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COVID-19: An Opportunity to Restore Lost Trust? A Narrative Review of Trust Trends Before and After the Pandemic
Hanieh Karimi, Ali Farahmand Asil, Saeedeh Saeedi Tehrani,
Volume 17, Issue 0 (12-2024)
Abstract
Trust between doctors and patients is a cornerstone of improved health outcomes and quality medical care. However, this trust has eroded in recent decades due to various factors. The global crisis of the COVID-19 pandemic presents a unique opportunity to examine and analyze changes in public trust towards the healthcare system. This narrative review explores the state of public trust in healthcare before and after the COVID-19 pandemic, analyzing the factors influencing this trust and proposing strategies for its maintenance and rebuilding. A narrative review was conducted, with information gathered from searches in reputable national and international scientific databases like PubMed, ScienceDirect, Springer, and Scopus. Relevant articles from Iranian databases such as Magiran and IranMedex were also included. The review focused on the components of trust, factors affecting it, and challenges faced by the healthcare system during the pandemic. The review revealed significant changes in the components of trust in doctor-patient relationships due to the COVID-19 pandemic. Prior to the pandemic, public trust in physicians had been declining due to factors such as perceived inequities in treatment, medical errors, and unprofessional behavior by some healthcare professionals. For example, surveys indicate a decline in public trust in healthcare professionals in the United States, dropping from 73% in 1966 to 34% in 2012. The COVID-19 pandemic significantly exacerbated this decline, with many people distrusting governmental institutions, pharmaceutical companies, and media outlets perceived to be providing misleading information. A study in Poland found that 31% of respondents viewed the pandemic as an exaggerated threat, while 3% considered it entirely fictional. However, the dedicated service and transparent communication of some institutions and healthcare personnel during the COVID-19 crisis partially restored public trust. This led to the emergence of a concept known as "dual trust," where people not only trust individual physicians but also pay closer attention to the overall performance of the healthcare system and governments. Dual trust has implications not only for the quality of healthcare services but also for the success of prevention and treatment programs. The COVID-19 crisis has had a profound impact on public trust in the healthcare system. To maintain and rebuild this trust, effective measures are essential. These measures should focus on enhancing service quality, fostering scientifically informed citizens, ensuring transparent communication, and promoting positive interactions between doctors and patients.

Challenges of Human Resource Allocation in the Health System
Kourosh Delpasand,
Volume 17, Issue 0 (12-2024)
Abstract
All health systems face the dual challenge of resource shortages, which prevent them from providing all the services needed by society, while also striving to enhance justice in access to health services and care. The prioritization and allocation of resources are critical issues in the health sector, and ensuring fairness in these processes requires consideration of various criteria. This study aims to examine the methods of allocating human resources in the health sector and explain the challenges associated with allocating skilled human resources in the country. This qualitative study involved faculty members and individuals with a history of responsibility in the university. Data collection was conducted through interviews, which were arranged based on mutual agreement with participants. Interviews continued until saturation was reached, meaning they concluded when participants had no further information to provide and the interviewer had no additional questions aligned with the research objectives. The findings were categorized as follows:
  • Prioritization Issues: The prioritization of resources is often directed towards newly established departments and hospitals, and personnel are allocated to new branches to launch new fields. The definition of processes important to the Ministry of Health is based on specific provincial conditions, which may not be included in standard lists. Prioritization should, therefore, be determined based on relevant indicators and the performance of personnel.
  • Organizational Challenges: Organizational charts are outdated, and organizational structures are often unresponsive. Recruitment is based on obsolete charts, and there are discrepancies between created positions and the personnel recruited to fill them. Political influences, such as deception and hypocrisy, also complicate the allocation process.
Population Considerations: The floating population of each province must be considered in resource allocation. The periodic involvement of some individuals as companions and contract personnel in advisory roles alongside university presidents poses challenges. A gradual approach with well-defined management and realistic goals should be implemented over a five-year period.
  • Management and Decision-Making: Human resource managers in universities lack decision-making authority. A national team of managers, specialists, and experts should be formed to address human resources needs. Human resources should be identified based on the estimated needs of existing fields. It is also essential to establish efficiency measurement frameworks grounded in relationships, but the Ministry of Health lacks specific notifications regarding these matters. Efficiency should be measured based on personnel performance and appropriately defined indicators.
  • Emerging Challenges: The migration of specialists in various fields, combined with reluctance among doctors to pursue specialist-level studies in areas such as emergency medicine and pediatrics, further exacerbates human resource allocation challenges. Adding specialist experts and evaluating personnel before hiring are essential measures to address this issue. Additionally, consideration should be given to restructuring the Ministry of Health by dividing it into separate sub-units with distinct financial and management mechanisms.
This study identifies and extracts the criteria used for prioritizing and allocating resources within the health system. According to experts and policymakers in health and medical organizations, additional criteria should be considered beyond traditional metrics when prioritizing and allocating human resources.

