Iranian Journal of Medical Ethics and History of Medicine

Today, the role of spiritual leaders is to stimulate employees by employing a spiritual perspective and creating cultural backgrounds based on human values to raise capable employees. On the other hand, professional ethics is one of the variables that has a significant impact on individual and group activities and outcomes of the organization. The purpose of this study was to investigate the relationship between spiritual leadership and professional ethics with organizational performance and quality of work life with the intermediate role of organizational learning among employees of Imam Reza Hospital in Urmia. The design of this research was a descriptive-correlational cross-sectional design model of structural equations. The statistical population of this research included 759 employees, 240 of them were selected by random sampling method. For data collection, standard questionnaires were used. Pearson Coefficient and Structural Equation Model Finding were used to analyze and examine the assumptions and the relation between the variants. The results show that there is a significant relationship between spiritual leadership variables and Professional Ethics with organizational performance and quality of life of employees (P<0.01, r=0.42, r=0.51), (P<0.01, r=0.36, r=0.75). Furthermore, the results showed that the intermediate role of organizational learning in the association between spiritual leadership and professional ethics with organizational performance and quality of work life (β = 0.17, β = 0.18, β = 0.16, β = 0.17) ) is confirmed. According to the findings, it can be concluded that paying attention to spiritual leadership and professional ethics can improve the organizational performance and quality of work life, as well as enhance organizational learning among the staff of Imam Reza Hospital.

The aim of this study was to determine the role of organizational health and job satisfaction in Work ethics of university staff. The research method was descriptive-correlational and the statistical population of the study consisted of all the staff of the University of Guilan. In this study, 134 participants were selected by stratified random sampling method. The research tools consisted of three questionnaires, work ethics, organizational health and job satisfaction. In order to analyze the data, Pearson correlation and regression analysis were used. The results showed that there is a positive and significant relationship between organizational health and Work ethics (P<0.01). There is a positive and significant relationship between job satisfaction and work ethics (P<0.01). Also, regression analysis showed that organizational health and job satisfaction could explain 39% of the variance of work ethics (P<0.01). The findings of this study indicate the importance of organizational health and job satisfaction in explaining the work ethics of university staff.

Ethical approach is one of the most important features of medical staffs expected to be used. One of the most important diseases that have been allocated to high moral challenges is HIV/AIDS. Nurses should provide standard care to these patients in their professional careers. In this descriptive study, 136 nurses working in the internal and surgical wards of one of the hospitals in Shiraz were selected through a cross-sectional questionnaire in 2015.Frequency of compliance with ethical values of nurses toward HIV/AIDS patients within various aspects showed that in total 40.4% of nurses in the observance of moral values has unsatisfactory performance, 33.1% relatively good performance and 26.5% has optimal performance. (P-value: 0.018)The mean score of different dimensions to separate parts of questionnaire showed no significant difference in dealing with AIDS patients among nurses according to different ages, sex and working years. The mean score of the separation of education in the respect of client/patient and keep his human dignity significantly differ between Diploma, B.S and M.S. Findings showed poor compliance with ethical code among nurses toward HIV/AIDS patients. Due to importance of ethical approach towards patients especially this vulnerable group of patients, regular educational program in relation to AIDS patients, in order to improve the quality of services, is recommended.

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

Considering the increasing prevalence of the malignant diseases and their great effects on the different aspects of the patients’ life and even their family, the disclosure of its diagnosis and trust telling to the patients have been changed to one of the main medical ethics challenges. This study aimed for the evaluation of patient’s tendency and their family to disclosure of malignant disease. This study was a cross-sectional research. It has been done with a questionnaire on the 270 people. The sample consisted of three groups: 100 patients without cancer disease, 100 patients’ family members, and 70 patients with cancer disease, who referred to Mustafa Khomeini Hospital. The data were analyzed through SPSS-16 software in this study, 74% of the patients with cancer and 85% of patients without cancer and 50% of patients’ families had tendency to know the diagnosis of malignant disease. In the case of prognosis, 39% of cancer patients and 75% of without cancer patients, were agreed to complete knowledge, and 42% of cancer patients and 22% of without cancer patients, agreed on relative knowledge. Regarding the result of this study and respecting the individuals' rights, it seems better for the patients with malignant disease to be informed of their diagnosis and prognosis by the health care workers. Furthermore, it would be better to implement strategies for improvement of patient-physician relationship through physicians' communication skills with patients.

