Iranian Journal of Medical Ethics and History of Medicine

Today, the role of spiritual leaders is to stimulate employees by employing a spiritual perspective and creating cultural backgrounds based on human values to raise capable employees. On the other hand, professional ethics is one of the variables that has a significant impact on individual and group activities and outcomes of the organization. The purpose of this study was to investigate the relationship between spiritual leadership and professional ethics with organizational performance and quality of work life with the intermediate role of organizational learning among employees of Imam Reza Hospital in Urmia. The design of this research was a descriptive-correlational cross-sectional design model of structural equations. The statistical population of this research included 759 employees, 240 of them were selected by random sampling method. For data collection, standard questionnaires were used. Pearson Coefficient and Structural Equation Model Finding were used to analyze and examine the assumptions and the relation between the variants. The results show that there is a significant relationship between spiritual leadership variables and Professional Ethics with organizational performance and quality of life of employees (P<0.01, r=0.42, r=0.51), (P<0.01, r=0.36, r=0.75). Furthermore, the results showed that the intermediate role of organizational learning in the association between spiritual leadership and professional ethics with organizational performance and quality of work life (β = 0.17, β = 0.18, β = 0.16, β = 0.17) ) is confirmed. According to the findings, it can be concluded that paying attention to spiritual leadership and professional ethics can improve the organizational performance and quality of work life, as well as enhance organizational learning among the staff of Imam Reza Hospital.

Development of new methods of treatments for infertility has given rise to a serious question as to the access to such methods. Determination of the ones who can access the mentioned treatments and the limits of this access, depends to the definition of infertility. The Law of the method for Embryo Donation to Infertile Couples according to Iranian legislature considers the infertile couple who “cannot reproduce in accordance with credible medical certificate” as eligible to receive the donated embryo. However, applicants for modern infertility treatment methods have gone beyond infertile couples and include those couples who wish, based on credible medical evidence, to avoid having unhealthy children, especially by using donation methods or surrogacy. Accordingly, having supported a preventive approach to ARTs, a new concept of infertility will appear on the horizon. Expanding this concept to couples who are considered fertile from a common medical perspective but give birth to seriously unhealthy children shall inevitably lead us to revise the common legal concept of infertility. Therefore, by resorting to ethical reasoning, laws, and regulations of various legal systems and Fiqhi opinions we can develop another interpretation of Embryo Donation Law and argue for the access of the “perceived as infertile” couples to the infertility treatment with the help of third parties.

Science considers using technologies for treatment of infertility as the important cause of multifetal pregnancies. Fetal reduction is a clinical procedure developed for reducing the number of fetuses in multifetal pregnancies in order to avoid their common complications. Three aims may be offered for fetal reduction: (1) pregnancy preservation, and prevention of and decreasing risks of multifetal pregnancy to the mother and the remaining fetuses (high-end multifetal reduction); (2) eliminating fetuses bearing certain kind of illnesses (selective reduction); and (3) just preventing multiple birth where no considerable risk threatens the mother or the fetuses (elective reduction). Moral evaluation on fetal reduction techniques varies depending on which of the mentioned aims is followed. However, in many cases this is “medical necessity” that morally justifies the reduction. Nevertheless, given the difficulty of reaching a decision on this issue, risks involved in fetal reduction procedure, and its psychological implications for the mother and the father, it is seriously recommended to avoid such an action by methods that prevent multifetal pregnancy.

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.

 

Spiritual intelligence is a set of personal capacities that helps to adaptation and problem solving. The aim of this study was determining domains and construct validity of cultural and religious context of spiritual intelligence scale in Iranian students. In this mixed methodological study, we assessed the existing scales, and selected 62 items. Then we interviewed with 67 students and derived 42 items. We determined the scale construct validity by exploratory factor analysis with 1000 students' samples that were selected by stratified random sampling from universities. The ethics permission of study was obtained from ethical committee of Tehran university. Factor analysis reduced items number from 104 to 39. Among 10 dimensions in theoretical model, 7 dimensions explained the 60.21% of scale total variance. These dimensions were meaning perception and religious works effect; perception and extension of consciousness; perception of extraordinary phenomena superior than material being; existential critical thinking; personal meaning production ability; problem solving by using spiritual resources, and spiritual adaptation in interpersonal relationship. Inter items’ reliability was determined by internal consistency as 0.731 to 0.906 and the scale total reliability was 0.945. A 39 items’ spiritual intelligence scale with optimal psychometric properties and acceptable structural model based on Iranian religious and cultural practices can be used as a valid and reliable scale in community of Iranian students.
 

