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Identification and Analysis of Organizational-Professional Factors Affecting the Trust Between the Patient and the Physician
Mahshid Safaei, Maghsoud Farasatkhah, Ehsan Shamsi Gooshki,
Volume 15, Issue 1 (3-2022)
Abstract
In the health system, professional problems and organizational obstacles cause patient fatigue, physician exhaustion, and ultimately interpersonal issues between the patient and the physician, including lack of mutual understanding and erosion of trust. Therefore, trust, as the central core of social capital, plays a significant role in the quality of interpersonal and intergroup interactions. The trust between the patient and the doctor and its general expansion requires a set of organizational considerations and professional principles in the health system. The purpose of this qualitative research was to analyze organizational and professional factors affecting trust between the patient and the physician. The data were collected through semi-structured interviews in the health service centers located in Tehran. Using purposeful sampling and snowball, a total of 39 participants were interviewed until theoretical saturation was reached. Using the systematic approach of grounded theory (GT) and ATLAS.ti software, the data were categorized and analyzed in three stages of open, axial and selective coding. The findings show that the professional-organizational components effecting on trust between physicians and patients include three components of "adaptable professional management", "adaptable insurance" and "adaptable policy" and nine sub-components as described in the article. These components are the composing elements of the structure and infrastructure of professional development in health system, which can restore the relationship and interaction based on trust between the patient and the physician in health system. The other strategic researches are needed to develop strategies and executive policies to increase the trust between the patient and the physician.

Policy Brief for Management and Prevention of Defensive Medicine in the Iranian Health System
Mohammad Hossein Eftekhari, Alireza Parsapour, Ayat Ahmadi, Bagher Larijani, Neda Yavari, Ehsan Shamsi Gooshki,
Volume 16, Issue 0 (11-2023)
Abstract
Defensive medicine is performing actions that have no medical indication and benefit for the patient (positive defensive medicine) or refraining from performing risky actions that have a medical indication and benefit for the patient (negative defensive medicine). These actions are carried out by the physicians with the sole motive of protecting themselves against complaints or tensions such as the protest of the patient or colleagues and usually cause physical, psychological, or economic harm to the patient or the institution that pays the treatment fee, such as insurance organizations. It can have consequences in terms of the quality of care and the efficient use of limited health resources. Factors such as the physician’s concerns about lawsuits and proceedings may lead to defensive behaviors. This study presented suggestions for the management and prevention of such behaviors, including three main categories related to the strategies for the reformation of the patient complaint handling system, social strategies for the management and prevention of defensive medicine, and managerial-organizational strategies. These strategies are based on the findings of a mixed-methods research including an unsystematic review of resources and a qualitative study conducted using semi-structured interviews. The results have been discussed by the Medical Ethics Committee of the Academy of Medical Sciences of Iran.

Proposing Ethical Guidelines for Providing Health Services to Afghan Immigrants and Refugees in Iran
Farzad Zakian Khoramabadi, Alireza Parsapour, Bagher Larijani, Amirhossein Takian, Ehsan Shamsi Gooshki,
Volume 16, Issue 0 (11-2023)
Abstract
The right to access health services as a part of fundamental human rights, affected by the conditions and facilities of governments and the international status, has always faced challenges. Despite the clarity of the general policies and upstream documents in the Iranian health system regarding the need to provide immigrants and refugees with health services and Iran’s membership in the relevant conventions, the implementation of the provisions of these documents is not consistent and complete for various reasons, including the inadequacy of laws related to immigrants and refugees and the incorrect implementation of some existing laws. The first draft of the ethical guidelines for providing health services to immigrants was prepared by the research team using the results of a review of relevant documents as well as a qualitative study and finalized according to the opinions of the participants in a panel of experts. In this draft, after explaining the values and ethical principles governing the provision of services to Afghan immigrants, the suggested guidelines and assignments were presented to the main stakeholders involved, including the policymakers and macro planners of the health system, institutions and centers providing health services, professionals and health service providers, professional organizations, civil society activists, media and non-governmental organizations,  and medical research and education authorities and researchers.

