Iranian Journal of Medical Ethics and History of Medicine

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Moral intelligence is one of the dimensions of intelligence that can provide a framework for the proper function of man, and be used as a predictor for people’s conduct. Nurses’ performance is of great importance because of the moral and human nature of their profession, and their adherence to ethical principles improves the nursing care quality as well as organizational performance. Therefore, the present study aimed to assess moral intelligence in nurses.This cross-sectional study was conducted on 400 nurses from teaching hospitals in South Khorasan. Participants were selected through census method. Data were collected by Lennik & Kiel’s moral intelligence questionnaire, and data analysis was performed using SPSS 16 software and descriptive and analytical statistics tests. The results suggest that the nurses’ moral intelligence score was 4.35 ± 0.56 (range: 1-5). There was a direct and meaningful relationship between moral intelligence and age and years of practice (P < 0.05).Optimal levels of moral intelligence suggest the importance that nurses attribute to moral values, and can also be an indirect manifestation of their moral conduct in healthcare environments.

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Medical ethics is a set of moral values that apply principles and responsibilities to the practice of medicine and is a fundamental part of medical education. The current study investigated the effectiveness of the medical ethics curriculum and the best method for its implementation from interns’ point of view. The current cross-sectional descriptive study was carried out in July 2012. The research tool was a questionnaire developed in the medical ethics department and handed to all interns. The validity and reliability of the tool was confirmed using content validity and internal consistency (α= 0.72) methods respectively. Data was analyzed using SPSS software and reported by the use of descriptive statistics, particularly mode, as a measure of central tendency.Seventy-one interns (60%) responded to the questionnaire, 54% of whom were female and 55% in the second internship year. In response to the achievement rate of expected outcomes such as the extent to which the educational objectives have been reached, and the suitability of content with the needs felt in real clinical situations, modes were all ranked in the ategory of "low". The modes of the responses to the stressfulness of different ethical situations were mainly ranked in the category of "high". To assess the best methods for teaching knowledge as well as medical ethics skills and attitudes, the following were the mode of interns' responses: group discussion (38%) for teaching the basics, and presentation of a case with the solution (70%) for teaching clinical ethics. The most appropriate methods of student evaluation were considered patient management problem and performance evaluation in the ward by 25 (36%) and 21 (31%) of interns respectively.The current study showed the effectiveness of medical ethics curriculum was low and the students requested presenting this course in a more practical way. It would appear that a two unit theoretic course does not have the efficiency to modify students’ attitudes and behavior to encounter challenging ethical situations, and therefore fundamental changes are suggested.

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Moral distress is an important issue in the field of medical ethics that can have serious effects on nurses, patients and health organizations. One of the most common effects of this phenomenon is professional stress in nurses. Stressful situations in nurses’ job environment lead to burnout and dissatisfaction, and adversely affect the quality of care.This was a cross-sectional study aimed to determine the relationship between moral distress and professional stress in 220 nurses of educational hospitals in the city of Birjand. Data were collected using a 51-item questionnaire based on Corley’s Moral Distress Scale and Wolfgang’s Health Professions Stress Inventory. Reliability and validity of the questionnaire were assessed by the researchers, and its reliability was calculated using Cronbach’s alpha (93%).The results indicated a positive relationship between moral distress and professional stress (P<0/05, r = 0/8). Intensity and frequency of moral distress and professional stress were reported average.Moral distress and professional stress were reported at a frequency and severity of moderate size. Findings of this study can provide guidelines for educating nurses on this phenomenon and the conditions leading to it. They may also be used to develop management strategies and establish organizations to prevent and minimize the consequences of these phenomena in nurses.

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Considering and preserving patients’ human dignity is one of the most essential moral obligations in the medical and nursing professions. Indeed, respecting patients’ human dignity is the essence of nursing care which is frequently emphasized by national and international nursing standards.This study was conducted based on the qualitative approach, using an interpretive phenomenological method, which aimed to explore the meaning of patients’ dignity preservation based on nurses’ lived experiences. Using purposeful sampling method, a sample of 12 participants was chosen and the data were collected through 16 individual, in-depth and semi-structured interviews. The transcribed interviews were analyzed based on the hermeneutic approach using the analysis method proposed by Diekelmann, Allen and Tanner (1989). The mentioned interviews continued until no new meanings emerged and until the researchers were satisfied with the depth of their understanding. Through fusion of the horizons of the participants’ lived experiences and the researchers’ pre-understandings, the extracted meanings of patients’ dignity preservation emerged as: “respecting the equal human essence”, “providing professional patient-centered care” and “respecting the rights of patients’ companions”.The findings revealed that it is essential to respect the patients’ and also their companions’ rights and recognize the humanness and individuality of each patient for preserving and promoting patients’ dignity and providing more dignified care at the bedside.

