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"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.

Ethical Challenges in Admission and Resource Allocation for Patients in Need of Rehabilitation Services
Mohammadjavad Hosseinabadi Farahani,
Volume 17, Issue 0 (12-2024)
Abstract
Ethical challenges and concerns have long been a part of healthcare, primarily focusing on acute care or end-of-life decisions. However, with the growing elderly population and society's emphasis on restoring patients to the highest possible level of functioning, ethical dilemmas in rehabilitation care have garnered increasing attention. Ethical decisions are a routine part of rehabilitation care. While some are straightforward, such as obtaining informed consent for therapeutic and rehabilitation procedures, others are far more complex. Among the most significant challenges are resource allocation and the selection of patients for rehabilitation services. The process of selecting patients for admission to rehabilitation centers is typically carried out by specialist physicians. However, many centers face demand that exceeds their capacity, necessitating difficult decisions about patient prioritization. Although some centers may have clear guidelines, patient selection is often subjective, involving multiple factors such as:
  • Clinical considerations: Diagnosis, prognosis, secondary complications, and learning ability.
  • Non-clinical factors: Social, occupational, personal, and financial circumstances.
This subjectivity in patient selection raises several ethical concerns. The rights, duties, and responsibilities of both patients and physicians must be carefully weighed. The potential for injustice exists when decisions become overly subjective, leading to possible inequities in resource allocation. Balancing the ethical principles of beneficence (acting in the patient’s best interest) and justice (fair distribution of resources) is essential but can be challenging, as these principles may occasionally conflict. To address these issues, members of the rehabilitation team, particularly physicians, must strive to minimize subjectivity in their decisions. Additionally, it is important to implement follow-up mechanisms for patients initially denied admission, ensuring that any changes in their condition are reevaluated. Medical and rehabilitation ethicists should prioritize the development of clear, evidence-based guidelines for patient selection and admission. These guidelines should be made accessible to the rehabilitation team to promote fairness, transparency, and consistency in decision-making, ultimately ensuring that resources are allocated equitably to those in need.

Ethics in Rehabilitation Research: A Review of Concerns, Challenges, and Ethical Principles
Shima Shirozhan ,
Volume 17, Issue 0 (12-2024)
Abstract
The rising prevalence of disabilities worldwide has drawn significant attention to the need for effective measures in preventing disabilities, managing existing conditions, and rehabilitating individuals with disabilities. These efforts can only be effective if grounded in evidence derived from high-quality research. A fundamental aspect of ensuring research quality in rehabilitation is adherence to ethical principles, which not only improve the study's quality but also safeguard the rights and address the needs of individuals with disabilities. Despite its importance, ethical considerations in rehabilitation research have received insufficient attention, and there is a lack of comprehensive insights into the challenges and ethical principles specific to this field. This study aims to review the concerns, challenges, and ethical principles pertinent to rehabilitation research.
This narrative review synthesizes existing evidence on ethics in rehabilitation research. A systematic search was conducted using English keywords such as "Ethics," "Rehabilitation," "People with Disabilities," "Disability," "Research," "Study," "Code of Conduct," "Challenge," "Issue," and "Concern" in databases including PubMed, Embase, and Web of Science up to the year 2024. Additional searches were performed via Google Scholar and the reference lists of relevant articles and key journals. From 150 extracted studies, 21 articles were selected for full-text review after initial screening. Ultimately, nine studies meeting inclusion criteria (relevance, English language, and full-text access) were included in the final analysis. The findings revealed that ethical principles and guidelines in rehabilitation research receive less attention compared to research involving other vulnerable groups. In addition to the four primary ethical principles, rehabilitation research requires greater focus on specific areas, such as assessing the decision-making capacity of individuals with disabilities for voluntary participation and obtaining informed consent. Challenges including cognitive impairments, speech disorders, and the complexity of symptoms and their effects create difficulties for researchers in study design and execution, thereby impacting research quality. A critical ethical concern in rehabilitation research is the potential decline in research quality due to inherent challenges in conducting studies with individuals with disabilities. Researchers must be aware of these challenges before initiating their studies and approach rehabilitation research with a strong commitment to ethical practices. Establishing standards and ethical guidelines for this vulnerable population, along with oversight by ethics committees, can significantly enhance the ethical standards and quality of rehabilitation research. The findings of this review can assist researchers, managers, and policymakers in addressing these issues. Future efforts should prioritize the development of robust ethical frameworks for rehabilitation research.

