Iranian Journal of Medical Ethics and History of Medicine

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Rapid development in assisted reproductive techniques has brought hope to many childless couples, while it has created new social, ethical and legal dilemmas. Stored frozen gametes and embryos have led to situations where the surviving spouse wants to create offspring after the person's death. Also, the possibility of sperm retrieval even after 36 hours of death, and getting oocytes from aborted fetus or brain dead people has brought a new term: "posthumous assisted reproduction". Posthumous assisted reproduction is the most challenging, difficult, and sensitive issue to be discussed ethically and religiously. In this paper, the acceptability of the posthumous reproduction in Islamic context was evaluated. In Islamic societies where infertility is viewed as a problem of families, posthumous assisted reproduction seems unacceptable. Major concerns such as consent and ownership of the gametes after death, family, marriage and welfare of the child are discussed together with some legal issues. Based on infertility as a disease of family, posthumous assisted reproduction is unacceptable even with previously frozen gametes or embryos. Also, Islamic vision to marriage, consent and welfare of the child confirms the unacceptability. There must be law or guideline to ban this procedure in Islamic contexts.

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Birth of a poor prognosis neonate (premature and/or congenitally affected) may potentially burden the family and/or society with many ethical, social, legal, etc challenges. Most of the decision making criteria used in handling the care of these neonates, such as disability, quality of life, etc., are multidimensional and heavily ethical bearing. In this study, we have tried to explore and present a perfect view on the existing challenges and different dimensions of the discussed criteria. In the end, the prominent standpoint of the Islamic school in confronting a severely disabled newborn has been introduced and analyzed. Most related discussions boil down to some fundamental and unanswered questions, for instance whether human beings should be permitted to make decisions about the life of severely diseased neonates, the decision making criteria themselves and their appropriateness, etc. Even though many scientists have theorized on the subject, a multilateral explanation of life and death criterion has not been presented yet. One thing is for certain and that is, in answering the basic questions of the subject, our present knowledge and experience is limited and insufficient. The authors have tried to show that despite many western views, decision making about the life of a neonate has no place in Islamic teachings, since it could be considered an unauthorized human action. Instead, it is proposed that any attempt to provide an ethical rationale, while utilizing today's science and technology, be in compliance with God's commandments.

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By the late 1960s, there seems to be a growing number of articles in medical journals on the subject of the distress that many terminally ill patients declared they had gone through due to repeated resuscitations that only prolonged their suffering. This demonstrates that standard protocols of resuscitating any patient who is undergoing a cardiopulmonary arrest may bring about new problems. A review of studies shows that dealing with patients who are in the last days or hours of their life has been a major challenge for healthcare professionals, and making decisions on therapeutic approach is one of the most fundamental skills for healthcare staff. The scientific, ethical, religious and legal dilemmas in this field make decision-making difficult in some cases. In this paper, we reviewed articles published during the past 30 years, through which the views of health care providers including physicians and nurses on the issue of do not resuscitate (DNR) orders in different societies had been studied. The Islamic perspectives have also been discussed in brief. Moreover, DNR guidelines prepared by various countries such as America, Britain and Saudi Arabia have been assessed. For searching the related studies, we used authentic electronic databases and many reliable websites. Some articles were obtained through hand searching of the references of searched articles.The results showed that despite substantial studies, caring teams are still facing the challenge of DNR in different societies. In Iran, considering the religious values and beliefs, the matter needs more deliberation to help the caring teams to deal with the clinical issues. The religious and cultural background call for a national guideline to be adopted based on Iranian-Islamic culture. Education and awareness rising of different groups including patients, general public, healthcare staff, and health policy makers is crucial in all countries all over the world, and particularly in Iran.

