Iranian Journal of Medical Ethics and History of Medicine

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Theologians describe the difference between active and passive euthanasia as in the former, we kill hopeless patients terribly suffering from an incurable disease and in the latter, and we let them die. The present research aimed at exploring for a solution to an ethical dilemma by which the difference between foundational concepts of the two types of euthanasia can be examined. Another objective of the study was to assess personal characteristics regarding this judgment. One hundred and five students were recruited, and in addition to reading the trolley problem and answering the related questions, they responded to a six-point scale self-assessment on morality and a short 20-point scale questionnaire on the five principle personality factors. Results showed that 83.8% of respondents found it immoral to kill one person in order to save 5 lives. Respondents' gender, religiousness and personality had no significant effect on their responses regarding the footbridge dilemma (P<0.05). Nonetheless, extroversion had an almost significant relationship (P=0.056, r=0.19). According to the results of the present study, the difference between "killing" and "letting die" is clear to most people, and they do not prefer killing even when there is more benefit than loss. Responses to the trolley problem were independent of personal characteristics, nonetheless, the quality of extroversion is suggested a as a potential determinant of agreement with active euthanasia.

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Moral dilemmas are among the most important challenges in medical ethics. Dilemmas can occur frequently during a physician’s career and if physicians lack the ability and skills to solve them, they may be pushed to unethical behavior. Bioethics experts have always been concerned with solving ethical dilemmas in the medical profession and facilitating physicians’ decision-making process. Therefore, they often try to find useful and practical solutions by combining the views of different schools of ethics. Designing decision-making models is part of their effort to apply ethics in medicine. It is impossible to solve dilemmas without acquiring the necessary skills, and the ability to apply a decision-making model can be part of the training process.

These models aim to facilitate ethical decision-making in the field of health care by providing various frameworks. This article aims to introduce and evaluate the popular models of ethical decision-making in medicine in the hope of helping physicians choose appropriate solutions when faced with moral challenges. By presenting the advantages of applying the model approach and offering a brief introduction to popular models, the article recommends applying the approach in analyzing and resolving ethical dilemmas. Although the models each have their advantages and disadvantages, becoming proficient in their application will facilitate ethical decision-making for physicians.

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Despite all recent advancements in medical sciences and the related technologies, the concept of death still remains obscure. It can be asserted that as death includes both physical and spiritual dimensions, medicine alone is not capable of fully illuminating its different features. Therefore, inter-disciplinary collaboration between different branches of science such as Quranic studies, humanities, and philosophy seems necessary in order to shed some light on this hitherto undiscovered subject. Through description of what the soul experiences before and during death, such collaborations may even enrich the knowledge and broaden the minds of physicians who are capable of the analysis of physical changes caused by death. This insight can promote the ethical decision-making process as well as the provision of end-of-life care and spiritual support in different stages of death. The current research, as a library literature review, endeavors to provide a descriptive view of death from a medical perspective, and then, a Quranic depiction of its different stages through an analysis of verses and quotations from the holy Quran and Islamic scriptures whose primary focus is the process of dying. The final discussion section presents some similarities and differences observed between viewpoints and raises questions which can be considered as being of great practical importance in terms of provision of necessary end-of-life spiritual support. We hope that further research in this field can better clarify the issues raised in this article so that practical measures aiming at the provision of Quran-based spiritual end-of-life care are designed and implemented.

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