Iranian Journal of Medical Ethics and History of Medicine

Today, health care providers are moving toward becoming professionals, so only academic knowledge and skills are not enough in complex medical environments, morality is an integral part of medical decision making and paying no attention to it may have adverse effects on quality of care. This Research investigated the moral intelligence and its relative demographic factors between medical and nursing students. In this descriptive cross-sectional study, 214 students were selected by census sampling. Data were collected by using Kiel & lennik questionnaire which its reliability is reported as r=0.94 and has been validated in previous studies. The mean age of students was 21.79±2.82 years. The moral intelligence mean scores in medical and nurse students were 76.44±7.10 and 74.07±8.26, respectively. There was no significant relation between demographic factors and moral intelligence scores but there was significant difference among nursing and medical (p=0.025) and the first and last year students (p=0.002). Trustworthy domain was significantly higher in medical students (p=0.003). Although the results indicate that the students' moral intelligence score is in good condition, this situation can be upgraded to be very good and excellent. The significant difference in the score of moral intelligence in first and last year students shows the effect of educational curriculum. There was significant difference in the scores of medical and nursing groups. So, the educational climate and curriculums can effect on moral intelligence development. Therefore, considering the proven effect of moral intelligence on the quality of professional performance, ethical dimensions, and professionalism in clinical education should be emphasized, evaluated, and monitored more than ever.

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.

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.

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
 

In the Qajar era, European countries deployed many doctors accompanied by their military, religious, and political groups to Iran consistent with their political goals and interests. Meanwhile, the role of France was more and more significant than the rest of European countries. This essay aims to introduce French physicians, to express the performance of French physicians in Iran during the Qajar period, to introduce the activities and extent of the influence of French physicians on the medicine of the Qajar period, and to examine the elements that advance the presence of French physicians in Iran during the Qajar era. This research was conducted using library resources and descriptive-analytical method. The findings indicate that the influence of French medicine on the developments of modern medicine in Iran was very significant, to the extent that the modern medicine was based on French physicians in Iran. Overall, the French effects on medicine in Iran can be found in two forms: establishment of the hospital and clinics and the formation of a health council. In addition, French physicians took important steps in the field of medical education such as ophthalmology, surgery, microbiology, vaccination, writing medical books, and quarantine to prevent communicable diseases. Therefore, French physicians, unlike other European countries, which only improved their health status, also evolved in the history of Iranian medicine. Finally it must be said the Qajar community was well-received by French medicine and physicians; Because both the Qajar court and the community were in need of medical care and the French government needed a comprehensive medical presence in Iran to achieve its political and economic goals.
 

It is a widely held belief that "health care" is an old concept. As one of the most important institutions dealing with this issue, the hospital has been treating human beings throughout human civilization. But historical studies show that, in the pre-modern era, the hospital was not for the treatment of patients. Its function was as a nursing home for the poor and patients. In this article, we attempt to examine the reasons for this in two ways. We first examine the socioeconomic conditions that led to this function for hospitals in the middle ages. We then show that the treatment of patients at that time was based on humorism and classification medicine, which was not only considered the hospital as a place of treatment but also considered it as a barrier to treatment. Therefore, the hospital served as a hospice for the elderly and disabled, and veterans.
 

The possibility of mistakes, negligence, injuries and damages in medical activities could give rise to a civil or criminal case. In such cases, resorting to experts’ opinion is necessary. Forensic medicine organization has important role in such cases. Therefore, understanding of the criteria used by experts of this organization is important and could give rise to awareness of doctors and reduce their professional failures. This is a practical research with a descriptive and analytical method and its necessary information are collected by documentary studies. This investigation shows that medics normally try to have correct medical diagnosis and select appropriate process, and treat patients through reasonable methods to reduce their suffering and pains. It is possible that medics make a mistake in their diagnosis and treatment. Although the result of medical treatment are not guaranteed always, they have to do their treatment and operation according to reasonable and scientific standards and any recklessness and negligence causes criminal or civil responsibility. Reflection on the medical cases shows that the reasons of medic’s conviction can be divided into two categories including pre-treatment and post-treatment factors. Pre- treatment indices contain errors related to diagnosis or choice of treatment.

