Iranian Journal of Medical Ethics and History of Medicine

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

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Surrogacy is considered as one of the selective methods for infertile women especially those who don't have womb. As this method is controversial and the sides should be analyzed both ethically and legally, the purpose of this study is to scrutinize the attitude of infertile women who visit Hazrat Masoumeh Infertility Centre in Qom for surrogacy.
This cross-sectional study  conducted on  300 infertile women. The information were gathered from a two part questionnaire which in one part there was personal information and the other part was for phrases related to attitudes. The earned data were analyzed by descriptive test analysis and P<0.05 was considered significant.
The results showed that 61.3% of infertile women were in favor of surrogacy and 38.7% were against it. The highest priority in terms of attitude was the fear of an emotional relationship between the surrogate mother and the baby, and also the problems of delivering the baby from surrogate mother to the applicant couple. There was a logical statistical relation between the infertile women's attitude  and age, educational level of the woman, educational level, the educational level of infertile women's partners, years of infertility and income of the bread winner( P<0.05).
As the attitude of vast majority of the study samples  was positive and as it is important to know about opinions and preferences of families to make this action lawful, wider investigations in this field in more variable groups is recommended.

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For some infertile couples, egg donation is the only option. In egg sharing programs, patients share half of their eggs with another couple in exchange for a discount on assisted reproductive technology. In many countries, using this method is legally discussed. Iran is the only Islamic country in which donation programs are practiced, so, we designed this study to compare egg sharing to ordinary egg donation from ethical, legal, and religious aspects.A complete review of ethical issues and debates about egg donation and sharing was done. For religious issues, we consulted clergies, Islamic texts, and current decrees (fatwas). Social issues and legal problems were examined by consulting expert opinion and jurists. Also a complete review of literature was done. Egg donation and egg sharing are both religiously accepted in Iran by the Shiite clergies as they are considered completely similar. Egg sharing has some religious (seeing and touching the female genitalia) and social (preventing repetitive donation) advantages to egg donation as well as avoiding complications of fertility drugs and procedures, financial and trading issues, advertisement and brokers. However, there are some disadvantages with egg sharing, such as reduced likelihood of conception by donating half of the eggs, challenges related to donor health, and emotional stress of failure for the donor and success for the recipient, which can be prevented by careful case selection, psychology and genetics consultation, and  practicing anonymity. As a result, egg sharing is ethically and religiously more acceptable than commercial egg donation.   

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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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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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Genes are considered as “green gold” in this era of biotechnology. Currently, multinational companies and governments search continents to find this valuable asset in the hope to discover people with unique genetic characteristics that can be converted into capital and marketed in the future. Modern economy provides the framework to analyze any new technology from the advantage perspective and has vastly transformed the concept of capital and market thus, humans or any organism with specific genetic characteristics can be converted to capital and offered in profitable markets. Patenting and ownership of genetic resources without consideration for principles of inherent human rights will impact the society and result in a violation of these rights, especially those of vulnerable individuals and groups. In spite of the numerous benefits of biotechnology for individuals and the society, the risks to human dignity, equality, health, autonomy and research, as well as the possibility of information abuse should not be ignored, especially considering the alliance between technology and economy. Biotechnology can make claims to ownership of human life and desired genetic traits, and this is a problem caused by the biotechnology revolution in developing countries and consequently, indigenous peoples of these countries have shown different reactions to such issues. This article will discuss “human commodification”, which is a serious concern in the field of biotechnology in our world today

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Human cloning is among the newest and most advanced technologies in the field of medical sciences and genetics, and has been a popular topic of discussion throughout the 21^st century. The success of scientists in the use of this technology on animals has caused great concern for outstanding thinkers of various fields.

Some issues that necessitate research on this subject include: physical injuries caused by manipulation of ovaries, the cell nucleus, and the embryo the possibility of mental and emotional damage, and premature aging potential threats to human will and discretion a violation of human dignity and conflicts with religions and world-views.

