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The Necessity of Social Solidarity and Sustainability Principles in Health System Programs
Mehran Seif-Farshad,
Volume 17, Issue 0 (12-2024)
Abstract
Health care services, in addition to being recognized as fundamental rights in various global human rights declarations, play a crucial role in advancing the development of human societies. The four principles of biomedical ethics introduced by Beauchamp and Childress—autonomy, non-maleficence, beneficence, and justice—are pivotal for ethical analysis and decision-making. However, certain other dimensions, which may not be explicitly addressed within these principles, are essential for policymaking at both macro and micro levels in health care. Two such important principles are social solidarity and sustainability, both of which hold a prominent position in health systems planning. The principle of social solidarity refers to the ways in which unity, cohesion, and collaboration are fostered within a community. A socially cohesive society embraces cultural diversity, respects human rights and the rule of law, and demonstrates a shared commitment to social order and collective responsibility. Social solidarity can significantly reduce health risks by creating a strong societal framework where cooperative efforts foster conditions for well-being, minimizing disability and disease. On the other hand, a health care system is fundamentally responsible for establishing and maintaining a sustainable and high-quality care environment. Sustainability in health services is achieved when ethical obligations—such as maximizing possible benefits, balancing risks against benefits, ensuring fairness (including for future generations), and respecting public rights—are prioritized. Continuity of health care ensures better coordination and improved delivery of services. Disruptions in health policies or intermittent provision of health services can severely undermine public trust. A conceptual understanding of sustainability and continuity in public health ethics is crucial, as these principles ensure that health policies, programs, and services enable access to the highest attainable standard of health, free from economic, social, or political instability. However, sustainability should not imply stagnation; services must remain responsive to the evolving needs of populations and societies. Ignoring these two principles in health policymaking and program design can seriously erode public trust and ultimately harm individual and Health system planning, should be changed to Health care programs.

Musts and Must-Nots of Continuing Professional Development: A Focus on Professionalism and Professional Ethics
Leila Afshar,
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.

Ethical Challenges of Truth-Telling for Terminally Ill Patient
Neda Yavari ,
Volume 17, Issue 0 (12-2024)
Abstract
Communicating the truth about a terminally ill patient’s diagnosis and prognosis is a profound ethical challenge in healthcare. While patients have the right to know the details of their medical condition, grounded in the ethical principle of autonomy, healthcare providers often grapple with concerns about causing distress or hopelessness. These concerns sometimes lead to paternalistic approaches where information is either manipulated or withheld from patients in end-of-life stages. Research on the timing, method, and extent of information sharing with terminally ill patients has yet to reach a consensus. The challenge is further complicated by cultural differences regarding death, as well as varying family and social dynamics. This article explores the views and experiences of both healthcare providers and patients regarding the ethical challenges associated with truth-telling in end-of-life care. This qualitative study involved semi-structured, in-depth interviews with 27 healthcare providers, 20 patients, and 15 caregivers. Participants were selected through purposive sampling, and interviews were conducted until data saturation was achieved. The data were analyzed using conventional content analysis. The findings were organized into four key themes:
1.Diverse methods of truth-telling employed by healthcare providers, influenced by personal values, institutional policies, and cultural contexts.
2.Patients’ and families’ preferences for receiving information, which frequently conflicted with healthcare providers’ practices.
3.The impact of timing, manner, and setting of truth-telling on the emotional health of both patients and their families.
4.The necessity for a patient-centered approach that acknowledges the unique circumstances, values, and preferences of patients and their families.
This research highlights the ethical complexities involved in truth-telling for terminally ill patients. While respecting patient autonomy is fundamental, the manner and timing of delivering the truth are crucial to maintaining trust in the physician-patient relationship and safeguarding the patient’s mental health. Further research should focus on developing effective communication strategies and support systems for healthcare providers engaged in end-of-life care. Educational programs should prioritize improving communication skills, cultural sensitivity, and ethical decision-making to enhance best practices and alleviate the emotional challenges faced by healthcare professionals in this sensitive area.