The Necessity of Social Solidarity and Sustainability Principles in Health System Programs
Mehran Seif-Farshad,
Volume 17, Issue 0 (12-2024)
Abstract
Health care services, in addition to being recognized as fundamental rights in various global human rights declarations, play a crucial role in advancing the development of human societies. The four principles of biomedical ethics introduced by Beauchamp and Childress—autonomy, non-maleficence, beneficence, and justice—are pivotal for ethical analysis and decision-making. However, certain other dimensions, which may not be explicitly addressed within these principles, are essential for policymaking at both macro and micro levels in health care. Two such important principles are social solidarity and sustainability, both of which hold a prominent position in health systems planning. The principle of social solidarity refers to the ways in which unity, cohesion, and collaboration are fostered within a community. A socially cohesive society embraces cultural diversity, respects human rights and the rule of law, and demonstrates a shared commitment to social order and collective responsibility. Social solidarity can significantly reduce health risks by creating a strong societal framework where cooperative efforts foster conditions for well-being, minimizing disability and disease. On the other hand, a health care system is fundamentally responsible for establishing and maintaining a sustainable and high-quality care environment. Sustainability in health services is achieved when ethical obligations—such as maximizing possible benefits, balancing risks against benefits, ensuring fairness (including for future generations), and respecting public rights—are prioritized. Continuity of health care ensures better coordination and improved delivery of services. Disruptions in health policies or intermittent provision of health services can severely undermine public trust. A conceptual understanding of sustainability and continuity in public health ethics is crucial, as these principles ensure that health policies, programs, and services enable access to the highest attainable standard of health, free from economic, social, or political instability. However, sustainability should not imply stagnation; services must remain responsive to the evolving needs of populations and societies. Ignoring these two principles in health policymaking and program design can seriously erode public trust and ultimately harm individual and Health system planning, should be changed to Health care programs.

Ethical Considerations in Healthcare Policy-Making and National Planning: A Qualitative Study
Peyman Parvizrad,
Volume 17, Issue 0 (12-2024)
Abstract
Healthcare policy-making and national planning are complex processes that require the integration of ethical principles to ensure fairness, effectiveness, and public trust. This qualitative study explores the key ethical considerations that should guide the development and implementation of healthcare policies and plans. A qualitative research design was utilized, incorporating semi-structured interviews with key stakeholders in the healthcare sector, including policymakers, healthcare providers, and patient representatives. A total of 15 interviews were conducted until data saturation was achieved. The interviews were transcribed verbatim and analyzed using thematic analysis. Thematic analysis identified seven key ethical considerations in healthcare policy-making and planning: (1) Equity and Justice – ensuring equitable access to healthcare regardless of socioeconomic status, race, or other demographic factors; (2) Autonomy and Informed Consent – respecting individual autonomy and ensuring informed decision-making in healthcare interventions; (3) Beneficence – prioritizing actions that maximize benefits and minimize harm; (4) Non-Maleficence – preventing harm to patients and communities; (5) Confidentiality and Privacy – safeguarding patient information and ensuring data protection; (6) Resource Allocation – making fair and justifiable decisions regarding the distribution of limited healthcare resources; and (7) Transparency and Accountability – promoting openness in policy decisions and ensuring accountability for outcomes. Ethical considerations play a critical role in shaping healthcare policies and national planning efforts. By integrating ethical principles into decision-making, policymakers and healthcare providers can foster policies that enhance public well-being, equity, and trust in the healthcare system. A structured ethical framework can help ensure that healthcare policies align with societal values and promote justice in health service delivery.

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 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.

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.

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.

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.
 