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Due to the development of societies and nursing sciences, complexity of the ethical situations that nurses encounter is increasing. Moral sensitivity is the first component of ethical behavior, but most of the nurses encounter many barriers in acquiring it. This study was an attempt to determine barriers to ethical sensitivity in nurses’ viewpoints in educational hospitals of Sabzevar in 2012.This descriptive cross-sectional study was conducted on a random sample of nurses working in hospitals affiliated to Sabzevar University of Medical Sciences, Iran (n = 125). Data were gathered through a questionnaire developed by the researchers containing 30 items in four categories of ethical sensitivity barriers including “managerial”, “environmental”, ”patient related” and “nurse related”. Validity and reliability of the questionnaire were assessed = α) 0.85), and data were analyzed by SPSS version 16.The most important barriers were “insufficient number of staff” (83.2%) in the management area, “inappropriate and intensive working shifts” (78.4%) in the nurse related category, “lack of awareness of nurses’ duties among patients” (84.8%), in the patient related category and “overcrowded wards” (76.8%) in the environmental area. The results of this study emphasize the importance of moral sensitivity barriers in all four areas of management barriers, environmental barriers, and barriers to nurses and patients, and could be of special interest to managers and health planners.

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Reproduction is one of the basic abilities of human beings. This is often realized in a natural way, though in certain cases new methods and technologies provide infertile couples with the opportunity to realize their wish to have children. In recent years, the term “right to reproduction” has emerged, and sometimes emphasis is placed on the obligation of governments to satisfy this right. However, it seems that the ambiguity of the aforementioned term may create serious problems in our understanding of the subject matter and, in consequence, affect the manner in which it is handled in the society. In this paper, in addition to discussing the concept of rights, it is argued that the right to reproduction may be embodied both by a claim right and a liberty right, even though the latter is only a justifiable and acceptable way of representing the right to reproduction. Therefore, this right entails the freedom to bear children and to pursue provision of the requirements, including utilizing ART. As in the case of other human rights, this should be in balance and proportion with public interests, in such a way that in particular circumstances, such as problematic population situations, it may be protected or prevented by the government.

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Moral distress is one of the ethical challenges that nurses face due to the nature of their career. Nurses' frequent confrontation with this phenomenon can have different outcomes such as frustration and boredom in providing patient care. This will lead directly to a decline in care quality and can hamper the accomplishment of health goals. Therefore, the present study examined the relationship between moral distress and compassion fatigue in nurses.This cross-sectional study was conducted on 260 nurses of intensive care units in Kerman who were selected through convenience sampling method. In this study, Corley’s moral distress scale and Figley’s Compassion Fatigue Scale were used for data collection. The collected data were analyzed using the SPSS software and descriptive and analytical statistics.The results of this study indicate that there is a significantly positive relationship between moral distress and compassion fatigue (P<0.05). From a total range of 0 to 5, the average score of moral distress was 3.5±0.8 in terms of intensity, and 3.9±0.55 in terms of frequency. The mean of compassion fatigue score was 3.5±0.68 from a range of 0 to 5.Moral distress and its association with compassion fatigue suggest that conditions contributing to moral distress can have an important role in the quality of care. It is clear that strategies should be adopted to prevent the occurrence of these conditions. Informing nurses about moral distress and its consequences as well as periodic consultations will play an important part in the identification and management of moral distress and its consequences.

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In the nursing profession, moral distress is a challenge thatc an have different consequences. The nurses’ moral courage to make the right decision can play an important role in the prevention of moral distress, and thus promote moral comfort. The present study examined the relationship between moral distress and moral courage in nurses. In this study, 313 nurses from hospitals in southern Khorasan Province were selected through quota sampling, and Corley’s Moral Distress Scale and the Professional Moral Courage Scale by Sekerka, et al. were used for data collection. The collected data were analyzed by descriptive and analytical statistics. The findings showed a significant relationship between the intensity of moral distress and moral courage (P = 0.03, r = - 0.44). From a range of 0 - 5, the mean of moral distress was 3.7 ± 0.5 in terms of intensity, and 3.55 ± 0.86 in terms of frequency. The mean score of moral courage was calculated at 3.33 ± 0.46 from a range of 1 - 5.The significant correlation between moral distress and moral courage strongly suggests that high levels of moral courage in nurses can play an important role in controlling moral distress. Determining the factors that create moral courage and developing strategies and circumstances such as promoting an appropriate moral climate could play a major role in encouraging moral behavior and controlling moral distress.

