Iranian Journal of Medical Ethics and History of Medicine

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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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By the ever-increasing discovery of pharmaceutical and chemical substances, their  adverse effects  will be considered too. To evaluate adverse effects, animals are used, and factors like standardization of species and breed, storage condition and biochemical system will be effective for animal selection. In Islamic education, animal issues are important. The principles of keeping animals, using them and prohibition of animal abuse are mentioned in this article. The information were gathered from electronic and non-electronic resources including articles and books. Based on this, the following issues need specific attention:

• 1- Infrastructure of rights: In Hajj and Nahl chapters of Quran (verses 18 and 49) it is mentioned that animals will bow down to God. This is the basis of animal rights.
• 2- Animal rights for keeping them: For this case Sheikh Tousi and martyr Saani mentioned that it is necessary for the owners to feed and water the animals enough.
• 3- The exploitation rights: In the Holy Quran, it is said that the power and the hygiene of the animals must be considered and it is major to exploitation.
• 4- Rights of animal's damages: It is advised to keep and defend the animal species and human beings are forbidden to harm and kill animals. Therefore, from Islam point of view, although animals lack the speech power, they must be treated emotionally and their owners have some responsibilities, too.

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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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Generally, when moral values and ethical principles are concerned, human beings are considered as the sole subject of these fields. It is then concluded that the only living creatures with some privileges and obligation towards their own bodies and also, towards their other human counterparts are humans. An emerging issue, particularly in the past recent three decades, has been the expansion of the ethical community to be inclusive of other living creatures, namely animals. Novel branches of science such as animal ethic are increasingly challenging the traditional view of ethics and aim to include animals in ethical community. In this article, a descriptive study and systematic review of literate was carried out on different aspects of animal ethics and the specific codes applicable to animals was studied in order to shed some light on the animal ethics and on what basis they are subjects to ethical considerations. As animals are proven to have the ability of perception and demonstrated to be able to feel and differentiate good and bad experiences, they are considered as being the subject of ethical considerations. Therefore, human beings should be responsible for their behavior towards animals in different aspects.

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Providing sufficient information for patients and other healthcare clients is necessary to protect their rights in health systems. In this realm, medical librarians, especially in hospital libraries, can play an important role in supporting patients' rights. Professional national and international associations have compiled and promulgated some codes and guidelines in some countries however, there are many shortcomings in this area in our country. This paper aims to review the status of patients' and other healthcare clients' rights in professional codes of ethics of library and information sciences and professional standards of hospital libraries. We hope the results can provide us with an approach for a more strict observance of patients' rights in our country. This paper reviews professional codes of ethics of library and information sciences and professional standards of hospital libraries. We will contemplate on the articles related to patients' and other healthcare receivers' rights. The findings show that providing patients with information is a pivotal element in professional codes of ethics of library and information sciences and professional standards of hospital libraries. Interactive and knowledge-based information (KBI) that is based on improvement of performance and finding clinical solutions (not just education without practical impact) have aided clinical librarians in protection of patients' rights in some countries.Considering the roles of libraries and information centers in collecting, organizing and making accessible the information for their users, librarians and information scientist should make effective utilization of information possible for healthcare clients, while taking into account their specific needs. Therefore, it is essential to compile professional codes of ethics containing the appropriate approach to disseminate information to patients and other healthcare clients, and to define specific roles for clinical librarians in hospitals and medical clinics.

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Recently larger numbers of women of advanced age are referring to fertility centers. Although there may be no age restriction for women who are naturally able to and want to be pregnant, using assisted reproductive techniques for women of advanced age is medically and ethically disputed, and this question is always raised: "Should there be an age limit for accessing assisted reproductive techniques for women?" This study was a review of ethical, legal and religious issues regarding pregnancy and reproduction in advanced age for women. We tried to cover codes, legislations and articles on the subject. There is no national legislation about age limit for women seeking assisted reproduction. In this regard, fertility clinics follow their own protocols. Most centers do not accept women older than 45 unless there is a specific clinical situation confirmed by a physician. In any case, the safety of the mother and her child must be the first concern of the physician, and all the treatment protocols should be determined accordingly. Obviously, age alone cannot be a suitable criterion for rejecting the infertile patient. Therefore, regardless of the patient's persistence and their ability to afford treatment, physicians should consider mother's safety and the welfare of the child before admission. Pursuing an all-inclusive legislation and guideline seems to be of great importance in Iran.  

