Iranian Journal of Medical Ethics and History of Medicine

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For some infertile couples, egg donation is the only option. In egg sharing programs, patients share half of their eggs with another couple in exchange for a discount on assisted reproductive technology. In many countries, using this method is legally discussed. Iran is the only Islamic country in which donation programs are practiced, so, we designed this study to compare egg sharing to ordinary egg donation from ethical, legal, and religious aspects.A complete review of ethical issues and debates about egg donation and sharing was done. For religious issues, we consulted clergies, Islamic texts, and current decrees (fatwas). Social issues and legal problems were examined by consulting expert opinion and jurists. Also a complete review of literature was done. Egg donation and egg sharing are both religiously accepted in Iran by the Shiite clergies as they are considered completely similar. Egg sharing has some religious (seeing and touching the female genitalia) and social (preventing repetitive donation) advantages to egg donation as well as avoiding complications of fertility drugs and procedures, financial and trading issues, advertisement and brokers. However, there are some disadvantages with egg sharing, such as reduced likelihood of conception by donating half of the eggs, challenges related to donor health, and emotional stress of failure for the donor and success for the recipient, which can be prevented by careful case selection, psychology and genetics consultation, and  practicing anonymity. As a result, egg sharing is ethically and religiously more acceptable than commercial egg donation.   

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Disclosing the diagnosis of cancer to a patient could impact various aspects of their life. The present study was performed to evaluate the views of cancer patients about disclosure of the diagnosis of disease to them. The present study was conducted on 385 cancer patients in three teaching hospitals (Afzalipour, Shafa, and Bahonar) affiliated to Kerman University of Medical Sciences between 2010 and 2011. These patients were evaluated for their views on revealing the diagnosis to them using a questionnaire that included the type of cancer, demographic information and their preferred manner of being informed of the diagnosis. Out of 385 cancer patients, 155 patients (%40) were aware of the diagnosis of their disease. The majority of patients who were aware of their diagnosis (%89) said they would like to know the diagnosis before treatment. Almost all patients who knew the diagnosis preferred to be aware of the prognosis of the disease and the complications of treatment. The only significant demographic variable was sex men were more eager to know the diagnosis of the disease (P value< 0.05). This study showed that the majority of cancer patients would like to be aware of the diagnosis, even though most of them were unaware that they had cancer.

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Medicine is known as a combination of science and art. Besides knowledge, a good physician should be equipped with the art of establishing communication with patients. The keystone of any efficient relationship like a therapeutic one is trust, and its deterioration makes the relationship deficient and based on mere need. Therefore, establishing an efficient relationship brings about positive results in treatment. In the last two decades, the trend in the physician-patient relationship has greatly changed, so that patient-centered care is now in focus. In this kind of relationship, physicians recognize patients as respectable human beings with their unique beliefs, attitudes, and concerns, etc. In this paper we intend to provide a brief introduction to the concept of physician-patient relationship and its chronological changes. Also, common models of physician-patient relationships (e.g. paternalistic, etc) are introduced, compared, and their most obvious strengths and weak points are analyzed. At the end, a succinct analysis on the dominant model(s) of physician-patient relationship in Iran&aposs medical settings has been provided, and the necessity of compiling a model based on Islamic values is proposed.

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Telling the truth to patients is a key issue in medical ethics. Today, most physicians hold that truth-telling to patients is crucial, and that lying to patients or withholding information from them is not acceptable. It seems, however, that absolute and unconditional truth-telling is not always possible, and it may not be feasible to tell some patients certain truths under some circumstances. Although truth-telling is a rudimentary principle in ethics, it is allowed to withhold truth or even to tell lies in some circumstances. From the point of view of reason and tradition, lying under certain circumstances is allowed for instance when one is disinclined to tell the truth, or in emergencies where truth-telling might lead to loss of life, property or someone's reputation, and when truth may involve two adequately unpleasant situations. In my opinion, it is necessary to tell the truth, regardless of possible harms, when continuation of treatment, or the patient's cooperation and consent depend on it, and also when the truth which needs to be told to a patient is the incurability of his disease and therefore his inevitable death,. In other cases, however, when there are truths such as severity of disease, death of others in the accident, family problems outside the hospital, predicted survival time, and other possible diagnoses, the truth can be withheld and the patient can even be lied to if there is any risk of harm to the patient.