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.
 


Modern Care and Ethical Challenges: Emerging Needs and Considerations
Aliasghar Pishdad , Soolmaz Moosavi,
Volume 17, Issue 0 (12-2024)
Abstract
Scientific advancements and emerging technologies in healthcare - such as Artificial Intelligence (AI), the Internet of Things (IoT), and telemedicine -have created unprecedented opportunities to enhance the quality of care. These innovations enable physicians and patients to achieve faster and more accurate methods in diagnosis, treatment, and monitoring. However, they also introduce new ethical challenges that require careful analysis and appropriate solutions. This study was conducted as a Scoping Review aimed at exploring and elucidating various dimensions of modern care. The methodological framework proposed by Arksey and O'Malley, along with its enhancements by Levac et al., was employed. The main steps included:
1. Research Questions
  • The review focused on the following key questions:
  • What is modern care, and what are its main dimensions?
  • What factors and evidence influence the design and delivery of modern care?
  • What are the major challenges associated with modern care?
  • What are the potential strategies to address these challenges?
2. Search Strategy Development
Reputable scientific databases including PubMed, Scopus, Web of Science, and Google Scholar were searched using relevant keywords such as “modern care,” “contemporary healthcare,” “innovative care,” and “advanced patient care.” Boolean operators were applied to refine the search strategy.
3. Study Selection
Inclusion and exclusion criteria were as follows:
  • Inclusion: Articles related to modern care, published within the last 10 years, in English or Persian, addressing challenges, strategies, or innovative care approaches.
  • Exclusion: Studies focused solely on traditional care or lacking full-text access.
  • Initial selection was based on titles and abstracts, followed by full-text screening
4. Data Extraction and Analysis
Key data were extracted using standardized forms, including study characteristics (year, location), definitions of modern care, focus areas, and main findings. A qualitative approach was used for data analysis, and core themes were identified. Findings were categorized into three major areas:
  • Types of Advanced Technologies and Applications in Care
  • Ethical Challenges in Modern Technology Use
  • Proposed Strategies for Addressing Ethical Challenges
1. Artificial Intelligence (AI)
  • AI algorithms assist in analyzing complex data, pattern recognition, and treatment outcome prediction. Their applications are significant in medical imaging, genetic data analysis, and patient outcome forecasting.
2. Internet of Things (IoT) in Healthcare
  • IoT enables real-time monitoring through connected devices, useful in remote monitoring and chronic disease management.
3. Telemedicine
  • Telemedicine provides patients in remote areas or at home with access to healthcare services, reducing the need for in-person visits and enhancing patient comfort.
Ethical Challenges in Modern Care
  1. Privacy and Data Security
    • Modern technologies, especially AI and IoT, require the collection and analysis of vast amounts of sensitive patient data, posing significant privacy risks and opportunities for unauthorized access.
    • Solution: Employ advanced security systems, data encryption, and adherence to privacy regulations such as GDPR.
  2. Automated Decision-Making by AI
    • AI systems may suggest or even make treatment decisions, sometimes without human oversight. This could result in ethically inappropriate decisions that overlook human and emotional aspects.
    • Solution: Ensure that AI-based decisions are supervised by medical professionals and account for human factors.
  3. Accountability and Responsibility
    • Determining responsibility in case of errors or failures in automated systems is complex. Is the medical team liable, or the technology provider?
    • Solution: Develop clear guidelines and legal frameworks outlining responsibilities and oversight mechanisms.
  4. Equity in Access to Advanced Services
    • Advanced care may not be accessible to all, especially in low-income areas or developing countries, leading to healthcare and social inequalities.
    • Solution: Plan for equitable access and provide support to underserved communities.
  5. Use of Genetic Data and Personalized Medicine
    • Although personalized medicine based on genetic profiling improves outcomes, it also raises concerns about genetic discrimination and privacy breaches.
    • Solution: Establish strict laws and ethical standards for handling genetic data.
  6. Changing Roles of Physicians and Patient Trust
    • Automation may diminish the central role of physicians, potentially undermining patient trust.
    • Solution: Reinforce the human element in care and ensure physicians maintain their role as primary decision-makers.
Proposed Strategies to Address Ethical Challenges
  1. Education and Empowerment of Medical Teams and Patients
    • Familiarity with new technologies and their ethical implications helps care teams make informed decisions. Patients should also be aware of their rights and data privacy issues.
  2. Development of Comprehensive Regulations
    • Clear and enforceable legal frameworks that uphold ethical standards and protect patient privacy are crucial.
  3. International Collaboration and Knowledge Sharing
    • Global standard development and sharing of best practices can enhance ethical use of medical technologies.
  4. Establishment of Ethics Committees and Oversight Bodies
    • Ethics committees in healthcare and research institutions can assess and manage emerging ethical concerns. Close monitoring of technology use is essential.
  5. Assessment of Long-Term Impacts
    • Longitudinal studies are needed to understand the long-term consequences of modern technologies, supporting better decision-making.
Modern healthcare technologies offer vast potential for improving quality of life. However, they also introduce new ethical challenges. Addressing these requires integrating ethical principles with scientific innovation and strategic planning. This article underscores the importance of comprehensive legislation, education, and maintaining the human role in medical processes to reduce these challenges and strengthen patient trust in modern care.