The Optimal Conditions and Requirements for New-Generation Medical Universities with Emphasis on The Structure of The Iranian Health Network
Zahra Kheiry, Iraj Nabipour, Neda Mehrdad, Abtin Heidarzadeh, Afshin Ostovar,
Volume 16, Issue 0 (11-2023)
Abstract
At first, education was the university’s only goal; nevertheless, scientific progress in the twentieth century added research to the universities’ missions. The industry sector’s knowledge-based technologies added a third mission to universities and brought the university into new fields. The fourth-generation universities provided a more comprehensive view by considering the four elements including university, industry, government, and civil society and the next generation (the fifth generation) of universities also considered the environment in addition to these four elements. The present study examined the optimal conditions and requirements for new-generation medical universities (third- to fifth-generation universities). This review study extracted 187 scientific documents from domestic and foreign databases and after screening, 56 documents were selected for the study. Finally, the propositions relevant to the objective of the study were extracted and categorized using content analysis. This study identified 17 optimal conditions for transitioning to new-generation universities. Moreover, 41 requirements were extracted and listed for achieving these conditions, each under its corresponding condition. New-generation universities are known as borderless and accountable universities. Thus, the communication and exchange of knowledge, capital, and value with institutions outside the university at the local, national, and international levels as well as accountability to the needs created at these levels are the main principles of new-generation universities. Given the unique structure of the Iranian health system and the infrastructure for communicating with society, by fulfilling other requirements, this structure can facilitate the transition to new-generation medical universities.

Ethical and Legal Aspects of Implementing Electronic Health Rrecords in Iran
Hossein Riazi, Somayyeh Abedian, Hamid Moghaddasi,
Volume 16, Issue 0 (11-2023)
Abstract
In summary, this project was carried out in the following steps: reviewing the literature, determining the ethical and legal aspects of the implementation of the electronic health records, reviewing the existing laws and regulations in Iran, identifying the shortcomings and localizing the ethical and legal aspects of implementing electronic health records in Iran, and providing operational suggestions. By reviewing the literature, a list of ethical aspects of electronic health records was extracted and analyzed. Moreover, through reviewing the laws and regulations, it was shown that in the last decade, numerous and diverse laws have been passed in the field of electronic health, especially regarding electronic health records, and there is no serious legal gap in this field in the country. However, certain serious problems were observed including non-implementation or incomplete implementation of some existing laws and regulations, lack of sufficient technical and executive regulations and determining the examples of deviation from the goals of the laws and regulations or their correct implementation, and lack of implementation guarantee for some laws and regulations. Based on the studied documents, the current state of electronic health records in Iran was investigated from legal and ethical aspects, and operational suggestions were presented for its reformation and promotion.

Elucidating the Role of Medical Professors in Promoting Health Literacy Among the Public: A Qualitative Study
Mahboubeh Shali, Samira Mohammadi, Hasan Shahbazi, Nooshin Kohan, Bagher Larijani, Shohreh Naderi Magham,
Volume 16, Issue 0 (11-2023)
Abstract
To enhance the level of health literacy among the public, it is essential to take steps towards empowering people to recognize and control the influential factors on health. University professors, as health knowledge promoters, are recognized as educators of health skills and advocates for healthy lifestyles and behaviors. This study aimed to elucidate the role of medical professors in promoting the health literacy of the public. The present study was conducted using conventional content analysis. The participants were selected using purposive sampling with maximum variation. A total of 20 professors from medical universities, the Academic Center for Education, Culture and Research, and the Ministry of Health were purposively selected until information saturation. Data were collected through semi-structured interviews and analyzed simultaneously with data collection. Twenty participants (9 females and 11 males) with an average age of 50.3 and an average work experience of 23.45 years took part in the study. After data analysis, 947 initial codes were extracted, and subsequently, categorized into five main categories and fifteen subcategories. Infrastructure development, content production, role model, self-empowerment, and culture building were identified as the main categories. University professors can, through a skillful combination of various elements within the educational system, either propel students and the general public towards lofty goals or deprive them of achieving such objectives. However, factors such as the low number of professors relative to the number of students, the high workload of faculty members, lack of resources, and the overwhelming life responsibilities of faculty members have influenced their performance and role in this regard. To achieve the goal of encouraging professors in enhancing the health literacy of society, it is imperative to bring these constraints to the attention of authorities for resolution.