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Avicenna wrote many great books and articles such as Canon of Medicine which is his most important medical work. This study has been conducted in order to provide the necessary information on Avicenna's adherence to ethical principles and ethical norms in Canon. Three aspects including his medical practice, researches and philosophical attitude have been studied. Avicenna offers some valuable guidelines on the ethics in medicine in Canon. The first necessary condition for the practice of medicine is to comprehend medicine. Congruently, Avicenna emphasizes in his book that the doctor must be masterful. The use of scientific resources and valid information with citation to the references is one of the ethical subjects that are highlighted in this book. Avicenna has put much emphasis on ethical principles as a religious issue in medical practice. He believed in Islam and Islamic ethics and felt responsible toward God and his creations including humans Although in Canon there is no chapter specifically devoted to medical ethics, there are numerous ethical references that focus on humans as the main target of medical activities. It offers recommendations regarding ethical issues such as how to treat patients and minimize hazards. In brief, the book of Canon represents many humanistic ideas.

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Narrative ethics is an approach that is well known for ethical education and moral development.  In narrative ethics, by using a story, its components and characters, ethical knowledge and awareness can be achieved. This approach is very useful in medical ethics education and is helpful in dealing with ethical dilemmas. In fact, part of ethical development, in addition to moral judgment, is to reinforce the ethical sensitivity in which narrative ethics can play a significant role for this purpose.This approach has been widely used for teaching morality in Persian literature and history telling, such as Mathnavi. Narrative ethics can be applied by telling stories about patients' life and their experience of illness. It can also be used to criticize and analyze the clinical situation and explore ethical challenges that healthcare providers face in their daily practice. Thus, it can help to prevent ethical conflicts by establishing interaction between ethical principles and patients' values. This paper emphasizes the application of this method in medical ethics education and ethical decision-making.    

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Medicine is a branch of health science with the purpose of maintaining health and health promotion, diagnosis, treatment and prevention of diseases, and rehabilitation of patients. In addition to possessing academic qualifications and legal training, physicians and service providers should be familiar with moral and jurisprudential considerations in their profession, as is rationally and logically expected.Respect for moral values ​​and legal principles is important since on the one hand it gives the service provider a feeling of fulfillment, and on the other hand it causes the patient to feel satisfied with the service offered.Islamic laws must be observed in all aspects of life in our country and medical practices are not an exception. Therefore it is necessary for all practices to be approved by jurists and to comply with the principles of Islamic jurisprudence and ethics. Consequently, practitioners need a thorough understanding of Islamic laws and ethics in order to be considered qualified. In this regard it should be remembered that Islamic jurisprudence, or Sharia refers to a set of laws and rules of life defined by the Quran and its interpretation and explanation by the great Prophet of Islam (SAW) and Imams (AS). In Islamic culture, law and medicine are closely related to each other. Many physicians are staunch followers of the Islamic jurisprudence and try to observe them in their diagnostic and therapeutic approaches, and in cases where they have dilemmas and are not certain what course of action to take, religious standpoint is what guides them to make the right decision. In recent decades, physicians have tried to apply Islamic laws in the context of medical or jurisprudential problems. This article investigates the realm of medical jurisprudence and medical ethics.