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Patient autonomy is the opposite of paternalism and an essential element in individualised, patient-centred, ethical care. Challenges associated with patient autonomy are culture-related and have not been fully investigated in Iran so far. The aim of this study was to explore the challenges to the autonomy of patients in Iranian hospitals.This was a qualitative study using conventional content analysis methods. In 2013 13 patients, 7 nurses and 1 doctor were selected from three Tabriz and Hamadan teaching hospitals using purposive sampling to participate in semi-structured interviews. The interviews were subjected to qualitative content analysis and analysed using the MAXQD10 software.Fifteen categories and three themes were identified. The three main themes related to challenges associated with patient autonomy were: interpersonal factors, altered relationships, and organisational constraints. In summary, this study revealed some challenges associated with patient autonomy that the treatment team, managers and planners in the health care system should target in order to improve patient autonomy.

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Nowadays academic life is closely related to the issue of publication. Consequently, there are numerous challenges in naming authors of scientific papers and publication ethics in general, making it essential to identify the various problems in this area. The present article acquires a historical view to investigate the challenges and solutions related to this topic.This is a review article based on a search of scientific databases from 1985 to 2014. Honorary authorship, coercion authorship, ghost authorship and non-compliance are instances of ethical issues in naming authors. To solve these problems, several agencies have provided ethical guidelines in this respect including the International Council of Medical Journals Editors (ICMJE), contributorship, objective measurement tools and the National Directory of Ethics in Medical Research Publications. Nevertheless, studies point to the existence of problems in this area.In order to solve the existing issues, the evaluation system of scientific and research organizations should propel quantity-oriented evaluation over quality oriented criteria. We also believe that the educational system, specifically in the post graduate period, can affect scientific research and publication ethics to a great extent and thus promote ethical conduct in students and researchers.

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Breaking bad news to patients and their families is an important issue in health care services. Since access to information is among the basic rights of the patient, investigating the experiences of patients and their families after receiving bad news can make the process more purposeful and prevent unnecessary suffering. This study aimed to describe the experiences of patients and their families after hearing bad news from health providers.The present study was conducted with a qualitative, phenomenological approach. Participants were selected through purposive sampling from people who had the experience of receiving bad news during 2013 in Birjand, Iran. The sampling process continued up to the point of data saturation, which reduced the number of participants to 10. Note-taking was used to complete the data collection process. In this study Colaizzi's method was used for data analysis, while robustness of the study was assessed based on the criteria of precision.The subjects were between 25 and 70 years of age. First, according to Colaizzi's Method, 280 codes were obtained which were the same as the developed concepts. At this point, the code lists were extracted. Different thematic categories with similar meanings were placed in 5 thematically larger groups as follows: 1) tension at the beginning of the encounter, 2) adaptive responses, 3) spiritual relief, 4) family crises, and 5) seeking support.Patients and their families showed different reactions upon receiving bad news. The study showed that health providers can contribute to a better adjustment of patients and families and promote peace by acquiring a methodical approach while delivering bad news. This can be achieved by identifying the reactions, confusions and tensions, as well as introducing adaptive or supportive resources to patients and their families.