The Professor’s Mission in the Cultural and Spiritual Education of Students; A case study of Higher Health Education
Mohammad Ali Mohagheghi, Seyed Mahmoud Tabatabaee, Narges Tabrizchi, Seyed Jamaleddin Sajjadi Jazi, Bagher Larijani, Seyed Mahdi Seyedi, Nasser Simforoosh, Maryam Khayamzadeh, Nazafarin Ghasemzadeh, Mina Mobasher,
Volume 16, Issue 0 (11-2023)
Abstract
Academic faculty members play the most influential role in realizing the goals and ideals of higher education and community health. In the contemporary period, the cultural and educational role of professors, in the most crucial mission of higher education, has not received the required and necessary attention, and neglecting it has resulted in irreparable damages and adverse consequences. This study attempted to identify the prominent cultural roles of professors in relation to students (with an emphasis on higher health education), while explaining the necessity and importance, and effective solutions were examined and proposed. The present study was conducted using a descriptive-analytical method and a focus group discussion. Selected views of expert professors and data from authentic local scientific articles and related topics in upstream documents were utilized. The findings of the study were classified into five main themes and forty categories. “Cultural goals and ideals”; “general mission of professors for the cultural education of all students” and “special mission of professors of higher health education”; “authentic methods”; and “requirements for cultural education of students” were identified and recommended under the eight selected topics in each axis in order of priority. University Professors play a central role in the cultural and ideological education of students. It is appropriate to develop this responsibility in an objective manner and with suitable scientific methods and observe its excellence and realization in the education system.

Ethics and Health Chatbots
Masoud Amanzadeh, Mahnaz Hamedan,
Volume 17, Issue 0 (12-2024)
Abstract
Health chatbots, powered by artificial intelligence (AI), are revolutionizing healthcare by providing accessible, personalized, and efficient health-related assistance. These tools have found applications in symptom checking, mental health support, and even aiding in clinical decision-making. While their potential to enhance healthcare efficiency is significant, the use of medical chatbots raises significant ethical considerations that must be considered and addressed. The aim of this study is to investigate the ethical challenges and considerations of health chatbots. In this article, we reviewed the literature on the ethical considerations of health chatbots. PubMed, Scopus, Web of Science, and Google Scholar were searched using related keywords such as "Chatbot," "conversational agent," "ethics," "medical," and "healthcare." Relevant studies were selected and reviewed based on specified inclusion/exclusion criteria. The review identified several ethical concerns associated with health chatbots: 1) Privacy and Data Security: Patient data collected by chatbots are vulnerable to breaches, raising concerns about confidentiality and misuse. 2) Accuracy and Reliability: Errors in chatbot responses can lead to misdiagnoses or inappropriate advice, potentially harming patients. 3) Bias and Equity: AI algorithms may perpetuate biases present in training datasets, leading to unequal care for certain demographic groups. 4) Accountability and Responsibility: Unclear legal frameworks complicate the allocation of responsibility in cases of harm. 5) Autonomy and Trust: Overreliance on chatbots may diminish the human element of care, affecting trust and patient autonomy in decision-making. While health chatbots offer substantial benefits in accessibility and efficiency, addressing their ethical challenges is imperative. A robust ethical framework emphasizing privacy, transparency, fairness, and accountability is needed to mitigate risks. Continuous monitoring, user education, and adherence to evolving AI regulations can ensure safe and equitable integration of chatbots in healthcare.

Ethical Considerations of Using Electronic Health Records by Healthcare Providers
Hamid Moghaddasi,
Volume 17, Issue 0 (12-2024)
Abstract
The ethical use of patient medical records by healthcare providers is fundamentally guided by the patient's right to privacy and confidentiality, enshrined in patient rights charters. Users of patient medical records are categorized as authorized (e.g., clinicians directly involved in patient care) and unauthorized (e.g., administrative staff, external entities). This categorization informs both internal and external information disclosure policies. Authorized users access patient records based on the "need to know" principle, ensuring confidentiality while adhering to internal disclosure protocols. Unauthorized users have limited access, primarily governed by external disclosure policies that restrict access to personally identifiable information.
The transition from paper-based to electronic health records (EHRs) significantly alters the ethical landscape for healthcare providers. While paper records primarily raised concerns about physical security, EHRs present unique ethical challenges in three key areas:
1. Respect for Patient Information: Proper use of patient data requires a deep understanding of the ethical implications of accessing and utilizing sensitive information.
2. Privacy and Confidentiality: Maintaining patient privacy and confidentiality in the digital age requires robust security measures and a commitment to data protection best practices.
3. Data Integrity and Accessibility: Ensuring the accuracy, completeness, and accessibility of EHR data while maintaining patient privacy presents a complex challenge.
Healthcare providers, particularly physicians and nurses with extensive EHR access, must prioritize patient privacy and data confidentiality when utilizing information technology in patient care. This includes proactively mitigating threats to data security and adhering to strict ethical guidelines for data access and use.