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Considering the professional position of physicians, ethics is of great significance in medical society and being among medical sciences, dentistry is not an exception. This research evaluates the Shiraz dentists' knowledge of professional ethics especially in regard to patients' rights, which is recommended by American Dentists Association. This research is of descriptive/observational and cross-sectional type. The society studied in this research included all dentists in Shiraz who owned an office, out of which 97 individuals were selected through simple random sampling. To collect the data, a 20-question questionnaire was used. The reliability and validity of this questionnaire was approved, and collected data was analyzed by SPSS software. ANOVA test was used as a method of gaining correlation of age and knowledge, and T-test was used to gain correlation of gender and knowledge. Results revealed that the score of dentists' knowledge was 61%, which is equal to 11 out of 18 scores. There was no relationship between knowledge and age (P=0.67) or gender (P=0.68). Dentists must be aware of patients' rights, and reviewing ethical education in the faculty of dentistry is essential, and reaching this goal requires public participation and proper planning for training on this issue in Iran.

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Recently larger numbers of women of advanced age are referring to fertility centers. Although there may be no age restriction for women who are naturally able to and want to be pregnant, using assisted reproductive techniques for women of advanced age is medically and ethically disputed, and this question is always raised: "Should there be an age limit for accessing assisted reproductive techniques for women?" This study was a review of ethical, legal and religious issues regarding pregnancy and reproduction in advanced age for women. We tried to cover codes, legislations and articles on the subject. There is no national legislation about age limit for women seeking assisted reproduction. In this regard, fertility clinics follow their own protocols. Most centers do not accept women older than 45 unless there is a specific clinical situation confirmed by a physician. In any case, the safety of the mother and her child must be the first concern of the physician, and all the treatment protocols should be determined accordingly. Obviously, age alone cannot be a suitable criterion for rejecting the infertile patient. Therefore, regardless of the patient's persistence and their ability to afford treatment, physicians should consider mother's safety and the welfare of the child before admission. Pursuing an all-inclusive legislation and guideline seems to be of great importance in Iran.  

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Confidentiality is one of the oldest principles of the medical profession that impacts on the relationship between physician and patient, the personal interests of patient and physician and consequently social welfare. While emphasizing the necessity of confidentiality, religious teachings consider disclosure of others' secrets a sin that deserves punishment thereafter. Nowadays, medical developments and the invention of new diagnostic and therapeutic procedures as well as the vastness of the informatics world make disclosure of patients' secrets easier than ever. This review article is the result of a descriptive study, and the information was collected using reliable library and internet resources. It will first expound the concepts and principles of confidentiality in medical ethics as well as Islamic ethics, and will then proceed to a comparative review of the similarities and differences in these two sets of­­­­ ethical views on the issue of confidentiality. In addition to the emphasis of medical ethics and Islamic ethics on the necessity of confidentiality in order to win public trust, both sets of teachings cover two areas of personal and public discretion, while in Islamic ethics, the issue extends to a third from, namely religious confidentiality. This makes Islamic ethics more comprehensive in the sense that based on Islamic teachings, the person who keeps someone's secret will also be rewarded in the Hereafter. Also, in medical ethics, only the behavior of the health staff is evaluated and their moods and motives are not taken into consideration, while Islamic ethics pays attention to human dispositions and therefore confidentiality is more stable and can maintain its efficiency without external supervision.

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Human germ cell engineering is a modern technology researched with the aim of studying perennial hereditary mutations in herbaceous, animal and human generations. It has led to abundant arguments and discords among ethics and law experts. Possible changes in the human genome that are identified - according to deceleration of human genome and human rights - as the heritage of humanity and the fundamental unity of all members of the human family lead to questions about the relations between this technology and the normal process of creation. At first glance it seems that human germ cell engineering may lead to innovations in the ordinary institution of creation and the old customs of reproduction. Pursuing the contrasting viewpoints on human germ cell engineering, we can observe an essential and material concern about "changing God's creation" or "interference in the will of God"."Changing God's creation" is a current term in Islamic juridical and moral literature. It performs the main role in the legal destiny of genetically engineered creations so the assertion of this phrase about a being can lead to its natural prohibition. The majority of Moslem interpreters maintain that creation bears upon man's Godly disposition, which is unchangeable. In this research, adopting a dominant approach, the author thinks that the process of human germ cell engineering is not exclusively a sample for the term "changing God's creation". In this article we will try to analyze the potentials of the subject of change in genetic engineering of the human germ cell while taking into consideration the holy religion of Islam.

