral sensitivity and specific demographic and professional characteristics. Notably, work experience emerged as a key determinant (P < 0.001). Regression analysis further emphasized work experience (β = 0.08, P < 0.001) as a strong predictor, demonstrating that increased exposure to clinical and ethical challenges over time enhances moral sensitivity. Enhancing ethical sensitivity among pre-hospital emergency personnel is paramount to improving their ability to identify and address complex ethical challenges and deliver high-quality patient care. Given the unique demands of emergency situations, including time constraints, resource limitations, and the need for immediate action, it is crucial to equip personnel with the tools necessary to recognize and navigate ethical dilemmas. Implementing comprehensive training programs that emphasize ethical awareness and reasoning can empower EMTs to make more informed and empathetic decisions. Furthermore, cultivating a supportive organizational culture that prioritizes ethical performance and provides ongoing training can further enhance their confidence and competence in managing ethically sensitive situations.
Mojtaba Parsa,
Volume 17, Issue 0 (12-2024)
Volume 17, Issue 0 (12-2024)
Abstract
"Under-the-table payment" refers to money a physician demands and receives from a patient, in addition to the established and approved medical tariff, typically for medical services such as surgical operations. This study aims to examine the ethical, legal, and juridical aspects of this phenomenon, which has become common among many physicians. This qualitative study is based on semi-structured interviews with 17 experts from various fields, including Islamic jurisprudence, law, professional ethics, philosophy of ethics, medical ethics, health economics, and social psychology. The interviews were analyzed using the conventional content analysis method. Additionally, the opinions (fatwas) of 11 Shia Grand Ayatollahs on under-the-table payments were obtained by posing a specific question to them. The findings from the expert interviews revealed several concerns regarding under-the-table payments, including:
· Disregard for patients' best interests, particularly causing harm to poor patients;
· Undermining trust between doctors and patients;
· Violations of national laws and public policies;
· Promotion of lawlessness;
· Breaches of medical and ethical obligations by physicians;
· Coercion or undue pressure on patients to pay such fees.
Experts emphasized that medicine is a profession in which patients' interests should take precedence over those of doctors, and in this practice, this fundamental principle is violated. Furthermore, in the fatwas issued by the majority of Shia Grand Ayatollahs - particularly those with governmental perspectives - nearly all deemed this practice impermissible, with some explicitly declaring it forbidden (haram). Receiving under-the-table payments is ethically, legally, and juridically problematic, and in some cases, is considered impermissible, particularly for the physicians involved. However, it is generally not considered problematic for patients who are coerced into making such payments.
· Disregard for patients' best interests, particularly causing harm to poor patients;
· Undermining trust between doctors and patients;
· Violations of national laws and public policies;
· Promotion of lawlessness;
· Breaches of medical and ethical obligations by physicians;
· Coercion or undue pressure on patients to pay such fees.
Experts emphasized that medicine is a profession in which patients' interests should take precedence over those of doctors, and in this practice, this fundamental principle is violated. Furthermore, in the fatwas issued by the majority of Shia Grand Ayatollahs - particularly those with governmental perspectives - nearly all deemed this practice impermissible, with some explicitly declaring it forbidden (haram). Receiving under-the-table payments is ethically, legally, and juridically problematic, and in some cases, is considered impermissible, particularly for the physicians involved. However, it is generally not considered problematic for patients who are coerced into making such payments.
Leila Afshar,
Volume 17, Issue 0 (12-2024)
Volume 17, Issue 0 (12-2024)
Abstract
Evidence from national and international institutions highlights a significant clinical practice gap, including the failure to adhere to best evidence-based practices at the point of care. This issue is multifaceted, stemming from incomplete information, poor communication by practitioners—resulting in inadequate patient compliance and understanding—and various environmental or social factors. A significant portion of these shortcomings lies in areas commonly referred to as professional behavior and professional ethics. While considerable efforts have been directed toward knowledge translation and implementing best clinical evidence, equivalent attention must be given to integrating professionalism and professional ethics into continuing medical education (CME) or, more aptly, continuing professional development (CPD). These aspects, however, appear underemphasized or even neglected in many CPD programs. This article seeks to address the essential "musts" and "must-nots" for designing an effective CPD program that incorporates professionalism and professional ethics as foundational components.
