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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Cloning, especially human cloning, is the latest technology of the present time and has become known as "the debate of the century". Since its appearance, the technique has created global concern for scholars. The physical injury ensuing from the manipulation of women ovaries, nucleus and embryo, potential mental and spiritual harm, incurable disease and early aging are among concerns in this regard which necessitate research and investigation. Providing a precise philosophical framework to alleviate these concerns and end the battle between scholars of natural sciences and humanities over this technology calls for more research and investigation with a deep and philosophical view.In the present manuscript titled "Human cloning technology with a view to Kant's anthropology", first philosophical thoughts and ideas of Kant about human beings are reviewed, his anthropologic thoughts and ideas were analyzed. Finally we conclude that human cloning conflicts with Kant's accounts in anthropology because according to Kant, humans have cognition, free will, and self-discipline, and they have the right to human dignity. According to Kant's anthropology, human cloning technology, whether for therapy or reproduction, should be declared illegal.

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Throughout history, various religions and schools of philosophy have viewed human dignity as an important issue and a topic of discussion. The theoretical roots of this concept lies in ancient philosophies and religions, in Medieval as well as Modern periods, the most significant of which may be the Cyrus Cylinder, Stoicism, teachings of philosophers of the Renaissance period and of thinkers such as Immanuel Kant and John Locke, the Universal Declaration of Human Rights, and Abrahamic religions. Human dignity is infallibly referred to as being intrinsic and inviolable, and although there is no one comprehensive, inclusive and universally accepted definition for the term, it is fundamentally the characteristic that lies at the core of the basic rights of humans. In biomedical ethics there are two different dimensions to human dignity: the dignity of the individual and the dignity of humanity as such, and while the former is considered to be absolute, the latter is relative, as it is realized simply by belonging to the human race. Human dignity applies to all the principles of biomedical ethics, and sets the standards for all manners of reasoning and inference in this field. In areas such as research ethics, ethics of beginning of life and end of life care, and public health ethics, human dignity has clear requirements and implications, for instance regarding issues such as unethical uses of the embryo, fetus, and the human body for commercial purposes, the right to live and die with dignity near the end of life, and the right to basic indiscriminate health care.

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The astonishing advances in medical sciences, owing to research in recent decades, have brought about endless advantages for humans, including improved level of health, prevention of communicable disease, and curative treatments. This trend, despite its great benefits, may undermine the principle of respect for human vulnerability and personal integrity, and expose certain risks to target populations or those excluded from investigations. Therefore, the principle of respect for human vulnerability and personal integrity has received attention by policy makers, law makers, human rights activists, and international organizations. It is necessary to cite the important question that arises here is there any contradiction between international documents' demands such as the Universal Declaration on the Human Genome and Human Rights and the legal actions of some countries on the principle and merits of Islamic teaching? If not, what type of activity should be undertaken by legislators in Islamic countries in general, and the Iranian Parliament in particular? An in-depth discussion of the issue reveals the fact that there is no contradiction between Islamic law and the principle of respect for human vulnerability and personal integrity. Therefore, there is room for the national legislative body to take legal actions in order to achieve the objectives of the principle of respect for human vulnerability and personal integrity in medical research and practice as articulated by international instruments such as the Universal Declaration on Bioethics and Human Rights in particular.

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 Practically, scientific foundations illustrate that the embryo plays a main role in the related technical scenarios. Considering this fact, if technical researches orientated to human subjects, essential legal and juridical arguments will be generated. This article aims to offer a new analysis about moral and juridical nature of human embryo and the associated parental relationships. Adopting this idea that the embryo before 4^th month has no human dignity, the author attempted to present a parental relationship based on ownership and material value. Although the author believes that this idea is built on the legal foundations, it primarily seems that the adopted idea will be faced to moral challenges. From the stand point of this article the concept of the material value of the embryo absolutely refers to an intrinsic value and it doesn’t necessarily relate to financial treats. On the other hand, according to the main pure content of the Islamic juridical rule of Taslit, it illustrates that the right of ownership has been limited by different restrictions .

