Iranian Journal of Medical Ethics and History of Medicine

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Information is the symbol of the present age due to the significant development in accessing, processing, storage and transferring information. Information societies have been formed by the widespread utilization of information and communication technologies in human social life and generally focus on the computer systems and information networks. Nowadays, various technologies of medical informatics comprise an important component of the management infrastructures of health care systems. Medical informatics is the development and assessment of specific methods and systems for acquisition, processing and analyzing patients' data with the help of knowledge and information from scientific researches. Moreover, it intends to increase access, improve quality and decrease the costs of care through decreasing chronological and geographical limitations. On the other hand, ethics have been always considered as a basic component of these systems. The increasing development of digital technologies and their application in health information management provides numerous benefits however, it encounters health care managers with new challenges in the information societies. These challenges may has been mainly caused by the conflicts among ethical principles by themselves or disregarding them in the field of medical informatics. Therefore, careful consideration of info ethics as well as beneficence, autonomy, fidelity and justice is essential to overcome those conflicts in the information societies.

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Illnesses and their treatment, pharmacy and pharmacology, medical equipment, hygiene and health related topics, health economics, preventative measures, lab equipment and supplies, human resource service delivery models, education and training of health care professional, and associated areas of law are collectively referred to as the health care system. At times it is even difficult to separate health care from social injuries and civil conditions, since these can pose direct or indirect threats to individuals’ health. As health policy makers, managers and professionals demand and encourage the observance of ethical considerations in providing health care, neglect of the legal aspect of the health care system can bring about unethical phenomena that necessitate legal measures. The present paper aimed to determine whether the general traditional legal classifications, that is, jurisdiction and sovereignty, apply to the health care system, and if so, which of the two it falls under. What further highlights the significance of answers to such questions is the fact that they are closely connected to regulations of the health care system. It could well be that some companies in the health industry have a negative effect on the ethical conduct of physicians and other health care professionals, as due to their commercial nature and structure, these companies are dominated by rules of business, and this exerts limitations on their observance of ethical considerations. This study investigated a number of such seemingly legitimate situations and the problems associated with them, hoping to eliminate legal conflicts and promote ethics in the process of providing health care in the society.

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Conflict of interest is a real situation in which a person as a decision maker simultaneously has two positions, one in private and the other in the public. In public role he or she has to pay attention to the society`s best interests and follows his or her best ones as private role. Conflict of interest is a common challenge of health system among both real and legal persons in all courses such as education, treatment, and researches.
The most causes of conflict of interest are named as deferent goals, lack of resources, authorities malfunction, health marketing and etc.
We aimed at discussing conflict of interest and its relation to law, its management, conflict of interest in pharmacy and pharmaceutical companies and also Iranian legal system viewpoint. In conclusion it seems that conflict of interest should be included in the law and the provisions to achieve the least conflict of interests in health system should be revised.

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Healthy volunteers are the first group who take part in experimental studies on the efficacy of new drugs. Parallel with expanding the boundaries of medical science, medical research has shown rapid growth which has caused new and critical ethical challenges in medical research.A clinical trial is one of the essential methods in clinical research and a very challenging method from the ethical viewpoint.Recruiting healthy volunteer participants is necessary in clinical trials of drugs, and it requires special and careful ethical considerations. Although recruiting healthy volunteers is not limited to clinical trials, we have focused our discussion on ethical issues of research on healthy volunteers in this kind of study. In this paper, ethical challenges of involving healthy volunteers in clinical trials have been discussed in four domains of risk-benefit assessment, fair subject recruitment, incentives, and informed consent. The authors believe and argue that using the daily life risks standard as the acceptable risk for healthy volunteers is impractical. We suggest defining a reasonable risk that is acceptable to the research ethics committee. The ethical committee, as a jury, can then evaluate the public acceptance of the risks.

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In the middle age (500–1500), while European countries were struggling with frightening epidemics such as plague, smallpox, tuberculoses, leprosy, and their medical treatments were based on superstitions and fanaticism, scientists such as Avicenna and Rhazes laid the foundation of the golden period in medicine. In the late periods of golden centuries, during the Mogul invasion of Iran, Rashidaddin Fazlollah Hamadani devoted a great deal of effort to preserve the knowledge by foundation of the knowledge city of Rabé Rashidi and Daralshafa (Medical and Health Service College) in Tabriz. Rashidaddin established a successful health management system which was accordance with the current modern health management systems. The objective of this review is to present a clear perspective of a successful Iranian Islamic model of health delivery system 700 years ago. The review was conducted in the form of descriptive bases of original documents with a systemic approach. Findings show a successful management experience in health system in terms of stewardship, resource allocation, provision of health services and financing which appears to be in accordance with the World Health Organization (WHO) declaration in 2000. Promotion of team working, employment of fulltime and part-time physicians, implementation of a fair and functional economic structure, health economic, sustainable financial mechanisms, public insurance, home care provision, and isolation of communicable diseases in hospitals can be considered as examples of a successful Iranian Islamic health management system. It can be concluded that as Iranian health management system is faced with many different challenges, gleaning lessons from successful national historical experiences can play a key role in the establishment of a competent system based on our Islamic and national values and in accordance with modern scientific achievements.