Ethical Considerations in the Use of Artificial Intelligence in Healthcare
Mohammad Shojaeinia ,
Volume 17, Issue 0 (12-2024)
Abstract
Artificial Intelligence (AI) represents a transformative and innovative approach in healthcare with the potential to revolutionize diagnostic, therapeutic, administrative, educational, research, and managerial processes. Given that AI systems influence reasoning, decision-making, and the delivery of care, their implementation faces challenges, particularly ethical considerations rooted in the unique nature of the healthcare system—where patient welfare, trust, and the autonomy of healthcare providers hold paramount importance. This study adopts a qualitative approach. Various information sources, including journals, articles, and publications, were reviewed. The applications of AI in clinical environments and its impact on individuals' interactions with healthcare systems, decision-making processes, and clinical workflows were analyzed, and relevant ethical considerations were extracted. The results indicate that the integration of AI in healthcare, despite its extensive benefits in prevention, diagnosis, treatment, prediction, decision-making, process automation, medication and therapeutic recommendations, surgical guidance, personalized medicine, telemedicine systems, and numerous other applications, is accompanied by a set of ethical considerations. Addressing these considerations is crucial to ensure the responsible and equitable use of these technologies. These include concerns related to patient privacy and data security, biases in AI systems, transparency, explainability, interpretability, accountability, informed consent, impacts on the relationships between healthcare providers and patients, equitable access to AI benefits, the appropriate and judicious use of technology, ethical use of automation, preservation of human dignity, effective oversight and regulation, legal and legislative issues, and long-term implications such as preventing misuse of predictive data by insurers or employers, among other patient rights-related issues. The utilization of AI in healthcare necessitates the development of ethical and legal frameworks that balance technological innovation with the humanistic principles underpinning healthcare systems. This ensures that while leveraging the advantages of AI, privacy, justice, equity, and human dignity are safeguarded. Emphasis on continuous monitoring and aligning AI-based systems with human values can foster trust in these technologies, ensuring that AI is used responsibly and adheres to ethical standards, ultimately serving to enhance public health outcomes responsibly and equitably.

Ethical Dilemmas in Health Policymaking
Tahmine Salehi ,
Volume 17, Issue 0 (12-2024)
Abstract
Ethical considerations have been underemphasized in health system policymaking compared to areas like clinical ethics and biomedical research. Allocating resources effectively, promoting equitable access, and resolving societal needs within the health system necessitate robust ethical frameworks. Neglecting these frameworks creates significant dilemmas and challenges. An analysis of health system policymaking and macro-decision-making reveals a pervasive disregard for systemic ethical thinking. A primary ethical dilemma stems from conflicts of interest, leading to policy choices that may not prioritize ethical service delivery. This can manifest as over-provision, non-standard services, or diminished quality of care. Economic constraints pose another critical dilemma, characterized by inadequate health expenditure as a proportion of gross domestic product (GDP). This limits equitable access to healthcare and exacerbates inequities in resource distribution. A prime example is the neglect of the network-based health system, favoring hosp ital-centric development and an overemphasis on specialized care over comprehensive primary care. Determining the appropriate model for the health system – enterprise-driven or governance-oriented – presents a fundamental conflict. This choice significantly influences health policy decisions. Furthermore, the simultaneous role of policymakers as both providers and purchasers of healthcare services fuels conflicts of interest and incentivizes "induced demand."Shifting towards an ethical perspective in health system policymaking requires a systemic and comprehensive approach. Incorporating ethical considerations into policy decisions, recognizing the unique characteristics of the health market, and addressing conflicts of interest are crucial for improving system performance. This approach would likely prioritize network-based care, strengthen primary care, enhance referral systems, develop a robust primary care workforce, and elevate the importance of health education within the system.