Ethical Considerations in Post-Crisis and Disaster Rehabilitation
Mohammad Javad Hosseinabadi Farahani,
Volume 17, Issue 0 (12-2024)
Abstract
Rehabilitation in disaster contexts, as part of the overall medical response, faces unique challenges, particularly during the early stages of post-disaster intervention. This is largely due to the relatively new integration of rehabilitation into disaster management. The four principles of bioethics—autonomy, beneficence, non-maleficence, and justice—are essential considerations in immediate post-disaster relief efforts and in the subsequent long-term rehabilitation processes. This review study involved a purposeful search of reliable databases using predetermined keywords, covering the period from 2000 to 2024. The reviewed studies highlight several ethical dilemmas in delivering rehabilitation services after crises and disasters. These challenges arise due to factors such as:
· Resource limitations,
· Insufficient focus on rehabilitation within health systems,
· Shortages of rehabilitation specialists,
· Inadequate follow-up cares post-discharge,
· Limited awareness of the significance of rehabilitation, and
· Stigma associated with disability.
Despite these challenges, it is critical to uphold the four principles of biomedical ethics even in crisis situations. Adhering to these principles ensures that rehabilitation services align with professional norms, ethical standards, and the medical aspects of the local culture. Furthermore, policies aimed at enhancing the status and importance of rehabilitation immediately after crises and disasters must emphasize the equitable distribution of resources.

Ethical Considerations in Post-Crisis and Disaster Rehabilitation
Mohammad Javad Hosseinabadi Farahani,
Volume 17, Issue 0 (12-2024)
Abstract
Rehabilitation in disaster contexts, as part of the overall medical response, faces unique challenges, particularly during the early stages of post-disaster intervention. This is largely due to the relatively new integration of rehabilitation into disaster management. The four principles of bioethics—autonomy, beneficence, non-maleficence, and justice—are essential considerations in immediate post-disaster relief efforts and in the subsequent long-term rehabilitation processes. This review study involved a purposeful search of reliable databases using predetermined keywords, covering the period from 2000 to 2024. The reviewed studies highlight several ethical dilemmas in delivering rehabilitation services after crises and disasters. These challenges arise due to factors such as:
· Resource limitations,
· Insufficient focus on rehabilitation within health systems,
· Shortages of rehabilitation specialists,
· Inadequate follow-up cares post-discharge,
· Limited awareness of the significance of rehabilitation, and
· Stigma associated with disability.
Despite these challenges, it is critical to uphold the four principles of biomedical ethics even in crisis situations. Adhering to these principles ensures that rehabilitation services align with professional norms, ethical standards, and the medical aspects of the local culture. Furthermore, policies aimed at enhancing the status and importance of rehabilitation immediately after crises and disasters must emphasize the equitable distribution of resources.

Ethical Considerations of Pregnancy in the “Supporting Families and Population Rejuvenation Law”
Kobra Joodaki,
Volume 17, Issue 0 (12-2024)
Abstract
Women play a central role in human reproduction, with the continuation of the human race relying on their pregnancies. When women contribute to this vital social function for the survival of humankind, society has a moral obligation to safeguard their health. While healthcare interventions benefit the fetus, the fetus is entirely dependent on the mother, and any treatment must occur through her body. Consequently, the best strategy for improving fetal health lies in enhancing the care and support provided to pregnant women. The current state of population dynamics, associated challenges, and the introduction of general population policies led to the formulation and enactment of the "Supporting Families and Population Rejuvenation Law." This legislation aims to address many—though not all—of the challenges related to population growth and childbearing. The efforts to combat population aging and meet demographic needs are laudable, and the law includes several economic incentives to encourage childbearing. However, financial incentives alone are insufficient to address the complex reasons behind individuals' unwillingness to have children. Cultural, social, and political factors also play significant roles, and these are addressed to some extent within the law. Notably, specific provisions focus on supporting infertile couples, assisting pregnant women, and offering solutions to address illegal abortions. Regrettably, during the drafting of these provisions, the expert opinions of relevant scientific associations were overlooked. As a result, numerous ethical and scientific challenges have emerged in the implementation of the law, leading to deviations from its intended objectives. In particular, certain sections fail to adequately protect the fundamental rights of pregnant women. This article aims to analyze these challenges and propose solutions grounded in the principles of medical ethics.

Ethical Considerations in the Application of Stem Cell Technology in Research and Clinical Practice
Rasool Esmalipour, Narges Dastmalchi , Khalil Hajiasgharzadeh,
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.