Rasool Esmalipour, Narges Dastmalchi , Khalil Hajiasgharzadeh,
Volume 17, Issue 0 (12-2024)
Volume 17, Issue 0 (12-2024)
Abstract
Stem cell technology and regenerative medicine are interdisciplinary fields that integrate engineering, molecular and cellular biology, and medical science to repair tissues and treat diseases using stem cell-based methods. The primary goal of this scientific field is to enhance the quality of life by replacing damaged cells and tissues with healthy ones, thereby improving injuries and disabilities. With recent advances in biomedical science and the unique potential of stem cells in treating diseases, ethical considerations surrounding this technology have become increasingly significant. Following a brief introduction to stem cell technology, this review explores ethical challenges, including the justifications for using stem cells, informed consent from patients, preservation of human dignity, and the social and cultural impacts associated with their application. As research in this field continues to expand, yielding numerous innovative findings and attracting growing interest from researchers, there has also been an increase in unproven commercial treatments that have not undergone necessary regulatory stages. The direct marketing of products in preclinical stages to consumers further underscores the importance of ethical considerations in the use of stem cells. Additionally, the unprincipled use of stem cells may lead to adverse effects, such as cancer or vascular diseases, exacerbating patients' conditions rather than improving them. The findings of this review emphasize the need to adapt existing laws and regulations to address ethical concerns and provide recommendations for enhancing ethical standards in clinical research involving stem cells. The results can serve as a guide for researchers and policymakers in addressing ethical challenges in stem cell research, ultimately improving the quality and safety of clinical research in cell therapy and regenerative medicine.
Saeed Biroudian,
Volume 17, Issue 0 (12-2024)
Volume 17, Issue 0 (12-2024)
Abstract
Effective oversight of scientific research is essential for ensuring adherence to ethical and legal principles, particularly in medicine and health sciences. This oversight plays a crucial role in maintaining research validity and safeguarding human health. As knowledge-based and technological projects continue to expand, the responsibilities of ethics committees become increasingly significant. Recognized as independent and credible entities, these committees conduct rigorous reviews of research initiatives. This article critically examines the significance, methodologies, and impact of ethics committee oversight on the quality and credibility of scientific research in knowledge-based projects. This study employs a review methodology, synthesizing data from established guidelines and regulatory frameworks governing ethics in biomedical research, as outlined by the National Committee on Ethics in Research of the Ministry of Health and Medical Education. Additionally, a comprehensive review of relevant scientific literature and empirical studies was conducted, focusing on the oversight of approved projects from reputable contemporary sources. The analysis indicates that knowledge-based projects require heightened ethical scrutiny compared to other research initiatives. This necessity arises from the imperative to adhere strictly to ethical standards outlined in research proposals. Rigorous oversight significantly enhances research quality while mitigating ethical violations. Furthermore, active engagement by ethics committees fosters a stronger commitment among researchers to uphold ethical principles. By offering targeted guidance and training, these committees contribute to the development of high-quality research proposals. Effective oversight by ethics committees is instrumental in enhancing the quality and credibility of scientific research, particularly in emerging technologies and knowledge-based projects. This oversight not only reduces ethical infractions but also strengthens public trust in research findings. Therefore, continuous advancements in ethical training and researcher awareness are imperative. Improving oversight mechanisms will further elevate ethical standards and reinforce responsible research practices within this domain.
Fatemeh Hekmatian, Akram Hashemi, Soodabeh Hoveida Manesh, Saeedeh Saeedi Tehrani,
Volume 17, Issue 0 (12-2024)
Volume 17, Issue 0 (12-2024)
Abstract
Obtaining informed consent is a fundamental ethical and legal right of participants in clinical trials. It ensures that individuals are adequately informed about the research, including its nature, potential risks and benefits, and their role in the study. This knowledge empowers participants to make informed decisions about their involvement. This study aimed to evaluate the awareness of participants regarding the information provided in informed consent forms (ICFs) for clinical trials conducted at Iran University of Medical Sciences (IUMS) in 2020. This study evaluated the accuracy of the content of ICFs of registered clinical trials and assessed participants' understanding of the information presented. ICFs were reviewed using a ministerial checklist. Participants were subsequently contacted to assess their comprehension of key aspects of the trial as outlined in the ICF. Analysis revealed a discrepancy between the information presented in the ICFs and participants' actual understanding. Despite adequate coverage of certain aspects, such as the research nature of the interventions (98.2%) and the mention of specific benefits (92.7%), significant gaps were observed in participants' comprehension of crucial information. Notably, lower levels of understanding were observed regarding the possibility of invasive interventions (25.7%), the random assignment of participants to study groups and the potential use of placebos (44%), and the possibility of not personally benefiting from the research outcomes (44%). Additionally, only 47.7% of participants reported understanding the confidentiality of their information. These findings highlight the need for improvements in the process of obtaining informed consent. While researchers may adequately address the overall research objectives and potential benefits, crucial aspects such as the potential for invasiveness, randomization procedures, and the possibility of no direct personal benefit may not be adequately communicated to participants. Enhancing participant understanding of these critical aspects is crucial for ensuring truly informed consent and upholding ethical research practices.
