Iranian Journal of Medical Ethics and History of Medicine

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A review of the history of the Patient’s Bill of Rights reveals the universal significance of this subject in health systems management. There is a long history of attempts to raise respect for patient’s rights and setting the legal frameworks associated with those rights in the health care of many countries. The present study aimed to evaluate observance of the Patient’s Bill of Rights according to patients in the teaching hospitals of the Mazandaran University of Medical Sciences. This descriptive cross-sectional study was carried out in 2009 in all 4 teaching hospitals of the Mazandaran University of Medical Sciences on 200 patients who were either hospitalized or about to be discharged at the time. Data were collected through interviews, using a fifteen-item Likert type questionnaire based on the Patient’s Bill of Rights, and its validity and reliability had been confirmed. Data analysis was performed through ANOVAs and t-tests, using SPSS version 17 software. The results showed that according to the population under study, the patients’ rights were respected in 14.59% of the cases based on the overall score of the Patient’s Bill of Rights. This figure was 16.63% for respect for patients, their privacy and, patient non-discrimination, 14.17% for patient information availability right, 14.15% for the right to make choices and decisions freely, and 13.20% regarding complaints. There was no meaningful relationship between patients’ views on observance of their rights and their sex (P = 0.106), education level (P = 0.723), marital status (P =0.260) and place of residence (P = 0.101). Based on the findings of this study, observance of the Patient’s Bill of Rights was not satisfactory according to the population under study and from their viewpoint. It is therefore recommended that measures be taken to eliminate any obstacles preventing observance of patients’ rights and to improve the present conditions of hospitals in this respect.

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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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Patient advocacy is an inherent element of professional nursing ethics that helps to protect the patient’s rights. Many codes of ethics in nursing are concerned with this particular role of nurses. The present study aimed to evaluate the protective advocacy beliefs and actions of the nurses employed in educational hospitals affiliated to Birjand University of Medical Sciences during 2014. Data in this cross-sectional study were collected using a demographic characteristics questionnaire and the protective nursing advocacy scale. Participants included 248 nurses working in six hospitals located in Southern Khorasan province selected by randomized stratified sampling. The Cronbach’s alpha for Protective Nursing Advocacy Scale was 0.74. Data were analyzed in SPSS version 16 using descriptive and inferential statistical tests.Moderate levels of protective advocacy were observed in the majority of participants (80.6%), with a total mean score of 137.39  13.65. Some of the protective advocacy components had significant correlations with age, work experience, type of ward, employment status, and history of participation in ethics education programs (P < 0.05). In other words, the total mean score of advocacy and some of its components were significantly higher among nurses who had attended ethics education programs than those who had not (P < 0.05). Moreover, nurses who were older had more work experience, had worked in the emergency ward, and had a permanent employment status had higher scores of advocacy than others. The total mean score of advocacy among the nurses in this study was relatively appropriate, although strategies are needed to improve the score. It can also be assumed that nurses’ involvement in ethics education programs can increase the level of nursing advocacy. On the other hand, changing nurses’ temporary employment status to permanent status and providing job security for them may reinforce protective advocacy beliefs and actions in nurses.

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Physician-assisted suicide is an important, challenging issue in medical ethics, which the right to die is a central point in this issue. Physician-assisted suicide is offered to end intolerable pain and suffering. Although, it is a legal practice in some countries, still it is a challenging and controversial practice in ethical and legal perspectives. It has been argued that based on the principles of medical ethics, physicians should respect patient’s decision, however many ethicists and jurists believe that Physician-assisted suicide is unethical. It should be noted that the main reason for proponents and opponents is based on their interpretation about human dignity. This controversy can be resolved by reference to religious interpretation of human dignity in which asserts that Physician-assisted suicide is against human dignity and respect for human life.