Iranian Journal of Medical Ethics and History of Medicine

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 Introduction
Physicians often hesitate to disclose their errors due to fears of legal repercussions and stigma. Understanding their attitudes toward error prevention and professional behavior is essential. This study aimed to evaluate the attitudes of interns at Iran University of Medical Sciences regarding the disclosure of medical errors.

 Materials and Methods
This cross-sectional descriptive study included all interns who entered the university in 2017. Data were collected using the Persian version of the Medical Mistakes Survey questionnaire and analyzed with SPSS software version 26.

 Findings
Among the 186 participants, 66% reported committing a medical error. Only 21% fully disclosed errors with no significant adverse effects, while 31% disclosed errors with severe consequences.

 Conclusion
Most interns avoid fully disclosing errors, primarily due to fears of legal action and concerns about being underestimated by patients. Further studies are needed to enhance physicians' performance and patient safety.

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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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Background: The first experimental lobotomy was performed in psychiatric patients at 1930. At the beginning, the purpose of such experiments was the treatment of certain patients such as psychotics, sexual offenders and schizophernics, but during the years, the unpredictable results and harms appeared. Nowadays the treatment is limited to medical treatment and psychosurgery which includes two new forms of lobotomy named cingulotomy and capsulotomy. Previously physicians were performing dangerous surgery on a wide rage of patients irrespective of their consent and objections. In fact they treated them in the favor of “patients’ and public (social) interests” and some claims have risen against it. In this regard some legislators such as Canadian legislator enacted or amended their regulations and these regulations criticized.
Method: We selected the most related articles and books among the related resources. For completing this article, we searched by the keywords of Lobotomy, enforced offender to treatment, ethics.
Results & Conclusion: Studying some known cases demonstrated harmful effects of this special surgery and regarding to the ethical and legal points of view, operating patients only for the interest of patients or public, irrespective of their consent is not legitimate.

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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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According to the professional definition of ethics, ethics is a sustainable and steady way of communication based on rights of both sides and also professional ethics is to know and act to your ethical responsibilities that every real or legal person has to others. Therefore, one of the measures of  the ethicality of a university is students rights and we can count those rights to find the ethical responsibilities.
From the very beginning of entering to the university and even when the student is admitted, he/she has rights which some of them are related to the educational system. (Of course the other parts are related to the environment, including family, friends, professors, different branches of university and totally other elements of society which are not the concern of this article). Students rights can be divided into two types: the first type is those rights which have been changed into rules and are in the form of regulations and instructions and need to be followed. The other type is those rights which are not official yet and they are just some ethical principles. These rights are called ethical responsibilities and in this article we deal with these responsibilities towards students. Therefore, it is necessary to know the students rightsin the educational system and they can be the basis of many ethical judgments for the university.
Students rights are not just related to the educational system and they surround other parts of university and society as well, but the students rights in the educational system have a straight relation to his/her learning and scientific development, so those are considered as the the most important rights of students and acting to them is also very crucial.
By counting the students rights in the educational system, the university would be aware of its duties practically and it will be the first step of implementation of ethics in the university. Total duties of university and educational system towards student's rights are as following:

• 1- To recognize the students right.
• 2- To comply and show sensitivity to the students rights.
• 3- To comply the characters
• 4- Make restitution for lack of compliance.
  

If we look at the students rights from the university's point of view, then we should consider the duties of university all based on professional principles which are like Copernican Revolution. According to this: "others have rights and we have duties." i.e. for determining the educational duties of universities towards the students, we should first consider the students rights and then the duties of the university.

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The medical Arjuze is one of the less known works of Avicenna, a great Iranian scientist and physician, which is written didactically in Arabic. In this book, Avicenna has composed 1326 lines about a complete cycle of traditional medicine of Iran in Arabic in the form of battle cry. Didactic poetry is one of the poetry forms which its main purpose is to provide educational aims and to convey scientific terms both in literature and poetical way. Avicenna's poetry in Arjuze is simple and fluent. The medical topics are overviewed in a sketchy way and not in full details in this book. In this book, theoretical and practical medicines are explained in two specific parts.
The existence of French and English translations of Arjuze shows the value of this work for Europeans as a complete outline about medicine in that time, but there is no Persian translation of this work, available. Traditional Medicine and History of Medicine Research Centre of Shiraz University of Medical Sciences has started the translation of medical Arjuze with the aim of introducing this precious work which shows the educational pattern of traditional Iranian scientists in using didactic poetry.
The purpose of this article is to introduce the characteristics of Avicenna's Arjuze with an overview of his position in modern traditional medicine.