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Heart failure not only affacts the patients but also their families and social networks. This study was conducted to evaluate the development & psychometric properties of the Social Dignity Questionnaire (SDQ) in heart failure patients. This study is an exploratory research of questionnaire design type. Twenty two patients with class II to IV heart failure (New York Heart Association Functional Classification) were chosen through purposive sampling from selected hospitals of Tehran, and semi-structured interviews were conducted with them. Qualitative content analysis was performed to analyze the interviews. The primary items were developed based on the findings obtained from the interviews, literature and designed questionnaires about social dignity. Content validity and construct validity were determined in 130 patients with heart failure. The data were analyzed using SPSS version 19. Through face validity and content validity analysis, 16 out of 101 primary items were removed. As a result of exploratory factor analysis, 2 items with factor loading less than 0.5 were deleted, and 6 were removed due to inclusion in other factors. The following five factors were extracted: family communication and support, social communication and support, health care communication and support, burden to others (physical, emotional and social), and burden to others (economic). Reliability of the Social Dignity Questionnaire (SDQ) was calculated to be 0.97 by using Cronbach’s alpha coefficient, and 0.99 by using split-half method.Considering the acceptable validity and reliability of the questionnaire in the present study, its application can be useful in planning support for patients and improving their treatment and care. The questionnaire may also be helpful in conducting further research related to dignity in different patients

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Respect for the inherent dignity of human beings means respecting their basic rights in different environments, and this has an important role in studies and discussions about health care. This study was conducted on the development and psychometric properties of the Inherent Dignity Questionnaire (IDQ) in heart failure patients. The present study is a methodological research for designing a questionnaire. First, 22 patients with class II to IV heart failure were chosen by purposive sampling from patients of Hazrate Rasoule Akram, Imam Hossein and Shariati hospitals of Tehran, and semi-structured interviews were conducted on ethical issues until data saturation was achieved. A qualitative content analysis was carried out to analyze the interviews. Then, based on the findings obtained from the interviews, literature, and the designed questionnaires about inherent dignity, 39 items associated with inherent dignity in heart failure patients were developed. The face validity of the questionnaire was determined. To measure the content validity of the questionnaire, opinions of 12 experts were used considering Content Validity Index (CVI), Content Validity Ratio (CVR) and Lawshe table. To assess construct validity of the IDQ, exploratory factor analysis and to determine the reliability of the questionnaire, internal consistency with Chronbach’s alpha coefficient and split-half method were used on 130 patients with heart failure. The data were analyzed using SPSS version 19.Through face validity and content validity analysis, 4 out of the 39 primary items were removed, leaving 35 items. Through exploratory factor analysis, 11 items with factor loading less than 0.5 were removed and the IDQ was created with 24 items and three factors (9 items on the first factor, 8 items on the second factor and 7 items on third factor). These factors were: "inherent dignity in family", "inherent dignity in the community" and "inherent dignity in health care environments". Reliability of the Social Dignity Questionnaire (SDQ) was calculated to be 0.94 by using Cronbach's alpha coefficient, and 0.96 by using split-half method.Results of this study showed that the IDQ is adequately valid and reliable. Therefore, using this questionnaire can be beneficial to planning support for patients and improving their treatment and care and doing further research related to dignity in different patients.

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Considering and preserving patients’ human dignity is one of the most essential moral obligations in the medical and nursing professions. Indeed, respecting patients’ human dignity is the essence of nursing care which is frequently emphasized by national and international nursing standards.This study was conducted based on the qualitative approach, using an interpretive phenomenological method, which aimed to explore the meaning of patients’ dignity preservation based on nurses’ lived experiences. Using purposeful sampling method, a sample of 12 participants was chosen and the data were collected through 16 individual, in-depth and semi-structured interviews. The transcribed interviews were analyzed based on the hermeneutic approach using the analysis method proposed by Diekelmann, Allen and Tanner (1989). The mentioned interviews continued until no new meanings emerged and until the researchers were satisfied with the depth of their understanding. Through fusion of the horizons of the participants’ lived experiences and the researchers’ pre-understandings, the extracted meanings of patients’ dignity preservation emerged as: “respecting the equal human essence”, “providing professional patient-centered care” and “respecting the rights of patients’ companions”.The findings revealed that it is essential to respect the patients’ and also their companions’ rights and recognize the humanness and individuality of each patient for preserving and promoting patients’ dignity and providing more dignified care at the bedside.