Exploring the Concept of Patient Advocacy
Reza Negarandeh ,
Volume 17, Issue 0 (12-2024)
Abstract
Patient advocacy is a cornerstone of ethical healthcare practice, encompassing actions that protect patient rights, uphold their autonomy, and ensure they receive high-quality care. Nurses are often seen as being in the best position to play this vital role. This conference abstract aims to provide a comprehensive understanding of patient advocacy and identify strategies for enhancing advocacy practices in healthcare settings. In this comprehensive review, scientific literature, including peer-reviewed articles, professional guidelines, and relevant policies, was retrieved and reviewed. Data extracted from the literature were synthesized using quantitative content analysis to identify different forms of patient advocacy, including clinical advocacy and systemic or workplace advocacy, as well as strategies to improve the necessary skills for each. Clinical advocacy involves ensuring patient safety, supporting informed decision-making, and advocating for appropriate pain management. Improving clinical advocacy requires a multifaceted approach that prioritizes building trust and rapport with patients to foster effective communication and shared decision-making. Encouraging patient participation in their care, supporting self-management strategies, fostering effective communication within the healthcare team, and staying informed about relevant ethical, legal, and policy developments are essential components. Workplace or systemic advocacy, on the other hand, focuses on addressing broader issues within the healthcare system that impact patient care. Improving systemic advocacy involves identifying and analyzing systemic issues, such as healthcare disparities, resource limitations, and policy barriers, through data collection, stakeholder engagement, and thorough analysis. Strategies to address these issues include policy advocacy, improved resource allocation, and quality improvement initiatives. Building strong partnerships with other healthcare professionals, community organizations, and policymakers is key. Additionally, promoting education and awareness within both the healthcare workforce and the public is crucial. Leveraging technology to enhance data collection, communication, and mobilization efforts can further support systemic advocacy initiatives. By implementing these strategies, healthcare professionals can effectively advocate for systemic change, improve the quality of care for all patients, and create a more equitable healthcare system. Patient advocacy is a dynamic and multifaceted role that requires continuous learning and adaptation. By embracing the principles outlined in this synthesis, nurses can effectively champion patient rights, improve the quality of care, and contribute to a more equitable healthcare system.

Oversight of Research Ethics Committees in Knowledge-Based Projects
Saeed Biroudian,
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.

Survey on Measuring Patients' General Trust in Doctors
Fatemeh Sadat Asgarian, Ali Saber, Sare Bagheri,
Volume 17, Issue 0 (12-2024)
Abstract
Trust is one of the most important aspects of human relationships, providing the foundation for participation and cooperation among individuals. It is also one of the most valuable social assets within the healthcare system. If trust is disrupted, it can impose significant costs on the system. The purpose of this study is to measure the level of patients' trust in doctors and its impact on the treatment process at Shahid Beheshti Hospital, Kashan. In this study, 325 patients referred to the emergency department of Shahid Beheshti Hospital in Kashan were selected. After applying the inclusion and exclusion criteria, 310 participants remained in the study. The General Trust Instrument was used for this research. This questionnaire consists of 33 questions covering six dimensions: patient-centered care (6 questions), macro-level patient care policies (6 questions), provider expertise (4 questions), quality of care (9 questions), communication and information provision (6 questions), and quality of collaboration between providers (2 questions). Scores ranged from 0 to 100, categorized as follows: 0–20 indicates very low trust, 20–40 low trust, 40–60 moderate trust, 60–80 high trust, and 80–100 very high trust in healthcare. Out of the 310 participants, 157 (50.6%) were male, and 153 (49.4%) were female. The mean age of the patients was 56.6 ± 20.6 years. Among the patients, 178 (57.4%) had acute illnesses, while 132 (42.6%) had chronic illnesses. The mean and standard deviation of the total score for the General Trust Questionnaire was 95.59 ± 13.8. This study demonstrated that the general trust score of patients in the doctors at this center is high. In delivering healthcare, interventions alone are insufficient; improving the quality of services is essential to enhance patient trust and satisfaction.

