Search published articles


Showing 17 results for Autonomy
Iranian patients views about surrogate decision maker
Komeil Mirzaei, Alireza Milanifar, Fariba Asghari,
Volume 4, Issue 2 (4-2011)
Abstract
Decision making by a surrogate on behalf of incompetent patients is based on the ethical principle of "respect for autonomy". The increase in advanced health services has lead to more instances of decision making for incompetent patients receiving such services, and the treatment team usually asks a family member to serve for this purpose without being aware of the patient's preference. This study was conducted to assess patients' wishes and preferences regarding surrogate decision makers and determinants of such preferences.The study was cross-sectional, and samples were selected randomly from patients presenting at Farabi Eye Hospital clinics who were 18 years of age or older. Questionnaires were completed through interviews. Two hundred patients between 18 and 83 years old were interviewed. About 52% (n=105) were men, and 73% (n=77) were married. Among the married, the spouse was chosen as the surrogate decision maker in only 51% of cases. Among singles, boys preferred their father in 36% (n=9) of cases, while girls chose their father in 5.6% (n=1) of cases and the most frequent choice was other unmentioned people (33.3%, n=6). Most patients (93.5%) wished to be asked about their surrogate decision maker upon admission.Results of this study demonstrated that the people we usually consult for decisions concerning patient treatment are significantly different from patients' preferred surrogate decision makers. We suggest leaving the choice of surrogate decision maker to the patient while they are conscious.
Authority in human reproductive cloning
Lila Nekooei Nejad ,
Volume 4, Issue 5 (10-2011)
Abstract
Human cloning is one of the latest and most complicated developments in the field of medical and genetic sciences that could fulfill man’s dream of eternal life. Scientists’ achievements in this respect, however, have brought about many concerns for thinkers, particularly ethics scholars. Human and animal cloning have been examined from different angles, but one basic aspect of human cloning has received less attention from researchers and scientists, and that is the autonomy of the cloned person the reason is that gaining informed consent, which is one of the most important principles of medical ethics in human experiments, is impossible in the case of human clones. Free will lies at the core of human perfection and divine revelation, and one important issue that the present study concerns itself with is whether or not technologies such as cloning or embryonic genetic modification violate the autonomy of cloned persons. This paper attempted to look into such issues regarding human cloning through library research.
The role and consequences of trust in physician-patient relationship
Amirahmad Shojaee, Fereshteh Abolhassani Niaraki,
Volume 5, Issue 4 (7-2012)
Abstract

Trust is a key element in the physician-patient relationship. Imam Jafar Sadiq (A.S.) stated that the proficient and trusted physician is in equal level of a just jurisprudent. Ancient ethical texts put much emphasis on physicians to be trusted. Nowadays, trust is a component of social health we believe that in the physician-patient relationship, trust has a significant impact on the practice, and increases the effectiveness of treatment and the satisfaction of patient and physician? also patient autonomy is preserved, health is positively reinforced, and patients will be more serious and less negligent with expenses, treatment, and follow up. This paper is a review/analytical article, and aims at classifying trust and examining its role in communication between physician and patient. If limited to practice, trust in the physician - patient relationship is divided into two types:

1- Unconditional trust, which means full confidence with no autonomy

2- Conditional trust, which entails maintaining autonomy.

 In the first type, where patient's autonomy is foregone, both patient and physician can be blamed. The patient is to blame due to an absence of self confidence and lack of participation in decision making and treatment, and the physician might in his place have the tendency to patronize. In this article we emphasize the importance of trust and warn against paternalism and conclude that if doctors truly comprehend the meaning of trust, they will try to avoid paternalism.


