Iranian Journal of Medical Ethics and History of Medicine

Spiritual health (SH) is a supernatural force and endeavor to achieve perfection and peace of mind in life.When it is endangered, a person experiences loss of meaning in life. In nursing, caring services and SH are related to each other. It is necessary to promote the SH of nurses so that patients will receive better care. The study aim was the effect of spiritual education on SH of nursing students. In this quasi-experimental study, 76 of undergraduate nursing students were selected using random simple sampling method and divided into experimental group (EG) and control group (CG) (n= 38) with random allocation method. Educational intervention was done for the EG for a period of 4 weeks, a 60-minute session per week, but no intervention was performed for the CG. Four weeks after the intervention, the post-test was taken in 2 groups. Data were collected using the SH scale by Paloutzian and Ellison. Independent t-test didn’t indicate any difference before the intervention in the mean score of SH in 2 groups (t=-0.49, p=0.62), while in the post-test, the independent t-test indicated the mean score of SH was higher in the EG than in the CG (t=-2.14, p<0.03). After the intervention, there was a significant increase in the SH (t=-4.39, p<0.001) in the EG. The paired t-test indicated no difference in the SH in the CG compared to the pre and post-test (t=-0.25, p<0.79). Spritual education influenced SH of nursing students. It is recommended that spiritual education be considered as one of the strategies for promoting SH in students.
 

Patients’ satisfaction of treatment centers is one of the most important indicators for the quality of care and treatment services. Taking care of patients’ satisfaction has essential role in managing programs of health services. The aim of study was to evaluate patients' satisfaction with the quality of services provided in Shahid Beheshti Hospital in Qorveh in 2015. The research method was cross-sectional and descriptive-analytic. The statistical population of the study consisted of 384 patients selected in one stage cluster sampling from different parts of hospital. Patient satisfaction was evaluated by means of questionnaire that its validity and reliability was confirmed. Information was analyzed by statistical software SPSS 20 and t-test. The results showed that most of satisfaction was related to the emergency department and the lowest levels of satisfaction was related to ICU. Overall satisfaction from health services of Shahid Beheshti hospital was 72%. In this study, the satisfaction and habitat of patient had meaningful relationship, but other factors had not significant relationship with patient statisfaction. In recent years, patient satisfaction had an acceptable level due to dramatic improvements in health system. Nevertheless, the problems and weaknesses in the health care field also should be concerned and resolved and we have to improve the quality of services.
 

Recent developments in the digital domain and its influence in the health sector have led to the development of digital health technologies. The development of these technologies in addition to the benefits such as lowering medical care costs and improving the quality of patient care, has introduced new ethical challenges into the field of medicine. In this study, 25 articles were identified on the ethical challenges in digital health technologies by using literature review. These articles were in areas of mobile health, electronic health records, telemedicine, electronic health, wearable and big data technologies. The ethical challenges found in the articles reviewed in the field of digital health include: the privacy challenges that are due to the creation of huge data sources in this type of technology, how to ensure access justice, challenges for determining the responsibilities of surgical and technical members in telemedicine technologies, changing the patient's role, challenges regarding data ownership and patient access to raw data, the challenge of balancing the privacy of patient information and data sharing in advancing the community's science and health big data, and guaranteed quality of provided health information. These surveys can be effective in identifying challenges and developing ethical guidelines before developing and applying these types of technologies.

Waqf (donation) has a long history in human history and can have a high impact on economics, society, and culture. One of the most influential fields of the waqf is on human health. This study is a descriptive study. In this article, after reviewing the tradition of waqf and charity throughout history, and the experiences of charity in other countries, including the Pasteur Institute of Paris, the role of waqf in establishment and promotion of Pasteur Institute of Iran is reviewed and the benefactors of this institute are introduced. The headquarters of the Pasteur Institute of Iran in Tehran and its branches in Shemiran, Khalid Islambouli, Amol (north) and Hamadan (west) are donated by the charities for diagnosis, production of vaccines, and research in the field of contagious diseases’ control and prevention.  In Iran, most cases of waqf on health have been dedicated in the field of treatment, but Pasteur Institute of Iran is a successful example in the field of public health and specialized health services. One of the ways to expand waqf is to explain the effects of these endowments in society. Investigating the role and influence of Pasteur Institute of Iran in promoting public health can be a good explanation of the impact of these endowments in the field of health. It is suggested that Pasteur institute of Iran and its persistent effects be explained to the beneficent, so that some of the future endowments be extended to areas such as public health and diagnostic services.