Tahereh Shafaghat, Elahe Rahmani Samani, Elnaz Haiery, Atiyeh Dehghan Niri, Zahra Raisi,
Volume 17, Issue 0 (12-2024)
Volume 17, Issue 0 (12-2024)
Abstract
An efficient healthcare system relies on active participation and a strong relationship between healthcare providers and recipients. Observing the Patients’ Rights Charter is an essential aspect of delivering high-quality healthcare services. However, the existence, formulation, and dissemination of the charter do not ensure its implementation and compliance. Therefore, evaluating adherence to the charter is critical. This study aimed to assess compliance with the Patients’ Rights Charter at Shahid Rahnemoon Hospital, Yazd. This applied, descriptive-analytical study was conducted cross-sectionally at Shahid Rahnemoon Hospital, Yazd, in 2024. The study population included all hospitalized patients in the hospital. Cluster random sampling was used, and a standardized questionnaire developed by Parsapour et al. measured adherence to the Patients’ Rights Charter. Data analysis was performed using the Mann-Whitney and Kruskal-Wallis tests via SPSS software version 26. The findings revealed that patients perceived an average level of adherence to the Patients’ Rights Charter in Shahid Rahnemoon Hospital (mean ± SD: 53.99 ± 11.10). The highest compliance was observed in the domain of respect for patients and protection of privacy (mean ± SD: 78.12 ± 2.65), whereas the lowest compliance was reported for the existence of a complaint resolution system (mean ± SD: 2.97 ± 1.74). Patient satisfaction, a vital indicator of healthcare quality, is closely linked to the observance of patients’ rights. To improve compliance, it is recommended to:
1. Raise staff awareness about the importance of adhering to patients’ rights.
2. Educate patients about their rights through staff training and media campaigns.
3. Develop plans by hospital management to address areas of non-compliance.
4. Foster greater collaboration between staff and patients.
5. Follow up on violations of patients’ rights and implement legal measures to ensure compliance.
6. Regularly monitor adherence to patients’ rights to enhance patient satisfaction and staff commitment to ethical practices.
1. Raise staff awareness about the importance of adhering to patients’ rights.
2. Educate patients about their rights through staff training and media campaigns.
3. Develop plans by hospital management to address areas of non-compliance.
4. Foster greater collaboration between staff and patients.
5. Follow up on violations of patients’ rights and implement legal measures to ensure compliance.
6. Regularly monitor adherence to patients’ rights to enhance patient satisfaction and staff commitment to ethical practices.
Fatemeh Rahimi,
Volume 17, Issue 0 (12-2024)
Volume 17, Issue 0 (12-2024)
Abstract
Televisits offer significant potential for enhancing healthcare accessibility, reducing costs, and improving patient satisfaction. However, their effective implementation requires careful consideration of ethical principles to ensure patient safety, privacy, and quality of care. This paper examines key ethical considerations for televisit implementation across three stages: pre-visit, during-visit, and post-visit. Pre-visit considerations include careful patient selection to ensure suitability for remote care, establishing a strong physician-patient relationship based on trust and obtaining informed consent, and demonstrating cultural sensitivity and inter-professional coordination. During the televisit, optimal technical conditions are critical, including reliable internet connectivity, high-quality audio-visual equipment, and a conducive physical environment. Comprehensive and transparent documentation of the televisit encounter is essential. Post-visit considerations include evaluating patient experiences, addressing any identified issues, and ensuring timely follow-up for continuous quality improvement. Ethical considerations extend beyond the clinical encounter. Addressing technical challenges such as data security, privacy breaches, and equitable access for all populations, including those with disabilities, is crucial. Transparent reimbursement mechanisms and ongoing education for both patients and healthcare providers are essential for successful televisit integration. The successful implementation of televisits requires a multi-faceted approach that addresses ethical considerations at all stages. Developing comprehensive guidelines, adhering to international standards, and establishing robust oversight mechanisms are essential for ensuring the safe, effective, and equitable utilization of this innovative technology in healthcare delivery.
