Iranian Journal of Medical Ethics and History of Medicine

Although, physicians have a duty to treat their patients, sometimes the cure is not possible in medicine and there is no result in attempt to cure patient. In this situation, we face with two types of patients: first, patients who are conscious but suffering with advanced disease and will survive only for a short time. The second group, are patients who are unconscious and may not be cured with the standard treatment based on physician experience.
The latter are the subject of the present article. So what a Hospital should do in dealing with these patients? How the hospital, should develop a community-based policy on providing care for these patients. Finally, how should inform the public to adhere to these policies.
 

Informal payments in clinics raise ethical concerns in healthcare delivery. This cross-sectional questioner survey aims to evaluate the prevalence and related factors of informal payment in healthcare system in Iran.
The study was carried out in 2013, prior to the implementation of the government' Health System Reform among physicians with different specialties. The questionnaire were distributed among the participants during the congresses and continuing medical education programs.
In results; of the total specialist physicians, 276   returned the questionnaires. The response rate was 81.17%. and out of 276 returned questionnaires 257 fulfilled the inclusion criteria. The prevalence of informal payments, among the physicians who were susceptible to receiving informal payments, was relatively high (63.8%). The physicians who practiced in the private sector, as well as physicians who practiced in Tehran and those who had a positive attitude towards the informal payments, received more informal payments. From the viewpoint of the respondents, the main cause of informal payments was unrealistic/unfair tariffs and the main consequence of informal payments was the rising costs of patient care.
This study showed that, unfortunately, more than half of the participants did not believe or did not decisively consider informal payments as unethical. This confirms the importance of physicians’ education about the unethical practice of informal payments. However, compare to private sectors, more supervision in public sector may be the main cause of less prevalence of informal payments in public hospitals.
In conclusion: Developing ethical guidelines to prevent informal payments as well as more realistic and fair tariffs would help to decrease the incidence of informal payments.
 

Modern medical ethics, in particular the principle of Non-Maleficent, advises the medical staff to avoid any harm to the patient. Islamic jurists, using religious texts and sources, have introduced rules that are applicable in many areas of life. Among these rules, is the rule Non-Harm, that in this article to review this rule and its applications in medicine. In addition to discussions of the documents, a better understanding of the words "Darar" and "Dirar" and deny or forbid the word "La" at the beginning of the base document, is one of the major issues and disputes. Organ transplants, family planning and birth control, responsibility to protect the health, need to see a doctor for treatment, civil responsibility for doctors in the treatment, responsibility for custodians of society for the control of AIDS, are the problems affecting today's health systems that the rule of No Harm is flowing in them.

Islamic culture has a bright and comprehensive history in human civilization. Based on Islamic teachings the spirit and body are in close relation with a mutual influence on humans’ health. The Holy Qur’an as well as the Prophet of Islam and his successors (peace be upon them) have paid deep attention to both spirit and body. Moreover, according to religious scholars’ decree (fatwa) cleanness and neatness has been mentioned as the main condition for worships to be accepted. The Prophet (PUH) said: “Neatness is half of the faith”. Therefore, efforts to keep the health of both spirit and body are important to Muslims.  Although, in ancient time, health and medicine were bined together, later they were divided into three sections including health, clinical diagnosis of disease and treatment. Based on Islamic teachings, Muslim scholars learned medicine and then began to translate some Greek, Seriani and Indian medical knowledge into to Arabic language, which has shaped the golden age of Islamic medicine spanning between the 8th and the 15th Centuries.
Among the Islamic countries Iran had a specific place in the field of medical sciences. Jondishapour was one of the most prominent medical educational centers back then. This article elaborates on the status of medicine based on historical evidence as well as Muslim physicians in the golden age of Islamic medicine.
 

