Iranian Journal of Medical Ethics and History of Medicine

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Medical laboratory services and its clients are somehow different from services of the other sectors in the health system. Patient’s Rights Charter, published by the Ministry of Health and Medical Education, was comprehensive, but addressing specific aspects of the related areas in medical laboratories could promote the commitment and dedication in laboratory professional services hence, development of the Patient’s Rights Charter in medical diagnostic laboratories was put on the agenda. After a comprehensive review of existing references and resources, a committee was formed consisting of representatives of laboratory associations and experts in this field, and the draft was prepared. Thereafter several meetings and workshops were held and the members of legal organizations, medical ethics experts as well as laboratory stakeholders, technical staff and laboratory directors attended these gatherings where the draft was surveyed and comments were received. The draft underwent some changes and was edited. Finally in August 2012, the charter was approved by the Health Policy Council of the ministry and in October 2012 was officially announced by the health minister.To be consistent with the context of the Patient’s Rights Charter, essentials of this bill have been based on 5 pillars: access to appropriate laboratory services, access to information in a sufficient and effective manner, the right to choose and decide freely, respect for customer privacy and the principles of confidentiality and integrity, and availability of an efficient system for investigating complaints and suggestions.Developing and delivering the bill of rights for health services recipients is one of the foremost matters, but implementation of the provisions of the charter and monitoring of its effectiveness are the most important goals ahead. Therefore, an effective strategy to implement the rights of patients in medical laboratories should be designed and established.

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Assessing nursing students’ level of respect for ethical codes of nursing is essential as these students are the future health care providers. There is a need to check observance of ethics codes among students, because that will determine ethics education and training needs. This study aimed to assess nursing students’ compliance with professional ethical codes and some of the relevant factors.This is a descriptive-analytic and cross-sectional study performed by census on 118 nursing students who were training in hospitals of Shahid Beheshti University of Medical Sciences. The data gathering tool consisted of a questionnaire including demographic information, and another questionnaire which was developed by the researcher based on studies in Iran and throughout the world.The ethical codes that were respected most included "principles of conflict management" and then "respect for the medical staff". "Respect for patients' rights" and "patient education" received less consideration. Grade point average, gender, marital status, interest in nursing and likelihood to work in nursing had significant association with respect for ethics codes.The results of this study can be used in developing courses on nursing ethics and educating nurses on the subject, and could be of special interest to health planners and policy makers.

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Holistic care is a comprehensive approach for achieving optimal level of care for patients. Identifying the motivational factors can increase quality of nursing care and improve the healing process. Investigation of nurses’ experiences will provide real and meaningful results in this field. In this study we aimed to explore nurses' experiences regarding holistic care.This qualitative study was conducted on 18 nurses from Uremia, Tabriz, Ardebil and Tehran teaching hospitals of Iran. The data were obtained by interviews with nurses. These interviews were transcribed and analyzed by the conventional content analysis method and using MAXQDA software.Personal characters and experience of hospitalization were identified as motivational and promotional factors in providing holistic care.Considering the role of personal characters and experience of hospitalization in holistic care, paying more attention to nurses’ characteristics and upgrading their communication skills and knowledge are necessary for development of holistic care and are highly recommended.

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Observation of ethical principles by health care organizations managers can direct and control human resources. Moreover, organizational commitment is a type of emotional and fanatical dependence on the values and goals of an organization that can help preparing an appropriate background for employee development. Therefore, this research is aimed to determine the relationship between management ethics and organizational commitment among employees of the Tehran University of Medical Sciences. This is a cross-sectional, descriptive and analytical research conducted among the headquarters employees of the Tehran University of Medical Sciences. One hundred and fifty employees were selected as a research sample using the Cochran formula. The research tools were two types of standard questionnaires including organizational commitment and principles of ethics questionnaires that were completed by the employees. The response rate was 86%. The collection and analysis of data were performed by SPSS software. The results of this research showed that most managers of TUMS headquarters observed the principles of ethics and also most of the employees had a high level of organizational commitment. However, organizational commitment of TUMS employees does not appear to be influenced by managers’ observance of ethical principles, and it seems that other factors like organizational culture or organizational health could be correlated with employees’ organizational commitment. The authors recommend preparation of ethical charters and avoidance of instrumental usage of ethical principles by the managers in order to direct the employees to follow ethical guidelines and create a unified culture within the organization.