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Political behaviors are a group of practices that are not essential in organizations, but can impact organizational resources and their reward systems. Employees and managers try to demonstrate political behavior to gain power. Today, most organizational behavior researchers have focused on the perception of political behaviors and how these behaviors are presented with regard to ethical considerations. Therefore, this review is aimed to study the goals, reasons, outcomes, and morality or immorality of political behaviors and power in organizations. The current paper is the result of a literature review that was conducted by using Medline, Ovid, Elsevier, Google, Pub Med, Scopus, Springer, and Cochran library search engines and through selection of 5 key words and 110 references out of which 41 references were ultimately chosen. Most political behaviors are the consequences of employees' personal differences and organizational specifications. Some employees follow moral political behaviors and the rest prefer immoral ones, although it seems difficult to establish which political behaviors are moral and which ones are not. We believe that political behaviors that are based on ethical considerations should be consistent with organizational interests. Seeing as political behaviors are a fundamental component of organizational conduct, they cannot be eliminated therefore, managers should believe in the political nature of their organizations and determine their political strategies and try to employ these strategies to the advantage of their organizations.

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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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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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In recent years, the financial relationship between the physician and the patient and some issues such as informal payments for health care have arisen as an unethical but common problem in many countries, including the Islamic Republic of Iran. Such issues are a threat to the professional reputation of physicians, and can have their own causes in different parts of the world. This study attempts to assess the causes of informal payments and the manners in which they are done in the hospitals of the Kerman Province in Iran in 2012. This study was carried out using qualitative research methods, and semi-structured interviews. Structured interviews were conducted on a purposeful sample of 45 participants including patients, providers and policy makers in the Kerman province in Iran in 2012. This study was authorized by the ethics committee of Kerman University of Medical Sciences, and the consent form was completed by all participants. In this study the participants were asked questions regarding reasons for informal payments, and data were analyzed using content analysis. There are several reasons for making informal payments, which include cultural, legal and quality factors. A number of reasons for asking informal payments by providers were discovered, including those related to tariffs, structural factors and ethical factors as well as to demonstrate the skill and competence of service providers. Most of the reasons discovered for informal payments in Iran are similar to other countries in the world. They showed that inadequate funding of the health systems and inadequate formal payments to providers are the most important supply-side factors leading to informal payments. Given that qualitative studies usually cover potential reasons only, further studies are needed to investigate the matter more extensively.

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Breaking bad news is an unavoidable part of the medical profession, and doctors and patients stand at the two sides of this function. There are different views about how to break bad news in different cultures and societies. In this study we assessed the viewpoints of hospitalized patients on how to break bad news. This cross sectional study was performed in 2011 at the Jahrom University of Medical Sciences. Sample size of 110 patients was calculated and the method of sampling was simple random sampling. Target population was the hospitalized patients of Peymanyeh and Motahari hospitals in Jahrom. Entry criteria consisted of being admitted to the above hospitals, and exclusion criteria included severely ill patients and patients with mental disorders. A reliable self-administered questionnaire was designed and validated. The questionnaires were completed and returned by 110 patients. Data were analyzed using the SPSS16 software through descriptive analysis. One hundred and ten patients were included in this study. The factor analysis showed three elements: methods of breaking bad news, the people involved in the breaking bad news process, and timing and location. Of participants 78% wanted to be told the bad news while their relatives were present, 63.2% wanted to be told the bad news in a private and quiet room. Almost all respondents emphasized the need for religious advisors and psychological counselors (77.2% and 62.5% respectively). Most of participants (91.5%) wished to receive all the information about the etiology of their disease, and 74.8% of them wanted to be told whether their illness was cancer.This study showed that there are different views on how to break bad news in different cultures and societies. Social and cultural differences must be considered in breaking bad news. In our country, patients’ families could have a prominent supporting role in the delivery of bad news to patients.