Iranian Journal of Medical Ethics and History of Medicine

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Lack of knowledge of the medical team about the regulations and laws of abortion can endanger mother’s health and also faces the medical community with serious problems. The aim of this study was assessment of knowledge and viewpoint of midwifery students in Tabriz Azad Islamic University and Tabriz University of Medical Sciences toward abortion. This study is a descriptive study which was conducted in 2013 on 300 midwifery students in Tabriz Islamic Azad University and Faculty of Nursing & Midwifery at Tabriz University of Medical Sciences. A four-part questionnaire was used for gathering data parts 1 to 4 included the personal, social, educational particulars of midwifery students and studying the students’ knowledge about the I. R. Iran’s regulations and laws regarding abortion, studying the students’ viewpoints toward legal and illegal abortion. Our study showed that 26.7% of midwifery students have proper knowledge about abortion, the knowledge of 53.7% of them was in the medium level and 19.7% of students have weak knowledge toward it. The positive viewpoint toward legal abortion was observed in 89.3% of the students and 10.7% of students had negative viewpoint. Our analysis showed that there is no statistically significant difference between students’ knowledge about abortion (P≤0.76), students’ viewpoint toward legal abortion (P≤0.44) and students’ viewpoint toward illegal abortion (P≤0.081). Although in our study midwifery students’ knowledge about abortion regulations was not sufficient, there is the high probability of their encountering with judicial problems. Therefore, it is recommended to raise the midwifery students’ level of knowledge about the authorized cases of abortion and regulations which may decrease the fines of criminal abortions in the future.

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Moral dilemmas caused by modern diagnostic and therapeutic advances in medical science have increased the need to address medical ethics a hundredfold. Medical ethics is a "science", so the method needs scientific work. In order to achieve the objectives of any science, we need to define and resolve the ambiguities surrounding it. Notwithstanding the definitions presented in conjunction with the science of medical ethics, still some issues remain unclear about it.An important part of our knowledge consists of the answers to what things are, and that is nothing but definitions. Definitions comprise the bulk of our perceptions and therefore need to be employed.This review article is the result of a descriptive study. The data were collected through studying credible textbooks and searching internet resources and related articles. While emphasizing the need to clarify the definition of science and characteristics of logical definition, this paper evaluates some of the definitions of medical ethics and by showing their weak points, notes that there is a need for a logical definition of this science and the necessary consideration

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Do not resuscitate order (DNR) is one of the most challenging issues in end of life care. The attitude of health care providers has an important role in legalization of this procedure. The aim of the present study was to investigate the viewpoints of nursing students on DNR orders. One hundred and eighty six nursing students from Tabriz University of Medical Sciences (TUOMS) and Kurdistan University of Medical Sciences (KUMS) participated in the present study. Data collection was performed by Attitude on DNR Order Questionnaire that consisted of 25 items. The results showed that nursing students have a negative attitude toward many aspects of DNR orders, had many misconceptions about this procedure and tended to acquire more information about it. Also, students reported a negative attitude about passive euthanasia and reported that cultural and religious factors are important in their attitude toward DNR orders. Moreover, there was no statistical difference between the attitudes of nursing students from these two universities with two different cultural and religious backgrounds (P > 0.05).Considering the lack of knowledge of nursing students about DNR orders it is suggested that nursing students should be educated on the subject. Due to little research evidence conducting further studies is recommended.

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Abortion is a challenging issue. It is proposed as a problem in medical philosophy and medical ethics texts. In dealing with abortion, graduate medical students may be influenced by different situations, or make a decision according to their conscience. Therefore they should acquire a satisfactory level of ethical development to deal with these issues during their years of education.Some things that are important for education on abortion are law, religious and moral reasoning, understanding the moral reasoning of people who request an elective abortion and related ethical philosophies. If health providers want to make the right decision and manage the patient suitably, they should be aware of the moral reasoning of the abortion applicant, religious moral reasoning, legal issues, and the ethical philosophies related to elective abortion, so they can do the best thing when dealing with abortion applicants. Sometimes the abortion applicant or the health provider thinks that abortion is an ethical action, but according to religion and the philosophy of ethics it is not. Therefore supporting health may be warranted by educating medical students on ethics as well as religious rules and legal issues.