A philosophical outlook on these issues can guide the researcher from the surface to the root of the problem and redirect such concerns, and at the same time shed light on the existing disputes between scholars of natural sciences and humanities regarding the cloning technology. This will be especially true if such an outlook is based on a tradition as rich as the Iranian Islamic philosophy. The present article uses analytical library research to investigate the anthropological teachings of Sadraian philosophy from the ontological and epistemological point of view. The article then proceeds to examine the outcomes and consequences of the cloning technology according to this doctrine.

It seems that the anthropological principles embedded in or hidden behind therapeutic or reproductive cloning technology are not in conflict with Sadraian anthropology.

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• The review focused on the following key questions:
• What is modern care, and what are its main dimensions?
• What factors and evidence influence the design and delivery of modern care?
• What are the major challenges associated with modern care?
• What are the potential strategies to address these challenges?

• Inclusion: Articles related to modern care, published within the last 10 years, in English or Persian, addressing challenges, strategies, or innovative care approaches.
• Exclusion: Studies focused solely on traditional care or lacking full-text access.
• Initial selection was based on titles and abstracts, followed by full-text screening

• Types of Advanced Technologies and Applications in Care
• Ethical Challenges in Modern Technology Use
• Proposed Strategies for Addressing Ethical Challenges

• AI algorithms assist in analyzing complex data, pattern recognition, and treatment outcome prediction. Their applications are significant in medical imaging, genetic data analysis, and patient outcome forecasting.

• IoT enables real-time monitoring through connected devices, useful in remote monitoring and chronic disease management.

• Telemedicine provides patients in remote areas or at home with access to healthcare services, reducing the need for in-person visits and enhancing patient comfort.

1. Privacy and Data Security
   • Modern technologies, especially AI and IoT, require the collection and analysis of vast amounts of sensitive patient data, posing significant privacy risks and opportunities for unauthorized access.
   • Solution: Employ advanced security systems, data encryption, and adherence to privacy regulations such as GDPR.
2. Automated Decision-Making by AI
   • AI systems may suggest or even make treatment decisions, sometimes without human oversight. This could result in ethically inappropriate decisions that overlook human and emotional aspects.
   • Solution: Ensure that AI-based decisions are supervised by medical professionals and account for human factors.
3. Accountability and Responsibility
   • Determining responsibility in case of errors or failures in automated systems is complex. Is the medical team liable, or the technology provider?
   • Solution: Develop clear guidelines and legal frameworks outlining responsibilities and oversight mechanisms.
4. Equity in Access to Advanced Services
   • Advanced care may not be accessible to all, especially in low-income areas or developing countries, leading to healthcare and social inequalities.
   • Solution: Plan for equitable access and provide support to underserved communities.
5. Use of Genetic Data and Personalized Medicine
   • Although personalized medicine based on genetic profiling improves outcomes, it also raises concerns about genetic discrimination and privacy breaches.
   • Solution: Establish strict laws and ethical standards for handling genetic data.
6. Changing Roles of Physicians and Patient Trust
   • Automation may diminish the central role of physicians, potentially undermining patient trust.
   • Solution: Reinforce the human element in care and ensure physicians maintain their role as primary decision-makers.

1. Education and Empowerment of Medical Teams and Patients
   • Familiarity with new technologies and their ethical implications helps care teams make informed decisions. Patients should also be aware of their rights and data privacy issues.
2. Development of Comprehensive Regulations
   • Clear and enforceable legal frameworks that uphold ethical standards and protect patient privacy are crucial.
3. International Collaboration and Knowledge Sharing
   • Global standard development and sharing of best practices can enhance ethical use of medical technologies.
4. Establishment of Ethics Committees and Oversight Bodies
   • Ethics committees in healthcare and research institutions can assess and manage emerging ethical concerns. Close monitoring of technology use is essential.
5. Assessment of Long-Term Impacts
   • Longitudinal studies are needed to understand the long-term consequences of modern technologies, supporting better decision-making.

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