The conflict of interest is a situation in which professional judgment and performance in the primary interest and obligation tend to be unduly influenced by a secondary interest. Pharmacy is one of the main rings in the process of providing healthcare services. In this process conflict of interest may occur frequentlywhich occasionally has influence on the professional and moral duties of pharmacists that as a result may put the interst of the patients at risk. Taking care of patients is the first duty of pharmacist and they always must make evry effort to avoid any situations that puts the interests of the patientincluding their health, financial or non-financialposition at risk. The pharmacist must be aware of conflict of interest that exist in the drugstore as well as its effects on their professional and moral responsibilities. They also need to be able to manage them through scientific policy and logical skills. These issues and challenges may happen in terms of the relationship between the pharmacist and patients, other people or organizations, such as the relationship between doctors and pharmacists, pharmacists and pharmaceutical or non pharmaceutical companies, irrational relationship between pharmacists and patients. Although various guidelines for managing conflict of interest have been developed, there is a lack of policy on how to manage conflict of interest in pharmacy. In this study, the situations of conflict of interest and how it affects the professional relations of pharmacist with others was considered and this result was achived that the pharmacy have to be asuitable and appropriate place to give services for patients and the first priority of pharmacists must be the patients’ treatment benefits and interest
 

Medical ethics in a reductive look can be handed to physician’s ethics and then call a physician who adheres to medical ethics attributed to the moral virtues. Moral virtues are counted to be about 137 in the teachings of Shiite, most of which are not related to the practice of medicine but nearly eighty virtues are linked to the practice of medicine.  This number is too much to be handled in a paper and analyzed by verses and hadiths. Therefore, we should take two steps: 1-Limit the virtues of physicians 2- Analyze the virtues of physicians. Believe and practice the virtues emphasized in the teachings of Shiite leads to a monotheistic look to the practice of medicine and provides physicians with a different and transcendental worldview. This insight that stood upon the teachings of the Qur'an and hadiths by Imams (AS) considers the practice of medicine a divine relation and then shows the communication between a physician and others. The current paper analyzes the divine relation of the physician and its impact to the practice of medicine. First literature review performed to find three most virtues. Then Factor analysis method was used and therapeutic virtues were limited to thirteen virtues. Then library study and focus group discussions were used to analyze the selected therapeutic virtues. The practical conclusions is that if we consider medical ethics practice based on virtue, and define and interpret virtues based on the teachings of Shiite, then we will get to a monotheistic view in the practice of medicine that distinguishes Shiite medical ethics monotheistic feature and the secular one, and helps to link between faith and morals.

Medical ethics is an old science. Some of its issues have historical precedence, and others are modern challenges, and have emerged with advances in technology. One of such historic but newly emerging challenges is "bi’natijeghi-e-pezeshki (futile treatment)", which is defined as the treatment that cannot achieve its goal. This term entered medical literature as "medical futility" in late 1980s. Based on this investigation, it can be concluded that this term should only be used when the desired outcome following medical procedure and the outcome sought by the medical team and patient/family (patient's health) is unlikely to be realized. There are various equivalents for this term in our country (Islamic Republic of Iran), including "bi’fayedegi-e-pezeshki (medical uselessness)", "bi’houdeghi (frivolity) in medicine", and even "inappropriate treatment". The present article aimed to find a suitable Persian equivalent for this concept. The use of interpretations such as "frivolity" or "uselessness" may cause misunderstanding between patient/family and the medical team, and can ruin the trust between patient/family and the medical team. Thus, the best alternative to this English term appears to be "bi’natijeghi-e-pezeshki (futile treatment)".