Ethical Considerations in Providing Healthcare Services to the Elderly in Iran: A scoping review
Jalal Saeidpour, Alireza Hajizadeh,
Volume 17, Issue 0 (12-2024)
Abstract
As one of the countries with the fastest growing aging population, it is predicted that more than 20% of the Iran’s total population will be elderly in 2040. It is important to address ethical considerations in providing healthcare services to aged population. This study aimed to review the evidence related to ethical considerations in providing healthcare services to the elderly in Iran.  This study was a scoping review conducted using the six-step protocol of Arksey and O’Malley. The English-language, Persian-language databases and Google Scholar, were searched without time limitation. After selecting studies and extraction the data, the narrative analysis was used to analyze the data. Providing comprehensive healthcare including, preventive, diagnostic, treatment, and rehabilitation services to the elderly needs to be based on humane-Islamic principles and values ​​accepted by society. The most important ethical considerations required are: Maintaining the dignity and eminence of the elderly in all situations, considering ethics in communication with the elderly, ensuring autonomy and independence of the elderly in relevant decision-making, paying attention to the principles of justice and benefit in healthcare interventions, empathy and cheerfulness among healthcare providers, ensuring confidentiality and privacy and protecting information, paying attention to privacy, obtaining informed consent in healthcare centers, paying attention to religious and Islamic rules in caring for the elderly, the responsibility of government and non-government institutions in preventing stigma and discrimination against the elderly, carrying out timely and ethically-based care actions, healthcare providers' adherence to teamwork and scientific and professional behaviors, supporting the elderly as a vulnerable population group in prioritizing health services, preventing conflicts of interest in elderly care, and using safe, affordable, reliable, and evidence-based healthcare services for the elderly. It is necessary to pay attention to the ethical considerations identified in this study in providing healthcare services to the elderly. So, it is recommended that policymakers, managers, and healthcare providers take actions at the levels of the ministry of health, medical universities, and healthcare centers providing services to the elderly to promote humane-Islamic principles and values.

The Dignity of the Elderly: The Missing Link in the Search for Primary Health Care Services: A Qualitative Study
Mohaddeseh Mohsenpour, Amir Zoka, Fahimeh Amani, Elham Charoghchian Khorasani, Seyyed Javad Hosseini,
Volume 17, Issue 0 (12-2024)
Abstract
Societies that fail to adequately address the growing needs of the elderly and the consequences of aging will face significant challenges. A critical challenge in many countries involves ensuring the provision of accessible and affordable healthcare services for the elderly. The active engagement of older adults in seeking healthcare services and adhering to preventive care measures is crucial for reducing healthcare costs. This study aimed to elucidate the lived experiences of elderly individuals regarding the factors influencing their utilization of primary healthcare services in Mashhad, Iran. This qualitative study employed content analysis. Participants were recruited through snowball sampling from a list of elderly individuals registered with health centers in Mashhad, including those who regularly utilized services and those who had not visited in the past two years. Eighteen elderly individuals participated in the study. Data were collected through in-depth interviews using open-ended questions and subsequent probing. Interview transcripts were analyzed using Bernard's formal content analysis approach. A significant barrier to accessing healthcare services identified by elderly participants was a lack of dignity during their visits to health centers. This theme encompassed two subcategories: perceived dignity violation and observed dignity violation. The imposition of feelings of worthlessness on the elderly was recognized as a prevalent cultural issue within society. Factors contributing to a diminished sense of dignity included: inadequate physical space to accommodate the limitations of the elderly, informal and unprofessional behavior of healthcare providers, excessive waiting times, unsanitary and overcrowded health centers, a lack of appointment scheduling, disruptions in internet and software systems that prolonged the healthcare process, shared waiting spaces with infants and young people, and insufficient seating. Participants emphasized the detrimental impact of a lack of dignity in healthcare settings, expressing feelings of worthlessness. These findings corroborate those of previous studies highlighting the paramount importance of dignity in healthcare environments. The perception among elderly individuals that healthcare services prioritize administrative processes over patient-centered care may discourage them from seeking preventive services. This study underscores the critical need for a cultural shift within healthcare systems to prioritize the dignity and respect of elderly patients and foster a supportive environment that encourages preventive care.