The Role of Ethics in Emergency Care for the Elderly
Soolmaz Moosavi ,
Volume 17, Issue 0 (12-2024)
Abstract
The elderly population is rapidly increasing, and as a result, the demand for emergency services for this age group is also growing. Due to their specific physical and mental conditions, the elderly are exposed to numerous ethical issues and challenges when receiving emergency services. These issues are significant because their physical and mental conditions can prevent them from making decisions independently and achieving informed consent. The aim of this article is to examine the ethical challenges associated with the care of the elderly in the emergency department and to provide suggestions for improving this care. This educational narrative review article examines and analyzes ethical challenges in elderly care in the emergency department using reliable sources and articles between 2005 and 2024. Keywords included "medical ethics," "elderly care," and "emergency," and sources were extracted from reliable scientific databases such as PubMed, Scopus, and Google Scholar. Ethical challenges in elderly care in the emergency department include maintaining the independence of the elderly, obtaining informed consent, ensuring privacy and confidentiality, decision-making at the end of life, observing justice and fairness, maintaining honesty, providing psychological and emotional support, offering compassion and empathy, upholding professional principles of education and awareness, communicating effectively with the family, managing pain, and ensuring patient comfort. Although developed countries have long faced the issue of aging, in recent years, the growth rate of aging in developing countries has accelerated. These countries face major challenges in elderly care due to inadequate infrastructure and rapid demographic changes. Ethical challenges in caring for elderly patients in emergency rooms are among the most important issues that healthcare teams face. These challenges are exacerbated by the physical and mental sensitivity of the elderly, the complexities of treatment, and the need for rapid decision-making. Adherence to ethical principles, along with ongoing education of caregivers, can improve the quality of care for the elderly in emergency situations and prevent physical and mental harm. Therefore, in addition to knowledge and skills, caring for the elderly requires adherence to ethical principles and humane behavior. By following these principles, a sense of trust and peace can be fostered in the elderly. Some suggested solutions include educating and raising awareness among healthcare teams, strengthening communication with family and legal representatives, using ethical standards, encouraging the elderly to prepare a medical will, and utilizing psychological and physical assessments.
Scientometric Analysis of Studies in the Field of Ethics and Artificial Intelligence
Nafiseh Rezaei, Rasha Atlasi,
Volume 17, Issue 0 (12-2024)
Abstract
Artificial intelligence (AI) ethics encompasses principles and standards guiding the design and application of AI, ensuring privacy, security, and fairness. This study aims to conduct a scientometric analysis of research in this field, identifying key features and emerging trends. A search was conducted in the PubMed database using the Medical Subject Headings (MeSH) terms "artificial intelligence" and "ethics." All indexed documents from inception to September 1, 2024, were retrieved and analyzed. Scientometric analysis and data visualization were performed using R, with results presented through tables, graphs, and scientific maps. A