A Review of the Ethical Challenges Surrounding Abortion and Related Perspectives in Islamic Societies
Mohammad Chahkandi, Yasaman Sadeghi, Vajihe Tanoumand ,
Volume 17, Issue 0 (12-2024)
Abstract
Induced abortion remains a significant global health concern, with an estimated 73 million procedures performed annually. While legal and medical frameworks vary across countries, many Islamic societies grapple with ethical dilemmas surrounding abortion. This review examines the ethical challenges surrounding abortion within the context of Islamic perspectives. A comprehensive literature search was conducted using the keywords "abortion," "Islam," and "ethics" in combination with Boolean operators (AND, OR) within PubMed, SID, Google Scholar, and other relevant databases. The search was conducted by three independent researchers. Inclusion criteria included articles published between 2014 and 2024 with the keywords appearing in the title, abstract, or keywords, and full-text availability. After removing duplicates, 11 articles met the inclusion criteria. The decision to undergo elective abortion is influenced by various factors, including the desire for pregnancy, maternal and fetal health status, family dynamics, social stigma, and legal and religious regulations. While Islam generally prohibits abortion, ongoing debates arise from challenges related to access to safe abortion methods and the protection of women's rights. Despite the religious prohibition of abortion, restrictions on access to safe abortion services do not eliminate the practice but rather drive women towards unsafe methods, leading to significant physical and psychological harm, particularly among vulnerable populations. Moreover, limitations on prenatal screenings can result in the birth of infants with genetic defects. These factors raise important questions about the effectiveness and ethical implications of restrictive abortion policies in Islamic societies. Ensuring access to safe and legal abortion services, along with comprehensive sexual and reproductive health education, is crucial for improving maternal health outcomes and upholding women's rights within these contexts.

Barriers to Equitable Healthcare Access Among People Living with HIV
Heshmatolah Heydari,
Volume 17, Issue 0 (12-2024)
Abstract
Acquired Immunodeficiency Syndrome (AIDS) is a disease that occurs in the final stage of infection with the Human Immunodeficiency Virus (HIV). According to the World Health Organization (WHO), approximately 39.9 million people were living with HIV worldwide in 2024, with an incidence rate of 1.3 million and a mortality rate of 630,000 globally. In Iran, the prevalence and incidence rates of HIV were reported as 54,000 and 2,400 people, respectively, with a mortality rate of 3,200 annually. Access to healthcare is considered one of the key goals of a health system. The Universal Declaration of Human Rights recognizes the right to health services as a common standard. People living with HIV, as a vulnerable group, may face barriers to accessing healthcare services. This study aims to explore the challenges faced by people living with HIV in accessing equitable healthcare. This qualitative study was conducted using a conventional content analysis approach between April and September 2024 in Iran. Participants included people living with HIV and healthcare providers, who were recruited through purposive sampling. Data were collected through 10 face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. From the data analysis, 406 initial codes were extracted. These codes were then grouped based on similarities and differences into three main categories:
1.Factors related to clients (with subcategories: fear of transmitting the disease to others, poverty, physical problems, unfamiliarity with their rights, and non-adherence to treatment regimens)
2.Factors related to the healthcare system (with subcategories: discrimination in accessing healthcare services, contemptuous attitudes of healthcare providers, incompetency of healthcare providers, fear of infection by the virus, disclosure of patient information, negligence by medical centers in identifying infected individuals, and failure to conduct premarital testing)
3.Cultural factors (with subcategories: non-acceptance of infected individuals in society, stigma, and discrimination in marriage and childbearing).
The right to access healthcare services, confidentiality of information, the right to marry, financial protection, and active participation in society should be prioritized for people living with HIV.

The Relationship Between Ethical Culture and Job Commitment of Nurses Working in Educational and Medical Centers of Hamadan University of Medical Sciences
Mehran Saadatmand, Abolfazl Ghani Honar,
Volume 17, Issue 0 (12-2024)
Abstract
Promoting an ethical culture is crucial for ensuring job commitment and competent clinical care among nurses. Ethical culture encompasses shared understandings and perceptions that guide ethical conduct within an organization. Job commitment reflects an individual's psychological and emotional attachment to their job. This study aimed to investigate the relationship between ethical culture and job commitment among nurses working in educational and medical centers affiliated with Hamadan University of Medical Sciences. This descriptive correlational study included 170 nurses selected from teaching hospitals in Hamadan using the Morgan table and based on inclusion criteria. Data were collected using demographic questionnaires, the Gobel et al. Ethical Culture Questionnaire, and the Schaufeli Job Commitment Questionnaire. Data analysis was performed using SPSS version 22 software. A significant and positive correlation was found between ethical culture and nurses' job commitment (r=0.42, p<0.05). Ethical culture was significantly higher among nurses with more work experience and female nurses compared to their counterparts. Additionally, job commitment was significantly higher among male nurses and those with formal employment status. The findings demonstrate a strong positive correlation between ethical culture and job commitment among nurses. Enhancing ethical culture within healthcare settings through effective leadership, clear ethical guidelines, and open communication channels can significantly improve job satisfaction and, ultimately, patient care. Further research is needed to explore the specific factors that contribute to ethical culture within different healthcare contexts.