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Although errors in health services are harmful and the consequences might be irreversible in some situations, none of the health care providers are free of errors. Since health provision is the main goal of the nursing care, it is important to report professional errors in order to reach this goal. However, there are many obstacles in reporting nursing errors that should be identified and solved. The present study tried to evaluate the nurses’ point of view about managerial and moral obstacles in expressing nursing errors.Two hundred and one nurses of the educational hospitals of Sabzevar University of Medical Sciences were enrolled in this descriptive analytic study. The students were selected by convenience sampling method and the study data was collected using a questionnaire that consisted of a demographic part and a researcher made part with 13 and 27 questions related to managerial and moral obstacles respectively. Content validity index and reliability were measured by internal consistency (α = 80) and test-retest (r = 0.84). Data analysis was done by SPSS 18 software.The results of this study showed that the main reported managerial obstacle in reporting nursing errors was endangerment of academic position (43.3%), and the main moral obstacle was losing physicians' support (55.2%). Thus this problem might be solved by designing appropriate plans from both managerial and moral points of view.

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Presence of physicians in different fields of the society has always been associated with ethical and legal considerations. Physician participation in legal punishment is one of the areas that are associated with different perspectives. In medical history, physicians and medical professionals have participated in legal punishment in different ways, but they have been directly involved with this process after the development of the lethal injection method. Proponents and opponents have discussed the ethical aspects of physician participation in legal punishment, and medical organizations have announced their viewpoints about this subject. In the Islamic Republic of Iran according to the Islamic punishment laws and their implementation regulations, physician participation in legal punishment is necessary, but the physician does not play a direct role in the execution of punishment. In this article we will study the main arguments of opponents and proponents as the background of the subject and will then evaluate the exact role of physicians in the execution of punishment in Iran and analyze the ethical aspects of this role.

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A thorough understanding of the characters, attitudes, and lifestyles of renowned scholars is of paramount importance for any nation. Dr. Hasan Habibi (1936-2012) was a prominent figure in science, theology, literature, and culture of Iran. The late Dr. Habibi was a pious and patriotic politician who was fully committed to safeguarding the pillars of the Islamic Republic of Iran and the Islamic Revolution. In this article, we aim to review some of his works and explore the memories of his family and acquaintances in the hope to shed some light on his manners, viewpoints, and lifestyle. Moreover, the first author’s personal remembrances of the late Dr. Habibi and his moral virtues are presented here, particularly with focus on his final years during which he was bedridden for a long period. Moreover, we aim to illuminate his ideas in terms of promoting science, supporting scholars, and building the infrastructure needed to expand the boundaries of science. We hope that this article will provide a model both for bedridden patients in Iran and the physicians and researchers who deal with them on a daily basis.

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Ethical performance is one of the main components of offering quality care to women and mothers. The aim of this study was to assess the degree of compliance with the professional codes of ethics among the midwives employed in maternal child health centers in Tehran.This was a descriptive, cross-sectional study performed on 125 maternal child health center midwives in Tehran. Method of sampling was stratified and cluster sampling. The data collection tool consisted of a valid, reliable questionnaire including two sections: demographic information and 43 questions in 10 areas of professional ethics based on a 5-point Likert scale. Data analysis was performed by descriptive statistics via the SPSS software.The overall compliance with ethical codes among midwives was 3.866±0.522, and compliance rates in each of the 10 areas mentioned above were as follows: respect for human dignity: 3.77±0.676 observance of clients’ decision-making right: 3.62±0.58 obtaining informed consent: 3.48 ± 0.988 truth telling: 4±0.74 respect for clients’ privacy: 4.08±0.709 observance of the principles of beneficence and non-maleficence: 3.97±0.689 revealing clients’ information: 3.47±0.723 confidentiality: 3.83±0.844 fair treatment of clients: 4.14±0.802 and professional relationship with colleagues: 4.23±0.709.In order to improve the quality of midwifery services, more attention should be paid to teaching professional ethics in midwifery courses, and after extensive notification, compliance with ethical codes should be monitored.