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The first step in battling against prevention and control of a social phenomenon is to distinguish it completely and clearly. Designing the information system of substance abuse, with the aim of converting data into information and knowledge, consists a great share in prevention and control of addiction, but it is faced with challenges and problems which have unpleasant and inappropriate consequences on consumer abusers. Therefore, this article is written with the purpose of studying the medical ethics challenges of information system of substance abuse.
The present research is a review of studies. The needed information is gathered form Medline, Ovid, Elsevier, Google and Pubmed search engines and also from Police Information and Statistic Centre, Ministry of Health, and Medical Education, Welfare Organization and National drug Studies centre.
Substance abuse information system has several legal and ethical problems that if they occur, abusers will show no zest for receiving any consulting and medical services and also participating in epidemiological studies.
World Health Organization has provided a special framework in eight compasses including respect for human dignity, secrecy and privacy policy, to respond to the health information system.
Before arranging the schedule, designers and programmers of  substance abuse information system should provide and codify the rules, regulations and necessary instructions to clarify and determine the legal status, in order to guarantee the secrecy and privacy policy of information.

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Ethical research and theories assign great importance to the role of intention in passing moral judgments about individuals’ actions. The doctrine of double effect is among ethical disciplines that differentiate between controversial medical situations such as end of life care or abortion, and intentional, premeditated damage, in that they consider the former impermissible and the latter permissible under specific circumstances. The present paper was conducted to investigate the role of intention in judging a person’s actions, and to provide empirical evidence for the doctrine of double effect. 200 students were asked to evaluate the morality of two situations: in the first situation, one person needs to be killed so that five other persons can be saved. In the second, the killing of one person is the side effect of saving five others. Data analysis was performed based on frequency, averages and ANOVAs using SPSS statistical software version 16. The analysis indicated completely different responses to these two situations: in the first situation most respondents (62.3%) considered the act of killing the one person unethical, while in the second situation the majority of respondents (60.6%) considered the act that would result in the one person getting killed as ethical. The findings of the present paper highlighted the role of intention in passing moral judgments and provided empirical evidence in support of the doctrine of double effect. This research also demonstrated that the attitude of theorists about the role of intention in moral judgments is consistent with the moral sense of ordinary people.

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Admitting medical errors is one of the professional obligations of physicians that unfortunately involves numerous challenges. The present paper aimed to investigate the attitude of surgery faculty and residents towards medical error disclosure and factors affecting it. In this cross-sectional descriptive and analytic study, a self-administered questionnaire was distributed among all faculty and residents of the department of general surgery of the teaching hospitals of the Tehran University of Medical Sciences. The response rate was 84.1% (53 out of a total of 63). Tendency to make minor and major errors among the respondents was 39.6% and 49.1% respectively, and 71.7% declared that the most significant factor hindering error disclosure was fear of litigation. Only 16.7% (8) had disclosed their most recent medical errors to their patients, 25% (2) of whom had to face legal action. There seems to be a clear distinction between the doctors’ inclination to disclose their medical errors and what actually happens in their practice, the most important reason being their professed fear of litigation. Considering the need in the majority of physicians for appropriate training on the subject of medical errors and communication strategies, it seems that in order to resolve this issue, changes need to be made in the current system for error management so as to provide professional support for physicians who make medical errors, and doctors should receive the necessary training on ethical principles and patient communication strategies.

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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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Observing patients’ rights in health care services plays an important role in improving and adjusting the doctor-patient relationship and is therefore of great significance in health systems management. Considering the role it plays as an important philosophical part of modern ethics in ethical and social functions, empathy has received much attention in various areas of research such as psychology, behavioral studies, neurosciences and psychiatry. The present study will first offer an overview of the history of empathy and its positive effects on the interactions between doctors and patients, and then move on to propose strategies to promote empathy in doctor-patient relationships. Empathy plays a significant role in patient empowerment and satisfaction, and therefore studying its effects on teaching medical ethics as a factor that can positively influence the doctor-patient relationship can provide all, including organizations such as the Ministry of Health and psychology and counseling centers, with valuable guidelines to promote mental health, from prevention to treatment.