Telehealth: Ethical and Legal Challenges in the Healthcare System
Hooman Heydary, Shakila Belkafeh, Mohammadreza Dinmohammadi,
Volume 17, Issue 0 (12-2024)
Abstract
Telehealth has emerged as a rapidly expanding method for delivering healthcare services, especially during the COVID-19 pandemic. This approach has opened new avenues for accessing medical care and contributed to reducing healthcare costs. However, the growth of telehealth has introduced significant legal and ethical challenges that warrant thorough investigation. This review study employed keywords such as "telemedicine," "telehealth," "ethical challenges," "legal challenges," and "healthcare system" to search scientific databases including PubMed, Scopus, CINAHL, and Google Scholar. Articles published in English and Persian between 2010 and 2024 were reviewed. Eligible sources included research articles, systematic reviews, and case reports focusing on legal and ethical issues related to telehealth. Following an initial screening, articles were assessed based on quality and scientific credibility, and the selected works were analyzed for the final synthesis. Telehealth presents several critical challenges that must be addressed to ensure safe and equitable care delivery. One of the foremost concerns is patient privacy and data protection; the exchange of sensitive health information necessitates robust security protocols and adherence to data protection regulations to uphold patient confidentiality and trust. Another key issue is informed consent, which must be adapted to the virtual context to ensure patients are adequately informed of both the benefits and potential risks associated with telehealth services. While telehealth enhances healthcare accessibility, it may also deepen existing health disparities due to unequal access to digital technologies. Therefore, investments in communication infrastructure and digital literacy are essential to promote inclusivity and equal access to care. Although telehealth offers substantial benefits—including improved access, convenience, and enhanced coordination of care—its legal and ethical implications must not be overlooked. To fully realize its potential, stakeholders must collaborate in developing comprehensive regulations and ethical frameworks. Addressing these challenges is imperative to advancing telehealth in a manner that ensures patient safety, protects rights, and promotes health equity.

Challenges of People Living with HIV in Equity Access to Health Care
Heshmatolah Heydari,
Volume 17, Issue 0 (12-2024)
Abstract
Acquired Immune Deficiency Syndrome (AIDS) occurs in the final stage of infection with the Human Immunodeficiency Virus (HIV). According to the World Health Organization (WHO), approximately 39.9 million people were living with HIV worldwide as of 2024, with reported global incidence and mortality rates of 1.3 million and 630,000, respectively. In Iran, the prevalence and incidence rates of HIV are reported at 54,000 and 2,400 cases, with an annual mortality rate of 3,200. Access to healthcare is considered a primary goal of the health system, and the Universal Declaration of Human Rights recognizes the right to access health services as a common standard. However, people living with HIV, as a vulnerable group, may face barriers to accessing healthcare services. This study aims to explore the challenges faced by people living with HIV in accessing equitable healthcare. This qualitative study utilized a conventional content analysis approach, conducted between April and September 2024 in Iran. Participants included people living with HIV and healthcare providers, recruited through purposive sampling. Data were collected via 10 face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. Data analysis revealed 406 initial codes, which were then categorized based on similarities and differences into three main categories: 1) Factors related to clients (with subcategories: fear of transmitting the disease to others, poverty, physical problems, unfamiliarity with self-rights, and non-adherence to treatment regimens). 2) Factors related to the healthcare system (with subcategories: discrimination in access to health services, contemptuous attitudes from healthcare providers, incompetency of healthcare providers, fear of virus transmission, disclosure of patient information, negligence of medical centers in identifying infected people, and failure to conduct premarital tests). 3) Cultural factors (with subcategories: non-acceptance of infected people in the general culture, stigma, and discrimination in marriage and childbearing). The rights to access health services, confidentiality of information, marriage, financial protection, and participation in society should be considered essential for people living with HIV. Addressing these issues is crucial for ensuring that individuals with HIV can live with dignity and equal access to healthcare.