Jundishapur was built during the Sassanid Shapur era to house Roman prisoners, and a scientific school, especially in the field of medicine was established there. Jundishapur's urban and scientific identity are intertwined with three concepts of Medical knowledge, Syriac, and Christian Christianity. In this research, the establishment of the Nestorian dynasty in Jundishapur, as well as the distinguished position of these physicians in the flourishing of Islamic civilization, has been studied and recognized. Therefore, this issue will be explained and highlighted by analytical descriptive method and relying on library resources. After the rise of Islam and the conquest of Iran, the medical elites of Syriac and Nestorian Jundishapuri; in particular, the Bakhtishoo, Masouyeh, and Maserjuyeh families continued to incorporate the medical traditions of various nations and the translation of Greek medical texts into other languages at Jundishapur Hospital. With the employment of prominent people of these dynasties in the Abbasid Caliphate of Baghdad, human resources, academic, and clinical achievements and the results of centuries of experience of Jundishapur Hospital Medical Center in compiling and translating medical texts have transferred to Islamic civilization by them.

The long-standing interaction of philosophy and medicine has assumed to be as follows: great physicians have been also philosophers, so there is a relationship between medicine and philosophy. In this paper, based on philosophical modeling, essentials of interaction for medicine and philosophy are presented. First, brief descriptions of two models of medicine-philosophy interaction are presented: Galen and Avicenna. Then, the distinct and innovative model of Fakhr Razi- that has been seriously neglected- will be descried. Galen believes “The best doctor is also a philosopher (logic and ethics)”. The logic helps physician to provide accurate diagnosis while the physician-patient relationship is regulated by ethics. Avicenna concerns more with the epistemological foundations of medicine, the position of medicine in the classification of knowledge and the importance of theory of medicine. He argues that philosophical debate on fundamental medical concepts is neither useful for medicine nor philosophy. Fakhr Razi's model can be described as Socratic Method, that is, understanding through dialogue based on questions and answers. His book called “Sharh Kulliyyat al-Qanun fi al-Tibb” (Commentary on Canon of Medicine) is philosophical reflection on basic concepts of medicine and It could be considered as of one of the first texts in medical philosophy. The main goal of his philosophical reflections seems to provide a deeper understanding of medical knowledge and its application in practice.

 Efforts of the medical staff are to provide efficient, desirable, and high quality services to patients. However, medical treatments are not immune to error and mistake. So, occurrence of injury following medical managements is inevitable, an issue that could lead to a lawsuit against the medical staff. In such cases, resorting to experts’ opinion is necessary. Therefore, knowledge about effective indicators in sentencing can increase awareness of the treatment staff in addition to reduction of traumatic behaviors. Reflection on the medical forensic cases shows that the reasons of medic’s conviction can be divided in two categories including pre-treatment and post-treatment factors. Errors after entering the treatment process indicate post-treatment index. Breach at the end of treatment, not doing (lack of) treatment in the appropriate place, mismatch or mistake of used techniques, and fault or blunder are the most important issues related to this index. The present study intends to examine the effective criteria in sentencing medical staff in a descriptive-analytical manner based on expert opinions’ of medical malpractice cases.

This study seeks to identify one of the pioneers of traditional clinical medicine named Abdullah Azdi and his medical dictionary. This research is an analytical study. The focus of the search was on two keywords, Abdullah Azdi and Kitab al-Ma'ma, but the scope of the search included all appropriate terms such as: medicine, Bu Ali Sina, traditional medicine, medical dictionary, ethics, and medical law. Data were collected and analyzed using comprehensive library software (version one), Islamic History Library, Islamic Iran History and reputable national and international centers. The main purpose of the forthcoming research, on the one hand, is to identify and introduce points about life and beliefs, as well as Abdullah Azdi's specialized knowledge in the field of medicine, and on the other hand, to introduce his book, which is in fact a dictionary called "Kitab al-Ma'a". The researches of this research show that Abdullah Azdi was one of the students of Ibn Sina and the companion of Abu Rihan al-Biruni. In addition of being expert in clinical medicine, he was an ethical and professional physician and in every part of his book, he observes the Shari'a. The use of specialized medical terms indicates that he was surrounded by medical knowledge.