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Medicine is a branch of health science with the purpose of maintaining health and health promotion, diagnosis, treatment and prevention of diseases, and rehabilitation of patients. In addition to possessing academic qualifications and legal training, physicians and service providers should be familiar with moral and jurisprudential considerations in their profession, as is rationally and logically expected.Respect for moral values ​​and legal principles is important since on the one hand it gives the service provider a feeling of fulfillment, and on the other hand it causes the patient to feel satisfied with the service offered.Islamic laws must be observed in all aspects of life in our country and medical practices are not an exception. Therefore it is necessary for all practices to be approved by jurists and to comply with the principles of Islamic jurisprudence and ethics. Consequently, practitioners need a thorough understanding of Islamic laws and ethics in order to be considered qualified. In this regard it should be remembered that Islamic jurisprudence, or Sharia refers to a set of laws and rules of life defined by the Quran and its interpretation and explanation by the great Prophet of Islam (SAW) and Imams (AS). In Islamic culture, law and medicine are closely related to each other. Many physicians are staunch followers of the Islamic jurisprudence and try to observe them in their diagnostic and therapeutic approaches, and in cases where they have dilemmas and are not certain what course of action to take, religious standpoint is what guides them to make the right decision. In recent decades, physicians have tried to apply Islamic laws in the context of medical or jurisprudential problems. This article investigates the realm of medical jurisprudence and medical ethics.

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Confidentiality is one of the oldest principles of the medical profession that impacts on the relationship between physician and patient, the personal interests of patient and physician and consequently social welfare. While emphasizing the necessity of confidentiality, religious teachings consider disclosure of others' secrets a sin that deserves punishment thereafter. Nowadays, medical developments and the invention of new diagnostic and therapeutic procedures as well as the vastness of the informatics world make disclosure of patients' secrets easier than ever. This review article is the result of a descriptive study, and the information was collected using reliable library and internet resources. It will first expound the concepts and principles of confidentiality in medical ethics as well as Islamic ethics, and will then proceed to a comparative review of the similarities and differences in these two sets of­­­­ ethical views on the issue of confidentiality. In addition to the emphasis of medical ethics and Islamic ethics on the necessity of confidentiality in order to win public trust, both sets of teachings cover two areas of personal and public discretion, while in Islamic ethics, the issue extends to a third from, namely religious confidentiality. This makes Islamic ethics more comprehensive in the sense that based on Islamic teachings, the person who keeps someone's secret will also be rewarded in the Hereafter. Also, in medical ethics, only the behavior of the health staff is evaluated and their moods and motives are not taken into consideration, while Islamic ethics pays attention to human dispositions and therefore confidentiality is more stable and can maintain its efficiency without external supervision.

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Biotechnology is a high technology that is bound to play an important role in the future world due to its wide range of applications in different parts of industry, agriculture, medicine, environment and so on. In our country special attention has been paid to biotechnology as a strategic technology. While the production and consumption of genetically modified organisms (GMO) products is witnessing an upsurge in the world on account of the value of cultivation and production, Iran does not have a noticeable share in this field. Food and agriculture organization (FAO) has predicted that food preparation for the 9.1 billion world population in 2050 will require a 70 percent increase in food production throughout the world and a 100 percent increase in food production in developing countries. Report of the International Service for the Acquisition of Agri-biotech Applications (ISAAA) indicates that biotechnology can be a key solution to the growing demand for food in the world. The development and operation of targeted biotechnology in compliance with all aspects of biosafety and bioethics will cause food production and productivity to increase. Naturally, this depends on culture making, production and commercialization of GMO products and changing the society’s consumption pattern. Jurisprudential views of consumption of GMO products, however, will lead us to bioethics-related issues and proper use of such products. In this study the views of grand jurisprudents were pursued about various aspects of direct and indirect consumption of GMO products in the form of four questions. All of the grand jurisprudents permit consumption of GMO products, and some do so with reservations: that they do not entail losses in the present and future, and that product information be truthfully disclosed to customers. This paper reports the responses received, and discusses the bioethical aspects of the views of grand ayatollahs.