Amin Arman, Mina Mobasher, Mohammad Aminizadeh,
Volume 17, Issue 1 (3-2024)
Volume 17, Issue 1 (3-2024)
Abstract
Deciding on whether to continue life-prolonging treatments for terminal patients is a major challenge in healthcare. Advance directive emerges as a proposed solution to this issue in the world. The patients record their preferences regarding the continuation of life-prolonging treatments while they still are able to make decisions. Although advance directive is morally justifiable from the perspective of principlism, respecting the patient’s right to autonomy and assessing the benefits and drawbacks of providing such services, the religious beliefs of patients, their families, and healthcare providers always exert a significant influence on this matter. In Islam, preserving human life heavily affects these decisions. Several juridical and legal rules can culminate in different decisions on the continuation or termination of life-prolonging treatments including the absolute legal power of the owner to exercise dominion[1] or control over property and permission of intervention in their body[2], the rules of prohibition on causing the death[3], the sanctity of human killing[4], the rule of prohibition of detriment[5], the concept of unstable life[6] in Article 372 of the Islamic Penal Code and the rules of preventing losses[7], and the rule of sanctity of idle[8]. Nevertheless, given various types of will in Islamic Jurisprudence and according to the contract of agreement[9], it is possible to record the patient’s request regarding how to continue the treatment. This study indicated that implementing advance directives in Iran’s health system requires a more accurate analysis of moral, legal, and jurisprudential foundations.
[1]. (tasli¯t)
[2]. (ezn dar tasarof)
[3]. (nafy al-d.arar )
[4]. (Hormat Ghatl)
[5]. (la¯ d.arar wa la¯ d.ira¯r fi¯ al-isla¯m)
[6]. (Ghayr-Mustaqarr)
[7]. (‘usr wa al-h. araj, al-)
[8]. (hormat laghw)
[9]. (agde solh)
Study of Research Misconduct Using an Analytical Approach to the Research System of Medical Sciences
Amirhossein Mardani, Maryam Nakhoda, Ehsan Shamsi Gooshki,
Volume 17, Issue 1 (3-2024)
Volume 17, Issue 1 (3-2024)
Abstract
Since research misconduct can be considered as an adaptive reaction against the limitations, pressures, and demands arising from inappropriate functions of the research system, to manage it, the activities of the research system should be investigated and traced during the path of transferring research policies (macro level) to research development programs in institutions (meso level) and research implementation by researchers (micro level). By introducing the macro-meso-micro analytical framework, this study clarified the tasks, strategies, and activities formed at three levels of the research system of medical sciences in Iran; from macro policies of research (macro) to operational plans for the development of research in universities and research centers (meso) and researchers as research conductors (micro). For this purpose, three analytical levels of the research system were explained and defined according to the assumptions of this framework. By performing a qualitative content analysis of the relevant texts, those activities that could be useful at different levels to support the research integrity were identified and presented as different strategies. The results showed that the research system, based on the existing analytical framework, is not seen as a mere macro-system without regard to the interaction of its parts, but rather a system in which there is cross-sectional influence and interaction among the components. This approach can improve the focus, clarity, and capability to study research misconduct, and by using micro, meso, and macro levels, it can trace challenges in the interactive path of various activities and functions of the research system and their intertwining.
Saeed Nazari Tavakkoli, Saeed Ghadirzadeh Toosi,
Volume 17, Issue 1 (3-2024)
Volume 17, Issue 1 (3-2024)
Abstract
Ehsan Shamsi Gooshki,
Volume 17, Issue 1 (3-2024)
Volume 17, Issue 1 (3-2024)
Abstract
Defensive medicine refers to actions taken by doctors and other medical professionals to protect themselves against potential threats and risks, particularly to prevent patient complaints or convictions in court, which is carried out in various forms including positive and negative defensive medicine. Since the primary motivation behind such actions, often viewed as morally unjustified, is to avoid legal proceedings and lawsuits, court rulings against doctors can intensify these behaviors. Reports of criminal sentences against some doctors in Iran and reactions from professional associations highlight the significance of this issue. This study examined the effects of such sentences on the healthcare system by referring to available documents and data on the widespread prevalence of defensive medicine in Iran, offering some suggestions for managing the issue. The objective of the study was to emphasize the importance of acknowledging the defensive motivations of doctors in healthcare and its influential factors, particularly the fear of criminal convictions, which can increase defensive behaviors among doctors and amplify their negative impacts on the healthcare system.