total of 534 papers were published in this domain from 1986 to 2024, with the highest number (n=70) in 2024. The American Journal of Bioethics had the most publications (n=30), and Melissa D. McCradden (University of Toronto) was the most prolific author with five articles. The University of Oxford (n=24) and Stanford University School of Medicine (n=21) were the leading institutions in this field. The most active countries were the USA (n=236), Germany (n=91), and France (n=52). In 2024, the top trending topics included "research personnel," "informed consent/ethics," and "artificial intelligence/ethics/trends," while in 2023, "privacy," "biomedical research," and "medical education" were predominant. The field of AI ethics has seen exponential growth in scientific output, paralleling the rapid advancements in AI applications across disciplines and daily life. Addressing ethical concerns and fostering international research collaboration will be essential for maximizing benefits while mitigating challenges in this evolving domain.
The Heart of Healing: How Narrative Medicine Deepens Nursing – A Systematic Review of Clinical Trials
Negin Farid, Nazanin Nazari, Narges Jafar Malek,
Volume 17, Issue 0 (12-2024)
Abstract
Narrative medicine has emerged as a transformative model in healthcare, emphasizing the role of patient stories in enhancing the quality of care. By recognizing the individuality of each patient's narrative—shaped by personal experiences and cultural contexts—this approach fosters deeper connections between caregivers and patients. Despite its growing recognition, narrative medicine remains underutilized in nursing, where the psychological and emotional dimensions of care are often overlooked. This systematic review examines clinical trials that investigate the integration of narrative practices into nursing education and care delivery, with the aim of assessing their clinical and educational impact. A comprehensive literature search was conducted across international and national databases including PubMed, Scopus, Web of Science, SID, Noor, Magiran, Irandoc, and Google Scholar, using relevant English and Persian keywords. Eligible studies were clinical trials published in English or Persian. After removing duplicates and applying inclusion criteria, eight studies were included for analysis. Selection and data extraction were conducted independently by two researchers, with discrepancies resolved by a third reviewer. The review adhered to PRISMA guidelines and ethical standards were maintained throughout. The studies, published between 2018 and 2024, involved nursing students (mean age 17.96–21.5 years), patients with lung tumors (mean age 49.31 years), and elderly patients (aged 61–89 years) with complex fractures. Findings were synthesized into three main domains. First, narrative-based education significantly enhanced empathy and academic performance among nursing students. Second, the implementation of narrative approaches led to measurable reductions in anxiety and depression among patients, particularly those with lung tumors. Third, improvements were observed in overall quality of life, pain management, and cognitive function, especially in elderly patients. These findings suggest that narrative education plays a critical role in improving both clinical and psychological outcomes. Narrative-based interventions enhance the empathetic capacity of nurses and contribute to higher standards of patient care. Incorporating narrative approaches into nursing curricula and clinical practice is recommended as a strategy to foster more holistic and human-centered care.