Moral responsibility of the physician in response to the patient’s request for assisted reproductive technology
Fatemeh Doomanlo, Amirhosin Khodaparast,
Volume 6, Issue 1 (4-2013)
Abstract
Professionals who provide assisted reproductive technology (ART) services may be approached by patients who have no chance of success of treatment, or can even be harmed during the requested futile treatment. In such cases, what is the moral duty of those who provide treatment services, in particular the physicians? Does the mere request on the part of the patient free the doctor from his/her professional moral responsibilities? On the one hand, principles of individual autonomy and beneficence require the doctor to provide the patient with necessary treatments regardless of the results and consequences. On the other hand, the principle of non-maleficence requires the physician not to impose any harm on the patient. In addition, due to the limitation of resources, doctors are obliged to allocate them to those patients who have a better chance of recovery and use them in cases in which the probability of resource waste is low. However, does this sit well with the principle of justice, especially where the patient is willing to pay all the costs of his/her treatment? Whose interest does the doctor have to prioritize, the patient’s, that of the child resulting from ART, or the society’s? Given the above points, moral training of the team providing treatment services seems necessary so that they acquire the essential skills to make the right decisions in difficult situations such as those mentioned above.
Ethical considerations of futile care
Mansureh Madani,
Volume 6, Issue 2 (5-2013)
Abstract
When medical treatment is futile, the physicians must refrain from treating patients, and this can lead to serious and stressful problems. In this paper, in order to facilitate ethical decision making relevant literatures have been reviewed. This review article aimed to explaining the different clinical forms of futile treatment, and exploring theoretical and practical dimensions of futility. The first problem in this field is ambiguity in the definition of futility. The next problem is determining the practical criteria and attributing the meaning of futility to particular treatments. This ambiguity is partly due to different perspectives about the goal of treatment, and variations in physicians' and patients’ values and also disagreements regarding the person who should have the right to make decisions ultimately. It may also be related to finances and immoral motives. The third problem is some practical conflicts the most notable are futile care, requested by the patient and the sanctity of life, especially in the concern of religious considerations. In this regard, several definitions have been proposed for the futile treatment. Studies indicate that requesting futile care is often due to emotional problems or lack of trust a case that requires the physician’s tact to resolve and rarely is resolved by rule. Another serious problem that is regarding to end of life cares, especially in the context of religious views, is the necessity of life saving, that is closely related to the inactive euthanasia. This can be solved by giving priority to more important issues such as health budget constraints.
Theoretical foundations of treatment refusal: ethical, philosophical and jurisprudential aspects
Mansureh Madani, Ensieh Madani,
Volume 6, Issue 5 (12-2013)
Abstract
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.
Ethical issues regarding fertility preservation for women
Shima Behnammanesh, Reza Omani Saman, Shayan Behnammanesh,
Volume 7, Issue 2 (7-2014)
Abstract
Fertility preservation consists of a set of procedures that help people maintain their reproductive ability in order to have a genetic child in the future. Nowadays, these procedures are widely accepted as long as they fall within the two categories of medical or social justification. In the first category, patients may lose their fertility due to diseases or treatment-related complications, while, in the second, healthy patients wish to preserve their ability to have children in the future for social and personal reasons. Since these procedures are considered invasive, many questions and criticisms have been raised about their application in the case of healthy women who seek them merely on account of aging.In this descriptive-analytic study, ethical issues were retrieved from books, papers, international guidelines, theses, declarations and instructions, and even some weekly journals, using keywords related to fertility preservation such as embryo cryopreservation, oocyte cryopreservation, and women’s reproductive autonomy. In cases of medical necessities, fertility preservation is considered acceptable and consistent with the principle of beneficence, which is the most important principle of medical ethics. As for cases that only have social justifications, some argue that they contradict the principle of non-maleficence. Nevertheless, a large number of feminists and scholars believe in women’s reproductive autonomy and therefore consider them ethical, provided that certain conditions are observed.
Challenges associated with patient autonomy in Iranian hospitals: a qualitative study
Hossein Ebrahimi, Effat Sadeghian, Naeimeh Seyedfatemi, Eesa Mohammadi,
Volume 7, Issue 4 (11-2014)
Abstract
Patient autonomy is the opposite of paternalism and an essential element in individualised, patient-centred, ethical care. Challenges associated with patient autonomy are culture-related and have not been fully investigated in Iran so far. The aim of this study was to explore the challenges to the autonomy of patients in Iranian hospitals.This was a qualitative study using conventional content analysis methods. In 2013 13 patients, 7 nurses and 1 doctor were selected from three Tabriz and Hamadan teaching hospitals using purposive sampling to participate in semi-structured interviews. The interviews were subjected to qualitative content analysis and analysed using the MAXQD10 software.Fifteen categories and three themes were identified. The three main themes related to challenges associated with patient autonomy were: interpersonal factors, altered relationships, and organisational constraints. In summary, this study revealed some challenges associated with patient autonomy that the treatment team, managers and planners in the health care system should target in order to improve patient autonomy.
Human commodification and ownership claims in biotechnology
Abdolhassan Kazemi, Soraya Mahmoud,
Volume 7, Issue 5 (1-2015)
Abstract
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
The Domain of Autonomy, Limitations and Solutions
Neda Yavari, Alireza Parsapoor,
Volume 10, Issue 0 (3-2017)
Abstract
Increasing attention to individual liberties in last decades, has led to considering respect to patients autonomy and involvement in making medical decisions as a critical ethical principle. In spite of a general emphasis on the Importance of the mentioned principle, there is a wide controversy about the logical limitations of respect to patients' wishes and preferences in medical decision making. While a significant number of theoreticians believe in necessity of considering rigid limitations for respect to patients' autonomy, others emphasize on respect to patients' absolute and unconditional right of self-determination. This article explains and analyzes each group's main arguments and finally suggests a functional and logical approach to the principle. This method helps avoidance of disadvantages of unconditional respect to patients' preferences while considering autonomy as an important ethical maxim.
Which Is The Most Determinative In Emergency Cases? Patient Autonomy or Physician's Decision: A Clinical Case-Study
Seyed Saied Seyed Mortaz, Parvin Delavar, Nafiseh Zafarghandi, Mohammad Reza Yektaei, Qolamreza Moarefi, Ali Davati, Shiva Rafati, Siamak Afshin Majd, Ahia Garshasbi,
Volume 11, Issue 0 (3-2018)
Abstract
A 62-year-old man referred to the emergency department 48 hours ago with chief complaint of repeated bloody vomiting. The patient is admitted and the necessary measures are taken. Within 24 hours, he received 6 units of blood. The patient has undergone endoscopy, but endoscopic endorsement has failed to stop the bleeding. The surgeon consulted and visited the patient. He considered urgent emergency laparotomy. The patient is alert and refuses surgery. The hemodynamic status of the patient is not stable and gastrointestinal bleeding continues. These questions are posed to medical staff and hospital managers: "What is our duty”? "Should we respect the choice of the patient and witness the progress of the disease and deterioration of the patient's condition"? "Can he be discharged from the hospital on the basis of the patient's refusal to take medical treatment"? "Can we take appropriate diagnostic and therapeutic measures with the use of legal capacity and support despite patient’s opposition? "How can one regard autonomy, beneficence, and nonmaleficence at the same time, in this situation "? In this study, which is one of the problems of medical ethics, the ethical, legal, and health aspects of the presented patient are discussed.

