Iranian Journal of Medical Ethics and History of Medicine

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Making decisions for recipients of health care while offering clinical care is an important part of nurses’ responsibilities. In order to ensure patient satisfaction, nurses are obligated to observe ethical standards in the decision-making process. This paper aimed to determine the effect of teaching professional ethical principles on ethical sensitivity in nurses’ decision-making. In this semi-empirical study, 80 Social Security nurses were selected through purposive sampling and were then randomly placed in two groups of 40 each, the intervention group and the control group. Research tool was the Ethical Sensitivity Scale Questionnaire for decision-making, the validity of which was assessed using content validity, and whose reliability was confirmed with a Cronbach’s alpha coefficient of 0.83 for internal consistency. At first the ethical sensitivity in decision-making was evaluated in both groups, and then an educational workshop on nursing ethics was held for the intervention group every other week the workshop consisted of 4 three-hour sessions, and upon completion of this workshop, both groups filled in the questionnaire once more, and data were analyzed using SPSS software. There was no significant difference between the average ethical sensitivity in decision-making of the two groups before the intervention after the intervention, however, the difference was meaningful (P = 0.001). Moreover, the average ethical sensitivity in decision-making of the intervention group was significantly different after the intervention (P = 0.001). Based on the findings of this study, teaching nursing ethical principles has a positive effect on nurses’ ethical sensitivity in decision-making. It is therefore recommended that this educational program be offered to nursing students and health care staff.

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Research ethics, as one of the main issues of modern bioethics, has attracted the interest of scientists and ethicists in various areas of science and technology around the world. Research Ethics Committees (RECs) have been established to improve putting ethics into practice in the field of research. RECs, fortunately, have received a great deal of attention in different countries, and their mission, goals, and tasks have been described in many national and international guidelines. Ethical guidelines for biomedical research and RECs administrative regulations have been developed in Iran too. The need for special training courses for capacitating members has been emphasized in both international guides and our national administrative regulations for RECs. In this brief article, we present suggestions concerning course presentation and contents, which are provided by international assemblies. In view of the fact that many RECs in our country do not have specific plans for their members' primary training and continuing education, there seems to be a need for fundamental changes in the educational prerequisites for membership in this important organization.

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Ethical decision making is an important issue in medical professional ethics. Recent advances in medical sciences and development of new ethical issues in medical ethics have added to the importance and specific complexities of this issue. In fact, ethical decision making is a manifestation of moral values in practical work. In this study, the ethical decision making process in medical ethics has been reviewed in Amir al-Mu'minin Ali (A.S.)’s views in Nahj al-Balagha. Therefore, the issue of ethical decision making in various scientific articles and resources were studied and examples of ethical decision making, its components and its determinants in Nahj al-Balagha were analyzed. In Ali (A.S.)’s word, the ethical decision-making components include knowledge and insight, trust, counseling, adherence to moral values, objectivity, commitment to justice, responsibility, privacy, confidentiality, obedience to law, monotheistic belief and human dignity. In Nahj al-Balagha, the barriers to ethical decision making include: the inability to predict and evaluate the probable consequences, hastiness, being overcome by feelings and financial incentives. In conclusion, according to Ali (A.S.)’s views, physicians’ decisions can be ethical when they perceive their profession not as a means of financial gain, but rather as a moral responsibility, and consider both human and divine rights in their professional practice.

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Secrecy or confidentiality has always been considered a crucial issue in the medical profession. Secrecy is a common and essential principle among patients and physicians, and is highly emphasized in professional ethical codes and guidelines.This case report is based on an actual case in Medical Ethics Grand Rounds in Tehran Children's Medical Center, with a glance at the boundaries and challenges of keeping and revealing the secrets of the patients.Case Scenario: In this report, a neonate with withdrawal symptoms was admitted to the hospital. After routine examinations by the medical team, they found the neonate’s mother was addicted and had concealed her addiction from her husband and her family. To facilitate treatment of the infant, they discussed the matter with the mother in order to get accurate information. The mother’s denial on one hand, and the need for accurate and comprehensive information necessary to begin treatment on the other caused a challenge to keeping or disclosing the mother’s secret. Here the medical team assumes responsibility to obtain the information from the mother, convince her and win her cooperation, and finally share the secret with the spouse to help their ill neonate.Although respect for patients’ confidentiality is an imperative issue for physicians and healthcare workers, it is not an unequivocal requirement. Due to logical and religious reasons and based on each specific case, it is necessary to make decisions that are more reasonable and less harmful to the patients and their families. Naturally the staff is required to keep the secrets of their patients permanently.

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Virtue ethics is an agent-centered approach that is concerned with good and bad character rather than right or wrong action. It is based on the virtues and moral character of the agent. Morality of the physician is emphasized in medicine as well, which demonstrates its affinity with virtue ethics. Nevertheless, a theory of applied or medical ethics should provide a criterion for ethical decision making by instructing what should be done, something which, according to some philosophers, is incompatible with virtue ethics. This article aimed to demonstrate how virtue ethics can offer rules and guidelines by resorting to the moral agent and emphasizing virtues, and help physicians to make decisions when faced with dilemmas. For this purpose, examples about abortion and selling kidneys for transplantation were provided.Some of the most important advantages of virtue ethics include: context-dependence and attention to relevant realities the importance of emotions and the likely motivations of the people involved and finally emphasis on exemplar based on the sensitivity and practical wisdom of the virtuous agent. These advantages cause virtue ethics to be better positioned than other approaches to solving problems in medical ethics.

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Chronic renal failure in infants is a life-threatening condition that can also severely affect their families. Patients and their families are under great physical, mental and social pressure, and therefore require medical, palliative and supportive care. Moreover, ethics has an important role in care for these infants and their families. The purpose of this study was to identify an ethical approach to providing medical, supportive and palliative services for infants with chronic renal failure and their families. The study was based on a case report in the Medical Ethics Grand Rounds of the Children's Medical Center in Tehran, Iran. The case pertained to a male newborn infant with diagnosis of renal failure. Assessments indicated severe bilateral hydronephrosis and multicystic dysplastic kidneys accompanied by high creatinine levels. The patient underwent surgery but further evaluations revealed a low glomerular filtration rate accompanied by elevated blood pressure. The physicians suggested insertion of a catheter for CAPD (continuous ambulatory peritoneal dialysis) after the initial peritoneal dialysis until a kidney transplant was performed. The proposal, however, was rejected by the parents and the patient was discharged by their consent. A few weeks later, the infant expired at home. It seems that health professionals need effective ethical strategies to offer medical, supportive and palliative services for infants with chronic renal failure and their families

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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.

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