Studying the history of medical ethics and analyzing the dynamics and effects of renowned physicians of the Islamic era and the exploitation of this precious heritage is indispensable. Therefore, in this research, by descriptive-analytic approach, , the books of Teb Al-fukhara and Al-Masakin, Ibn al-Jazar, Full medical industry, Ahvazi, Law in Medicine of Ibn Sina, and Kharazmshahi Save of Jorjani were investigated, by analyzing the guidelines and ethical recommendations contained in the physician and patient interactions, as well as their practical applications in this regard, six important principles of Islamic medical ethics were attained: trust in God, profitability, harmlessness, trusteeship, compassion, and goodness. Two principles of profitability and harmlessness have been more emphasized than other ones, which can indicate the significance of these two ethical principles in Islamic teachings. The ethical issues in the field of medical sciences during the Islamic period did not have the diversity, breadth, and necessity of the present. Thus, in pre-natal and human-era discussions, only the prohibition of abortion is mentioned and there is no debate about the end-of-life care of the patient.

Since 1984, criminal law more than any other period has been specified under the framework of human rights and consequently limited based on its principal. It was followed by the emergence of a new approach called “quality of law principle”. In criminal law, which was presented by European Court of Human Rights for the first time then in the content of verdicts issued by this international judicial institute and reconsideration of criminal law legality principle, it has developed and become more consistent with social justice and manners. According to this principle, the qualitative law is a law which is consistent with quality elements of law based on human rights and moral principles. It is interesting to note that lack of each requirement voids the related law and according to Court’s case law, the existence of such law would not be different from lack of law. In present paper, through the investigation of physician liability and focus on article 495 of Islamic Penal Code as the key to legislation in this regard, and given the requirements of quality of law principle, it has been concluded that the above mentioned provision and all other articles related to this context are not consistent with elements of “the Quality of Law”, thus with failure to meet the minimum criteria of justice, social morality and human rights, the law fails to have the required quality and consequently, it is recommended to legislate based on the criteria of Quality of Law.

Empathy is considered an essential prerequisite for a nurse to effectively care for a patient. Also, spirituality is an important component in nurse-patient relationships. The aim of this study was to determine the relationship between empathy and spiritual attitude among nursing students. In this descriptive and correlation study, the samples consisted of 272 nursing students that were studying in 3 Medical Sciences Universities in Tehran, 2017. Samples were selected through convenience sampling method. Data were collected by demographics’ data form, validated and reliable scales of empathy and spiritual attitude. Data were analyzed by descriptive and analytical (Pearson Coefficient, Independent T test, and ANOVA) statistics. The students had a mean empathy score of 106.982 ± 14.65 that this was more than median scores of scale (60). Furthermore, they had a spiritual attitude score of 115.79 ± 15.8 that this was more than median scores of scale (86). Findings indicated that a significant relationship between empathy and spiritual attitude among nursing students (r=.265, p=.0001). Gender, educational level, interest in nursing, work status, and the average score of the previous term had significant relationships with empathy (P < 0.05). Interest in nursing and work status had significant relationships with spiritual attitude (P < 0.05).Research findings support the hypothesis of association between empathy and spiritual attitude. Since empathy has a significant relationship with spiritual attitude, it seems that nursing students’ empathy will increase by promoting their spiritual attitude.

Pharmacists, as a member of the health team face a lot of ethical challenges in performing their professional duties. This study was aimed to evaluate status, challenges and improvement strategies of pharmacy professional ethics in drugstores. It was a descriptive-analytic study carried out in 2015-2016. Data was collected using a standardized questionnaire related to principles of pharmacy professional ethics’ code from the viewpoint of qualified faculty members and students of Tabriz faculty of pharmacy. The overall score obtained for each principles of professional ethics code indicated moderate and high level status for each of the principles. However, there are some shortcomings in counseling to patients, consulting and interacting with physician, delivery of non-OTC drugs without any prescription, and accepting professional responsibility among the pharmacists. In addition, 71.5% of the professors and 75.5% of the students believed that inadequate income of pharmacists, the economic problems of drugstores, defects in the insurance systems, lack of proper culture for pharmacist's position, insufficient training of professional ethics at universities, priority of physician in Iran health system and giving gifts by some pharmaceutical companies are the main factors influencing professional ethics in pharmacies. Thus, comprehensive management is essential for improving professional ethics in pharmacies. In this regard, promoting professional ethics education, paying attention to economic problems of pharmacists and pharmacies, improving the performance of insurance organizations, developing culture to promote the position of pharmacists and serious supervision of health system officials on drugstores and pharmaceutical companies are necessary.

This research reviews the scientific productions of the field of biomedical ethics based on articles published in Iranian scientific journals in Farsi (Persian language). The findings showed that from 2003 to 2017, researchers have published 1238 Persian articles in this field. The average annual growth rate of published articles is 23.17 percent, but this growth has been declining since 2013. The citation rate of articles (0.4 per article) suggests a small impact. Shahid Beheshti University of Medical Sciences and Tehran University of Medical Sciences with the publication of 36% and 33% had the largest share in the publication of articles, respectively. Biomedical ethics research was interdisciplinary and researchers from the medical, nursing, and law sciences played a major role in compiling and publishing them. The topics such as medical ethics, medical education, and Islamic ethics were, repetitive subjects in articles, respectively. Only 22% of these articles referred directly to funding provided by universities and research centers.