Models for Assessing the Impact of Policies on Health Equity: A Review
Hakimeh Mostafavi, Efat Mohamadi, Amirhossein Takian, Pr Alireza Olyaeemanesh,
Volume 17, Issue 1 (3-2024)
Abstract
Health inequalities in different populations continue to be the main challenge of health systems; Therefore, it is necessary to address health equity in the developed policies. The study aims to review the studies related to tools and models for assessing the impact of policies on equity in health. This study was conducted as a systematic review to identify the tools and models of assessing the impact of policies on equity in health and the process of assessing health outcomes from 2005 to 09/30/2022 in English and Farsi. National and international databases such as Scopus, PubMed/Medline, and Google Scholar were searched. First, 16901 studies were obtained. After the initial screening, 243 articles entered the abstract review phase. Then, 99 studies entered the phase of studying the text. Finally, 53 studies entered the final phase of analysis. Screening steps, identification of decision-making assessment scope, evaluation, and follow-up were the four dominant steps in most of the developed tools. The study showed that to choose the appropriate tool to assess the impact of policies on equity in health, it is necessary to pay attention to various factors such as assessment time, policy level, available resources, and the population affected by the desired policy.

A Critical Review of the Ethical Aspects of the Electronic Health Record System (SPAS in Iran)
Shiva Khaleghparast, Saied Bagheri Faradanbeh, Samaneh Karimian, Fahimeh Khosrobeigi Bozchaloei, Seyed Ebrahim Hoseini Zargaz, Ehsan Shamsi Gooshki,
Volume 17, Issue 1 (3-2024)
Abstract
The electronic health record system (SPAS in Iran) records information related to the health of individuals in an electronic format. It is the center for collecting health information and data on outpatients and inpatients. This system records information such as the patient's full name, marital status, gender, date of admission, level of education, occupation, type of admission, and other relevant medical data. The core values and ethical requirements of SPAS include safeguarding citizens' rights, respecting individuals, observing justice and fairness, transparency, encouraging participation, and accountability. In this study, the ethical aspects of SPAS were evaluated using the model proposed by the World Health Organization (WHO) for ethical evaluation. This model emphasizes fundamental ethical principles such as human well-being and health, respecting individuals and communities, justice, and fairness. Concerning human well-being and health, SPAS can prevent unnecessary and redundant interventions and provide physicians with quick access to an accurate patient history. Furthermore, the system ensures the confidentiality of information, which is essential to respect individuals and communities. Regarding justice and fairness, the system can improve access to health services for disadvantaged and remote areas. Moreover, SPAS adheres to procedural ethical principles such as solidarity, transparency, participation, and accountability. Therefore, by critically examining the ethical dimensions of the electronic health record system (SPAS), the findings of the present study provide valuable insights for policymakers, health professionals, and regulatory organizations to ensure the ethical and efficient performance of electronic health record systems in Iran.

A Comprehensive Practical guideline for Breaking Bad News to Patients and Their Families in Intensive Care Units: A Qualitative Study
Sooreh Khaki, Masoud Fallahi -Khoshknab, Farahnaz Mohammadi-Shahboulaghi, Gülbeyaz Can, Mohammad Ali Hosseini,
Volume 17, Issue 1 (3-2024)
Abstract
Conveying bad news to patients and their families is a process that requires team collaboration. Different countries have taken into consideration providing suitable solutions. This study aimed to develop an practical guideline, according to the experiences of patients, families, and healthcare providers in intensive care units across three phases. In the first phase, in-depth interviews were conducted with 31 participants selected through purposive sampling, and the initial draft of the practical guideline was created. In the second phase, the initial draft was discussed and reviewed by experts in two focus group meetings, and a secondary draft was developed. In the third phase, the practical guideline compiled by the Delphi method was validated by 43 experts in policymaking and decision-making. Finally, an practical guideline to deliver bad news to patients and their families was developed with 8 main steps and 43 sub-steps. The main steps included before delivering bad news (assessment, planning and preparation, coordination), during delivering bad news (announcing bad news, emotional support, summary and documentation), and after delivering bad news (referral, follow-up). This practical guideline is intended to facilitate the process of delivering bad news in intensive care units to achieve the desired outcomes and reduce the resulting consequences and harms. Accordingly, healthcare providers are recommended to consider the importance of patient and family preferences, adhering to scientific and standard methods for delivering bad news, and upholding the principles of professional ethics.