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Moral distress is one of the ethical challenges that nurses face due to the nature of their career. Nurses' frequent confrontation with this phenomenon can have different outcomes such as frustration and boredom in providing patient care. This will lead directly to a decline in care quality and can hamper the accomplishment of health goals. Therefore, the present study examined the relationship between moral distress and compassion fatigue in nurses.This cross-sectional study was conducted on 260 nurses of intensive care units in Kerman who were selected through convenience sampling method. In this study, Corley’s moral distress scale and Figley’s Compassion Fatigue Scale were used for data collection. The collected data were analyzed using the SPSS software and descriptive and analytical statistics.The results of this study indicate that there is a significantly positive relationship between moral distress and compassion fatigue (P<0.05). From a total range of 0 to 5, the average score of moral distress was 3.5±0.8 in terms of intensity, and 3.9±0.55 in terms of frequency. The mean of compassion fatigue score was 3.5±0.68 from a range of 0 to 5.Moral distress and its association with compassion fatigue suggest that conditions contributing to moral distress can have an important role in the quality of care. It is clear that strategies should be adopted to prevent the occurrence of these conditions. Informing nurses about moral distress and its consequences as well as periodic consultations will play an important part in the identification and management of moral distress and its consequences.

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The nursing profession is based on ethics. Clinical decisions that most nurses have to deal with include cases that involve moral conflicts. Moral distress is a phenomenon that causes pain, suffering, anxiety, depression and psychological damage. Emotional exhaustion can cause moral distress and is a consequence of job stress that has even been investigated as a reason for the high turnover in nursing. Therefore, the present study investigated the relationship between moral distress and emotional exhaustion among nurses.In this cross-sectional study, 265 nurses who employed in teaching hospitals of Sabzevar University of Medical Sciences were selected through convenience sampling. Data collection tools included a questionnaire on personal information a moral distress scale whose validity and reliability had been measured in previous studies (Cronbach's alpha 0.86) and a scale for emotional exhaustion that had also been tested for validity and reliability through content validity and test-retest (r = 0.84). Data analysis was performed using SPSS version 18.In this study, mean and standard deviation of moral distress and emotional exhaustion of nurses were 4.99 (0.91) and 4.17 (1.58) respectively. A statistically significant correlation was found between moral distress and the nurses’ field of work (rho = 0.338, P = 0.000). There was also a significant correlation between emotional exhaustion and rotating working shifts (rho = 0.385, P = 0.000) and ward (rho = 0.173, P = 0.03).The moral distress and emotional exhaustion of the nurses in this study were found to be higher than average. Education, counseling and raising nurses’ awareness of these concepts seem to be necessary in order to empower them to better deal with ethical issues.

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Patience is a moral construct and is related to persistence, tolerance, restraint, contentment and transcendence in difficult and unpleasant situations. It can be discussed in the field of medical ethics and is related to many variables. The aim of the present study was to examine the role of patience and its components (transcendence, tolerance, contentment, persistence, and restraint) as moral constructs in predicting hope among university students.The study population of the present study consisted of all of the university students studying at Shiraz University. Three hundred and ninety university students were recruited via cluster sampling. The participants completed the patience scale and hope scale. According to the findings of the Pearson’s correlation test, patience and its components correlated positively and significantly with hope and its subscales (pathway and agency). Moreover, the total patience score effectively predicted the total hope score (β = 0.58, P ≤ 0.001), pathway (β = 0.52, P ≤ 0.001) and agency (β = 0.52, P ≤ 0.001). Transcendence, contentment, and persistence were important predictors of hope and its subscales. It can be concluded that reinforcing patience as one of the most important and valuable moral constructs can increase hope and lead to success. Thus, applying educational strategies of patience in order to curtail despair and promote hope among patients is recommended for clinicians working in the fields of psychology, health and medical ethics.

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Decision making is an important part of nurses’ responsibilities in providing clinical interventions for patients. Religion is among the moral factors that affect the performance and clinical decision making of nurses. The present study aimed to investigate the relationship between religious orientation and moral sensitivity in the decision making process among nurses.This study was a cross-sectional, analytical research that was carried out on 170 nurses working in Gonabad hospitals. Subjects were selected by census, and data were collected using the Allport Religious Orientation Scale and the Moral Sensitivity Questionnaire. Data analysis was performed using SPSS version 16.In the present study, internal religious orientation mean was 36.39 ± 4.65, external religious orientation mean was 33.77 ± 6.89 and moral sensitivity mean was 159.21 ± 14.1, and therefore internal religious orientation was higher among the nursing staff. Moreover, Pearson's correlation test showed that there was a significant, positive relationship between internal religious orientation and moral sensitivity (P = 0.01, r = 0.17). Nevertheless, no significant relationship was found between external religious orientation and moral sensitivity (P = 0.86, r = - 0.01).Based on the findings of this study, it seems that authorities need to develop and implement strategies to educate nurses on morality and spirituality, since members of this profession play an important part in the health and well-being of the community.