Ethical Challenges in Parental Refusal of Mandatory Vaccination of Children: Balancing Parental Autonomy and Public Health
Farzaneh Soleimani, Leila Afshar,
Volume 17, Issue 0 (12-2024)
Abstract
According to the World Health Organization (WHO), vaccination has significantly reduced the burden of infectious diseases. However, low disease rates do not eliminate the need for continuous monitoring to address the threat of potential outbreaks. The presence of unimmunized individuals can place any community at risk of disease outbreaks. This review aimed to explore the ethical challenges associated with parental refusal to vaccinate children and to identify knowledge gaps in this area for further research within the country. A comprehensive search was conducted using PubMed and ScienceDirect. The final selection included 35 academic articles, one book, and one master’s thesis. In Iran, as in many other countries, anti-vaccination movements have grown in recent years, particularly following the rollout of COVID-19 vaccines. These movements often oppose vaccination for reasons such as philosophical or religious beliefs, poor health literacy, mistrust in healthcare systems, and personal or social experiences. The debate surrounding mandatory vaccination has persisted, primarily due to ethical concerns about coercion. One of the central ethical challenges involves the conflict between parental autonomy and public health. The degree to which parental autonomy is respected is a critical issue in the ethics of vaccination. Factors such as misinformation, inadequate information, or misinterpretation of information can constrain parental autonomy. Conversely, the state has a duty and vested interest in safeguarding children from harm, which may lead to challenging parental autonomy in cases where a child’s well-being is at risk. In conclusion, the extent of parental autonomy in planned interventions such as vaccination depends on the balance between the benefits and burdens of the intervention, taking into account the ethical principles of beneficence and non-maleficence. The greater the benefit, the less decisive parental autonomy becomes, and vice versa. Various studies addressing this issue have proposed strategies such as public education, organizing community-level vaccination discussions, educating vaccine-hesitant parents with evidence-based information, providing trustworthy resources for research, identifying factors influencing parental autonomy, conducting regular follow-ups, and implementing negative policies, including legal enforcement, fines, and restrictions on access to daycare centers and schools.

Promoting Ethical Motivation in Health Care Organizations: Ethical Accreditation of Healthcare Service Facilities: A Review Study
Seyed Ali Enjoo ,
Volume 17, Issue 0 (12-2024)
Abstract
Organizational ethics in healthcare literature encompasses a set of complex and interrelated topics. It is regarded as the frontier of medical ethics or the next stage in the evolution of bioethics. To effectively address organizational ethical issues within healthcare organizations, it is crucial to understand both the similarities and differences between competing concepts. Moreover, the presence of financial and contractual concerns often makes it challenging to motivate managers to enhance the ethical climate of their organizations. This study aims to develop a deeper and more comprehensive understanding of organizational ethics in the healthcare system. This review study involved a comprehensive search of the literature on healthcare system ethics, utilizing the following databases: PubMed, Scopus, Web of Science, and CINAHL. Additionally, grey literature from published books on Healthcare Organization Ethics and websites of organizations such as JCAHO and VBN were also included. The search strategy employed a combination of keywords such as 'health ethics,' 'organizational ethics,' 'health organizations,' 'ethical decision-making,' 'manager motivation,' and 'CEO incentives.' Only English-language sources with accessible full-texts were considered. All search results were reviewed, and duplicates were removed. This study offers a comprehensive overview of the existing literature on organizational ethics in healthcare, providing a detailed map of key texts in the field.
 

An Islamic Bioethics Framework for Decision-Making on the Life Support of Periviable Newborns
Forouzan Akrami,
Volume 17, Issue 0 (12-2024)
Abstract
For many years, the question of whether or not to resuscitate periviable newborns has been a topic of debate among perinatologists, neonatologists, and ethicists. Unlike other studies that focus on the value and sanctity of human life during intrauterine development, the present study seeks to address the ethical question of what constitutes the right decision regarding life-support measures for newborns born at peri-viability ages, within the ethical norms of the Islamic tradition. This study assumes the inherent value of every moment of human life and acknowledges the human dignity of individuals from the time of conception. This multi-method study was conducted in three parts: (1) a review of the ethical frameworks presented for supporting the lives of periviable newborns, (2) an explanation of the principles of Islamic bioethics based on common Sunni and Shiite sources, and (3) the development of an Islamic bioethics framework. According to the ethical principles of the Islamic tradition—contrary to secular biomedical ethics—first and foremost, efforts should be made to preserve and prolong the life of periviable newborns regardless of their anticipated quality of life. Second, in decisions involving life and death, the priority is not the preferences of the infant's parents but rather the saving of the infant's life and its preservation by the physician and medical team. Nonetheless, parental participation in the decision-making process is essential. Preserving life, however, is not an absolute obligation; the aim of life-support measures is not merely to extend the infant's life for a short period but to do so in proportion to the prognosis and expected benefits. Specifically, these measures should be considered when there is a significant probability of the newborn’s survival. This requires a case-by-case assessment of risks, taking into account the newborn’s clinical condition, as well as regional resources and conditions. It is recommended to use the proposed Islamic bioethical framework to develop a clinical guideline that includes criteria for classifying infants born at the edge of viability based on their clinical condition. Ethical decisions to intervene should then be based on the infant's clinical state, probability of survival, and the resources available in the region.