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.

The Importance of Patient Autonomy in Home Care: A Systematic Review
Mohammadreza Jalilfar, Hedayat Jafari, Fatemeh Roudi, Seyed Tohid Hoseini, Soodabeh Eslami, Seyed Mohammad Mirshafiei,
Volume 17, Issue 0 (12-2024)
Abstract
With the increasing need for home nursing care, patient autonomy emerges as a crucial ethical principle in delivering care services. Therefore, this study aimed to investigate the importance of autonomy and individual independence in home-based patient care. In this systematic review, articles from PubMed, Scopus, ScienceDirect, Magiran databases, and Google Scholar search engine, published within the last 10 years, were used to search for articles related to autonomy and independence in home nursing care. The keywords used in the search were: "patient autonomy", "home nursing care", "nursing ethics" and "autonomy in nursing home care".  After reviewing and filtering the articles based on the study's objectives, 20 articles related to autonomy in home nursing care were included in this systematic review. The findings of these studies indicated that various factors can influence patient autonomy at home-care, including: · Individual factors: age, gender, physical and mental health status of the patient; · Family factors: family support, family relationships, family culture; · Social factors: social support, access to social resources; · Organizational factors: care policies, organizational structure, organizational culture.  Considering these findings and their comparisons, it can be concluded that to promote patient autonomy at home, all the mentioned factors should be considered. Some of the suggested solutions to promote patient autonomy are: · Educating the patient and family about patient autonomy; · Strengthening family support for the patient; · Providing social support services to the patient; · Developing care policies that support patient autonomy; · Improving organizational structure and culture.  Patient autonomy is one of the essential ethical principles in home nursing care. Considering the factors affecting patient's autonomy, comprehensive solutions should be considered to promote it. Patient and family education, strengthening family support, providing social support services  and improving organizational structure and culture are among the effective solutions in this field.

Moral Sensitivity Among Nurses in Cardiac Critical Care Units of Selected Hospitals Affiliated with Isfahan University of Medical Sciences in 2024
Safoura Dorri, Seyed Ali Rasooli, Hamideh Hakimi,
Volume 17, Issue 0 (12-2024)
Abstract
Moral sensitivity, defined as the ability to recognize and assess the ethical complexities of clinical situations and make appropriate ethical decisions, is a crucial skill for nurses. Despite its importance, various studies report varying levels of moral sensitivity among nurses, suggesting a gap in this competency. Nurses’ continuous exposure to ethical dilemmas can lead to adverse outcomes, including psychological and moral distress, decreased job satisfaction, and compromised care quality. As moral sensitivity can differ across healthcare settings and may change over time, studies assessing its levels across different periods are essential. This study aims to assess the level of moral sensitivity among nurses in hospitals affiliated with Isfahan University of Medical Sciences in 2024. This cross-sectional descriptive study was conducted with 200 nurses working in cardiac intensive care units (CICUs) of four large hospitals affiliated with Isfahan University of Medical Sciences. Participants were selected using a random sampling method. Data were collected using a demographic information form and the Lutzen Moral Sensitivity Questionnaire. Data analysis was performed using SPSS version 26, employing descriptive statistics such as means and standard deviations. The findings revealed that the average moral sensitivity score among the nurses was moderate (60.17±13.04). When analyzing the different dimensions of moral sensitivity, the highest score was observed in the dimension of "honesty and benevolence" (15.30 ± 4.48), while the lowest score was found in the dimension of "professional knowledge" (3.25 ± 1.88). The mean scores for the remaining dimensions were as follows: "respect for patient autonomy" (7.44 ± 2.13), "awareness of how to communicate with patients" (15.18 ± 3.41), "experiencing ethical problems and dilemmas" (7.74 ± 2.03), and "applying ethical concepts in ethical decision-making" (11.95 ± 3.35). The study revealed that nurses demonstrated a moderate level of moral sensitivity, with the lowest scores in the dimension of professional knowledge. This suggests that nurses may not be sufficiently involving patients in their treatment and care decisions. Given these findings, it is critical for healthcare policymakers and nursing managers to implement continuous assessment and feedback systems to accurately evaluate nurses' moral sensitivity and professional knowledge. By identifying the weaknesses and educational needs of nurses, targeted training programs can be developed, ultimately enhancing nurses' moral sensitivity and improving the quality of care.
 