Professional nurse should be familiar with the principles of biomedical ethics and how to deal with situations of moral conflict. Nurses encounter a variety of ethical conflicts in their work environments, which, if not properly educated for that, may be destructive. One of the first steps to recognize and help resolve moral conflicts seems to be a better understanding of the underlying causes of these conflicts. For this purpose, this study compared the exposure of pre-hospital emergency staff and nurses of the ophthalmologic departments in Isfahan with ethical conflicts in their careers. This descriptive-analytic study was performed on 44 pre-hospital emergency personnel and 42 nurses in ophthalmic and postgraduate degrees. Data were collected using Falco's moral conflict questionnaire. The results were analyzed using descriptive statistics such as frequency distribution tables, dispersion indexes, and mean and analytical statistics such as T test and ANOVA. Data were analyzed using SPSS software version 8. The results of this study showed that the prevalence of ethical conflicts among pre-hospital emergency personnel with a mean of 61.65 was higher than nurses in ophthalmic departments with an average of 40.23. Therefore, according to the results of this study, the degree of exposure to ethical conflict situations for pre-hospital emergency personnel more common in comparison with the staff of the elective hospital units in more stressful situations. The degree of exposure to ethical conflict situations is also more significant for pre-hospital emergency personnel than nurses in the ophthalmic departments.

Superior ethics badge (NAB plan), that is election of most moral person, best nursing and midwifery in a university is a kind of professional ethics. The purpose of this study was to investigate the effect of the implementation of the NAB plan on the professional ethics of nursing staff in Baharloo Hospital. This semi-experimental study was done in before and after design. A 360-degree questionnaire as a data collection tool was used to assess ethical nursing staff in a checklist consisting of 5-4 questions. The five-choice Likert scale was used to describe the data from the central indices and in the inferential part, the t-test, for independent and dependent variables, repeated measure ANOVA and ANOVA were used. The results of the present study showed that the implementation of the NAB plan has a significant effect on the ethics of the nursing staff from the general viewpoint of the evaluators (P <0.001). Also gender, age (30-20 years old were more than 30 years old), education, employment status (formal, covenant, etc.), marriage status and work experience in implementation of the NAB plan had a significant effect on professional ethics of nursing staff but the interactive effect of participants' demographic characteristics was not significant. The results of current study showed that the implementation of the NAB design (superiority of ethics) in Baharloo Hospital promoted the professional ethics of the nursing staff.

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

The most important conditions necessitating Hajj are financial affordability, physical, and psychological capacity. Most persons who become bound to make the Hajj ignore the psychological capacity. Each year many persons lacking psychological capacity, go on Hajj and cause other mentally qualified people deprived of travel. A number of these pilgrims undergo medical treatment or are hospitalized during their travel and some of them are returned back to the country. No study has been carried out so far on these special conditions, psychological capacity, of Hajj. In quantitative part of this study, information of all records existing in the medical center of Hajj during 2012-2015 was extracted. The information was analyzed by assistant psychiatrist, professor, and physicians based on DSM-IV-TR standards. In qualitative part, systematic information was extracted from authorities of Hajj organization. From studied records related to psychiatric disorders, cases of schizophrenia and psychotic disorders were identified as lacking mental and psychological capacity. The results of this study showed that about 16% of the people with mental disorders such as schizophrenia and psychotic disorders, and that their dispatch to Hajj's journey was in contradiction with the principles of jurisprudence and ethics. This study can be regarded as a religious and ethical guide for identifying the examples of people who have been deprived, to help policy makers of the Hajj system to apply more strict monitoring of the dispatch of pilgrims, eliminating the time spent by other pilgrims and defusing national pride, and helping to replace eligible people instead of those who are not qualified for Hajj.

One of the issues that today is considered in the moral system and jurisprudence of Imamiyah is the issue of fertility, it has considered the issue of postnatal fertility, which, if it can be considered legitimate, will have many effects. This is considered the subject of dispute between jurists and ethics scholars. In this regard, by examining the existing evidence and considering the ethical approach to the subject, this subject can be considered legitimate and, therefore, this study will examine its effects. However, the aspects of this method have not ambiguity in terms of medical sciences, but from a moral and jurisprudential point of view, there are complexities and ambiguities that require adequate accountability according to the current requirements of human societies. Therefore, this subject is considered to be a useful category as well. Naturally, since science is responsible for maintaining public order and organizing private relationships, scientific processing seems to be necessary. In this research, the concept of good legal and legal jurisprudence approach to post-death reproductive effects such as ownership of gametes based on the element of consent (explicit or implicit), custody (based on family solidarity and child abuse) and will (declaration of consent and the will of the gamet frozen by the gamet player) will be dealt with.
 