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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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Medical laboratory services and its clients are somehow different from services of the other sectors in the health system. Patient’s Rights Charter, published by the Ministry of Health and Medical Education, was comprehensive, but addressing specific aspects of the related areas in medical laboratories could promote the commitment and dedication in laboratory professional services hence, development of the Patient’s Rights Charter in medical diagnostic laboratories was put on the agenda. After a comprehensive review of existing references and resources, a committee was formed consisting of representatives of laboratory associations and experts in this field, and the draft was prepared. Thereafter several meetings and workshops were held and the members of legal organizations, medical ethics experts as well as laboratory stakeholders, technical staff and laboratory directors attended these gatherings where the draft was surveyed and comments were received. The draft underwent some changes and was edited. Finally in August 2012, the charter was approved by the Health Policy Council of the ministry and in October 2012 was officially announced by the health minister.To be consistent with the context of the Patient’s Rights Charter, essentials of this bill have been based on 5 pillars: access to appropriate laboratory services, access to information in a sufficient and effective manner, the right to choose and decide freely, respect for customer privacy and the principles of confidentiality and integrity, and availability of an efficient system for investigating complaints and suggestions.Developing and delivering the bill of rights for health services recipients is one of the foremost matters, but implementation of the provisions of the charter and monitoring of its effectiveness are the most important goals ahead. Therefore, an effective strategy to implement the rights of patients in medical laboratories should be designed and established.

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Presence of physicians in different fields of the society has always been associated with ethical and legal considerations. Physician participation in legal punishment is one of the areas that are associated with different perspectives. In medical history, physicians and medical professionals have participated in legal punishment in different ways, but they have been directly involved with this process after the development of the lethal injection method. Proponents and opponents have discussed the ethical aspects of physician participation in legal punishment, and medical organizations have announced their viewpoints about this subject. In the Islamic Republic of Iran according to the Islamic punishment laws and their implementation regulations, physician participation in legal punishment is necessary, but the physician does not play a direct role in the execution of punishment. In this article we will study the main arguments of opponents and proponents as the background of the subject and will then evaluate the exact role of physicians in the execution of punishment in Iran and analyze the ethical aspects of this role.

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A thorough understanding of the characters, attitudes, and lifestyles of renowned scholars is of paramount importance for any nation. Dr. Hasan Habibi (1936-2012) was a prominent figure in science, theology, literature, and culture of Iran. The late Dr. Habibi was a pious and patriotic politician who was fully committed to safeguarding the pillars of the Islamic Republic of Iran and the Islamic Revolution. In this article, we aim to review some of his works and explore the memories of his family and acquaintances in the hope to shed some light on his manners, viewpoints, and lifestyle. Moreover, the first author’s personal remembrances of the late Dr. Habibi and his moral virtues are presented here, particularly with focus on his final years during which he was bedridden for a long period. Moreover, we aim to illuminate his ideas in terms of promoting science, supporting scholars, and building the infrastructure needed to expand the boundaries of science. We hope that this article will provide a model both for bedridden patients in Iran and the physicians and researchers who deal with them on a daily basis.

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Patience is a moral construct and is related to persistence, tolerance, restraint, contentment and transcendence in difficult and unpleasant situations. It can be discussed in the field of medical ethics and is related to many variables. The aim of the present study was to examine the role of patience and its components (transcendence, tolerance, contentment, persistence, and restraint) as moral constructs in predicting hope among university students.The study population of the present study consisted of all of the university students studying at Shiraz University. Three hundred and ninety university students were recruited via cluster sampling. The participants completed the patience scale and hope scale. According to the findings of the Pearson’s correlation test, patience and its components correlated positively and significantly with hope and its subscales (pathway and agency). Moreover, the total patience score effectively predicted the total hope score (β = 0.58, P ≤ 0.001), pathway (β = 0.52, P ≤ 0.001) and agency (β = 0.52, P ≤ 0.001). Transcendence, contentment, and persistence were important predictors of hope and its subscales. It can be concluded that reinforcing patience as one of the most important and valuable moral constructs can increase hope and lead to success. Thus, applying educational strategies of patience in order to curtail despair and promote hope among patients is recommended for clinicians working in the fields of psychology, health and medical ethics.

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Social capital and altruism are the most effective factors on the cultural development of a society and can play an important role in promoting ethics within the health care system. The purpose of this study was to investigate the relationship between social capital and altruism and the ethical attitudes of physicians. This correlational and descriptive study was performed on 322 doctors working in medical centers in west Azerbaijan during 2013 who were selected by cluster-random sampling. Onyx and Bullen social capital scale, Carlo et al. altruism scale and Karamporian et al. ethics questionnaire were used to collect data. The results of this study indicated that there was a significant positive relationship between the ethical attitudes of physicians and altruism (R = 0.238), the structure subscale (R = 0.489), cognition subscale (R = 0.581) and relationship subscale (R = 0.554) of social capital. The significance level was set at p < 0.05 in this study. The multi-variable correlation coefficient and enter method indicated that social capital subscales can influence the ethical attitudes of physicians (0.457). The results showed that there was a correlation between social capital and altruism and ethical attitudes in the medical profession. Thus, it seems that promoting social capital and altruism can positively influence individuals’ ethical attitudes in the medical profession.

