Iranian Journal of Medical Ethics and History of Medicine

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The practice and study of medicine in Persia has a long and prolific history. The present study examines recorded information on the subject of medicine during the Sassanid period based on Avesta and Pahlavic texts such as Dinkard, Bundahishn, Sad dar Nasr and Sad dar Bundahishn. Moreover, Sassanid medicine was under the influences of neighboring countries such as Egypt and Greece. The Sassanid Empire was the last pre-Islamic Persian dynasty that ruled Persia from 224 CE to 651 CE. In this period Persia witnessed great achievements and progress in medicine as well as in other sciences.

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The Iranian model of compensated living unrelated (LUR) kidney donation has achieved some unique success, but there is an urgent need for a structural revision in the program. In spite of these achievements, the program lacks secure measures to prevent the risk of a direct monetary relationship between donors and recipients, and it must be revised in order to be morally justifiable. By presenting the current organ procurement program from living unrelated kidney donation, this paper calls for the revision of the current procurement system. The paper suggests a “non-directed living donation” policy for organ donation from LUR donors based on anonymous donation. Under such a policy, individuals can donate their organs to unknown recipients altruistically and receive compensation.

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 Practically, scientific foundations illustrate that the embryo plays a main role in the related technical scenarios. Considering this fact, if technical researches orientated to human subjects, essential legal and juridical arguments will be generated. This article aims to offer a new analysis about moral and juridical nature of human embryo and the associated parental relationships. Adopting this idea that the embryo before 4^th month has no human dignity, the author attempted to present a parental relationship based on ownership and material value. Although the author believes that this idea is built on the legal foundations, it primarily seems that the adopted idea will be faced to moral challenges. From the stand point of this article the concept of the material value of the embryo absolutely refers to an intrinsic value and it doesn’t necessarily relate to financial treats. On the other hand, according to the main pure content of the Islamic juridical rule of Taslit, it illustrates that the right of ownership has been limited by different restrictions .

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When medical treatment is futile, the physicians must refrain from treating patients, and this can lead to serious and stressful problems. In this paper, in order to facilitate ethical decision making relevant literatures have been reviewed. This review article aimed to explaining the different clinical forms of futile treatment, and exploring theoretical and practical dimensions of futility. The first problem in this field is ambiguity in the definition of futility. The next problem is determining the practical criteria and attributing the meaning of futility to particular treatments. This ambiguity is partly due to different perspectives about the goal of treatment, and variations in physicians' and patients’ values and also disagreements regarding the person who should have the right to make decisions ultimately. It may also be related to finances and immoral motives. The third problem is some practical conflicts the most notable are futile care, requested by the patient and the sanctity of life, especially in the concern of religious considerations. In this regard, several definitions have been proposed for the futile treatment. Studies indicate that requesting futile care is often due to emotional problems or lack of trust a case that requires the physician’s tact to resolve and rarely is resolved by rule. Another serious problem that is regarding to end of life cares, especially in the context of religious views, is the necessity of life saving, that is closely related to the inactive euthanasia. This can be solved by giving priority to more important issues such as health budget constraints.

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Justice is one of the main principles of ethics in the healthcare system, and its establishment at macro level depends on formulation of appropriate policies by policy-makers and healthcare providers. Health care policies and payment and reimbursement systems have a significant impact on health systems’ efficiency and cost control. In this paper, payment and reimbursement policies and their impact on financial incentives will be reviewed moreover, financial policies in the national health care in Iran and related challenges will be mentioned in brief. There is no doubt that none of the payment and reimbursement policies is perfect and each of them has the potential to put caregivers or health care providers financially at risk. Therefore, policy-makers should select a combination of the best approaches, considering socioeconomic factors, in order to provide a maximum coverage of health services and ensure fairness in the health system. Efficient payment and reimbursement approaches should undoubtedly preserve the rights of all parties in a fair and logical manner. Current national policy shows that a high percent of health care expenditures are financed through out-of-pocket payments, and therefore appropriate policies should be adopted to lighten this burden. Considering the accelerated trend toward the Family Doctor Plan in big cities in Iran, the present paper would be helpful for many health care providers, physicians and other health care professionals.

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Presumption of innocence is one of the fundamental principles of criminal law that has its roots in moral and religious principles. Presumption of innocence is consistent with human nature, and special attention has been paid to it in Islam. For this reason it has been included in our constitutional law as well as in the constitutions and ordinary laws of other nations, and this indicates its significance. In Shiite jurisprudence there are two major theories on the responsibility of physicians as “daman al-tabib”. Most jurists (famous) consider the physician responsible even if he or she has committed no fault. Only a minority of jurists (less-known) consider the physician to have no responsibility. Islamic criminal law believes the physician to have absolute liability, although medical practices have become more sensitive than in the past and medical incidents have increased as a result of new technology and new methods of treatment. The present study intends to adopt a new approach to rules and principles of jurisprudence, and study the necessity of using them according to the requirements of time in solving everyday problems. Moreover, the study seeks ways to prevent the regression of those rules. Therefore, it seems essential that the golden principle of presumption of innocence be applied to physicians as the manifestation of God's healing, and more attention be paid to it.