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The study of work ethics has gained great significance in recent years following the failures of major corporations and the West’s crisis. The main objective of this study is to examine the relationship between Islamic work ethics (IWE) and organizational commitment and its three dimensions including affective, continuance and normative commitments. This is a descriptive study that has been conducted in 2010. One hundred and fifty nine employees participated in this study who selected from hygiene, nursing & midwifery, pharmacy & medicinal sciences, dentistry, rehabilitation sciences, and management & information faculties through stratified random sampling. Data were collected via the 17-item Islamic Work Ethics Questionnaire, constructed by Ali (2000), and the 24-item Organizational Commitment and its dimensions questionnaire, constructed by Meyer & Allen (1991). The collected data were analyzed through correlation and regression using SPSS17. The result of factor analysis confirmed the multidimensional nature of organizational commitment. The result of correlation and regression analysis also showed that there is a positive and direct relationship between IWE and total organizational commitment and its three dimensions. The demographical variables did not impact on IWE and organizational commitment. According to the results, the employees of Isfahan University of Medical Sciences are committed to the organization either because of an emotional bond to the organization or in the absence of better job opportunities outside the organization. It may be beneficial to convey these results to managers in order to make them aware of the fact that the employees are not reluctant to leave the organization for a better job with better conditions. In view of the relationship between Islamic work ethics and organizational commitment, it is recommended that university directors and presidents attempt to increase organizational commitment by providing ethical codes and promoting Islamic work ethics principles.

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Presumption of innocence is one of the fundamental principles of criminal law that has its roots in moral and religious principles. Presumption of innocence is consistent with human nature, and special attention has been paid to it in Islam. For this reason it has been included in our constitutional law as well as in the constitutions and ordinary laws of other nations, and this indicates its significance. In Shiite jurisprudence there are two major theories on the responsibility of physicians as “daman al-tabib”. Most jurists (famous) consider the physician responsible even if he or she has committed no fault. Only a minority of jurists (less-known) consider the physician to have no responsibility. Islamic criminal law believes the physician to have absolute liability, although medical practices have become more sensitive than in the past and medical incidents have increased as a result of new technology and new methods of treatment. The present study intends to adopt a new approach to rules and principles of jurisprudence, and study the necessity of using them according to the requirements of time in solving everyday problems. Moreover, the study seeks ways to prevent the regression of those rules. Therefore, it seems essential that the golden principle of presumption of innocence be applied to physicians as the manifestation of God's healing, and more attention be paid to it.

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Ali Afzal Ghate’ Ghazvini was a renowned physician, scholar, and calligrapher of the Safavid era whose personality and efforts in the field of medicine have not been fully recognized thus far. Among his works, three medical treatises can be of use in researching the medicine of the Safavid era. The present article adopts a descriptive-analytic method to introduce one of these treatises, Favaed-al-Afzalieh, and present a survey of its content in addition to the author’s biography. The findings here are based on the three chapters of this medical classic, which indicates the encyclopedic nature of this treatise. Favaed-al-Afzalieh reveals details on a variety of practical medical issues prevalent in the Safavid era, and is considered outstanding due to the volume of all the medical information it contains. The present study discusses the standing of this treatise in the history of medicine along with a suggestion to revise and publish this valuable, comprehensive work and reintroduce it to the world of medicine.

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Recent provisions to the Islamic Penal Code have provided favorable regulations that absolve the skilled physician from absolute liability and adjust liability according to fault. The revised code adopts a new approach by allowing physicians more freedom while providing added protection, which is consistent with ethical standards and Jurisprudential principles. The present paper aimed to investigate the development process of statutory laws in Iran regarding medical liability and at the same time analyze articles of the Islamic Penal Code of 2013 on the subject. Some articles have been found to contain ambiguities that need to be modified. As an instance there seems to be a conflict between Article 492 and Clause 1 of Article 496 that should be resolved as it pertains to a case of the cause and the perpetrator (physician and nurse). In these situations the doctor orders and the nurse acts, and it is therefore necessary and proper that physicians not be absolved from liability.