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The principal objective of the nursing profession is to provide evidence-based and competent care mainly based on humanitarian and ethical principles. Ethical care is contingent on a proper level of moral reasoning, which can be categorized into pre-conventional, conventional and post-conventional reasoning. At the pre-conventional level, individuals are mostly self-oriented and prefer obedience to avoid blame. At the conventional level people apply laws and social principles to decision-making, and at the post-conventional level they try to guide their actions and behaviors with regard to ethical principles and make humanist and ethical decisions. This study aimed to assess the level of moral reasoning in nurses and nursing students by providing an analysis of the existing literature on moral reasoning.For the purpose of this study, we conducted an extensive search of the papers published between 1980 and 2014 on international electronic databases including Scopus, Google scholar, Science Direct, PubMed, Proqust and Elsevier. We also reviewed papers published between 1985 and the autumn of 2014 on Persian electronic databases Sid, Magiran and Iran Medex. A broad range of search keywords were used such as: ethical growth, moral growth, ethical development, moral development, ethical reasoning, moral reasoning, nurse, and nursing student. In total, 35 studies were reviewed at this stage.Based on the results of the above-mentioned studies, most nursing students and nurses reason at the conventional and post-conventional level, and nursing students reason at a higher ethical level in comparison with nurses. We also found that teaching ethical concepts helps improve ethical reasoning, and that an inverse relationship exists between clinical experiences and ethical reasoning.Although in most studies, the level of moral reasoning in nursing students and nurses was found to be at the conventional and post-conventional level, this is not enough to provide superior professional care. It is therefore essential to apply the necessary measures such as improving clinical environments and the ethical education system to further promote the reasoning ability of nurses and nursing students, so that they can make their decisions based on ethical principles and at the post-conventional level

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Nowadays, ethics is an important factor that can determine the clinical competency of nurses. The aim of this study was to compare the moral intelligence of nurses in civilian and military hospitals.In this descriptive-comparative study, 315 nurses from hospitals in Tehran and Kerman were recruited by convenience sampling. Lennick & Kiel’s Moral Competency Inventory was used for data collection. The data were analyzed by SPSS software version 17 using descriptive and inferential statistical tests including T- test, ANOVA and Chi-square test.149 study subjects were military nurses and the remaining 166 were civilians. The nurses’ moral intelligence was found to be at an average level. On the other hand, there was a statistically significant difference between the moral intelligence level of civilian and military nurses (P < 0.001).The results showed that the moral intelligence of most nurses in this study was at an average level. It is therefore recommended that health managers pay more attention to this issue and incorporate it into the required courses for their employees especially during service training. Moreover, offering extensive training courses on ethical issues is a solution that should be considered in military hospitals.

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Any contract in the Iranian legal system contains features that need to be explained in order to better understand the exact terms of agreement. Some such features are related to whether the contract is irrevocable or voidable, gratuitous or with considerations, and may bear upon accountability and suspension, formality or contentment, and so on. In surrogacy, the sperm and egg of an infertile couple are fertilized and then transferred to another woman's uterus to carry till birth, when the child is delivered to the owners of the sperm and egg. The specific features and uncertain nature of surrogacy specify the standing of this type of contract among others. The present article is aimed to examine the features of surrogacy agreements from ethical and legal perspectives

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Respecting patients’ privacy leads to increased satisfaction among hospitalized patients and can accelerate the healing process and reduce hospitalization time. This study aimed to determine the level of respect for patient privacy in the teaching hospitals of Zanjan city during 2012. In this cross-sectional study 256 hospitalized patients were selected by multistage sampling and completed the study questionnaire. The questionnaire consisted of two parts: the first part collected the participants’ demographic data and the second part examined the various aspects of patients’ physical privacy. Data were analyzed using SPSS version 21. The results showed that most of the samples (76.2%) were unaware of patients’ rights, and about half (49.2%) believed that their physical privacy was respected most of the time. Meanwhile, 56.3% of the patients declared that medical team members never closed the curtains during physical examinations and medical procedures. The mean score of observation of privacy was less for single patients (51.23 ± 14) compared to married patients (58.88 ± 13) (P <0.05). Based on our findings, most patients were not aware of their rights and some measures of physical privacy were not observed. Therefore, authorities must pay more attention to systematic planning in order to ensure that patients’ privacy is respected in all areas of health and education.

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Eugenics or the science of breeding humans is a movement based on biological concepts that advocate policies for improvement of the human population genetics. It has also served as a determinant factor and reference in many social disciplines including law and punishment during certain periods in history. In fact, based on eugenic policies, which were affirmed by biologists, health experts and physicians, many people were sentenced to elimination from the society’s gene pool and thereby underwent sexual sterilization. Such practices were approved by economists and jurists involved in the executive affairs of many countries as well. Publication of two separate journals about eugenics and the corresponding empirical data confirming the influence of genetics on behaviors along with the solidity of eugenics-related policies demonstrate the scientific significance of this movement in its heyday. This public legitimacy started to decline, however, after sterilization of tens of thousands of mentally or physically handicapped people by Nazi Germany and the ascending criticism on moral and scientific bases of eugenics, which almost led to the exclusion of the subject in public. In this essay, eugenic concepts, relevant policies and its legitimacy throughout history are discussed to provide a better outlook for adopting more effective strategies in public health policymaking