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The nature of human dignity is among the most basic queries about the essence of humanity, and research in this area can produce results that may be applied to various health related topics. There is a need for defining comprehensive criteria for the bio-human in order to protect human rights and other values that are attributable to human biology.The present paper first attempts to determine whether abstraction is the base of human dignity, as opposed to contraction. The authors argue that the former may not be the case, as dignity is value-based and therefore implicates moral orders. Such issues cannot be abstracted from external existence, so one can assume contraction to be the base of human dignity. In that case, contraction requires a contractor or an origin for contraction. Self-contracted values are invalid and worthless, and by the same token, external existences are incapable of dignity. Therefore, a stable contractor is required to justify stability and the native essence of contracted dignity, and only God can be that stable, conscious, senior contractor.Among the criteria for dignity, the authors focus on those essential characteristics that differentiate humans from other organisms, and argue that these could be considered as the basis for dignity.

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Genes are considered as “green gold” in this era of biotechnology. Currently, multinational companies and governments search continents to find this valuable asset in the hope to discover people with unique genetic characteristics that can be converted into capital and marketed in the future. Modern economy provides the framework to analyze any new technology from the advantage perspective and has vastly transformed the concept of capital and market thus, humans or any organism with specific genetic characteristics can be converted to capital and offered in profitable markets. Patenting and ownership of genetic resources without consideration for principles of inherent human rights will impact the society and result in a violation of these rights, especially those of vulnerable individuals and groups. In spite of the numerous benefits of biotechnology for individuals and the society, the risks to human dignity, equality, health, autonomy and research, as well as the possibility of information abuse should not be ignored, especially considering the alliance between technology and economy. Biotechnology can make claims to ownership of human life and desired genetic traits, and this is a problem caused by the biotechnology revolution in developing countries and consequently, indigenous peoples of these countries have shown different reactions to such issues. This article will discuss “human commodification”, which is a serious concern in the field of biotechnology in our world today

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The criteria for human dignity are among the most important topics associated with the concept. Some related questions are what makes man worthy of dignity, and what properties make him more dignified than other creatures? Although biological classifications of species should be considered in humanities, research on dignity must focus on differences that are fundamental and separate humans from all other species. Morphological, genetic and communal differences cannot be the criteria for dignity, and behaviors are subject to individual outlooks. This manner of reasoning guided scholars to categorize humans on the basis of wisdom, but the author of the present article believes that wisdom cannot be the criterion for dignity. There is a degree of intelligence and wisdom in other creatures that is not sufficient to make a fundamental differentiating factor. Like other faculties, wisdom may be regarded as an instrument for a better life. The authors believes that the “authority” to choose (that is, free will) is the essential difference between humans and other creatures because the latter are driven only by their structures or needs. This authority enables people to choose between good and bad or desirable and undesirable, and shapes most human values. Consequently, this authority creates the basis for dignity and any given type of choice passes its value on to the chooser.

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“Koran” had affirmed “Human Dignity” but in other verse, it had mentioned “Caliphate/Substitution” and “Deposit” about human in comparison with other creatures that they had difficult and covered interpretations. “The choice of good and evil” as Human Dignity criterion, makes it easy and transparent.
“Deposit” verse says Human accepts Deposit and others refuse it because of 2 adjectives: “Zaloom” and “Jahool” from roots of oppression and ignorance. Interpretations are different in meaning this adjective and their relation to deposit. If deposit is choosing, it can make oppression and justice and knowledge and ignorance. Then “FAOOL” structure in Arabic can show potency of action/adjective. Thus, they mean potent for oppression and ignorance like justice and knowledge. It means choosing potency, not actual ugliness.
In “Caliphate” verse, angels say to God that Human creation tend to corruption and killing. God hadn’t refused it but had referred to an upper knowledge. If Caliphate is good choosing too along justice and knowledge, angels had seen properly contemporaneous ignorance and oppression and corruption and killing but they couldn’t recognize the difference between good free discretion and their algebraic goodness that is caliphate and moral similarity and free worship of God with Lordship essence.

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