Research Misconduct Cases Reviewed by the National Committee for Ethics in Biomedical Research of Iran
Amirhossein Mardani, Maryam Nakhoda, Ehsan Shamsi Gooshki,
Volume 17, Issue 0 (12-2024)
Abstract
Research misconduct cases reviewed by ethics committees serve as a valuable source of data for managing potential future misconduct. This study examines the reported cases within closed research misconduct files of the National Committee for Ethics in Biomedical Research of Iran, aiming to identify common manifestations of misconduct and influential factors across various activities within the research system. Documentation from 100 closed cases reviewed by the National Committee for Ethics in Biomedical Research during 2016 and 2017 was analyzed. A documentary research method and qualitative content analysis were employed. Using a directional analysis approach, the manifestations and factors contributing to misconduct in each case were extracted and categorized. Subsequently, causal relationships between the reported factors were defined. Twenty-one manifestations of research misconduct were identified, most of which involved undesirable micro-level activities, particularly the failure to adhere to ethical standards in research publication. Although negative impacts were observed at the meso level, including issues with research oversight, training in research standards and skills, journal management structures, and administrative and financial structures within universities, macro-level activities and deficiencies in research system performance—such as inadequate investment and financial resource allocation—were not addressed. Twelve causal relationships contributing to research misconduct were identified, highlighting how inadequate performance across different levels of the research system—including administrative structures for research approval and funding, research infrastructure, research evaluation, training, journal management, and oversight mechanisms—can interact and exacerbate misconduct.  A key finding was the insufficient reporting of reasons for research misconduct in case documentation. Ethics committees appear to lack significant focus on analyzing the underlying causes of misconduct. Detailed and precise reporting of misconduct reasons, alongside independent studies, would provide decision-makers with valuable insights for preventing future occurrences.

Financial Relationships and Conflicts of Interest Between Physicians and Patients: Guideline to Professional Ethics for Medical Practitioners, Medical Council of Islamic Republic of Iran
Saeed Biroudian,
Volume 17, Issue 0 (12-2024)
Abstract
Conflicts of interest, particularly financial ones, pose a significant ethical challenge in the medical field. They can compromise clinical decision-making, erode patient trust, and ultimately diminish the quality of healthcare. This study reviewed ethical documents and guidelines published by the Medical Council of the Islamic Republic of Iran, including the Charter of Rights for the Medical Community. A comprehensive review of relevant scientific literature on conflicts of interest in healthcare was also conducted. The analysis revealed that financial relationships between physicians and external entities, such as pharmaceutical companies, can create conflicts of interest that negatively impact patient care. These conflicts can erode patient trust and lead to suboptimal clinical decisions. The Medical Council's ethical guidelines address these concerns by emphasizing the importance of transparency regarding financial ties and relationships. They advocate for the disclosure of such relationships to patients and the implementation of educational programs to enhance physician awareness of ethical principles and conflict-of-interest management strategies. Adherence to the ethical guidelines established by the Medical Council of Iran is crucial for effectively managing conflicts of interest in the physician-patient relationship. By prioritizing transparency, disclosure, and ongoing education, healthcare professionals can mitigate potential conflicts and maintain the highest standards of ethical conduct in patient care.

Ethical Challenges in ICU
Atefe Salimi Akinabadi, Maryam Jahangiri, Mitra Zandi,
Volume 17, Issue 0 (12-2024)
Abstract
The intensive care unit (ICU) is a complex environment where diverse healthcare professionals collaborate to care for critically ill patients. Evidence suggests that ethical issues or conflicts are prevalent and can negatively impact ICU care. This research aimed to investigate the ethical challenges encountered by critical care nurses in clinical practice. Using the PRISMA guideline, relevant studies were identified through searches of the PubMed, Scopus, and Web of Science databases from 2015-2024 using the following MeSH terms: "ethics," "ethical challenges," "nursing," and "intensive care unit." Only English-language manuscripts were included. Ethical challenges in the ICU were categorized as follows:
1. Internal Constraints: Lack of self-confidence, fear, maladaptive coping mechanisms, religious conflicts, and spiritual conflicts.
2. External Constraints: Lack of collegiality, hierarchical structures, poor communication, inadequate staffing, restrictive policies, shortages of full-time critical care physicians and nurses, and working with incompetent staff.
3. Clinical Situations: Futile treatment, inappropriate care, inadequate pain relief, hastening death, providing false hope, end-of-life care decisions, decisions about life-sustaining treatments, and the use of physical restraints.
Recognizing ethical challenges in the ICU is crucial. It enables the implementation of measures to minimize ethical conflict, design effective strategies for preventing ethical dilemmas, and improve the nursing work environment.