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Patient's refusal of treatment is the rational consequence of informed consent and is considered among the patient's rights but can lead to patient harm or harm to others, or damage to the health care system. Major ethical challenges in the field of treatment refusal arise from capacitated patients. This paper mainly examines theoretical issues related to this group by reviewing books on jurisprudence, philosophy and bioethics, especially textbooks that include moral philosophers' perspectives, the views of experts in bioethics and jurisprudential considerations related to this issue. These views sometimes are very different or in conflict with each other. Based on different schools of philosophy or ethics, our encounters with patients who refuse treatment can range from abandoning patients on the one hand to treating them at any cost, even by coercion or deception on the other hand. According to Islamic perspectives, people have no right to harm themselves, but because of the authority that each person has on his or her body, this does not mean that compulsory treatment is permitted it means that caregivers must try to persuade patients to accept treatment, and must not cooperate with them to harm themselves and to discontinue treatment specifically.

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Medical laboratory services and its clients are somehow different from services of the other sectors in the health system. Patient’s Rights Charter, published by the Ministry of Health and Medical Education, was comprehensive, but addressing specific aspects of the related areas in medical laboratories could promote the commitment and dedication in laboratory professional services hence, development of the Patient’s Rights Charter in medical diagnostic laboratories was put on the agenda. After a comprehensive review of existing references and resources, a committee was formed consisting of representatives of laboratory associations and experts in this field, and the draft was prepared. Thereafter several meetings and workshops were held and the members of legal organizations, medical ethics experts as well as laboratory stakeholders, technical staff and laboratory directors attended these gatherings where the draft was surveyed and comments were received. The draft underwent some changes and was edited. Finally in August 2012, the charter was approved by the Health Policy Council of the ministry and in October 2012 was officially announced by the health minister.To be consistent with the context of the Patient’s Rights Charter, essentials of this bill have been based on 5 pillars: access to appropriate laboratory services, access to information in a sufficient and effective manner, the right to choose and decide freely, respect for customer privacy and the principles of confidentiality and integrity, and availability of an efficient system for investigating complaints and suggestions.Developing and delivering the bill of rights for health services recipients is one of the foremost matters, but implementation of the provisions of the charter and monitoring of its effectiveness are the most important goals ahead. Therefore, an effective strategy to implement the rights of patients in medical laboratories should be designed and established.

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Respect for the inherent dignity of human beings means respecting their basic rights in different environments, and this has an important role in studies and discussions about health care. This study was conducted on the development and psychometric properties of the Inherent Dignity Questionnaire (IDQ) in heart failure patients. The present study is a methodological research for designing a questionnaire. First, 22 patients with class II to IV heart failure were chosen by purposive sampling from patients of Hazrate Rasoule Akram, Imam Hossein and Shariati hospitals of Tehran, and semi-structured interviews were conducted on ethical issues until data saturation was achieved. A qualitative content analysis was carried out to analyze the interviews. Then, based on the findings obtained from the interviews, literature, and the designed questionnaires about inherent dignity, 39 items associated with inherent dignity in heart failure patients were developed. The face validity of the questionnaire was determined. To measure the content validity of the questionnaire, opinions of 12 experts were used considering Content Validity Index (CVI), Content Validity Ratio (CVR) and Lawshe table. To assess construct validity of the IDQ, exploratory factor analysis and to determine the reliability of the questionnaire, internal consistency with Chronbach’s alpha coefficient and split-half method were used on 130 patients with heart failure. The data were analyzed using SPSS version 19.Through face validity and content validity analysis, 4 out of the 39 primary items were removed, leaving 35 items. Through exploratory factor analysis, 11 items with factor loading less than 0.5 were removed and the IDQ was created with 24 items and three factors (9 items on the first factor, 8 items on the second factor and 7 items on third factor). These factors were: "inherent dignity in family", "inherent dignity in the community" and "inherent dignity in health care environments". Reliability of the Social Dignity Questionnaire (SDQ) was calculated to be 0.94 by using Cronbach's alpha coefficient, and 0.96 by using split-half method.Results of this study showed that the IDQ is adequately valid and reliable. Therefore, using this questionnaire can be beneficial to planning support for patients and improving their treatment and care and doing further research related to dignity in different patients.