Nowadays, social networks play a remarkable role in human societies. Instagram, as one of the most influential platforms, along with other functions, has become a place for the marketing and advertising of economic undertakings. Advertisements on Instagram are different from other forms of advertising. The market-driven nature of this network will create many legal challenges in the relationship between professions and consumers. Goods (such as medicines and herbal medicines) and health services (such as medicine, dentistry, and pharmacy) are related to the health of consumers. It is evident that any negligence on the part of the profession can cause serious harm to consumer’s physical and mental health. This article assesses the evolution of the relationship between the professional and the consumers. It discusses the ethics of Instagram marketing and health problem, along with reviewing the legal protection of consumer’s health in the -related goods and services using an analytical-descriptive method. The results of this paper show that violating consumer rights on Instagram can lead to four types of liability (criminal, legal, disciplinary, and ethical) for the offenders. In this way, the support of the legislator and the responsible authorities is essential for increasing the quality of this protection.
 

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.
 

In recent decades, the concepts of healthy lifestyle and healthcare choices have been the subject of focus by healthcare policymakers. Together with financial, mental, and ethical reasons for citizens to have a free hand as far as their healthcare, numerous arguments based on the social aspects of healthcare have also been made by proponents of the necessity to limit these options by government, believing that in addition to personal consequences, an individual's healthcare choices have social ramifications as well. On the other hand, the definitions of the concept of freedom along with the impressionability factor of the individual's healthcare choices to government and society are other parameters that affect government policy in this area. By looking at the meaning of freedom from both the functional and opportunity creating standpoints, we have attempted to demonstrate that the optimal definition of freedom in the healthcare system is a responsibility based freedom in which it is although limited by the government, a person still maintains his individuality. According to the findings of this study, without establishing the necessary prerequisites by government and society, the freedom and equality of individuals in healthcare choices is meaningless. In this context, the special role of government is to create a balance between the individual rights and public interest as well as to cultivate responsible and well-informed citizens to protect themselves and others, building a society that would not allow the withdrawal or disregards of the right to freedom.

The "Legal language" has provided a strong supportive argument for right to health advocacy. In such a way that, human rights rules has been established as the most important globalized political value at the heart of the theory and practice of public health discourse. Its power of enforceability guaranties fair distribution of health resources in each country. At the same time, the right to health, the “Right-claim” which has been identified by international and national documents  requires preconditions that will not come true without the proper cultural, social, economic, and political infrastructures, in general the factors shaping the "context of people's lives”. In other words, a legal reasoning for right to health can be followed by an argument for the right to health determinants. Therefore, by adopting an epistemological approach, this paper presents a legal narrative of “governance for health”. This paper creates a new perspective on the "right to health" debates. Additionally, it provides powerful arguments that health policy should be based on a perception of factors with major impacts on the people health and what have being described as "health hazard", "health protector", and "health promoter". However, this claim for right to health as an "individual enforceable right" is criticized, and there may be theoretical and practical obstacles to the full realization of this human right.

Undesirable experience as “moral distress” is one of the major issues faced by nurses when making moral decisions. The spiritual dimension is one of the dimensions that influences their moral distress; therefore, this study was conducted with the aim of determining the relationship between spiritual health and the moral distress of nurses working in the emergency departments. In this descriptive-analytic study, 140 nurses working in the emergency departments of the educational and medical centers of Hamedan participated by census sampling. Data were collected through a three-part questionnaire, including demographic information, Paloutzian and Ellison spiritual health questionnaires and Corly moral distress questionnaire. The data was analyzed by Chi-square test and Pearson correlation coefficients using SPSS software, version 16. The mean age of participants was 31.9 ± 7.31 years. The spiritual health score and moral distress of most nurses were moderate. A negative and significant correlation was observed between spiritual health and the severity of nurses' moral distress, (r = -0.200, p = 0.05), meaning that the higher the nurse's spiritual health score, the lower their moral distress. The results indicate that spiritual health is an effective parameter in reducing moral distress in nurses, so it is suggested to pay attention to spiritual’s dimension in promotion of nurses' health.