Ethical Challenges in Nursing and Midwifery Schools from the Perspective of Faculty Members: A Qualitative Study
Mahrokh Keshvari, Negar Farajzadeh, Mohsen Shahriari, Mohammad Azadmanesh, Aliasghar Jamalinasab,
Volume 17, Issue 0 (12-2024)
Abstract
Nursing and midwifery professors play a crucial role in transmitting societal norms, providing cultural experiences, shaping students' behavior, beliefs, and attitudes, and cultivating moral virtues. As significant influencers on students' moral development during their academic journey, careful attention to this aspect is essential. This study aimed to elucidate the ethical challenges encountered by faculty members within the Faculty of Nursing and Midwifery. This qualitative study employed content analysis. Purposive sampling was utilized to select 23 faculty members from the Faculty of Nursing and Midwifery at Isfahan University of Medical Sciences, with data collection spanning eight months. Data were collected through semi-structured interviews and analyzed using conventional qualitative content analysis. Continuous and comparative data analysis revealed three primary categories of ethical challenges perceived by faculty members: discrimination and injustice, low professional commitment, and unprofessional behavior.
· Discrimination and injustice: This category encompassed three subcategories: disparities in rule implementation across faculties and groups, unfair financial compensation, and inequitable distribution of academic units and points.
· Low professional commitment: This category included two subcategories: educational underselling and non-adherence to established rules by faculty members.
· Unprofessional behavior: This category comprised two subcategories: unhealthy competition among faculty members and inappropriate student evaluations.
The experiences of faculty members in this study highlighted the presence of numerous challenges, with ethical issues significantly impacting their performance and motivation. The identified ethical challenges primarily revolved around discrimination and injustice, low professional commitment, and unprofessional behavior. Given the pivotal role of faculty members in teaching ethical principles and actively addressing ethical challenges, it is imperative for administrators and officials to acknowledge these concerns and implement strategies to mitigate these issues.
Explaining Nursing Students’ Experiences of Professional Ethics in Relation to Psychiatric Clients: an Analysis Based on Narrative Writing-Reflection
Mina Gaeeni, Hamid Asayesh, Ahmad Parizad, Zahra Abedini,
Volume 17, Issue 0 (12-2024)
Abstract
Clinical education constitutes the cornerstone of nursing education. Enhancing students' theoretical and practical knowledge within the psychiatric department is crucial for improving their attitudes, acceptance, and delivery of care. The outcomes of effective clinical learning encompass the development and refinement of professional competencies, including communication and professional ethics, the cultivation of critical thinking for clinical judgment and decision-making, the enhancement of ethical sensitivity, and the fostering of effective team and group performance. Recognizing the significance of these factors, this study aimed to "explain the experiences of nursing students based on narrative writing-reflection during their first encounter with psychiatric clients." This qualitative study was conducted during the psychiatric nursing internship at the Faculty of Nursing, Qom University of Medical Sciences, over two consecutive semesters. Purposive sampling was employed, and data were collected through 10 semi-structured individual interviews and 2 face-to-face and virtual focus groups (n=5 per group). Data collection continued until data saturation was reached. Data analysis was conducted using a qualitative content analysis approach with the assistance of MAXQDA20 software. The clinical experiences of students during their initial psychiatric nursing training course, as reflected in their narrative writing-reflections, revealed a primary theme: "encouraging ethical and spiritual communication in nursing." This overarching theme encompassed four sub-themes: "enhancing empathetic communication," "enhancing ethical sensitivity," "respecting the dignity of clients," and "listening to the voice of clients' feelings." The experiences gained through the reflective method within the clinical education setting, particularly in specialized clinical environments such as psychiatric wards and during initial encounters with clients in these departments, can provide valuable insights into students' attitudes and perspectives towards these clients and their families. These rich experiences can be effectively utilized to cultivate and strengthen communication and professional ethics among medical science students.