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Reproduction is one of the basic abilities of human beings. This is often realized in a natural way, though in certain cases new methods and technologies provide infertile couples with the opportunity to realize their wish to have children. In recent years, the term “right to reproduction” has emerged, and sometimes emphasis is placed on the obligation of governments to satisfy this right. However, it seems that the ambiguity of the aforementioned term may create serious problems in our understanding of the subject matter and, in consequence, affect the manner in which it is handled in the society. In this paper, in addition to discussing the concept of rights, it is argued that the right to reproduction may be embodied both by a claim right and a liberty right, even though the latter is only a justifiable and acceptable way of representing the right to reproduction. Therefore, this right entails the freedom to bear children and to pursue provision of the requirements, including utilizing ART. As in the case of other human rights, this should be in balance and proportion with public interests, in such a way that in particular circumstances, such as problematic population situations, it may be protected or prevented by the government.

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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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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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Medical laboratory is one of the health service providers that intensely responsible for the life of patient / client. With an increase in the number and variety of laboratory tests in recent years, the role of laboratory science in identifying and assessing the cause of disease has been more recognized. Performing the laboratory tests with the utmost accuracy, precision and speed using up to date methods as well as protecting the rights, integrity and respecting human dignity and also the establishment of priorities and the requisites for quality management systems can have a significant impact on patient satisfaction and quality which are the characteristics of a good medical laboratory. The principle concept of doing good and not doing bad is the essence of every code of medical ethics. Therefore, in laboratory medicine like other areas of medical sciences, there are ethical questions that have become more complex with the development of diagnostic tests. Medical laboratory practitioners usually deal with issues of confidentiality of patient information, as well as issues related to research ethics, professional ethics and business ethics.This study has collected important and common topics of medical ethics in laboratory medicine which leads to increase readers’ and practitioners’ information in this field. It is hoped that such information could be effective and practical to improve the laboratorial services for patients.

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Observation of patients’ rights as a major component in defining the standards of clinical services can increase patient satisfaction and is an important indicator of health care quality. Since most hospital patients are admitted through the emergency department, this study was conducted to investigate the observance of patients’ rights in the emergency department of Nemazee Hospital during 2015.

This cross-sectional study was performed on 100 patients over a period of one month. Data were collected by a questionnaire and analyzed using SPSS version 21 and statistical tests including descriptive statistics and inferential analysis.

The mean of the patients’ age in this study was 54.4 ± 19.35. Based on our findings, the overall level of observing patients’ rights was 51%, while patients’ expectations were 93%. Moreover, there was a meaningful difference between observance of the patients’ rights and their expectations in all aspects based on the paired sample t-test (P<0.05). It was also established that age was one of the factors affecting observance of patients’rights (P<0.05).

In this study, observation of patients’ rights in the emergency department was at the intermediate level, while patients’ expectations were higher in comparison.

In order to promote patient satisfaction, it seems necessary to educate the personnel and medical students on patients’ rights by holding workshops, reducing the waiting time for receiving services, and establishing an order in the system based on the patient’s condition.

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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.

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Nursing is an ethical profession and nurses are responsible for patient care. In providing healthcare services, patient right is an important issue to consider. However, not only the awareness the patient right is important but also moral sensitivity to ethical decision-making is crucial. This study aimed to determine the relationship between moral sensibility and attitude towards patients' rights. A descriptive-analytic study was used and 194 nurses working in intensive care units in hospitals affiliated to medical university of South Khorasan province were selected by convenience sampling method. The data collected through a questionnaire consisting of three parts: 1) demographics 2) the moral sensitivity questionnaire (Korean version), and 3) a questionnaire survey of nurses' attitudes towards the patients’ rights. Data collected by the software SPSS version 16, and were analyzed descriptive and analytical statistical tests.