Spirituality Components in the Nurses' Health Monitoring Website
Nasrin Rasoulzadeh, Abbas Abbaszadeh,
Volume 17, Issue 0 (12-2024)
Abstract
A crucial aspect of nurses' professional performance is adherence to ethical principles, which can significantly impact their spiritual health. Strengthening spiritual well-being contributes to improved physical and mental health for individuals and society as a whole. By prioritizing spiritual dimensions such as faith, purpose in life, and moral commitment, individuals can mitigate anxiety and its associated complications. Spiritual aspects of life foster greater tolerance for shortcomings and challenges, facilitating more appropriate interactions with others within society. To effectively monitor the health status of nurses, accurate and readily accessible online health information is essential. Therefore, this study aimed to determine the key spirituality components that should be incorporated into a nurses' health monitoring website. This research was conducted in two stages. The first stage employed a content analysis approach with 25 participants, followed by a Delphi approach involving 51 participants across four rounds. Purposive sampling was utilized, with participants including nurses and other relevant specialists. In the first stage, data were collected through semi-structured interviews and guiding questions related to nurses' health monitoring. In the second stage, a questionnaire with open-ended questions was administered to participants in four rounds. Items achieving consensus from more than 75% of experts were incorporated into the final statements defining the information structure of the health monitoring system. Qualitative data were analyzed using directed content analysis. In the first qualitative stage, analysis of participant statements within the category of "spiritual peace" revealed a primary focus on the stability of health monitoring pillars. Participants identified belief in God and service to humanity as key contributors to establishing inner peace. However, all participants did not initially recognize the necessity of assessing spiritual health within the health monitoring framework. They tended to equate religious behavior with spiritual health, considering it primarily an internal and personal category, likely influenced by the prevailing religious and cultural context. In the second Delphi stage, expert consensus emerged regarding the importance of assessing nurses' spiritual health. While nurses initially may not have explicitly identified the need to assess spiritual health, neglecting this aspect can potentially hinder their ability to identify and address the spiritual needs of their patients. Therefore, it is recommended that the implementation of the health monitoring system incorporate a component for assessing nurses' spiritual health, tailored to the specific cultural context of Iran, enabling users to evaluate their own spiritual well-being.

Investigating Ethical Considerations in the Use of Artificial Intelligence in the Field of Health: A Narrative Review
Reza Salehinia, Marzieh Nasiri Sangari, Hossein Abbasian, Sajjad Salehian,
Volume 17, Issue 0 (12-2024)
Abstract
Artificial intelligence (AI) represents a significant human advancement. The proliferation of AI technologies within the healthcare sector has led to substantial improvements in health outcomes and medical indicators. However, the application of AI in healthcare is accompanied by numerous ethical challenges. This study aimed to investigate the ethical considerations associated with the use of AI in the healthcare domain. This narrative review included articles published between February 2019 and November 2024. A comprehensive literature search was conducted across internal databases, including Magiran and SID, as well as external scientific databases such as PubMed, Web of Science, Medline, ScienceDirect, and Google Scholar. Keywords used for the search included "Ethics," "Artificial Intelligence," and "Health" in both Persian and English. After applying inclusion criteria and conducting quality assessments, nine studies were deemed eligible for inclusion in this review. The findings of previous studies demonstrate that the utilization of AI in healthcare has yielded significant benefits, including more accurate disease diagnoses, improved clinical predictions, more efficient hospital management, optimized resource allocation, enhanced patient care, streamlined clinical workflows, and advancements in medical research. These technologies have contributed to increased efficiency and quality within healthcare services. However, significant ethical challenges remain, including data privacy and security concerns, algorithmic bias, transparency issues, the need for robust clinical validation, and the importance of ensuring professional responsibility. Adherence to principles such as transparency, fairness, privacy protection, and equitable access is crucial for the responsible development and deployment of AI in healthcare. Ultimately, achieving a balance between technological advancements and human values is paramount for the sustainable and ethical utilization of AI in this domain. The findings of this review underscore the profound impact of AI on improving quality of life and enhancing services across various sectors, particularly healthcare, by providing innovative solutions. However, the optimal utilization of AI in healthcare necessitates a meticulous consideration of ethical implications, rigorous monitoring of AI systems, and proactive efforts to address the existing challenges.

Health Needs Assessment Based on Capabilities Theory
Reza Khadivi,
Volume 17, Issue 0 (12-2024)
Abstract
Over the past few decades, various models have been employed to assess health needs and allocate resources within the health sector. These models include economic approaches based on cost-effectiveness, epidemiological methods using indicators such as disease burden or disparities in health outcomes between socioeconomic groups, and comparative studies between societies or countries. Efficiency and equity are often seen as competing goals in the resource allocation process, making it challenging for health systems to achieve both simultaneously.  Traditional approaches primarily focus on deficiencies and adopt an individualistic perspective. When individuals experience limitations due to disease or disability, the relationship between their health status and social functioning is not always directly linear. Disease and disability inherently tend to widen the gap between individuals and their ability to fulfill normal roles, responsibilities, primary social dependencies, and desired capabilities. The capability approach advocates for respecting the life contexts of individuals and collaborating with them to enhance their skills, assets, and capabilities. Instead of focusing solely on deficiencies and addressing them through resource redistribution, this approach emphasizes empowering individuals to manage their lives with minimal external interference. These capabilities encompass skills that allow individuals to navigate their social, economic, and personal environments effectively. They include:
  • Interpersonal skills for fostering meaningful relationships.
  • Technical skills for managing routine aspects of life.
  • Emotional and psychological resilience to cope with challenges.
  • Purpose-building abilities to find meaning and direction in life.
Such capabilities equip individuals to manage both the normal struggles of everyday life and significant life events. As capabilities are enhanced, individuals gain greater control over their life circumstances, thereby becoming more resilient. The ability to control one’s life world is a fundamental capability. The unequal distribution of this ability forms the foundation of health inequities, as not everyone has the same capacity to exercise such control. Health needs assessments based on the capabilities theory align more closely with the goals of achieving and sustaining equity in healthcare. By focusing on empowering individuals and addressing their life contexts, this approach provides a more holistic and equitable framework for health resource allocation.

