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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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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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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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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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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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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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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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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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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