Assessing Responsiveness to Non-Medical Needs of Inpatients in Educational-Therapeutic Hospitals in Gorgan, 2022
Alireza Heidari, Seyed Hamed Atashi, Farideh Kouchak, Zahra Khatirnamani,
Volume 18, Issue 1 (3-2025)
Abstract
Addressing patients’ non-medical needs reflects the desires of patients and their families to engage more actively in decision-making and treatment processes. The present study aimed to assess the level of responsiveness to the non-medical needs of hospitalized patients. This was a cross-sectional study conducted using a descriptive-analytical approach. A total of 392 patients hospitalized in Shahid Sayad Shirazi and 5 Azar educational-therapeutic hospitals, affiliated with Golestan University of Medical Sciences in Gorgan, were included in the study. Participants were selected through systematic random sampling. Data were collected using the validated and reliable responsiveness questionnaire developed by the World Health Organization (WHO). The mean (±SD) age of participants was (45.17 ±16.92) years, with 55.1% being male. The mean (±SD) overall score for the importance of responsiveness was (33.37 ±4.45), which was above the average. The majority of patients (over 65%) rated all dimensions of responsiveness as very important or extremely important. The most important dimension from the patients' perspective was the quality of the surrounding environment (95.9%), while the least important was the confidentiality of personal information (34.7%). The mean (±SD) overall score for responsiveness performance was 54.54 (0.70 ± 8), which was above the average. The overall score of the responsiveness performance and importance in Sayad Shirazi and 5 Azar educational hospitals was above average. Dimensions deemed important by patients but with weaker performance should be prioritized, and educational and therapeutic centers should pay more attention to patients’ non-clinical expectations.

The Necessity of Spiritual Health Education in Iranian Universities of Medical Sciences: A Qualitative Study
Akram Heidari, Morteza Heidari, Baqer Larijani, Professor Ali Mohammad Mosadeqrad,
Volume 18, Issue 1 (3-2025)
Abstract
Spiritual health refers to having purpose and meaning in life and a sense of belonging to something beyond the self, which strengthens inner peace, satisfaction, and happiness. This qualitative study was conducted in 2024 using an interpretive phenomenological approach. Through semi-structured interviews with 47 policymakers, managers, faculty members, staff, and students, a total of 183 benefits of spiritual health education in universities of medical sciences were identified. These benefits were categorized into six groups: benefits for faculty members, students, staff, patients, society, and the university. For faculty members, spirituality education leads to enhanced ethical awareness, increased motivation, job satisfaction, professional commitment, and improved quality of education. Students, by strengthening spirituality, gain greater communication and empathy skills, experience reduced stress and anxiety, and demonstrate improved professional competencies. Healthcare staff benefit from reduced medical errors, increased resilience, improved social relationships, and enhanced quality of care. Patients receiving spiritual care experience lower levels of stress and depression, improved mental health and quality of life, and a more rapid course of treatment and recovery. At the societal level, spiritual health education contributes to more positive social behaviors and the development of a healthier community. Furthermore, universities implementing such education can design more comprehensive curricula, promote interdisciplinary research, strengthen professional ethics, and train holistically oriented healthcare professionals, thereby increasing their credibility and productivity. Spiritual health education in Iranian universities of medical sciences, by exerting positive effects on faculty members, students, staff, patients, society, and the university itself, results in the improvement of psychological and professional well-being, the enhancement of educational quality, and the increased productivity and credibility of the higher education health system of the country.

Is the Use of Video Recording Important in the Intensive Care Unit?
Parsa Farmahin Farahany, Zahra Torkashvand,
Volume 18, Issue 1 (3-2025)
Abstract
 One of the key ethical-legal concerns in the medical profession is patients’ trust in the quality of care and adherence to professional standards. This viewpoint explored the ethical-legal dimensions of using surveillance cameras in Intensive Care Units (ICUs), focusing on a specific legal-ethical case. In this scenario, the patients’ family caregivers express doubt about the quality of care and request access to recorded footage. From an ethical-legal perspective, documenting events by the medical team—provided that privacy, data protection regulations, and visual monitoring standards are respected—can help safeguard patients’ rights, clarify staff performance, and prevent legal misunderstandings. While acknowledging the potential benefits, this study also outlined legal considerations, such as patient notification, access limitations, and data management protocols. The key conclusion is that the use of cameras in ICUs, if aligned with legal and institutional requirements, can enhance trust, demonstrate ethical compliance, and reduce legal complaints.

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