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Abstract Ethical and moral values lie at the root of employee behavior and activities. Hence, observance of professional ethics and the related benefits are among the most fundamental research topics in organizational areas. This descriptive-correlational research was performed according to the practical study objectives and through adopting a data collection approach. With the aim of exploring the mediating effect of organizational identification on the relationship between professional ethics, organizational citizenship behavior and job deviation behavior, a sample of 225 employees and hospital specialists were chosen from the cities of Maku, Showt and Poldasht using random stratified sampling. Data were gathered through standard questionnaires of Van Dick’s organizational identification, professional ethics, citizenship behavior and deviation behavior. In order to evaluate the relationship among variables measured in a conceptual model, Structural Equation Modeling was used. The results showed that there is a positive and significant relationship between organizational identification and professional ethics (r = 0.177) and organizational citizenship behavior (OCB) (r = 0.179). Findings also showed that the relationship between professional ethics and citizenship behavior and deviation behavior is mediated through organizational identification. In the above-mentioned model, all regression weights were statistically significant, except for the relationship between professional ethics and deviation behavior. The results of this study indicated that professional ethics strengthened organizational identification on the one hand, and organizational identification strengthened citizenship behavior and reduced the deviation behavior of the employees and hospital specialists on the other hand.

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Social capital and altruism are the most effective factors on the cultural development of a society and can play an important role in promoting ethics within the health care system. The purpose of this study was to investigate the relationship between social capital and altruism and the ethical attitudes of physicians. This correlational and descriptive study was performed on 322 doctors working in medical centers in west Azerbaijan during 2013 who were selected by cluster-random sampling. Onyx and Bullen social capital scale, Carlo et al. altruism scale and Karamporian et al. ethics questionnaire were used to collect data. The results of this study indicated that there was a significant positive relationship between the ethical attitudes of physicians and altruism (R = 0.238), the structure subscale (R = 0.489), cognition subscale (R = 0.581) and relationship subscale (R = 0.554) of social capital. The significance level was set at p < 0.05 in this study. The multi-variable correlation coefficient and enter method indicated that social capital subscales can influence the ethical attitudes of physicians (0.457). The results showed that there was a correlation between social capital and altruism and ethical attitudes in the medical profession. Thus, it seems that promoting social capital and altruism can positively influence individuals’ ethical attitudes in the medical profession.

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Nowadays academic life is closely related to the issue of publication. Consequently, there are numerous challenges in naming authors of scientific papers and publication ethics in general, making it essential to identify the various problems in this area. The present article acquires a historical view to investigate the challenges and solutions related to this topic.This is a review article based on a search of scientific databases from 1985 to 2014. Honorary authorship, coercion authorship, ghost authorship and non-compliance are instances of ethical issues in naming authors. To solve these problems, several agencies have provided ethical guidelines in this respect including the International Council of Medical Journals Editors (ICMJE), contributorship, objective measurement tools and the National Directory of Ethics in Medical Research Publications. Nevertheless, studies point to the existence of problems in this area.In order to solve the existing issues, the evaluation system of scientific and research organizations should propel quantity-oriented evaluation over quality oriented criteria. We also believe that the educational system, specifically in the post graduate period, can affect scientific research and publication ethics to a great extent and thus promote ethical conduct in students and researchers.

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It is universally acknowledged that death is a complex concept and different factors such as complicated philosophical ideas, contradictory descriptive approaches, and diversity in interpretations add to this complexity. Although a thorough understanding of the notion of death is important for everyone, this concept is of crucial importance to health care providers as they face enormous ethical challenges in the course of their careers. A few instances are controversial issues such as brain death, euthanasia and end-of-life care, where it seems essential to define a set of robust criteria for death. On the other hand, it can be argued that death is not a scientific concept and only different branches of medicine can provide a framework to clarify the subject of death. Therefore, it could be argued that theological approaches may shed some light on this concept. In this article, we aim to extract ontologic components of death mentioned in the Holy Quran, and will move on to propose a set of 12 criteria for death. This may help provide a clear understanding of the concept from the point of view of the Holy Quran, although more research is warranted to further illuminate this complex subject.