"The Other" and Public Health Ethics with Emphasis on the Views of Avicenna and Levinas
Abdollah Salavati ,
Volume 17, Issue 0 (12-2024)
Abstract
When we think of public health, we often picture patients, doctors, nurses, healthcare professionals, and medical facilities. However, this is only part of the picture. Public health operates within a 360-degree environment, which extends beyond these visible elements to include health policy and governance, laws, social dimensions, the environment, technology and data, societal and cultural factors, individual participation, education, and safety. Neglecting this comprehensive environment risks destabilizing public health. Though health can be conceptualized within this framework, it remains vulnerable to threats. A critical challenge within this environment is the potential to overlook the human element, leading to large-scale systems and plans that marginalize and exclude individuals—a risk that must be conscientiously avoided. When "the Other" is perceived as merely a "thing," "patient," "customer," "financial opportunity," or "a solution to problems," what emerges is a reductionist perspective that dehumanizes the individual. In such a framework, public health ethics lacks a solid foundation. This research seeks to analyze and critique this reductionist perspective on health ethics, drawing from the "Other"-centered views of Avicenna, the great philosopher of the Islamic world, and Emmanuel Levinas, the prominent French thinker. The methodology of this research employs a phenomenological approach, describing the lived experiences of public health and their intersection with ethics through the lens of Avicenna's and Levinas' philosophies. Avicenna's philosophy emphasizes that external factors such as reputation, status, outward behaviors, and age can obscure our perception of others. His views highlight the human tendency to be distracted by falsehoods and the joy derived from discerning truth. Levinas' concept of "the Other" as an infinite entity and a responsibility to be borne challenges us to transcend the self and recognize and respect the "Other" within a 360-degree environment. Together, their metaphysical perspectives provide a foundation for moving beyond the limitations of the self and fostering an ethical framework that perceives "the Other" in an infinite light. Policies, planning, management, and actions that reduce "the Other" to mere economic considerations inevitably lead to the marginalization of certain groups, such as rural or disadvantaged communities. This undermines efforts to achieve distributive justice, including providing essential medicines and healthcare services for all. Consequently, such an approach erodes public health ethics and reduces "public health" to "healthcare for those who can afford it." In our tradition, "the Other" is regarded as "God's family," irrespective of race, religion, social status, or other distinctions. A hadith states: "All human beings are the family (dependents and household) of God. Therefore, the most beloved person to God is the one who is beneficial and helpful to God's family and brings joy to the members of this household." This teaching underscores the need for healthcare providers, institutions, and policymakers to embrace the universal kinship of humanity. Without cultivating a mindset that transcends the self and embraces the infinite, public health remains incomplete. Without this shift, the sun of wellness will not shine equally on all, and hope will give way to despair. In this context, the "I" of the physician, the "I" of the healthcare worker, the "I" of the healthcare institution, the "I" of policy, and the "I" of processes and procedures risk devaluing, suppressing, or erasing "the Other" through reductionist thinking. This, in turn, leads to the erosion of the moral foundation of public health.