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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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In the modern world, reproductive right is considered among the basic human rights in countries such as America and Britain. There has been growing interest in the subject and its various aspects including contraception and assisted reproductive technologies, which are giving rise to the ongoing debates. National and international legislators, governments and religions are striving to resolve the controversy among individuals and between individuals and governments and devise the perfect legislation that will cover all aspects of the subject and control all activities in this area.In the realm of bioethics and law, the issue is introduced as a right not duty, while in Christianity and Judaism it falls under the category of duty. In Islam, on the other hand, childbearing decision-making is left to the couple, which highlights the teachings of Islam regarding reproduction. In this paper, we attempted to offer a comparative study of four different points of view regarding the issue of reproductive rights

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According to the principle of respect for autonomy, which is one of the essential precepts of medical ethics, patients are entitled to the right of self-determination for a hypothetical future when they may lose the decision-making capacity. Thus, when still adequately competent to make decisions, a person can prepare a document and predict their therapeutic options and state their wishes for the possible time of lack of decision making capacity, or assign a surrogate who will make the best decision considering the attitudes and interests of the patient. This document, called advance directive, has advantages and disadvantages, and has been investigated from different perspectives. The present study addresses this new issue through non-systematic internet and library review of resources, and aims to investigate some aspects of this subject and examine the possibility of its naturalization from certain viewpoints, particularly from the Islamic perspective. In Islam, life is highly respected and physicians are obliged to do their best to protect human life. In cases where patients refuse the suggested treatments, even when it harms them fundamentally, the physician is obliged to respect their wishes for several reasons. Nevertheless, physicians should avoid any direct measure that may end up in the patient’s death. As regards advance directives, the patient no longer has the capacity to make decisions and has done so formerly, which may be in conflict with the physician’s responsibility to save the patient’s life under present circumstances. In such cases, despite a preliminary injunction, there is no reason to extend the patient's right to the time of their consciousness. Therefore, based on the religious principles observed in Iran, acting on the patient's previous decisions can only be valid as long as they do not conflict with the physician’s responsibilities. Furthermore, advance directives currently do not have a place in our legal system and the recognition of such documents is contingent upon further studies, including legal and cultural reviews.

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The present study tests a model of the relationship between Islamic work ethics and job satisfaction and organizational commitment with mediation of intrinsic motivation. Research design was correlation through structural equation modeling (SEM) and the sample consisted of 203 employees of Sabzevar University of Medical Sciences selected by census sampling method. Participants in this study completed questionnaires on Islamic work ethics, job satisfaction, organizational commitment and intrinsic motivation. Reliability and validity of all questionnaires were reported to be at an acceptable level. Data were analyzed through structural equation modeling (SEM) using AMOS-21 and SPSS-19 software packages. In addition, Preacher and Hayes’ SPSS macro program was used for testing mediation. The results showed that the proposed model fit the data properly, and that Islamic work ethics directly affected job satisfaction and organizational commitment. Moreover, the mediating effect of intrinsic motivation on the relationship between Islamic work ethics and job satisfaction and organizational commitment was confirmed. Employers can therefore rely on Islamic work ethics and training the employees and supervisors to reinforce intrinsic motivation, and thus promote job satisfaction and organizational commitment

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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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Since the beginning of the Imamia school of thought, Imamia scholars paid a great attention to issue of physicians’ responsibility. With a long-lasting debate on this issue, in most cases they have confirmed physician’s responsibility in medical error. However, in terms of a skilled medical doctor who treats the patient with no medical error but harm occurs, there is no consensus. Some scholars have said that if the physician had the patient’s (or family) consent for the treatment, then the physician is not guilty. In the contrary, some scholars believe that the physician still should bear the responsibility.This paper aims to examine the Islamic Pinal Code (no. 495) by relying on changing trajectory Imamia jurisprudence in exchange for claimed physicians’ responsibility. The legislators in Article 495 of the Islamic Penal Code (Act. 92), seems to take into account both mentioned perspectives and try to choose a middle way. However, in practice, this has caused confusion.

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