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Abortion has remained a subject of intense controversy in medical ethics, particularly in the case of malformed fetuses. Review of the existing literature on the issue indicates that there are two main challenges in this regard: firstly, the question as to whether a malformed fetus has the right to live, and secondly, the fate of the soul (vegetative and animal) after induced abortion.This descriptive research presents different viewpoints in order to investigate the aforementioned questions in Mulla Sadra’s philosophy with a focus on the “right to live”. The results of the study demonstrate that according to Mulla Sadra’s theory, all fetuses possess potential human souls even if they are extremely malformed or disfigured. He considers the fetus a vegetable with the potential to convert into a human. Based on this ideology, which encompasses both creation and resurrection, the malformed fetus has the right to live. The assumption is founded upon Mulla Sadra’s Theory of Substantial Motion, which implies that abortion may influence the evolution of the soul in the limbo period (intermediate state) after abortion and might even affect its resurrection. It can be concluded that in the Iranian society, which has an Islamic background, theological views should be considered in decisions about abortion. It should be mentioned, however, that philosophical approaches alone cannot be relied on for decision-making regarding the abortion of a malformed fetus. Furthermore, interdisciplinary contributions are indispensable to a thorough analysis of this controversial issue so that the ethical challenges surrounding abortion in such cases can be overcome.

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The purpose of this research was to explore the components of nurses’ ethical conduct in public hospitals in Mashhad. This study employed an eclectic method for research and followed a mixed exploratory design. A qualitative study was first performed, and then based on the results the quantitative method was applied. The statistical population consisted of all the nurses in public hospitals in the city of Mashhad. In order to collect data, in-depth semi-structured interviews were conducted, and the data were then analyzed using thematic content analysis. A preliminary model was developed for the nurses' ethical conduct comprising three levels. The first level covered areas of ethical behavior toward patients, patients’ families and the core group. At the second level 13 dimensions and at the third, 51 components (themes) were abstracted. The questionnaire was then distributed among 176 experienced nurses employed in public hospitals in Mashhad. In order to assess the fit of the model in quantitative research, data were analyzed using confirmatory factor analysis and AMOS software. The results of the confirmatory factor analysis showed that all dimensions and components were acceptable with the exception of the component "patient education". Using AMOS software, the comparative fit index (CFI) was calculated at 0.9, which indicates a good fit of the model and validates the components and sub-components. The results of this study can guide human resource managers in public hospitals to promote ethical conduct in nurses.

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Nursing theories have their roots in philosophical schools, and acceptance of a school of philosophy can direct the theoretical and clinical activities of a nurse.The present paper used a qualitative and explanatory-applied method. After a review of the general features of post-structuralism and post-structuralist ethics, the challenges and opportunities of post-structuralism in nursing and nursing codes of ethics were discussed.Ethics is one of the areas of nursing that have been affected by the arrival of post-structuralism. Ethics in post-structuralism is nomadic, based on discourse, democratic, relative, rhizomatic and anti-authoritarian.Despite the positive outcomes of post-structuralism in nursing, some features of this philosophical school presents challenges to nursing ethics. Some of these challenges that are in contrast with nursing codes of ethics are the relativism in ethics, anti-authoritarianism, rejection of hierarchy, representation and paternalism.

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Axiology is an important topic of discussion in philosophical schools that deals with aesthetics and ethics. Axiology is related to ethics in its general sense and professional ethics in specific. Today, moral systems are seeking to answer man’s needs in various areas including professional ethics for psychotherapists. In this article, we have examined the axiology of illuminationism as the basis of our view and a major Islamic philosophy in order to draw from it the principles and methods of professional ethics for psychologists and psychotherapists. Sohrawardi, the founder of illuminationism, has offered certain instructions for the purification of ego. The aim of this article is to extract from this axiological system some implications that would be beneficial to psychotherapists. The method used in this research is descriptive-interpretive. Capacity, honesty, justice, benevolence, trustworthiness, commitment, respect for human dignity and secrecy are among the ethical principles of Illuminationism, and if psychotherapists can apply these values, their treatments and therapies will be more effective.