The increasing number of social and individual problems caused by occupational stress have been indicative of the ineffectiveness of the previous models despite many attempts. This article is intended to measure the current status of organizations in order to correct and reduce staff stress. After obtaining the reliability and validity of the model derived from the review of literature and interviews and the questionnaire of expert opinion, the model test required a field study, so a researcher-made questionnaire was developed with the allocation of 90 items. The questionnaire was prepared for distribution in the high-stress zone of six hospitals including public, military, and private hospitals. After receiving the opinions of the employees in the high-stress zones and analyzing the findings of the statistical population, the conceptual model of occupational stress management from the point view of Islam was obtained and it was based on "God-belief, continuity of life after death and centrality of ethics". Considering that hospitals are one of the most important occupational organizations, the model test was used in the high-stress zones of hospitals' and proved the researchers’ hypothesis. So, the obligation to strengthen religious beliefs was explained in these organizations and the model of occupational stress management of employees from the Islamic point of view was confirmed by assessing the status of organizations. The indicators, components, and dimensions of the above model can be used by authorities of health policy such as Iranian medical council, the ministry of health and medical education, and medical sciences’ universities.

Emotional intelligence and critical thinking are important factors affecting professional performance and mental health of health care professionals. In this research, the relationship between emotional intelligence and critical thinking is investigated. This is a descriptive-correlational study. The statistical population of this study was all nurses working in hospitals affiliated to one of medical universities located in Iran in 2016. The sampling method was random. Using Cochran formula, 174 subjects were obtained. The main tool for data collection was the Bar-On Inventory and California Critical Thinking Skills Questionnaire. The validity of the questionnaire was confirmed by the professors and reliability was calculated using Cronbach's alpha coefficient for emotional intelligence and critical thinking questionnaire 0.82 and 0.79 questionnaire. The mean scores of emotional intelligence in nurses working in studied hospitals were 3.46±0.78 of 5 and the average score of critical critical thinking nurses was 22.66 out of 34. Also, Pearson coefficient confirmed the significant correlation of all components of emotional intelligence with critical thinking. Among the components of emotional intelligence, social skills have the most positive and meaningful relationship with critical thinking. There is a positive and significant relationship between emotional intelligence and critical thinking of nurses working in studied Hospitals. Therefore, selecting students and employing nurses based on the measurement of emotional intelligence and critical thinking will improve the performance of nurses.

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.

Nowadays, transplantation is the final treatment for the patients with end-stage organ dysfunction. Considering the importance of the organ donation and the important role of teachers in raising the knowledge and attitude of a large group of people, the present study aimed to determine the level of knowledge and the attitudes of the teachers in Sanandaj regarding organ donation. This study was a descriptive-analytic (cross-sectional). A total of 250 teachers working in the first and second level of high school in Sanandaj city were selected by cluster sampling method in the academic year 2017-2018 and completed the questionnaire on knowledge and attitude towards organ donation. Data were analyzed by SPSS software version 20, independent t-test and ANOVA. The findings of this study showed that 152 (60.8%) had moderate knowledge and 92 (36.8%) had high knowledge about organ donation. 166 teachers (66.4%) had moderate attitude and 81 teachers (32.4%) had high attitude toward it. 90.8% of teachers lacked donation cards, while 144 (57.6%) were inclined to receive a donation card. According to the results, the knowledge and attitude of the majority of teachers were moderate and most of them did not have a donation card. Considering the importance of this effective group in raising the culture and knowledge of students and their families in the community toward organ donation, education and preparing appropriate background for receiving, raising knowledge, and attitudes toward organ donation for the teachers are required.

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.
 

Nursing ethics is one of the most basic aspects of nursing profession, which nurses are required to follow the principles receiving nursing care with confidence by patients. This study was conducted to determine the level of moral development of nurses and its contributing factors. This descriptive, analytic study was performed in 2017, study samples were 310 nurses working in educational hospitals of Ardabil University of Medical Sciences. Samples were selected by convenience method. The data was collected using a Kohlberg’s nursing dilemma test. The questionnaire included six scenarios: newborn with anomalies, forcing medication, adult's request to die, new nurse's orientation, medication error, and uninformed terminally ill adult. The data was analyzed by IBM SPSS 18 using descriptive and analytic tests. In this study, 51 nurses (16.45%) were in the pre-conventional level, 101 nurses (32.58%) in the conventional level, 132 nurses (42.58%) at the post-normal level and 26 nurses (8.38%) at the level of clinical considerations. Moral thinking mean score was 42.58 ± 5.6 and the mean score of the clinical considerations was 21.53 ± 4.3. The present study showed that the majority of nurses are in the post conventional and conventional level; but this is less than 50% of all nurses, which shows that the level of moral development of nurses is in the moderate level. It requires further investigation of the causes and related factors and more efforts for improving it.
 