Elham Malekzadeh, Zahra Alizadeh Birjandi,
Volume 17, Issue 1 (3-2024)
Volume 17, Issue 1 (3-2024)
Abstract
This study examined the history of the establishment and evolution of Tehran’s insane asylum during the Qajar and Pahlavi periods. The significance of this study in medical history lies in its exploration of the founding of one of Iran’s earliest medical institutions and the factors that influenced its subsequent transformations. Given its focus on the development of insane asylum (Dar al-Majanin) and the public’s appeals for its improvement, this study offers valuable insights into the social history of the period. Employing a descriptive-analytical approach and relying on unpublished archival documents, this study presented a narrative of the history of madness that shed light on the untold stories of the mentally ill (Majanin) and prevailing societal beliefs about them. These beliefs profoundly influenced the treatment of patients within these institutions. The findings revealed that while the care provided to the mentally ill improved during this period, ongoing challenges persisted due to limited resources and a growing patient population. The prevailing attitude of officials toward the mentally ill was primarily one of containment, aimed at protecting the public from perceived threats.
Hosein Fasihi, Dr. Syyed Ahmad Fazeli,
Volume 17, Issue 1 (3-2024)
Volume 17, Issue 1 (3-2024)
Abstract
In the realm of philosophy, numerous thinkers have offered profound, and at times amazing, insights into the nature of existence. Among them, Spinoza stands out with his unique perspective, establishing a deep connection between ethics, religion, and the divine nature. Spinoza posits that religious texts, beyond their religious teachings, serve a motivational role in inspiring moral behavior. He locates the foundation of virtue within human nature and essence, arguing that the moral quality of actions is not inherent but is derived from God as the ultimate source of good and evil. Ultimately, adhering to the principle of universal necessity, Spinoza extends this concept to ethics, viewing it as an expression of divine nature. This perspective implies that morality and all human actions unfold within the framework of natural and divine necessity. An examination of Spinoza's views reveals a profound unity between humanity and the divine, characterized by a harmonious and interactive relationship between religion and ethics. Within Spinoza's philosophical system, these two categories are aligned, guiding individuals toward happiness and virtue. This innovative approach not only enriches our understanding of Spinoza's thought but also, by bridging religion, reason, and health, opens avenues for reconsidering medical ethics and spirituality in the contemporary world. This study, through a critical analysis of Spinoza's views, lays the groundwork for future investigations into moral philosophy, religion, and medical ethics, fostering a constructive dialogue between tradition and modernity.
Hamidreza Namazi, Navid Ravan,
Volume 17, Issue 1 (3-2024)
Volume 17, Issue 1 (3-2024)
Abstract
Medical considerations about aging are as old as medicine itself. However, due to the controversy about whether aging should be classified as a disease or merely a stage of life, geriatric medicine was separated from medicine with a considerable lag. The differentiation of geriatrics from other medical specialties is not rooted in subjecting a specific organ of the body or specific pathophysiological processes but based on a particular stage of life. On the other hand, different stages of life, such as old age, are also subjects for medicalization. Therefore, geriatric medicine may sometimes be threatened by geriatric medicalization and its associated harms. In addition, the relativity and ambiguity in defining the concept of aging and its dependence on social contexts can lead to confusion in understanding the subject matter of geriatric medicine. Mitigating these harms requires philosophical and ethical reflection on health and disease concepts as well as on the essence of aging. Considering that Iran is expected to face an aging crisis in the coming decades, this philosophical reflection at different levels among researchers in the philosophy of medicine and medical ethics, researchers and practitioners in geriatrics, as well as among civil society, can lead to separating geriatric medicine from geriatric medicalization, hence increasing the integrity and efficiency of geriatric medicine, and promoting the health status of the elderly.
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