Cutting the Financial Relationship Between Doctor and Patient: A Key Solution to Health Ethics Challenges
Mohsen Rezaei Adaryani,
Volume 17, Issue 0 (12-2024)
Abstract
The relationship between healthcare providers and patients is often marred by financial issues, which present significant ethical challenges. These financial interactions can be categorized into direct and indirect communications, both of which give rise to various ethical dilemmas. In direct financial communication, issues such as under-the-table payments, fee splitting, self-referral, inappropriate referrals, induced demand, and unnecessary surgeries or hospitalizations are prevalent. These practices compromise the ethical standards of medical care. On the other hand, indirect financial communication occurs when a small portion of the healthcare cost is paid by the patient, while the majority is covered by intermediary institutions like insurance companies or the Ministry of Health. The family physician system, with accurate patient referrals and cost management, supports this model. Under such a system, service tariffs align with actual costs, creating "real" tariffs, and reducing opportunities for many ethical challenges to arise. The current health system provides practical examples of the disconnection of financial relationships, notably through policies such as the Accident Insurance Law (Article 92 of the Fourth Development Plan) and the family physician system within the Imam’s Relief Committee. Health centers involved in treating injured patients and staffed with experienced personnel have observed and reported significant improvements following the implementation of the Accident Insurance Law, highlighting the positive impact of financial disconnection on healthcare ethics. This study demonstrates that cutting financial ties between doctors and patients, through indirect financial communication models and accurate referral systems, is an effective solution to addressing a wide range of ethical challenges in healthcare.

Moral Sensitivity in Psychiatric Nurses: A Qualitative Content Analysis
Fariba Borhani, Mariye Jenabi Ghods, Ladan Fattah Moghadam, Tahereh Gilvari, Amirreza Rafiei Javazm, Mahshad Naserpour, Mohammad Javad Hosseinabadi ‑farahani,
Volume 17, Issue 0 (12-2024)
Abstract
Moral sensitivity is a fundamental characteristic of professional ethics in nursing, significantly influencing patient care. This qualitative study aimed to explore the concept of moral sensitivity among psychiatric nurses. The study employed a qualitative approach using content analysis. Participants included 15 psychiatric nurses working at Razi Psychiatric Hospital in Iran, selected through purposive sampling based on defined inclusion and exclusion criteria. After obtaining ethical approval, data were collected through semi-structured, in-depth interviews. The interviews were audio-recorded, transcribed, and managed using MAXQDA software. Data analysis was conducted following Granheim and Lundman’s five-step method (2004), and the trustworthiness of the findings was ensured using Guba and Lincoln’s criteria. The findings revealed three main categories and six subcategories:
  1. Ethical Knowledge (comprising clinical experience and education, and professional development).
  2. Ethical and Legal Conflicts (including discrepancies between ethical principles and legal frameworks, and challenges in ethical decision-making within complex legal situations).
  3. Ethical Atmosphere (encompassing individual ethics and organizational ethics).
Based on these findings, it is recommended that these insights be integrated into nursing education, research, and management to enhance care for patients with psychiatric disorders.