The results showed that there is a significant direct relationship between average moral sensibility and nurses' attitudes towards patients’ rights (r= 0.6, P=0.03). The average nurse's ethical sensitivity has been reported 3.05±0.68 0f the total score (0-4). The average attitude towards the patients’ rights was 4 ± 0.8 of the total score (1-5). The relationship between moral sensitivity whit the years of service and age of the participants was significant (P<0.05). There was also a significant relationship between the attitudes of nurses towards patients' rights with gender and years of service (P<0.05). In conclusion it is necessary to provide more moral education to increase nurse’s moral sensitivity towards patients’ rights. It should be noted that due to the fact that moral sensitivity and attitude towards patients' rights increases with the number of years of service the article suggests that considering more experienced nurses in the teams would result a more morally sensitive care for the patients.

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The cultural competence, responsibility and ethical beliefs are influential factors in providing quality services by nurses and pay an important role in patient's right. The purpose of this research was to illustarte a predictive model of patient's right based on cultural competence, responsibility and ethical beliefs. The research method was correlational study conducted in 2016 among 300 nurses in west Azerbaijan in 2016, selected by multistage cluster sampling. For gathering the data, the Perng and Watson’s nurses’ cultural competence questionnaire, and the Mergler and Shield responsibility questionnaire as well as the Mahmoudi and et al questionnaire on ethical beliefs and Scale rights of patients were used. The data were analyzed by using Pearson correlational coefficient and bootstrap through SPSS software and amos-22. The results indicated that the model was fitted and has direct effect in cultural competence (0.11), responsibility (0.57) and ethical beliefs (0.24) on nurse’s attitude with the rights of patients were significant. The indirect effects of cultural competence (0.03) and responsibility (0/03) with mediating of forming the model of ethical beliefs were significant. In conclusion, %65 of the variance in nurses’ attitudes to the patients' rights was determined by the variables of this research model. Due to the direct and indirect effects of cultural competence, responsibility and ethical beliefs on the attitudes of nurses towards patients' rights, it is important to increase cultural competence relationship and responsibility with nurses’ attitudes towards   patient’s rights by focusing on ethical beliefs.

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Privacy and confidentiality are the inalienable rights of every human being to preserve his dignity. This issue should be considered in all levels of medical interventions. In the healthcare system, based on respect for privacy and confidentiality, patients decides what information to provide to their physicians. However, if a patient does not provide necessary information to his physician this may impact the diagnosis and treatment. This study aims to evaluate patients’ attitude regarding privacy and confidentiality in healthcare delivery. The result helps policy makers to establish appropriate relations between healthcare providers and patients by realizing its strengths and weaknesses.
This cross-sectional study was carried out on 200 patients, selected in a systematically random way, in Imam Khomeini and Shariati hospitals in Tehran the capital of Iran in 2010. The data were collected directly from patients by trained interviewers based on a questionnaire survey. In order to analyze the data based on the scores of the attitude, patients’ attitudes were classified into three groups of negative, slightly positive, and positive and were evaluated by using various statistical tests.
In result, 56.5% (113) of participants were females and 43.5% (87) were male. In this study, it was found 71 (35.5%) patients were “strongly agree” that male physician can examine female patients and 99 (49.5%) patients were “agree”. Fifty three patients were “strongly agree” that physician may consult with his assistant through training (without the patient's permission) and 103 patients were “agree”. Participants’ attitude about disclosing the patient’s information if a he has threaten self-harm or harm to another person was as follow, 45 (22.5%) patients were “strongly agree”, 82 (41.0%) patients were “agree” and 56 (28.0%) patients had “no comment”. In this study, in general 36 (18.0%) patients had “negative”, 162 (81.0%) patients “slightly positive”, and 2 (1.0%) patients had “positive attitude” towards privacy and confidentiality in healthcare settings.
In conclusion, the study population possessed a moderate attitude towards privacy and confidentiality. These results show that in addition to performing further studies, patients’ attitude towards privacy and confidentiality should be adequately improved.
 

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