The concept of Islamic medicine, which differs from traditional medicine and even Muslims’ medicine, has become more and more popular in recent years in Iran, especially in religious cities. In the present article, we have addressed the extremist approach of the claimants of Islamic medicine (which considers itself a competitor of modern medicine and traditional medicine).Our theoretical basis for the ethical criticism of this approach has been the principlism of "Beauchamp and Childers". Thereby, we have attempted to challenge the clinical position and medical performances of extremists in the Islamic medicine on the basis of four principles of "justice, autonomy, beneficence, and non-maleficence". Then, we have concluded that the claim of the Islamic medicine cannot, in the present circumstances, satisfy the principle of distributive justice. It also violates patients' autonomy by making unfair judgments and fears about modern medicine. It is very prone to harm clients by refusing scientific evaluation of medicines and therapies and lacking a valid certification system.  Accordingly, we  particularly challenged the attribution of this process to Islam.  This attribution may cause serious damage to the religious beliefs of the clients.

One of the most common ethical issues in nursing profession is moral distress which causes discomfort and impedes nurses proper moral performance, despite having sufficient knowledge. Moral distress disturbs the relationship between nurse and patient which leads to the decreased quality of care. Caring behaviors greatly contribute to improving the quality of care and patient safety. The present study aimed to determine the correlation between moral distress and caring behaviors of nurses in intensive care units of Bandar Abbas hospitals in 2018. This was a descriptive correlational study that was performed on 173 nurses working in ICU and NICU departments of Bandar Abbas hospitals. The data collection tools were demographic information questionnaire, the moral distress scale of nurses of intensive care units, and nursing Caring Behaviors Inventory. Data were analyzed using IBM SPSS 20. Moral distress in nurses in the intensive care unit was in the middle range (1.75 ± 0.81 of 4 score). Also, the mean score of nurses' caring behavior was 5.28 ± 0.48 of 6 score which was considered as an acceptable level. There was a significant negative correlation between moral distress and caring behavior (r = -0.150, P = 0.049). Regarding the importance of moral distress, as well as the role of caring behaviors in improving the quality of care of nurses and satisfaction of patients, it seems necessary that nurses get more familiarized with this concept and attempts to provide solutions for coping and reducing moral distress and improving nurses' caring behaviors.
 

Communication with patients is an important issue in nursing meaning that to realize the truth from their viewpoints. This study was performed to compare levels of nurses’ empathy with patients at drug abuse treatment centers (DATCs) and the internal ward of hospital. The present research was a cross-sectional and descriptive-analytic study conducted at two environments of the internal ward and DATCs. A total of 60 subjects comprised research participants and were listed in the study through census method. A two-part scale was used including personal information and Jefferson scale of empathy with verified validity and reliability. Data were analyzed using SPSS16 software. The scores of nurses' empathy with patients recorded in the internal ward and at DATCs were 67.84±6.32 and 79.73±9.21 (out of 100), respectively (P=0.001). Male nurses (76.80±9.88), married nurses (75.93±9.98), ages of >40 years (79.1±11.12), masters’ degrees (75.5±3.78), job experiences of >10 years (83.53±8.53) and overtime hours of <50 h (80.61±9.9) attained the highest empathy scores with significant differences (P<0.05). The scores of nurses’ empathy with drug-dependent patients at DATCs were higher than those of internal wards indicating that the care of addicted patients in a specialized ward leads to increased empathy. Considering the relationship between empathic communication, educational levels and occupational experience of nurses, it is essential to consider training empathy skills to nursing students from the first semester and to provide in-service training to nurses working at hospitals and centers by nurses of higher educational qualifications and experiences.

Scientific research as well as a lot of social and individual effects for human beings has caused many moral problems. The prospect of children building through somatic cell nuclear transfer (SCNT) or human cloning has caused widespread moral concerns around the world. Accordingly, various reports and regulations have been published at the national and international levels that address the ethical principles for research involving human subjects. In this regard, the Belmont report is of particular importance, in which three fundamental principles of human research have been taken into consideration. These three principles are: the principle of "Respect for Persons", the principle of "Beneficence" and the principle of "justice". In the field of this new biotechnology, namely, human cloning with respect to the use of human subjects in it and according to the ethical principles for research involving human subjects, there are three types of discussion: problems of Safety; a particular problem in the field of business Satisfaction and the problem of the exploitation of women. Considering that about 90% of cloning efforts in animals have been encountered with many problems such as abortion, early death, the development of certain diseases and physical defects, etc., it is not wise to use it in humans and it causes certain and unpredictable problems in cloned people.
 

Imamate jurisprudents, consider Damie as a little rupture in the flesh while Motalaheme is a deep one. Hence, the place of the two injuries is the same but the depth of the rupture in Motalaheme makes the difference. This difference has been identified in Clause “b” and “p” of article 709 of the Islamic Punishment law. Furthermore, their historical understanding of the anatomy of this injury led to the concept of rapture in the flesh because they believe in order for the bleeding which is constituent of Damie, rupture in the flesh is necessary. However, contemporary anatomy explains that rupture in the flesh is not necessary for bleeding. Bleeding can occur through derma and hypoderm of the skin. This analysis adds on the hypothesis of the historicity of their definitions of the two injuries. With a descriptive-analytic approach and library study, we prove this hypothesis and make modification of their definitions on Damie and Motalaheme.
 