Studying the history of medical ethics and analyzing the dynamics and effects of renowned physicians of the Islamic era and the exploitation of this precious heritage is indispensable. Therefore, in this research, by descriptive-analytic approach, , the books of Teb Al-fukhara and Al-Masakin, Ibn al-Jazar, Full medical industry, Ahvazi, Law in Medicine of Ibn Sina, and Kharazmshahi Save of Jorjani were investigated, by analyzing the guidelines and ethical recommendations contained in the physician and patient interactions, as well as their practical applications in this regard, six important principles of Islamic medical ethics were attained: trust in God, profitability, harmlessness, trusteeship, compassion, and goodness. Two principles of profitability and harmlessness have been more emphasized than other ones, which can indicate the significance of these two ethical principles in Islamic teachings. The ethical issues in the field of medical sciences during the Islamic period did not have the diversity, breadth, and necessity of the present. Thus, in pre-natal and human-era discussions, only the prohibition of abortion is mentioned and there is no debate about the end-of-life care of the patient.

Medical Philosophy is essential part of medical ethics and history. I has long history and owes its current status to developments resulted by historical, philosophical, social, and cultural experiences. The most important reflection of its revolution is its influence on the goals and missions of higher education in different time periods. In this study, two of the most important philosophical perspectives towards the medical education are compared with the aim of investigating possibilities and limits of each perspective in general education, specialized education, and treatment. The descriptive-analytical method is used for this comparison. These two perspectives are: 1) biomedical philosophy, which is based solely on human biological mechanisms, and 2) humanistic philosophy, which is based on the integrity of the human being. The results of this study show that medical education from the perspective of the biomedical philosophy focuses on specialized education, and treatment from this perspective is performed in the form of a patriarchal relationship. Whereas, from the humanistic perspective, general education is based on the integrity of the human being (including biological, psychological, and ontological) together with the specialized education. Treatment in this approach is achieved through a collaborative relationship between the physician and the patient.

 

Moral intelligence as a dimension of intelligence can provide a framework for the proper functioning of human. This function can be effective in the clinical environment such as dentistry. Therefore, the present study examined ethical intelligence of the first and sixth year dental students in the Tehran University of Medical Sciences. The present cross-sectional study was conducted in 2018 among 106 of the first and sixth year dental students. The students were selected by census sampeling and the Lennic & Kiel's Ethical Intelligence Questionnaire were used for data collection. The variables were analyzed by SPSS-Ver.22 software using descriptive and analytical statistical tests. Findings of the study indicate that there is no significant relationship between the ethical intelligence of the first and sixth year dental students. Also, in the first year students, only the indirect relationship between ethical intelligence and mother's education (P value = 0.026) and the level of household economic condition (P- value = 0.009) were found. In the sixth year students', only the direct relationship between ethical intelligence and the level of household economic condition was found (P -value = 0.015). This study showed that the ethical intelligence of dental students during education was not significantly improved, which indicates that the educational system not effecient on for promoting ethical intelligence of dental students.

This research reviews the scientific productions of the field of biomedical ethics based on articles published in Iranian scientific journals in Farsi (Persian language). The findings showed that from 2003 to 2017, researchers have published 1238 Persian articles in this field. The average annual growth rate of published articles is 23.17 percent, but this growth has been declining since 2013. The citation rate of articles (0.4 per article) suggests a small impact. Shahid Beheshti University of Medical Sciences and Tehran University of Medical Sciences with the publication of 36% and 33% had the largest share in the publication of articles, respectively. Biomedical ethics research was interdisciplinary and researchers from the medical, nursing, and law sciences played a major role in compiling and publishing them. The topics such as medical ethics, medical education, and Islamic ethics were, repetitive subjects in articles, respectively. Only 22% of these articles referred directly to funding provided by universities and research centers.

Several definitions for medical futility has been proposed in the literature. Medical futility is defined as the condition in which an intervention, either for diagnosis, prevention, treatment, rehabilitation or other medical goals, has no benefit for the individual patient. This critical review aimed to increase the understanding of physicians and other healthcare providers on the issue of futility in complementary and alternative medicine (CAM). Our comprehensive search resulted in more than 1000 studies; unrelated studies were excluded by title and abstract screening, then 219 full-texts were read and finally, 118 studies were included. The conclusion concerning whether or not it is morally acceptable to provide a futile treatment in CAM, becomes a controversial issue based on different approaches. Using futile treatments is not acceptable according to the duty-based approach, and the principle of justice. In contrast, the case-based approach  and the principle of autonomy of the patient, hold that such treatments could be morally acceptable. Based on utilitarianism, only evidence-based treatments can be morally discussed, and those CAM therapies that have been shown to be futile, should be prohibited; thus health care providers must not offer them to patients since it would be a kind of deceit. We suggest that more comprehensive studies should be performed to clarify the boundary between placebo, nocebo, and futility.