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Justice is one of the main principles of ethics in the healthcare system, and its establishment at macro level depends on formulation of appropriate policies by policy-makers and healthcare providers. Health care policies and payment and reimbursement systems have a significant impact on health systems’ efficiency and cost control. In this paper, payment and reimbursement policies and their impact on financial incentives will be reviewed moreover, financial policies in the national health care in Iran and related challenges will be mentioned in brief. There is no doubt that none of the payment and reimbursement policies is perfect and each of them has the potential to put caregivers or health care providers financially at risk. Therefore, policy-makers should select a combination of the best approaches, considering socioeconomic factors, in order to provide a maximum coverage of health services and ensure fairness in the health system. Efficient payment and reimbursement approaches should undoubtedly preserve the rights of all parties in a fair and logical manner. Current national policy shows that a high percent of health care expenditures are financed through out-of-pocket payments, and therefore appropriate policies should be adopted to lighten this burden. Considering the accelerated trend toward the Family Doctor Plan in big cities in Iran, the present paper would be helpful for many health care providers, physicians and other health care professionals.

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In recent years, the financial relationship between the physician and the patient and some issues such as informal payments for health care have arisen as an unethical but common problem in many countries, including the Islamic Republic of Iran. Such issues are a threat to the professional reputation of physicians, and can have their own causes in different parts of the world. This study attempts to assess the causes of informal payments and the manners in which they are done in the hospitals of the Kerman Province in Iran in 2012. This study was carried out using qualitative research methods, and semi-structured interviews. Structured interviews were conducted on a purposeful sample of 45 participants including patients, providers and policy makers in the Kerman province in Iran in 2012. This study was authorized by the ethics committee of Kerman University of Medical Sciences, and the consent form was completed by all participants. In this study the participants were asked questions regarding reasons for informal payments, and data were analyzed using content analysis. There are several reasons for making informal payments, which include cultural, legal and quality factors. A number of reasons for asking informal payments by providers were discovered, including those related to tariffs, structural factors and ethical factors as well as to demonstrate the skill and competence of service providers. Most of the reasons discovered for informal payments in Iran are similar to other countries in the world. They showed that inadequate funding of the health systems and inadequate formal payments to providers are the most important supply-side factors leading to informal payments. Given that qualitative studies usually cover potential reasons only, further studies are needed to investigate the matter more extensively.

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Breaking bad news emotionally affects both health professionals and patients. Breaking bad news is a sensitive issue for both health care providers and patients. It is generally believed that the patient’s adjustment can be affected by either a positive or a negative experience in this respect. This study aims to determine health care providers’ attitudes toward breaking bad news to parents in NICU and labor wards.This cross-sectional study was conducted in Shahrecord in 2011 with a study sample of 70 health care providers drawn from neonatal intensive care units and labor wards and the department of nursing and midwifery who had had at least one year’s clinical experience. The sampling method was census. Data were collected through a self-administered questionnaire in two sections: demographic information and health care providers’ attitudes toward breaking bad news. Data were analyzed by SPSS software with descriptive and Chi-square and T-student test statistics. Most participants (63.2%) had a positive attitude toward disclosing bad news to parents. 77.6% of caregivers faced difficulties in delivering bad news to parents, 92.6% of them believed that training workshops in this field are necessary. There was a significant statistical relationship between the attitudes of the health care providers and their education level and work place (P < 0.0001). Health professionals with higher education levels and nursing and midwifery staff had more positive attitudes.There was no significant statistical relationship between the attitudes of the health care providers and their history of difficulties in transferring bad news, workshop trainings, work experience, gender, age and marital status (P > 0.05). The majority of health professionals had a negative attitude toward immediate disclosure of bad news to parents, mothers holding and seeing their deceased babies, dedicating a special room to perinatal loss mothers with similar problems, and preventing other patients and their families from contacting them.Based on the findings of this study, teaching bad news communication skills to personnel of NICU and labor wards should receive prioritization in future continuing medical education programs in order to best prepare the staff for disclosure of bad news to parents.