The Status of Informed Consent Process in Pediatrics’ Wards of an Educational Hospital
Roghayeh Zare, Sedigheh Ebrahimi,
Volume 11, Issue 0 (3-2018)
Abstract
Involving children in their own treatment decision-making improves their abilities. Factors such as the ability to reason, previous children's experiences in relation to the subject as well as information, and their general understanding of the subject affect the child's ability to make decisions. The current laws of informed consent in children allow alternate decision makers to decide on their own. Our goal in this study was to examine the current conditions for the informed consent of children in to provide appropriate guidelines in this regard. In this qualitative study, participants were selected through targeted sampling. The data were collected by semi-structured interview with open questions. Coding and classification was carried out using continuous comparative analysis. Participants included 6 admitted children, 15 parents of children, and 4 pediatricians. Three general categories of "satisfaction culture", "environmental conditions", and "child world" were extracted. Parents and children were not clear about the purpose of obtaining consent. The gender of children was not significantly affected by the process of obtaining formal consent in medical settings. The existing conditions have created a non-appropriate balance in the expectations of parents regarding the treatment decisions and giving vital information and treating the child by doctors disregarding child’s competency. This defective balance can, in the meantime, cause instability and harm to human dignity and autonomy of parents and children, waste of resources, challenging the sense of trust in the community towards doctors and the lack of growth in child’s decision-making power.
 