The system of Iranian medicine in the Qajar era was the continuation of the system based on the humors view. Accordingly, the incidence of most diseases was attributed to whole view of the quadruple imbalance of blood, soda, bile, phlegm. Preventive and therapeutic approaches were also carried out in the same cognitive atmosphere. The example of Smallpox disease, indicates such a view in the Qajar era. According to the findings of this research, in Qajar medical literature, the bumps of pus in the skin of is described to be hard, single or non-separated with different colors and was called as Jodri or Smallpox. In terms of cognitive aspects, physicians of Qajar era following former physicians classified Smallpox disease in terms of humor among the hot and wet diseases and described boiling of blood in the body as the cause of this disease. Exposure to this disease was through the two pathways preventive and therapeutic measures. In order to prevent the disease, the necessary orders was recommended by the physicians by “sette zarurieh” and especially avoidance of several behaviuors. In terms of therapy, along with several types of diets, different kinds of medicines was used to relieve the symptoms and complications of the disease at different body parts. This study is a review, it has been attempted to examine the nature and purpose of the descriptive and analytical method and the therapeutic approach to treating Smallpox disease in medical system of Iranian Qajar era. Required information and data have been created in a desk research.

Patient rights is one of the essential rights that should be considered by the medical staff, checking and comparing the attitudes of first and last year medical students to inform the ethical points of service delivery is important. The aim of this study was to compare and evaluate of first and last year medical students' attitude about respecting patients' rights in hospitals of Bushehr University of Medical Sciences. The present study was a descriptive, cross-sectional study carried out by using a questionnaire derived from Patient Right Charter approved by the Ministry of Health. The study population included all the first and last year of medical students of Bushehr University of Medical Sciences. The sample size was 113 and the sampling method was census. By using independent t-test and Pearson correlation, data analysis was performed by SPSS19 software. The attitude of first year students' was 76.36 ± 13.90 and among seniors was 71.63 ± 8.08, which was statistically significant (p<0.05). %52 of first and %84 of last year medical students had respectively and relatively favorable attitude regarding patients' rights. There was not statistically significant relationship between students' attitude and demographic factors. First year students had a better attitude among patient rights than the last year students. Therefore, planning to improve the students' attitude of observing patients' rights during the years of study is recommended.
 

The white coat ceremonies are a recent phenomenon in medical education at the first steps of their education, that use as a symbol to impress upon medical students the importance of professionalism in medicine. This ceremony is known as one of the primary preparations for entrance of medical students to clinical courses. This study aims to investigate the effect of white coat ceremonies on professional ethics and student familiarity with their professional tasks in clinical departments. The present study is a qualitative study on the students' viewpoints regarding white coat ceremony and based on goal-based sampling. The statistical population included 4th-year medical students of Shiraz University of Medical Sciences in 1394. Data collection was done by a mixed method which one part of it was the half structural interview and another part by answering the open questions. Data collection continued to the saturation phase, furthermore; the data were analyzed by content analysis method according to the instructions. Most of the participants in this study considered holding a ceremony before entering the hospital as an important event for the readiness of students to go through a clinical course. The most important positive effects of white coat ceremony were increased students' commitment and accountability, improved interactions with patients, increased motivation and self-confidence, and familiarity with some of the basic principles of professional ethics. A white coat celebration can enhance the students' familiarity with their professional duties and motivations. More studies are needed to better understand the strengths, weaknesses, and shortcomings of this ritual.