The Effect of Using Student Reflective Narratives to Observe Dignity and Respect for Patients’ Rights in Clinical Education
Hoda Ahmari Tehran, Ahmad Mashkoori, Tayebeh Ilaghinezad, Maryam Tajadini,
Volume 17, Issue 0 (12-2024)
Abstract
Research shows that stress in medical students leads to burnout and a loss of respect for patients’ rights. These declines in mood and an increase in malpractice are particularly evident during the internship period. On the other hand, literature highlights the importance of reflective practice in education. This study investigates the effect of using student reflective narratives on observing dignity and respect for patients’ rights in clinical education. A mixed-methods study based on reflective learning theories (Gibbs' Reflective Model) was conducted over 12 months with 48 intern students. In a quasi-experimental design, 38 medical students were randomly assigned to either an intervention or a control group. Only students in the intervention group were allowed to engage in conversations with patients and inquire whether they had properly respected the patients’ rights and dignity. The students then reflected on their performances. In the first week, a pretest was conducted in both groups. The intervention group received reflective education and participated in reflection writing during the second and third weeks. In the final week, a post-test was conducted for both groups. To explore students’ perceptions of the effectiveness of reflecting on their performance, a qualitative content analysis was carried out, including 12 semi-structured interviews and 144 reflection notes. The mean scores of students’ performance regarding respect for patients in the intervention group improved significantly in the post-test (12.32 ± 1.21) compared to the pretest (9.85 ± 1.39) (p < 0.05). An independent t-test indicated that the difference in post-test scores between the two groups was significant (p = 0.01). From the interviews, four main themes emerged: improving empathy and understanding patients’ feelings, paying attention to patients’ humanistic dimensions, respecting patients’ autonomy and rights, and promoting interpersonal communication skills. This study demonstrated the positive emotional effects of reflective narrative writing interventions on medical students in observing dignity and respecting patients' rights. It is recommended to incorporate reflective narratives into medical education programs to enhance these qualities.

Evaluation of Participants' Awareness of Informed Consent Forms in Clinical Trials at Iran University of Medical Sciences in 2020
Fatemeh Hekmatian, Akram Hashemi, Soodabeh Hoveida Manesh, Saeedeh Saeedi Tehrani,
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.

Assessment of Compliance with the Patients’ Rights Charter by Healthcare Staff from the Perspective of Hospitalized Patients in Shahid Rahnemoon Hospital, Yazd
Tahereh Shafaghat, Elahe Rahmani Samani, Elnaz Haiery, Atiyeh Dehghan Niri, Zahra Raisi,
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.

Ethical Considerations in Televisits: A Framework for Safe and Effective Implementation
Fatemeh Rahimi,
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.
 

The Impact of Professional Ethics Training on the Spiritual Care Competence of Emergency Nurses
Milad Kazemi Najm, Tahereh Toulabi, Abbas Abbaszadeh, Rasoul Mohammadi, Nasrin Imanifar,
Volume 17, Issue 0 (12-2024)
Abstract
Nurses, as the largest group of healthcare workers globally, are responsible for providing holistic care to patients. Holistic care encompasses physical, mental, social, and spiritual dimensions. This study aimed to determine the effect of professional ethics training on the spiritual care competence of emergency nurses. This two-group field trial study with a pre-test and post-test design was conducted with 84 nurses working in the emergency departments of Lorestan University of Medical Sciences. Participants were selected through stratified random sampling. The intervention group participated in four workshops. The study tool was the Spiritual Care Competency Questionnaire. Data analysis was performed using SPSS, employing descriptive statistics (mean, median, and percentage) and inferential statistical tests, including repeated measures ANOVA, independent t-tests, and Fisher’s exact test.
The study included two groups: intervention (n = 42) and control (n = 42). Most participants in both groups were women. A significant difference was observed in the average total spiritual care competence scores and its dimensions (excluding the self-knowledge subscale) over different time points in the intervention group (P < 0.001). However, for the self-knowledge subscale, no significant difference was found in the average scores between the control and intervention groups at different time points. The results of this study demonstrated that professional ethics training improves nurses' spiritual care competence. By conducting workshops, training programs, and in-service courses on professional ethics and spiritual care, the quality of nursing care can be enhanced, ultimately improving patient safety. It is recommended that healthcare policymakers and nursing managers prioritize professional ethics as the foundation of all nursing practices. Employing innovative and engaging methods, such as the scenario-based approach used in this study, can further support the development of professional ethics in nursing.

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