Medical errors in pediatrics if different from adults. This study aimed to investigate type and frequency of medical errors and the related contributing factors from pediatric residents' point of view. This descriptive and cross sectional study was done in 2016. After determining validity (face and content) and reliability the final questionnaire with 17 questions categorized in six parts was used for data collection. Data were analyzed descriptively using SPSS v.22. ''Errors of diagnosis or delay in diagnosis' (8.6)', ''choosing appropriate dose (8.3) and medication (8.2)'' had the highest average weights. Fellows of pediatrics (12.6) and pediatrics’ professors (12.1) with the highest average weights had the most dominant role in diagnosis and prevention of errors. The most and the least average weights of the errors was reported for urban general physicians and pediatrics’ professors, respectively. Errors could occur at 2-8 AM more likely. Junior residents were the ones with the most chance of doing errors. Medical errors were mostly reported to occur in the group of children (70.6%) than neonates (29.4%). Reconstruction and strengthening educational and supervision role of pediatric fellowships and attending with the aim of in time diagnosis and then prevention of medical errors could be considered as a must in teaching hospitals. Holding purposeful educational courses and control of contributing factors like workload, exhaustion, inexperience, etc. are among duties of educational and executive managers.
 

One of the main methods of improving patient safety is use of reporting systems and providing facilities for analyzing and preventing mistakes. The aim of this study was to determine the attitude of nursing managers of hospitals affiliated to Kurdistan University of Medical Sciences towards the voluntary reporting system of medical errors in 2015. In this descriptive-analytic study, all managers of selected hospitals in Kurdistan province were enrolled in this study. The data was collected through a valid questionnaire for attitude towards the voluntary reporting system of medical errors. Data were analyzed by SPSS software version 20, independent t-test, chi - square and ANOVA. According to the results of the study, 87.9% (80 participants) of the managers encountered reporting of errors in their workplace. 68.1% (62 participants) of the managers had a positive attitude toward the voluntary system of medical errors and 16.15 % (15 participants) had a negative attitude and 15.38% (14 participants) were indifferent. According to the results of the research, more than 68.1 % of managers have a positive attitude towards the voluntary reporting of medical errors and with the necessary measures a suitable platform for launching the voluntary reporting system of medical errors in the treatment centers can be provided.

The criminal responsibility of physicians and assistants is a complex area of ​​medical law. The purpose of this study was to investigate the responsibility of medical residents and medical students in performing diagnostic and therapeutic measures with case study of forensic medical files in Fars province from 2012 to 2017. In this study, 63 plaintiffs' cases were assessed, including 33 males (52.4%) and 30 females (47.6%). Most of the complainants were illiterate and under-graduate, and the least frequent was at doctoral level. Regarding the physical condition of the plaintiff (patient), the highest frequency was related to death ( 73%). Most of the complaints were from treatment group (95.2%) and physicians (4.8%). In terms of field of study, the field of obstetrics and gynecology (44.4%) included more complaints than other fields. In total, 26 (41.3%) cases were finally acquitted and 37 (58.7%) were convicted. The most common type of failure was neglect (91.9%). In this study, the highest frequency of associate education was related to senior resident (11.1%). Based on the results of the present study, medical errors were made by trainees (interns) and residents, specifying the criminal responsibilities of medical students and residents for errors and omissions and explaining their findings. Educational materials in each course are of particular importance. Additionally holding forensic courses and defining the legal and criminal responsibility for medical students are important for the improvement of treatment quality
 

A study on the adaptability of the patient's admission process with ethical standards has a significant role in reducing the misconduct of the medical staff and increasing the satisfaction of patients. Hence, by the study of the patient's admission process in the Neurosurgery ICU and the identification of its personnel faults; we are going to provide a platform for excellent service to patients. This study is a qualitative study. It had done with the In-depth interviewing with 28 staff of the Neurosurgery ICU of Loghman Hospital during the winter of 1396 (December2017- March 2018). The data is collected and analyzed with triple coding: open, selective, and axial. "The lack of ethical sensitivity to nursing profession and its importance" is a general tag for seven categories of functional status of ICU staff: the use of staff with insufficient professional competence, the impact of staff tastes in professional relationships, irrational expectations, lack of communication skills, the inability to admission new patients and work in other health centers. Accordingly, "the lack of moral sensitivity to the profession and its importance" in the ICU staff is a central phenomenon that results from neglect of the importance of developing transparent processes for various activities in the ICU, as well as the lack of professional training. This will make the ICU staff ignore the implementation of the defined standards, and subsequently  the decline in the quality of health care services in ICU.