Ethical Considerations in Respecting Patient's Autonomy and Right to Refuse Treatment: A case Report
Mohamad Nader Sharifi, Pooneh Salari,
Volume 13, Issue 0 (3-2020)
Abstract
One of the most challenging aspects of treatment is when patient seriously refuses the desired by treating physician. On the other hand, refusing treatment is a condition of the patient's right to be aware, but does such a right also imposes a moral obligation on the treating physician or not? This study discusses the diagnosis of Systemic Lupus Erythematosis disease. This article attempts to provide an overview of the ethical considerations for obtaining informed consent for a patient who refuses treatment. In this report, according to the patient's age, it can be concluded that although the patient has the capacity to make decisions, but because her age is below the legal age and does not have the authority to decide, her refusal to receive treatment cannot be accepted and it is necessary to make a decision based on the supreme interests of the patient with the opinion of a qualified legal guardian in this regard, taking into account the scientific aspects.

Exploring Advance Directives and End-of-Life Preferences in Heart Failure Patients: A Systematic Review and Meta-Analysis
Aydin Feyzi, Amirali Soheili, Samira Chaibakhsh, Fidan Shabani, Shiva Khaleghparast,
Volume 17, Issue 0 (12-2024)
Abstract
Advance directives (ADs) are legal instruments that enable individuals to express their healthcare preferences in anticipation of a future loss of decision-making capacity. These directives are particularly important in the context of chronic conditions such as heart failure (HF), a disease marked by progressive functional decline and unpredictable medical crises. ADs help safeguard patient autonomy by ensuring that care aligns with personal values and preferences, especially at the end of life. This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines to examine the preferences of patients with heart failure regarding life-sustaining treatments and end-of-life decision-making. A comprehensive literature search was performed across PubMed, Scopus, and Web of Science databases, covering publications up to March 2024. Search terms included "advance directive," "advance care planning," "heart failure," and "end-of-life decision-making." Studies were included if they were original, peer-reviewed, full-text articles focusing on HF patients aged 18 and older. Non-peer-reviewed works and inaccessible full texts were excluded. A total of 25 eligible studies were identified and appraised using the NIH quality assessment tool. Extracted data included demographic characteristics, preferences for treatment, surrogate decision-making, and educational interventions. Findings from the reviewed literature reveal consistently low levels of awareness and completion of ADs among HF patients. Completion rates varied significantly across studies, reflecting potential cultural and systemic influences. Preferences for surrogate decision-makers overwhelmingly favored family members over healthcare professionals. A notable finding from Jawahri et al. (2016) indicated that patients who received video-based education were significantly less inclined to choose cardiopulmonary resuscitation (CPR) or mechanical ventilation compared to those receiving only verbal information. Additional qualitative insights, such as those from Formiga et al. (2004), showed that patients prioritized maintaining dignity, independence, and meaningful relationships over merely extending life. These patterns highlight the necessity of aligning care with patients’ broader goals and values. Across the 25 studies included, a total of 4,091 heart failure patients were analyzed, with a mean age of 68.22 years. Meta-analytic findings demonstrated diverse preferences regarding life-sustaining interventions: approximately 53.73% of patients favored such treatments, while 45.37% declined CPR. These statistics underscore a substantial variability in end-of-life preferences, further reinforcing the need for individualized care planning. In conclusion, patients with heart failure display heterogeneous preferences concerning end-of-life care, shaped by cultural context, personal values, and the type of information provided. Despite the established importance of ADs, significant deficits in awareness, understanding, and documentation persist. These findings point to a critical need for tailored educational interventions, improved provider-patient communication, and culturally sensitive approaches to advance care planning. Future research should focus on designing and integrating standardized AD facilitation tools into routine clinical practice to support truly patient-centered care.