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It is universally acknowledged that death is a complex concept and different factors such as complicated philosophical ideas, contradictory descriptive approaches, and diversity in interpretations add to this complexity. Although a thorough understanding of the notion of death is important for everyone, this concept is of crucial importance to health care providers as they face enormous ethical challenges in the course of their careers. A few instances are controversial issues such as brain death, euthanasia and end-of-life care, where it seems essential to define a set of robust criteria for death. On the other hand, it can be argued that death is not a scientific concept and only different branches of medicine can provide a framework to clarify the subject of death. Therefore, it could be argued that theological approaches may shed some light on this concept. In this article, we aim to extract ontologic components of death mentioned in the Holy Quran, and will move on to propose a set of 12 criteria for death. This may help provide a clear understanding of the concept from the point of view of the Holy Quran, although more research is warranted to further illuminate this complex subject.

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Abortion has remained a subject of intense controversy in medical ethics, particularly in the case of malformed fetuses. Review of the existing literature on the issue indicates that there are two main challenges in this regard: firstly, the question as to whether a malformed fetus has the right to live, and secondly, the fate of the soul (vegetative and animal) after induced abortion.This descriptive research presents different viewpoints in order to investigate the aforementioned questions in Mulla Sadra’s philosophy with a focus on the “right to live”. The results of the study demonstrate that according to Mulla Sadra’s theory, all fetuses possess potential human souls even if they are extremely malformed or disfigured. He considers the fetus a vegetable with the potential to convert into a human. Based on this ideology, which encompasses both creation and resurrection, the malformed fetus has the right to live. The assumption is founded upon Mulla Sadra’s Theory of Substantial Motion, which implies that abortion may influence the evolution of the soul in the limbo period (intermediate state) after abortion and might even affect its resurrection. It can be concluded that in the Iranian society, which has an Islamic background, theological views should be considered in decisions about abortion. It should be mentioned, however, that philosophical approaches alone cannot be relied on for decision-making regarding the abortion of a malformed fetus. Furthermore, interdisciplinary contributions are indispensable to a thorough analysis of this controversial issue so that the ethical challenges surrounding abortion in such cases can be overcome.

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Virtue ethics is an agent-centered approach that is concerned with good and bad character rather than right or wrong action. It is based on the virtues and moral character of the agent. Morality of the physician is emphasized in medicine as well, which demonstrates its affinity with virtue ethics. Nevertheless, a theory of applied or medical ethics should provide a criterion for ethical decision making by instructing what should be done, something which, according to some philosophers, is incompatible with virtue ethics. This article aimed to demonstrate how virtue ethics can offer rules and guidelines by resorting to the moral agent and emphasizing virtues, and help physicians to make decisions when faced with dilemmas. For this purpose, examples about abortion and selling kidneys for transplantation were provided.Some of the most important advantages of virtue ethics include: context-dependence and attention to relevant realities the importance of emotions and the likely motivations of the people involved and finally emphasis on exemplar based on the sensitivity and practical wisdom of the virtuous agent. These advantages cause virtue ethics to be better positioned than other approaches to solving problems in medical ethics.

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In recent years, the general consensus is that medical education should comprise ethics courses focusing on clinical decision-making skills and professional ethics in order to institutionalize a set of values in physicians. The purpose of this study was to evaluate the internal and external qualities of the medical ethics curriculum from the perspective of students.This was a survey research on a study population of 157 medical students who were taking the medical ethics course. A sample of 113 students were selected by simple random sampling, and data collection tool consisted of two researcher-made questionnaires. In this research, the internal quality of the curriculum was evaluated according to the following 9 elements as proposed by Francis Klein: objectives, content, learning activities, learning strategies, instructional material, resources, grouping, time, location, and evaluation. The external quality of the curriculum was assessed based on Kirkpatrick’s model with attention to students' views on achievement of course objectives in terms of knowledge, skills and attitudes. Data analysis was performed using descriptive statistics (mean and standard deviation) and inferential statistics (one-sample t-test). Based on the findings, the students viewed the internal quality of the medical ethics curriculum as undesirable in terms of the above-mentioned nine elements. Students also believed that the external quality of the ethics curriculum was at an average level in the knowledge and attitudes components, and undesirable in the skills component. Overall, our findings indicate that from the perspective of students, the quality of the medical ethics curriculum is low and the course needs to be reviewed and redesigned.