The necessity of governing ethics is desirable in the work environments and is universally accepted. Ethical performance is based on the ethical criteria that employees are expected to adhere to. The purpose of this study was to determine the relationship between ethical educational needs and ethical efficiency in health workers of Sistan province. This is a descriptive correlational study. Data of 377 healthcare providers of Sistan rural areas were collected through a multi-stage cluster sampling method.  Information was collected with a valid and reliable questionnaire. The data were analyzed by SPSS 19 software using descriptive correlation, independent t-test, one-way ANOVA, and Pearson correlation coefficient. The results showed mean score of the need for ethical education of health care providers was relatively high (with respect to the maximum of the score), and the ethical performance of health care workers was low. There was also a significant and inverse relationship between score of ethical educational needs and ethical performance of health care providers (P >0.05). Based on the results, there was a significant and inverse relationship between ethical educational needs and ethical performance of health care providers. Providers who had a higher level of information and less educational needs had higher ethical performance. So, implementation of educational programs based on ethical educational needs is recommended for increasing ethical performance of health care providers as they are first-line practitioners who interact with people and health care clients.

Dementia is a major health problem due to the high costs of treatment, high prevalence in the elderly, severe consequences, and the imposition of physical and psychological stresses on families of the patients. Occupational therapy is one of the most important approaches among many technologies employed for helping the patient and reducing the burden of healthcare for patients. This applied study aimed to investigate the ethical and legal aspects of occupational therapy technology in the elderly with dementia using qualitative methods. The study population consisted of 12 specialists and practitioners in the field of dementia and elderly services in the country. Data collection was carried out by interviewing the expert subjects. The results of this study showed that beneficence/non- maleficence, autonomy/informed consent, maintaining dignity/respect for persons, concern for equality and justice in accessing services, legal support for technology use, need for the principle of discretion, and patient confidentiality, and proper technology utilization are  seven major ethical and legal challenges in occupational therapy technology in the country. According to the results, lack of insurance coverage for occupational therapy technology and the lack of access to this service for the elderly are major barriers to its application and the Ministry of Health must provide the initiatives for its implementation across the country and place it in the elderly service package.

All children have a right to benefit from health facilities, goods and services and be protected from physical or mental violence, injury or abuse, and neglect or maltreatment. Some groups of children need special support to enjoy their rights. The aim of this paper is to review Iran’s laws and policies on the protection of children’s right to health. The method of this descriptive and analytical study was content analysis of international and national law and reports related to children’s right to health and the current situation of Iranian children. The data was collected from academic literature and official webpages of United Nations and Iranian government’s organizations. Realizing citizens’ right to health and protection, Iran’s laws respect the right of vulnerable groups of children to special support. Moreover, to protect Iranian children from health risks and maltreatment, there are several deterrent laws. Iranian laws on children often are consistent with international human rights laws.  However, not all of them are adequately and completely implemented. To promote the health of children, weaknesses in the implementation of laws should be identified and removed.

Good and healthy communication between physician and patient is cornerstone of a complete medical care that has long been considered in sociology. From the classical point of view, the physician-patient relationship as a unique relationship encompasses a wide range of cultural and social influences. Electronic health record not only has facilitated the treatment and diagnosis process, but also has promoted the health care system by organizing patient records; however, it alters the physician-patient relationship process culturally and it will create new ethical challenges. Based on current findings and analyses Opinions of health experts about the cultural and communication dimensions of this technology, the electronic health record, despite its effectiveness, easy and convenient diagnosis, awareness of other physicians' diagnosis, earlier and better treatment, has cultural obstacles such as security, reduction of emotional and face-to-face actions, and fear of social stigma. Having a suitable cultural context and information and awareness can affect development of health technology. The results of this study, which have identified the role of culture on physician-patient relationships in context of using electronic health record, shows that building trust in patients and changing cultural conditions through education and improving system security can increase the efficiency of this system in health care processes.

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.

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.