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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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New antiviral remedies have greatly improved the prognosis of patients infected with AIDS, as well as their life expectancy and quality of life, and assisted reproductive techniques have made it possible for many HIV positive patients to have healthy children. Nevertheless, most assisted reproduction centers continue to reject these couples, and this is a factor that contributes to their isolation from the society. The present study was performed through document and library research, and the results were investigated from the viewpoints of the infected couple, their future children, and health care staff. Social and legal issues were evaluated through consultation and collaboration of experts, and related articles, guidelines and accessible material were examined for this purpose. Every individual has the right to reproduction. If it is possible for HIV positive couples to have children with the help of fertility lab techniques, and provided that throughout the process there is no danger of disease transmission to others and particularly the embryo, ART centers should not reject HIV positive couples. Rejection of these couples is against the principles of medical ethics and in violation of the current effective laws of the country. On the other hand, acceptance of patients infected with Hepatitis type C, advanced cancers, mental diseases, and so on is further proof that rejecting HIV positive couples is a form of discrimination and unethical. The word HIV itself is synonymous with the stigma of social deviance, and it seems children of infected parents are not in the ideal position from the public point of view. One step that needs to be taken is for the society to try to remove this stigma and provide support for all chronically ill patients. There is no valid justification for rejecting HIV positive couples in ART centers, and it appears to be unethical and a violation of human rights to deny these couples the right to have healthy children through modern technology.

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Medical Ethics is a branch of science that has received attention due to developments in medical treatments and technology as well as complex social transformations and involvement of social sciences, law and so on in medicine. The present paper attempted to perform an analysis and historiography of scientific publications in the field of medical ethics and their growth and development rate between the years 1990 and 2008. This study used scientometrics to examine scientific publications in the field of medical ethics between 1990 and 2008 in three bibliographic databases: The Arts & Humanities Citation Index (A&HCI), the Social Sciences Citation Index (SSCI), and the Science Citation Index Expanded (SCIE). An evaluation of the nature of the documents showed that 5690 bibliographic items had been presented in fifteen different formats. The documents had all been published in 1289 journals by 3634 universities or higher education institutions, with the Harvard University in the lead. 10326 authors had composed articles during this period and made reference to a total of 109301 sources. The Journal of Medical Ethics had published the majority of works in the field. One major topic in this field is “medical ethics education and its necessity”, as medical policies and regulations are constantly changing in order to ensure patients’ rights. Consequently, a need is clearly felt for teaching medical ethics in order to offer medical care in an ethical and human manner, and to make difficult decisions concerning new technologies.

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Attempts to promote medical ethics principles on the national level should be consistent with the needs, expectations of the target audience, social orientations and determination of priorities. The present study was conducted through distribution of a questionnaire containing twenty medical ethics topics, and thus the priorities of instructors, researchers and policy makers regarding medical ethics were determined on a national level. Through determination of medical ethics priorities in the country, the study aimed to encourage a scientific approach to the issues and challenges faced throughout the nation based on the opinions of thinkers of this field, and to help resolve each of those issues according to national priorities. The findings revealed ten priorities in the field of medical ethics nationwide: patients’ rights, doctor-patient relationship, justice in the distribution of health care resources, autonomy and informed consent, the financial relationship between doctor and patient, hospital ethics committees, ethical considerations in public health, strengthening and capacity building in teaching medical ethics, ethical considerations in medical education, and medical research ethics.

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Adherence to ethical standards in the medical profession is one of the fundamental principles of the traditional Iranian medicine, and its significance is reflected in the words and works of founders of this school of medicine. One particularly valuable source is the esteemed work by the Iranian scholar Hakim Seyed Mohammad Hussein Aghili Khorasani Shirazi entitled “Kholasat-Al-Hekmat”, which was written more than two centuries ago. The present paper is a descriptive library research on this work. One significant characteristic of this book is the author’s careful attention to details in clarifying the principles of medical ethics. Although the “four principles” approach to medical ethics is a relatively recent concept in modern medicine, it has been fastidiously expounded and evaluated in Iranian works on medicine. For young physicians and researchers, being familiar with such sources and their analysis and comparison based on principles of modern medical ethics is a clear indication of the humoral medicine being deep-rooted and ethics based. The present study aimed to investigate and analyze medical ethics as presented in Kholasat-Al-Hekmat.