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Medical laboratory is one of the health service providers that intensely responsible for the life of patient / client. With an increase in the number and variety of laboratory tests in recent years, the role of laboratory science in identifying and assessing the cause of disease has been more recognized. Performing the laboratory tests with the utmost accuracy, precision and speed using up to date methods as well as protecting the rights, integrity and respecting human dignity and also the establishment of priorities and the requisites for quality management systems can have a significant impact on patient satisfaction and quality which are the characteristics of a good medical laboratory. The principle concept of doing good and not doing bad is the essence of every code of medical ethics. Therefore, in laboratory medicine like other areas of medical sciences, there are ethical questions that have become more complex with the development of diagnostic tests. Medical laboratory practitioners usually deal with issues of confidentiality of patient information, as well as issues related to research ethics, professional ethics and business ethics.This study has collected important and common topics of medical ethics in laboratory medicine which leads to increase readers’ and practitioners’ information in this field. It is hoped that such information could be effective and practical to improve the laboratorial services for patients.

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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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Cryopreserved embryos are considered as abandoned embryos in two situations. The first situation is when the embryo`s owners have no definite domicile and no written guideline has been provided by the couple regarding the embryo`s status. The second one is when the owners of cryopreserved embryos explicitly state that they permit the freezing centers to decide about their embryos` fate. The aim of the present study was to determine the best possible decisions about cryopreserved embryos in case of their abandonment by couples.

This research was conducted through library and analytical research methods.

As the cryopreservation of embryos is expensive, cryopreservation centers must be exempted from preserving embryos after unsuccessful attempts at communication with the owners and passing of reasonable time.

Making decisions about the fate of abandoned cryopreserved embryos depends on the nature we attribute to them. If we consider abandoned cryopreserved embryos as humans, it is possible to destroy them according to the rule that necessities allow prohibitions. If we consider them as properties or quasi-properties, when there is no accessibility to their owners in order to determine their fate as properties, the governor is permitted to make decisions about their disposal or donation for researches.

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Despite all recent advancements in medical sciences and the related technologies, the concept of death still remains obscure. It can be asserted that as death includes both physical and spiritual dimensions, medicine alone is not capable of fully illuminating its different features. Therefore, inter-disciplinary collaboration between different branches of science such as Quranic studies, humanities, and philosophy seems necessary in order to shed some light on this hitherto undiscovered subject. Through description of what the soul experiences before and during death, such collaborations may even enrich the knowledge and broaden the minds of physicians who are capable of the analysis of physical changes caused by death. This insight can promote the ethical decision-making process as well as the provision of end-of-life care and spiritual support in different stages of death. The current research, as a library literature review, endeavors to provide a descriptive view of death from a medical perspective, and then, a Quranic depiction of its different stages through an analysis of verses and quotations from the holy Quran and Islamic scriptures whose primary focus is the process of dying. The final discussion section presents some similarities and differences observed between viewpoints and raises questions which can be considered as being of great practical importance in terms of provision of necessary end-of-life spiritual support. We hope that further research in this field can better clarify the issues raised in this article so that practical measures aiming at the provision of Quran-based spiritual end-of-life care are designed and implemented.

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Traditional and complementary medicine centers, as providers of health services, have a special responsibility towards patients and clients. With increase in the number of these centers, the role of traditional and complementary medicine has become more important in the analysis, diagnosis, and treatment of illnesses. The accurate and fast performance of medical approaches using evidence-based diagnostic and therapeutic procedures, with consideration of the rights, integrity, and dignity of clients are among the priorities and necessities that can have a significant impact on the satisfaction and acceptance of the scientific and legal institutions, parallel to the deployment of new services provision systems. Lack of sufficient scientific evidence of efficiency and effectiveness, lack of definition and determination of authorities to handle complaints, the legal process of ethical and legal aspects of medical errors has caused challenges for the field of complementary and alternative medicine. Thus, this legal void must be filled through formulation and revision of laws and regulations, defining of the practical and acceptable set of scientific resources, and determination of authorized service centers to resolve complaints and to punish. It is hoped that the results of this review study increase the information of the professionals in this field and attract the attention of authorities of medical ethics to this field.

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Physician-assisted suicide is an important, challenging issue in medical ethics, which the right to die is a central point in this issue. Physician-assisted suicide is offered to end intolerable pain and suffering. Although, it is a legal practice in some countries, still it is a challenging and controversial practice in ethical and legal perspectives. It has been argued that based on the principles of medical ethics, physicians should respect patient’s decision, however many ethicists and jurists believe that Physician-assisted suicide is unethical. It should be noted that the main reason for proponents and opponents is based on their interpretation about human dignity. This controversy can be resolved by reference to religious interpretation of human dignity in which asserts that Physician-assisted suicide is against human dignity and respect for human life.