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.

Retracting or Discrediting Articles: Dos and Don'ts
Mina Mobasher,
Volume 17, Issue 0 (12-2024)
Abstract
As scientific output continues to grow and researchers strive to share their findings, the number of article retractions and cases of discreditation has also increased. Articles may be discredited for several reasons, including authors voluntarily admitting to errors in their work, discoveries of research misconduct, or concerns raised by reviewers or readers about the authenticity of the research. Retractions can harm public trust in science and have broader implications, such as damaging the reputation of the universities, research centers, and institutions associated with the retracted papers. This study considers the causes, contributing factors, and impacts of research discreditation, drawing on international guidelines and credible publications. It will examine the types of research misconduct and other issues that lead to article retractions. Additionally, the study will analyze cases of retracted articles authored by Iranian researchers using Retraction Watch. The Committee on Publication Ethics (COPE) identifies eight key reasons for journal editors to retract published research. According to COPE guidelines, retraction may occur when there is clear evidence of issues such as data or image manipulation that invalidate the findings. Other grounds for retraction include plagiarism, duplicate submission or publication without proper disclosure or permissions, inadequate oversight during data collection, violations of regulations like copyright laws, unethical research practices, flawed peer review processes, and undisclosed conflicts of interest. Additionally, other studies have pointed out factors contributing to article retraction, such as the pressure on researchers to publish, a lack of essential skills to conduct valid and reliable research, and inadequate training in research ethics. In the context of Iranian author retractions, common issues include authorship manipulation and plagiarism. With the growth of research and scientific production in universities and research centers, it's becoming increasingly important to address the issue of article retractions. By understanding the underlying causes, we can develop effective guidelines and oversight strategies while also providing researchers with the necessary training to prevent such issues in the future.

Juridical, Legal, and Ethical Aspects of "Under-the-Table Payments " from the Perspective of Experts and Shia Grand Ayatollahs
Mojtaba Parsa,
Volume 17, Issue 0 (12-2024)
Abstract
"Under-the-table payment" refers to money a physician demands and receives from a patient, in addition to the established and approved medical tariff, typically for medical services such as surgical operations. This study aims to examine the ethical, legal, and juridical aspects of this phenomenon, which has become common among many physicians. This qualitative study is based on semi-structured interviews with 17 experts from various fields, including Islamic jurisprudence, law, professional ethics, philosophy of ethics, medical ethics, health economics, and social psychology. The interviews were analyzed using the conventional content analysis method. Additionally, the opinions (fatwas) of 11 Shia Grand Ayatollahs on under-the-table payments were obtained by posing a specific question to them. The findings from the expert interviews revealed several concerns regarding under-the-table payments, including:
· Disregard for patients' best interests, particularly causing harm to poor patients;
· Undermining trust between doctors and patients;
· Violations of national laws and public policies;
· Promotion of lawlessness;
· Breaches of medical and ethical obligations by physicians;
· Coercion or undue pressure on patients to pay such fees.
Experts emphasized that medicine is a profession in which patients' interests should take precedence over those of doctors, and in this practice, this fundamental principle is violated. Furthermore, in the fatwas issued by the majority of Shia Grand Ayatollahs - particularly those with governmental perspectives - nearly all deemed this practice impermissible, with some explicitly declaring it forbidden (haram). Receiving under-the-table payments is ethically, legally, and juridically problematic, and in some cases, is considered impermissible, particularly for the physicians involved. However, it is generally not considered problematic for patients who are coerced into making such payments.

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