The most important factor in interpersonal relationships is trust. Trust in the physician-patient relationship is key and essential. Understanding the factors that affect trust is a prerequisite for trust. These factors vary in different societies. So we need to identify these factors and provide a single criterion for measuring them. Therefore, because we need a tool to measure these different factors in the context of culture and society, the purpose of this study is to determine the factors that influence public confidence in physicians to provide the necessary evidence for making appropriate instruments in Iran. The first step was to investigate the factors affecting patients' confidence in physicians during a library study. Then, during interviews and numerous discussion sessions, nineteen factors influencing public confidence in physicians were provided. Then, to determine the content validity, twenty experts evaluated the transparency, relevance and importance of the factors. Content validity ratio (CVR) and content validity index (CVI) were measured. CVR value for each of nineteen factors was 0.42, therefore content validity of the tool was significant with P.value 0.05. CVI value was 0.944 and content validity of the tool was confirmed. Factors affecting public confidence in physicians in Iran include 19 factors extracted during this study and can be used as factors for assessment of public confidence in physicians. Factors affecting public confidence in physicians in Iran include 19 factors extracted during this study.

Nursing ethics is one of the most basic aspects of nursing profession, which nurses are required to follow the principles receiving nursing care with confidence by patients. This study was conducted to determine the level of moral development of nurses and its contributing factors. This descriptive, analytic study was performed in 2017, study samples were 310 nurses working in educational hospitals of Ardabil University of Medical Sciences. Samples were selected by convenience method. The data was collected using a Kohlberg’s nursing dilemma test. The questionnaire included six scenarios: newborn with anomalies, forcing medication, adult's request to die, new nurse's orientation, medication error, and uninformed terminally ill adult. The data was analyzed by IBM SPSS 18 using descriptive and analytic tests. In this study, 51 nurses (16.45%) were in the pre-conventional level, 101 nurses (32.58%) in the conventional level, 132 nurses (42.58%) at the post-normal level and 26 nurses (8.38%) at the level of clinical considerations. Moral thinking mean score was 42.58 ± 5.6 and the mean score of the clinical considerations was 21.53 ± 4.3. The present study showed that the majority of nurses are in the post conventional and conventional level; but this is less than 50% of all nurses, which shows that the level of moral development of nurses is in the moderate level. It requires further investigation of the causes and related factors and more efforts for improving it.
 

Gene therapy entails the introduction of specific, functional genes into cells for therapeutic or preventive purposes. This process may be used in vitro or directly in vivo. One of the novel methods of gene therapy and genome editing that has been introduced in recent years and have made great changes in the field of genetic engineering and biotechnology is CRISPR-Cas gene-editing system. This system is faster, cheaper, more accurate and efficient than another genome editing one, such as TALEN and ZFNs. As with any other emerging process, the ethical concerns and challenges associated with the genome editing methods including the potential application of this technique for nefarious purposes, such as, bioterrorism, harmful mutations to the living being, and disrupting ecological balance. This review was prepared using the databases of Science Direct, Pub-Med, SID, Scopus,  Web of Science, and then, the selected papers were fully reviewed and information was extracted and summarized. According to the ethical and legal considerations surrounding the processes in gene therapy, it is expected that appropriate conditions will be provided to make the best use of gene therapy and to reduce concerns and possible abuses. The purpose of this review was to investigate ethical issues of the genome editing and gene therapy with an emphasis on the CRISPR-Cas system.

The concept of Islamic medicine, which differs from traditional medicine and even Muslims’ medicine, has become more and more popular in recent years in Iran, especially in religious cities. In the present article, we have addressed the extremist approach of the claimants of Islamic medicine (which considers itself a competitor of modern medicine and traditional medicine).Our theoretical basis for the ethical criticism of this approach has been the principlism of "Beauchamp and Childers". Thereby, we have attempted to challenge the clinical position and medical performances of extremists in the Islamic medicine on the basis of four principles of "justice, autonomy, beneficence, and non-maleficence". Then, we have concluded that the claim of the Islamic medicine cannot, in the present circumstances, satisfy the principle of distributive justice. It also violates patients' autonomy by making unfair judgments and fears about modern medicine. It is very prone to harm clients by refusing scientific evaluation of medicines and therapies and lacking a valid certification system.  Accordingly, we  particularly challenged the attribution of this process to Islam.  This attribution may cause serious damage to the religious beliefs of the clients.