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Evaluation of the factors related to the patients&apos complaints against medical staff, especially doctors and efforts towards its reduction affects patients&apos satisfaction of health care system.  The main purpose of the present study was to determine the factors related to the patient`s complaint against doctors with the verdict of Medical Council of Kerman.
This study was a descriptive, analytical and practical evaluation, assessing 250 documents related to the patients&apos complaints of doctors in Kerman Medical Council during 2004-2009.
 The most reasons of complaints (%73.2) were carelessness and disrespecting scientific and legal standards, and obtaining funds out of legal standards (%9.3) respectively. In the case of issuing vote, the most opinions (%31.7) were innocence and suspended and barred from prosecuting (%22.9) respectively. Most complaints were of ophthalmologists and private hospitals.  There were significant relationship between the reason of complaint and issued out (P<0.01, c²= 53.706) and the reason of complaints and field practitioners (P=0.026, c²= 49.27). No significant relationship between issued out and the type of hospital was found.
Regarding the results, respecting scientific, and legal standards, and decreasing financial relationships between doctors and patients is an effective way in reducing patients&apos complaints of physicians. Improvement in physicians&apos patients&apos relationship by explaining the disease condition, its risks and treatment options to patients are effective in reducing patient&aposs complaint against physicians.

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The definition of disaster is diverse but certainly the similarity between disaster and normal condition is negligible. The most important characteristic of critical condition is the number of human victims. Therefore each critical condition needs medical intervention and the presence of health care providers is necessary.
Health care services are divided into two categories one in normal situation and the other in the critical condition so the ethical considerations and responsibilities of the health care providers will differ accordingly.
Our approach for explaining medical ethics or ethics in health care n critical conditions is two dimensional including the responsibilities of health care providers and ethical problem solving. The second dimension needs systematic approach which is not possible in this article. In the case of the responsibilities of health care providers we may focus on individualized viewpoint or systematic and strategic view point however the later is more complete and acceptable.
From systematic viewpoint three important issues should be considered ethical principles, ethical codes and multi dimensional ethical charter of each organization.
In this review we aimed at describing some ethical principles and codes of conduct and the ethical principles of Red Cross and Red Crescent as well.
In conclusion, critical conditions are far wider and there are full range of special situations in which no unique solution can be followed. It is necessary to determine the diverse fields affecting the condition and solve the resultant ethical issues in a problem oriented manner.  In addition medical ethics should be considered as one of the most important priorities of the Ministry of Health and other related organizations.

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Despite advances in science and technology, human is not yet capable to produce a material or solution to compensate blood loss or act as blood this vital material of the body. Blood loss is only recovered through transfusion of blood prepared from donors.
Blood safety widely depends on the information obtained from voluntary blood donor. It is his/her ethical responsibility to provide valid information. On the other hand, some ethical issues about the donor and the recipients right should be considered. For this reason, the International Society of Blood Transfusion (ISBT), in 1980, in Montreal, approved the code of Ethics for Blood Transfusion. This code emphasizes on access to safe blood, free blood without need to be substituted, informed consent for blood transfusion, the right not to accept the blood and the right to be informed if they have been harmed. This article attempts to highlight some of the important points in blood transfusion medicine, and ethical aspects of blood transfusion according to the Islamic principles and Iran laws.

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Breaking bad news to the patients does not back to a long history and is a controversial issue between patients and physicians. Many physicians are reluctant to breaking bad news to patients and this is not desirable for most patients. For example, in Northern European countries and United States, most physicians usually break bad news to the patients, while in Southern and Eastern European countries or many Asian countries they would not do so. In Iran, physicians prefer to break bad news to patient's family rather than the patient. Cultural differences also influence people's viewpoints about breaking bad news. In Western countries, most people agree with breaking bad news to patients while it is not common in the other populations. Nowadays, the dominant view in the most countries is that it is the duty of the physicians to break bad news to patients. Some advantages of breaking bad news to patients including strengthening the trust between physician and patient, preventing non - maleficience, increasing patients satisfaction and reducing legal action against the doctors. There are some exceptions to breaking bad news the most important is serious psychological damage to the patient. Quality and quantity of information that should be released depends on situation of each patient. Breaking bad news needs specific communication skills and physicians must be trained for this purpose.