Exploring the Concept of Patient Advocacy
Reza Negarandeh ,
Volume 17, Issue 0 (12-2024)
Abstract
Patient advocacy is a cornerstone of ethical healthcare practice, encompassing actions that protect patient rights, uphold their autonomy, and ensure they receive high-quality care. Nurses are often seen as being in the best position to play this vital role. This conference abstract aims to provide a comprehensive understanding of patient advocacy and identify strategies for enhancing advocacy practices in healthcare settings. In this comprehensive review, scientific literature, including peer-reviewed articles, professional guidelines, and relevant policies, was retrieved and reviewed. Data extracted from the literature were synthesized using quantitative content analysis to identify different forms of patient advocacy, including clinical advocacy and systemic or workplace advocacy, as well as strategies to improve the necessary skills for each. Clinical advocacy involves ensuring patient safety, supporting informed decision-making, and advocating for appropriate pain management. Improving clinical advocacy requires a multifaceted approach that prioritizes building trust and rapport with patients to foster effective communication and shared decision-making. Encouraging patient participation in their care, supporting self-management strategies, fostering effective communication within the healthcare team, and staying informed about relevant ethical, legal, and policy developments are essential components. Workplace or systemic advocacy, on the other hand, focuses on addressing broader issues within the healthcare system that impact patient care. Improving systemic advocacy involves identifying and analyzing systemic issues, such as healthcare disparities, resource limitations, and policy barriers, through data collection, stakeholder engagement, and thorough analysis. Strategies to address these issues include policy advocacy, improved resource allocation, and quality improvement initiatives. Building strong partnerships with other healthcare professionals, community organizations, and policymakers is key. Additionally, promoting education and awareness within both the healthcare workforce and the public is crucial. Leveraging technology to enhance data collection, communication, and mobilization efforts can further support systemic advocacy initiatives. By implementing these strategies, healthcare professionals can effectively advocate for systemic change, improve the quality of care for all patients, and create a more equitable healthcare system. Patient advocacy is a dynamic and multifaceted role that requires continuous learning and adaptation. By embracing the principles outlined in this synthesis, nurses can effectively champion patient rights, improve the quality of care, and contribute to a more equitable healthcare system.

Ethical Decision-Making in Pediatric Nursing: Managing Critical and Serious Conditions
Azam Khorshidian,
Volume 17, Issue 0 (12-2024)
Abstract

Nurses are committed to protecting the rights of their patients. However, significant challenges often arise in their communication with physicians and patients. In some situations, nurses feel that patient autonomy is not respected, and sufficient, appropriate information is not provided to patients and their families. These challenges are particularly pronounced in pediatric nursing, as children often cannot fully express their needs. Pediatric nurses must be especially sensitive to the vulnerability of children and their families, actively supporting their welfare and best interests. When a child is suffering from a serious illness or nearing the end of life, the ethical challenges become even more complex. Some of these challenges include:
- How should healthcare decisions be made for these children?
- Who should make these decisions?
- How is the best interest of these children determined?
- Who can best advocate for children's rights?
- When treatment involves life-sustaining therapies (LST), is preserving life more important than ensuring quality of life?
- Who has the authority to transition from therapeutic or life-sustaining interventions to palliative care?

To address these challenges, nursing associations in various countries have developed ethical charters. However, no universal consensus or definitive solutions exist for navigating these complex clinical situations. Consulting experts across different fields and developing comprehensive professional ethics codes can serve as valuable guidance for pediatric nurses making ethical decisions in cases of serious illness.
 


Promoting Ethical Motivation in Health Care Organizations: Ethical Accreditation of Healthcare Service Facilities: A Review Study
Seyed Ali Enjoo ,
Volume 17, Issue 0 (12-2024)
Abstract
Organizational ethics in healthcare literature encompasses a set of complex and interrelated topics. It is regarded as the frontier of medical ethics or the next stage in the evolution of bioethics. To effectively address organizational ethical issues within healthcare organizations, it is crucial to understand both the similarities and differences between competing concepts. Moreover, the presence of financial and contractual concerns often makes it challenging to motivate managers to enhance the ethical climate of their organizations. This study aims to develop a deeper and more comprehensive understanding of organizational ethics in the healthcare system. This review study involved a comprehensive search of the literature on healthcare system ethics, utilizing the following databases: PubMed, Scopus, Web of Science, and CINAHL. Additionally, grey literature from published books on Healthcare Organization Ethics and websites of organizations such as JCAHO and VBN were also included. The search strategy employed a combination of keywords such as 'health ethics,' 'organizational ethics,' 'health organizations,' 'ethical decision-making,' 'manager motivation,' and 'CEO incentives.' Only English-language sources with accessible full-texts were considered. All search results were reviewed, and duplicates were removed. This study offers a comprehensive overview of the existing literature on organizational ethics in healthcare, providing a detailed map of key texts in the field.
 

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