The purpose of this study was to perform a narrative review and documentary research in the history of community medicine specialty formation and the needs for its existence in health systems. We searched and reviewed related literature and documents in English and or Farsi (printed or online). Data was extracted and findings were categorized, summarized, and reported. About a century ago community medicine specialty was formed to respond to major health challenges of that time such as neglecting the effects of social determinants on populations’ health and total separation between clinical care and public health. Community medicine professionals are able to address many of the current health problems such as inequalities in health, fair financing problems, increasing demands and costs and disease-based health system approaches. They can be the leading advocates to emphasize the importance of social determinants in health of populations. They can promote communications with influencing institutions outside the health system to improve the health of the communities. This discipline can pave the way for the health systems to tackle the most important contemporary health challenges. Lack of attention to this discipline may hinder the achievement of sustainable development goals and health promotion of the communities. More support from officials and utilizing the skills of community medicine specialists can help health systems not only to better respond to the health needs of the society but also to facilitate the achievement of their main goals.

One of the most important and influential events in the interaction between Islamic civilization and the West was the Crusades, which lasted for nearly two centuries and extended from Europe to the Levant and Egypt. The main reasons for these wars, apparently, were the religious zeal of the Christians to seize Jerusalem from the Muslims and, in fact, the territorial expansion and influx of the surplus population of Europe to the east. The present study aims to explore the role of the Crusades in the transfer of medicine to Europe. The present research uses a descriptive-analytical method and library resources to explain the process of transferring Islamic and Eastern medical science to the world, affected by religious wars. Referring to texts, honesty and trustworthiness, citation of used texts, avoidance of bias in inference from texts or analyzes have been observed. The results of the research show that during the Crusades, Europeans, observing the scientific progress of Muslims, decided to translate the works of Islamic physicians and transfer them to Europe. This led to the advancement of medical knowledge and the development of health in Europe's Renaissance. Thus, he most important consequence of the Crusades was facilitation of the transfer of the cultural and civilizational foundations of the Islamic world, including the reserves of Islamic and Persian medicine to Europe

The present study seeks to find an answer to this question, “how effective was the religious and moral advice on environmental health situation of cities under the territory of Al-Buwayh dynasty”? Findings indicate that in the first half of the Al-Buwayh era, following the increase in population and expansion of some cities, the need for health measures in various areas was felt, of which is considered a responsibility of environmental health authorities nowadays. In addition to the instructions and recommendations being embodied in some verses of Quran and hadiths being the basis of health laws, a number of rulers of this dynasty, like Azd al-Dawlah intervened in the health affairs of cities in various fields such as providing drinking water, constructing of medical and service centers, and appointing Sheriffs (Darougheh). A part of the mentioned actions was involved with the community health in the field of food hygiene, roads and public places, water hygiene as well as sewage disposal. In the present study, first, narrative, historical, medical and geographical books were indexed by using descriptive-analytical method and relying on library resources; second, the data in the most important areas related to environmental health was classified; and then, a conclusion was reached.

The medical terms currently used are derived from a variety of sources. These terms are often derived from an eponym. Eponyms are a long-standing tradition in medicine. Eponyms usually involve honoring a prominent physician-scientist who played a significant role in identifying the disease or the person who first reported the disease or the area where a disease first broke out in there. Eponyms are sometimes associated with myth, literature, and art. Of course, the mythological, literary, and artistic figures used in medicine as eponyms are mostly related to Greek and Roman mythology and English and German literature. However, without knowing the ancient records of a disease such as Sarsam (delirium), Barsam (pleurisy), Da'alfil (elephantiasis), Da'al-Raqs (chorea), Pisi (Vitiligo), Degg (languish), Zat-ul- reyeh (Pneumonia), and Zat-ul-Janb (pleurisy), one can specialize in medicine, but, recalling of literary and mythological letters, even those that have no practical application today or have been forgotten somewhere in the history of medicine, can soften medical science and allow us to link science and art. In this article, eponyms that are related to the sciences of anatomy and biochemistry are studied based on myth.