Iranian Journal of Medical Ethics and History of Medicine

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Philosophers of ethics and those who are involved in the debates concerning Medical Ethics have discussed the issue of human dignity and its cluster of meaning from different angles and have suggested many interesting points in this respect. However, a cursory glance at the published works in this field reveals that most of those writers who have contributed to this issue have either based their arguments on notions such as rights or justice, or have used theological doctrines, or have conducted their debates within the frameworks of pragmatic or particularistic ethics. In the present paper, I shall approach the issue from a new viewpoint which is mostly inspired and informed by the ideas of some analytic philosophers. The main argument of the paper revolves around the pivotal notion of “value of life”. All those who take positions vis-à-vis stem-cell researches and the morality or otherwise of using embryos for such investigations, or those who form opinions concerning the ethicality or otherwise of abortion, or those who try to find satisfactory solutions for the vexing issue of the allocation of limited medical resources, maintain, at least in an intuitive way, that the life of a human organism, in whatever shape or form, has intrinsic value. The life of such an organism whether it is a newly conceived egg or an embryo ready to be implanted in the womb or a foetus whose neurological system has just emerged, or a morally fallen adult, is intrinsically valuable. The idea that some things or events are valuable in themselves, namely, we respect them not because they serve our interests but because they are intrinsically valuable, is a familiar intuition. We have developed this ‘intuition’ through our long existential experiences. Now if we reflect upon this very intuition we will be able to discover further layers of meaning in it. For example, we realize that from the belief that ‘human’s life is intrinsically valuable’ one cannot conclude that one should multiply human life as much as possible. On the contrary, some of our other intuitions would inform us that at least some parts of the world would be better off if less populated than crowded. Thus the question arises that if the intrinsic value of human life does not mean its multiplication, then how the continuation of human life, once it has appeared, can have intrinsic value? In the present paper I shall try to use the apparatus of analytic philosophy to explore the ways of reconciliation between the two seemingly contradictory notions of ‘the intrinsic value of life’ and ‘the morality of sacrificing life under particular circumstances’.

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Lack of knowledge of the medical team about the regulations and laws of abortion can endanger mother’s health and also faces the medical community with serious problems. The aim of this study was assessment of knowledge and viewpoint of midwifery students in Tabriz Azad Islamic University and Tabriz University of Medical Sciences toward abortion. This study is a descriptive study which was conducted in 2013 on 300 midwifery students in Tabriz Islamic Azad University and Faculty of Nursing & Midwifery at Tabriz University of Medical Sciences. A four-part questionnaire was used for gathering data parts 1 to 4 included the personal, social, educational particulars of midwifery students and studying the students’ knowledge about the I. R. Iran’s regulations and laws regarding abortion, studying the students’ viewpoints toward legal and illegal abortion. Our study showed that 26.7% of midwifery students have proper knowledge about abortion, the knowledge of 53.7% of them was in the medium level and 19.7% of students have weak knowledge toward it. The positive viewpoint toward legal abortion was observed in 89.3% of the students and 10.7% of students had negative viewpoint. Our analysis showed that there is no statistically significant difference between students’ knowledge about abortion (P≤0.76), students’ viewpoint toward legal abortion (P≤0.44) and students’ viewpoint toward illegal abortion (P≤0.081). Although in our study midwifery students’ knowledge about abortion regulations was not sufficient, there is the high probability of their encountering with judicial problems. Therefore, it is recommended to raise the midwifery students’ level of knowledge about the authorized cases of abortion and regulations which may decrease the fines of criminal abortions in the future.

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Abortion is a challenging issue. It is proposed as a problem in medical philosophy and medical ethics texts. In dealing with abortion, graduate medical students may be influenced by different situations, or make a decision according to their conscience. Therefore they should acquire a satisfactory level of ethical development to deal with these issues during their years of education.Some things that are important for education on abortion are law, religious and moral reasoning, understanding the moral reasoning of people who request an elective abortion and related ethical philosophies. If health providers want to make the right decision and manage the patient suitably, they should be aware of the moral reasoning of the abortion applicant, religious moral reasoning, legal issues, and the ethical philosophies related to elective abortion, so they can do the best thing when dealing with abortion applicants. Sometimes the abortion applicant or the health provider thinks that abortion is an ethical action, but according to religion and the philosophy of ethics it is not. Therefore supporting health may be warranted by educating medical students on ethics as well as religious rules and legal issues.

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In recent decades, advancements in genetics and medical technologies have made it possible for clinicians to diagnose and sometimes treat fetal abnormalities in early gestational stages. This issue presents numerous ethical challenges for parents, doctors, ethicists, jurists and other professionals in terms of the continuation or termination of such pregnancies. A non-systematic review was performed to extract the main ethical codes that should be considered when offering counseling to pregnant mothers of fetuses with congenital anomalies. Moreover, since the attitude toward the status of such fetuses in the world of creation can strongly affect ethical decision-making, we attempted to investigate the issue further by offering some Islamic perspectives on the subject.Considering Islamic principles in offering ethical advice to Muslim parents of fetuses with congenital anomalies will help them make an informed and more appropriate decision in serenity. We hope the results of this study will facilitate ethical decision-making in health care and related disciplines, and thus help us deal properly with the issue of disabled fetuses.For future studies, it is recommended to compile related ethical guidelines based on Islamic principles to investigate various aspects of the issue.

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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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Chronic renal failure in infants is a life-threatening condition that can also severely affect their families. Patients and their families are under great physical, mental and social pressure, and therefore require medical, palliative and supportive care. Moreover, ethics has an important role in care for these infants and their families. The purpose of this study was to identify an ethical approach to providing medical, supportive and palliative services for infants with chronic renal failure and their families. The study was based on a case report in the Medical Ethics Grand Rounds of the Children's Medical Center in Tehran, Iran. The case pertained to a male newborn infant with diagnosis of renal failure. Assessments indicated severe bilateral hydronephrosis and multicystic dysplastic kidneys accompanied by high creatinine levels. The patient underwent surgery but further evaluations revealed a low glomerular filtration rate accompanied by elevated blood pressure. The physicians suggested insertion of a catheter for CAPD (continuous ambulatory peritoneal dialysis) after the initial peritoneal dialysis until a kidney transplant was performed. The proposal, however, was rejected by the parents and the patient was discharged by their consent. A few weeks later, the infant expired at home. It seems that health professionals need effective ethical strategies to offer medical, supportive and palliative services for infants with chronic renal failure and their families

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Self-defence is everyone’s right. Based on this right, one can defend himself against any eminent threat, even if it cause the predator’s death. This ethical principle is an applicable principle in ethics in war. However, the principle of self-defence has been applied in other situation such as justification of abortion if mother’s life is threatened by her fetus. Judith Thompson is a philosopher who defend abortion by applying this principle, in her book, “ A Defence of Abortion”  Thompson categorized pregnancy into two types, wanted and unwanted pregnancy, argues that abortion is justified in wanted pregnancy if mother’s life is endanger. She also discusses the involvement of a third party in performing abortion. However, her argument has been criticised by her proponents as well as opponent. This article examines the principle of self-defence and its application in justifying abortion as well as   the involvement of a third party in Thompson’s perspective.

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