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In the modern world, reproductive right is considered among the basic human rights in countries such as America and Britain. There has been growing interest in the subject and its various aspects including contraception and assisted reproductive technologies, which are giving rise to the ongoing debates. National and international legislators, governments and religions are striving to resolve the controversy among individuals and between individuals and governments and devise the perfect legislation that will cover all aspects of the subject and control all activities in this area.In the realm of bioethics and law, the issue is introduced as a right not duty, while in Christianity and Judaism it falls under the category of duty. In Islam, on the other hand, childbearing decision-making is left to the couple, which highlights the teachings of Islam regarding reproduction. In this paper, we attempted to offer a comparative study of four different points of view regarding the issue of reproductive rights

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Severe combined immunodeficiency (SCID) is an inherited primary immunodeficiency syndrome characterized by a profound deficiency in T-lymphocytes and variable defects in the B-lymphocyte number. The present study aimed to evaluate the ethical aspects of the clinical management of children with SCID. This report is based on the case of a 6-month-old male infant with SCID diagnosis presented during the Medical Ethics Grand Rounds in the Children's Medical Center in Tehran, Iran.

The patient had a positive history of recurrent infections and frequent hospitalization. His parents were consanguineous and came from a low socioeconomic level of the community. He was the fourth child of the family. The first and second children were healthy girls, while the third child was a boy with a history of numerous problems post vaccination who had eventually died of widespread infections. The physician had recommended bone marrow transplant, but the parents had been directed by a neighbor to visit a religious healer.

Timely management of severe combined immunodeficiency can reduce complications and improve the patients’ quality of life. The need for early screening tests is therefore ethically justified, although ethical issues surrounding the subject should not be overlooked. Instances of these issues include: neglecting the scientific criteria necessary to conduct the tests the economic burden imposed on the family of the child failure to provide sufficient information to parents and ignoring their consent to conduct testing and treatment lack of equitable access to diagnostic and treatment facilities and lack of attention to the child’s autonomy. It should, however, be noted that in certain cases, healthcare providers could perform their management activities with an ethical and supportive approach, taking into account all physical and psychological needs of infants with severe combined immunodeficiency, as well as those of their families

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Ethics is important in all professions, particularly in nursing, since morality and commitment in nurses can play a significant role in improving patients’ health and recovery. The nursing profession is therefore rooted in ethics, and the observance of nursing ethics is more important than other aspects of health care. This study aimed to determine patient's views on standards of professional ethics in nursing practice in Imam Hussain Hospital during 2015.

This was a cross-sectional study conducted on 575 patients in different wards of Imam Hussein Hospital in Shahroud. Research instrument was a 22-item questionnaire designed by the researchers to evaluate nurses’ observance of professional ethics in the three dimensions of accountability, improvement of care quality, and respect for patients. Data analysis was performed using SPSS 20 software.

The mean age of participants in this study was 51.32 (± 19.03), and 299 participants (52%) were male. The mean total score of professionalism was 18.38 (± 2.74), and the relationship between age and observance of professional ethics was statistically significant (P = 0.006).

According to the subjects of this study, the nurses’ observance of professional ethics was relatively good and at a desirable level. It is recommended to utilize a variety of learning styles and employ the services of professors of nursing ethics in order to enhance the quality of nursing education with respect to professional ethics.

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Aromatherapy is a form of alternative medicine that is now widely practiced throughout the world. Medical history studies indicate the popularity of aromatherapy in ancient civilizations such as Persia as a method of decontamination and treatment.

The present study uses religious texts, ancient Persian manuscripts in the Pahlavi language, and the history of Persia to confirm the status and application of aromatherapy as a method of treatment in ancient Persian medicine.

In ancient Persia, illness was perceived as a product of evil. Ahriman and Ganak Mainyu were the main causes of diseases, often associated with foul odors and filth. Thus, ancient Persians tried to cure illnesses by using herbs and applying certain principles of hygiene.

Evil, foul odors and stale air were believed to transmit diseases, while ahuric divinities were associated with sweet smells. Therefore, fragrances were used in keeping with the divine forces, and aromatic substances, herbs and woods were employed as a means of prevention to eliminate the causes of illnesses, and as a cure for certain mental and physical diseases.