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Ethical decision making is an important issue in medical professional ethics. Recent advances in medical sciences and development of new ethical issues in medical ethics have added to the importance and specific complexities of this issue. In fact, ethical decision making is a manifestation of moral values in practical work. In this study, the ethical decision making process in medical ethics has been reviewed in Amir al-Mu'minin Ali (A.S.)’s views in Nahj al-Balagha. Therefore, the issue of ethical decision making in various scientific articles and resources were studied and examples of ethical decision making, its components and its determinants in Nahj al-Balagha were analyzed. In Ali (A.S.)’s word, the ethical decision-making components include knowledge and insight, trust, counseling, adherence to moral values, objectivity, commitment to justice, responsibility, privacy, confidentiality, obedience to law, monotheistic belief and human dignity. In Nahj al-Balagha, the barriers to ethical decision making include: the inability to predict and evaluate the probable consequences, hastiness, being overcome by feelings and financial incentives. In conclusion, according to Ali (A.S.)’s views, physicians’ decisions can be ethical when they perceive their profession not as a means of financial gain, but rather as a moral responsibility, and consider both human and divine rights in their professional practice.

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In this article, we aim to discuss one of the essential concepts of medicine. As a rule, such studies attempt to clarify the philosophical principals of medicine, whereby the act of medic can be regulated based on his clear perceptions of the principles of his knowledge. In this article, we will evaluate the concept of causation in medicine from a philosophical point of view and through historical review, and we aim to clarify the significance of such concepts in clinical decisions. Medicine is an academic discipline dedicated to learning about illnesses and their causes, curing ailments and promoting social as well as individual health. There are four general paradigms in the world of medicine, and accordingly four definitions of causation. Along the line of these thaughts are the views of modern philosophers such as rationalists, empiricists and post-modern philosophers. In this article we will look at these four medical paradigms and consequently the four definitions of causation. Hippocratic paradigm, with reprsentatives such as Hippocrates, Ibn Sina and Galen, was the first paradigm in medicine to presuppose a rationalistic and realisitc view about causation.Biomedical paradigm aquires an attitude similar to logical positivism, seeing causation as a real concept that is true and is provable not through intelect, but by experience. Within this paradigm, a critical clinical approach is specially noticable according to which causation is not a real and necessary concept, but a mental, unprovable concept that is abtained through symmetry-based association, repetition and statistics. Finally, in the post-modern hermenutical paradigm, discussions of scientific causation and biological and mechanistic topics are replaced by ethical discussions about humans thus the causation is marginalized and loses its relevance.

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Euthanasia or mercy killing is a new and challenging topic in medical law. This article examines all types of euthanasia based on the Islamic criminal code of 2011, and demonstrates that active and involuntary euthanasia is murder if conditions exist the basis for active and voluntary euthanasia, however, is the victim’s consent, so the penalty is less. As the physical element of inactive euthanasia is omission, clause 296 of the criminal code and clause 2 of the penal code on refusing to help the wounded apply. Lastly, it is suggested that legislators criminalize euthanasia with a new approach and independent title, and consider principles of justice to determine less punishment for this type of killing compared to murder with malice aforethought.

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With the progress of science, organ transplantation emerged as one of the modern innovations of the medical science. Like other innovations, organ transplantation brings individuals in the society some disadvantages alongside numerous advantages. Legislators have therefore adopted rules and regulations for the mutual support of society members and their rights.In this article the researchers will examine the current regulations on organ transplantation in Iran. Legal sources in Iran, especially the constitution, Islamic criminal law, health and sanitary regulations, moral codes and so on will be referred to in this respect.In the constitution (as epigraph of all laws and regulations within the country), articles 14, 29, 43, 167 will be examined, and in Islamic criminal law articles 159, 372, 495, 497 and 724 will be discussed as the most significant existing articles on organ transplantation. In relation to the moral codes and medical and sanitary regulations we studied the following: Organ transplantation act of April 5, 2000 about the deceased or patients whose brain death has been confirmed the protocol on confirmation of brain death, established 2000 executive regulations for transplant from the deceased or patients whose brain death has been confirmed, adopted May 15, 2002 act of renal transplantation and donation from living donors passed on October 20, 2008 executive regulation 13101 approved on April 29, 2006 about living donors (with the exception of transplantation from a living donor to a foreign citizen) and the charter of patient’s rights ratified in 2009. Lastly, it should be mentioned that transplantation laws and regulations that presently exist in Iran appear to be inadequate for the purpose of resolving the current challenges and problems.

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Surrogacy is an infertility treatment in which the sperm and egg of couples are mixed in vitro and then transferred to the womb of other woman to grow until the end of pregnancy, and this woman is called the surrogate mother. According to article 1168 of the Iranian civil law, children conceived through surrogacy must remain in custody of their parents like other children, and it is the right and responsibility of the parents to maintain their children. Now what will happen if the surrogate mother refuses to release the baby to his/her parents? Based on the various provisions of the civil law, criminal law and the civil liability act, on the one hand, the surrogate mother is obligated to deliver the baby to the couple, and on the other hand, she will be held liable for any damage or injury to the child should she choose to take custody of the child.