Ethical Challenges of Truth-Telling for Terminally Ill Patient
Neda Yavari ,
Volume 17, Issue 0 (12-2024)
Abstract
Communicating the truth about a terminally ill patient’s diagnosis and prognosis is a profound ethical challenge in healthcare. While patients have the right to know the details of their medical condition, grounded in the ethical principle of autonomy, healthcare providers often grapple with concerns about causing distress or hopelessness. These concerns sometimes lead to paternalistic approaches where information is either manipulated or withheld from patients in end-of-life stages. Research on the timing, method, and extent of information sharing with terminally ill patients has yet to reach a consensus. The challenge is further complicated by cultural differences regarding death, as well as varying family and social dynamics. This article explores the views and experiences of both healthcare providers and patients regarding the ethical challenges associated with truth-telling in end-of-life care. This qualitative study involved semi-structured, in-depth interviews with 27 healthcare providers, 20 patients, and 15 caregivers. Participants were selected through purposive sampling, and interviews were conducted until data saturation was achieved. The data were analyzed using conventional content analysis. The findings were organized into four key themes:
1.Diverse methods of truth-telling employed by healthcare providers, influenced by personal values, institutional policies, and cultural contexts.
2.Patients’ and families’ preferences for receiving information, which frequently conflicted with healthcare providers’ practices.
3.The impact of timing, manner, and setting of truth-telling on the emotional health of both patients and their families.
4.The necessity for a patient-centered approach that acknowledges the unique circumstances, values, and preferences of patients and their families.
This research highlights the ethical complexities involved in truth-telling for terminally ill patients. While respecting patient autonomy is fundamental, the manner and timing of delivering the truth are crucial to maintaining trust in the physician-patient relationship and safeguarding the patient’s mental health. Further research should focus on developing effective communication strategies and support systems for healthcare providers engaged in end-of-life care. Educational programs should prioritize improving communication skills, cultural sensitivity, and ethical decision-making to enhance best practices and alleviate the emotional challenges faced by healthcare professionals in this sensitive area.

The Importance of Patient Autonomy in Home Care: A Systematic Review
Mohammadreza Jalilfar, Hedayat Jafari, Fatemeh Roudi, Seyed Tohid Hoseini, Soodabeh Eslami, Seyed Mohammad Mirshafiei,
Volume 17, Issue 0 (12-2024)
Abstract
With the increasing need for home nursing care, patient autonomy emerges as a crucial ethical principle in delivering care services. Therefore, this study aimed to investigate the importance of autonomy and individual independence in home-based patient care. In this systematic review, articles from PubMed, Scopus, ScienceDirect, Magiran databases, and Google Scholar search engine, published within the last 10 years, were used to search for articles related to autonomy and independence in home nursing care. The keywords used in the search were: "patient autonomy", "home nursing care", "nursing ethics" and "autonomy in nursing home care".  After reviewing and filtering the articles based on the study's objectives, 20 articles related to autonomy in home nursing care were included in this systematic review. The findings of these studies indicated that various factors can influence patient autonomy at home-care, including: · Individual factors: age, gender, physical and mental health status of the patient; · Family factors: family support, family relationships, family culture; · Social factors: social support, access to social resources; · Organizational factors: care policies, organizational structure, organizational culture.  Considering these findings and their comparisons, it can be concluded that to promote patient autonomy at home, all the mentioned factors should be considered. Some of the suggested solutions to promote patient autonomy are: · Educating the patient and family about patient autonomy; · Strengthening family support for the patient; · Providing social support services to the patient; · Developing care policies that support patient autonomy; · Improving organizational structure and culture.  Patient autonomy is one of the essential ethical principles in home nursing care. Considering the factors affecting patient's autonomy, comprehensive solutions should be considered to promote it. Patient and family education, strengthening family support, providing social support services  and improving organizational structure and culture are among the effective solutions in this field.

Ethical Considerations in Decision-Making for an Elderly Alzheimer's Patient: A Case Report
Maryam Modabber, Mojtaba Parsa, Shiva Khaleghparast,
Volume 17, Issue 1 (3-2024)
Abstract
In the current era, the alarming increase in the number of patients with Alzheimer's disease has led to greater attention to issues related to care and alternative decision-making for this special group in society. The four ethical principles of "beneficence", "non-maleficence", "respect for autonomy", and "justice" serve as fundamental guidelines in medical decision-making. This study presents a case report of an elderly Alzheimer's patient and the ethical issues related to medical decision-making in the absence of a substitute decision-maker. Typically, for individuals lacking decision-making capacity, decisions are made by a substitute decision-maker and, in some countries, an advance care directive. In the absence of these, the medical team may make decisions in the best interest of the patient, considering the individual's cultural and social conditions, while taking into account the aforementioned ethical principles.

Page 1 from 1     

© 2026 , Tehran University of Medical Sciences, CC BY-NC 4.0

Designed & Developed by: Yektaweb