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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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It has been over five decades since the concept of “spiritual health” was first introduced in academic texts, and although many studies have been conducted on the subject, there exists no consensus on its definition and components yet. Nonetheless, this concept has been an inextricable part of Islamic Theology, which is more than several hundred years old. Therefore, it can be asserted that observation and analysis of the lifestyles of Muslim scholars may shed some light on this seemingly complex concept. This analytic-descriptive article was designed to provide a straightforward definition for spiritual health and explore its different components from the viewpoint of Ayatollah Hassanzadeh Amoli, a renowned Shiite scholar. In this article, spiritual health refers to the health of the soul and is related to both material soul and the body itself. The Ayatollah puts special emphasis on the importance of living a healthy lifestyle and on the health of the material soul in order to promote spiritual health. In this article, we endeavor to conduct a thorough analysis of the lifestyle and views of Ayatollah Hassanzadeh Amoli.

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A model is a summarized representation of facts. Health-related models show values, perceptions and various understandings of health care. This study investigated the nursing advocacy models and the nurses’ protective role. In this review article, related literature and documents were searched in PubMed, Science Direct, Proquest, Google Scholar, Magiran, Iran Medex, and Scientific Information Database, using the general search engine Google. The search was performed by keywords “advocacy” and “nursing advocacy model”. In this stage, 89 sources including books, articles and dissertations on the subject of nursing advocacy written between 1991 and 2014 were collected. In the next stage, 43 sources were chosen for the review article. Finally, 8 models that were more consistent with the topic and objectives of the study were extracted. Considering the findings of this study and the benefits of nursing advocacy, we propose to design a model in order to promote the advocacy role of nurses in Iran. In this model, legal constraints, social factors and values, organizational culture, position of the nurse in the health care system and political‌ and economic considerations should be taken into account.

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Patient autonomy is the opposite of paternalism and an essential element in individualised, patient-centred, ethical care. Challenges associated with patient autonomy are culture-related and have not been fully investigated in Iran so far. The aim of this study was to explore the challenges to the autonomy of patients in Iranian hospitals.This was a qualitative study using conventional content analysis methods. In 2013 13 patients, 7 nurses and 1 doctor were selected from three Tabriz and Hamadan teaching hospitals using purposive sampling to participate in semi-structured interviews. The interviews were subjected to qualitative content analysis and analysed using the MAXQD10 software.Fifteen categories and three themes were identified. The three main themes related to challenges associated with patient autonomy were: interpersonal factors, altered relationships, and organisational constraints. In summary, this study revealed some challenges associated with patient autonomy that the treatment team, managers and planners in the health care system should target in order to improve patient autonomy.

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Breaking bad news to patients and their families is an important issue in health care services. Since access to information is among the basic rights of the patient, investigating the experiences of patients and their families after receiving bad news can make the process more purposeful and prevent unnecessary suffering. This study aimed to describe the experiences of patients and their families after hearing bad news from health providers.The present study was conducted with a qualitative, phenomenological approach. Participants were selected through purposive sampling from people who had the experience of receiving bad news during 2013 in Birjand, Iran. The sampling process continued up to the point of data saturation, which reduced the number of participants to 10. Note-taking was used to complete the data collection process. In this study Colaizzi's method was used for data analysis, while robustness of the study was assessed based on the criteria of precision.The subjects were between 25 and 70 years of age. First, according to Colaizzi's Method, 280 codes were obtained which were the same as the developed concepts. At this point, the code lists were extracted. Different thematic categories with similar meanings were placed in 5 thematically larger groups as follows: 1) tension at the beginning of the encounter, 2) adaptive responses, 3) spiritual relief, 4) family crises, and 5) seeking support.Patients and their families showed different reactions upon receiving bad news. The study showed that health providers can contribute to a better adjustment of patients and families and promote peace by acquiring a methodical approach while delivering bad news. This can be achieved by identifying the reactions, confusions and tensions, as well as introducing adaptive or supportive resources to patients and their families.

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Nowadays, electronic communications technology propounds new forms of the patient-physician relationship in the field of medicine. Effective communication between the patient and the physician can play a crucial role in the process of treatment. This new form of communication greatly influences promotion of the health system by improving access to inexpensive and fast services regardless of geographic boundaries. In times of crisis, telemedicine plays an important role in delivering health services to deprived areas in a just manner. Usage of communications technology is inevitable, and due to the virtual nature of this kind of medical communication, recognition of certain ethical considerations seems essential. Successful examples of telemedicine are abundant throughout the world and usage of this technology is a helping solution for inadequacies in the healthcare system. In Iran, because of the geographical extent of the country, this technology can provide access to medical services in some cases.In order to achieve the best outcome in telemedicine, it is essential to respect confidentiality, privacy, informed consent and commitment to professionalism in this field.

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