Iranian Journal of Medical Ethics and History of Medicine

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Philosophers of ethics and those who are involved in the debates concerning Medical Ethics have discussed the issue of human dignity and its cluster of meaning from different angles and have suggested many interesting points in this respect. However, a cursory glance at the published works in this field reveals that most of those writers who have contributed to this issue have either based their arguments on notions such as rights or justice, or have used theological doctrines, or have conducted their debates within the frameworks of pragmatic or particularistic ethics. In the present paper, I shall approach the issue from a new viewpoint which is mostly inspired and informed by the ideas of some analytic philosophers. The main argument of the paper revolves around the pivotal notion of “value of life”. All those who take positions vis-à-vis stem-cell researches and the morality or otherwise of using embryos for such investigations, or those who form opinions concerning the ethicality or otherwise of abortion, or those who try to find satisfactory solutions for the vexing issue of the allocation of limited medical resources, maintain, at least in an intuitive way, that the life of a human organism, in whatever shape or form, has intrinsic value. The life of such an organism whether it is a newly conceived egg or an embryo ready to be implanted in the womb or a foetus whose neurological system has just emerged, or a morally fallen adult, is intrinsically valuable. The idea that some things or events are valuable in themselves, namely, we respect them not because they serve our interests but because they are intrinsically valuable, is a familiar intuition. We have developed this ‘intuition’ through our long existential experiences. Now if we reflect upon this very intuition we will be able to discover further layers of meaning in it. For example, we realize that from the belief that ‘human’s life is intrinsically valuable’ one cannot conclude that one should multiply human life as much as possible. On the contrary, some of our other intuitions would inform us that at least some parts of the world would be better off if less populated than crowded. Thus the question arises that if the intrinsic value of human life does not mean its multiplication, then how the continuation of human life, once it has appeared, can have intrinsic value? In the present paper I shall try to use the apparatus of analytic philosophy to explore the ways of reconciliation between the two seemingly contradictory notions of ‘the intrinsic value of life’ and ‘the morality of sacrificing life under particular circumstances’.

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The most basic research in the area of human science is the research about human beings and people, while the first introduction to the immense concept of people is facing independence towards defining this concept because we feel the instances of it every day. Lack of attention in human recognition can prevent us from reaching generalized results and therefore, will lead us to transient decisions. But in fact there are some trembling parts towards human recognition, like getting far from the definition of concept, the inseparability of living species from each other up to dismissing the reality of specie's existence, a quick glance to the challenges of extraverts, ambiguity of biological definitions (morphological, fertilization, genetical and behavioral) and also lack of logical definitions.
From our point of view, there is no pervasive criterion about humanistic living therefore, the rights and characteristics which we consider for human beings are related to the humanistic living from a philosophical view point. To attach this expansion, the philosophical human beings and its differences are incorporated into the minimal human. It is clear that there is no incorporation the same as this rule and we should overcome some steps about them, if not, this incorporation will get beyond the philosophical control of human. In a steady view, what makes a difference from human beings and other creatures is not the biological definition of them, while in the approval view sometimes this definition is the only tool to separate the people. Autonomy and free choice are the exact criterion for this recognition.

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Cloning, especially human cloning, is the latest technology of the present time and has become known as "the debate of the century". Since its appearance, the technique has created global concern for scholars. The physical injury ensuing from the manipulation of women ovaries, nucleus and embryo, potential mental and spiritual harm, incurable disease and early aging are among concerns in this regard which necessitate research and investigation. Providing a precise philosophical framework to alleviate these concerns and end the battle between scholars of natural sciences and humanities over this technology calls for more research and investigation with a deep and philosophical view.In the present manuscript titled "Human cloning technology with a view to Kant's anthropology", first philosophical thoughts and ideas of Kant about human beings are reviewed, his anthropologic thoughts and ideas were analyzed. Finally we conclude that human cloning conflicts with Kant's accounts in anthropology because according to Kant, humans have cognition, free will, and self-discipline, and they have the right to human dignity. According to Kant's anthropology, human cloning technology, whether for therapy or reproduction, should be declared illegal.

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Throughout history, various religions and schools of philosophy have viewed human dignity as an important issue and a topic of discussion. The theoretical roots of this concept lies in ancient philosophies and religions, in Medieval as well as Modern periods, the most significant of which may be the Cyrus Cylinder, Stoicism, teachings of philosophers of the Renaissance period and of thinkers such as Immanuel Kant and John Locke, the Universal Declaration of Human Rights, and Abrahamic religions. Human dignity is infallibly referred to as being intrinsic and inviolable, and although there is no one comprehensive, inclusive and universally accepted definition for the term, it is fundamentally the characteristic that lies at the core of the basic rights of humans. In biomedical ethics there are two different dimensions to human dignity: the dignity of the individual and the dignity of humanity as such, and while the former is considered to be absolute, the latter is relative, as it is realized simply by belonging to the human race. Human dignity applies to all the principles of biomedical ethics, and sets the standards for all manners of reasoning and inference in this field. In areas such as research ethics, ethics of beginning of life and end of life care, and public health ethics, human dignity has clear requirements and implications, for instance regarding issues such as unethical uses of the embryo, fetus, and the human body for commercial purposes, the right to live and die with dignity near the end of life, and the right to basic indiscriminate health care.

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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.

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Human cloning is one of the most controversial issues in ethics. This paper, with analytic-descriptive method, deals with Kant&aposs principle of ends and permission or prohibition of human cloning from its point of view. According to Kant&aposs principle of ends, any action in which humanity is taken as a means, not as an end, is prohibited. There are different interpretations of taking humanity as an end: to do without one&aposs awareness anything, to respect human&aposs freedom and autonomy, to help his happiness and to respect the humanity of others. According to the Kant&aposs principle of ends our review shows any human cloning in which human being is taken as a means to other ends, is prohibited. Thus human cloning in order to produce many groups of humans with the same genetics and using them in war or excruciating work, to reproduce geniuses, politicians, soldiers, scientists..., produce children with ideal genotype and to replace recently died family, is prohibited. But human cloning in which humanity of produced people is taken as an end is permissible, such as cloning at the purpose of human happiness without limiting their freedom and autonomy, therapeutic cloning for producing tissue and transplant organs, for helping infertile couples and for giving birth to healthy newborns without genetic disorders.

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Animal cloning is one of the animal biotechnology branches. Although this method has been used since 1950, but many have paid attention to cloning by birth of Dally. Because the way of Dolly production was completely different from other existed methods in cloning.
This new-found and unprecedented method has been called "Somatic Cell Nuclear Transfer" (SCNT), so scientists have eagerly paid attention to many profitable abilities such as, duplicating valued animals traits, preventing endangered animal species from extinction or even restoration of extinct animals, producing high quality food and drug by using cloning as a way for propagating transgenic animals.
Even though all these instances sound good and encourage use of SCNT, in fact, none of them has practically become feasible so far. The main reason for this claim is that in spite of whole attempts taken for producing cloned animals, the method still is under debate and the hit-rates of this method has been kept considerably low and disappointing.
Because of several reasons, we cannot ignore this recognized obstacle as low efficiency. Along with this issue, there are various sub-effects, which put human and animals life at risk. Not only the High rates of miscarriages or birth of genetically abnormal animals, causes many different health-oriented problems for human and animals, but also it can directly and indirectly endanger human and animals welfare. Nowadays hordes of legal and ethical criticism around SCNT in reaction to these portentous signs, invite scientists to be more scrupulous and patient in its broad enforcement.
Taken together, although at first glance SCNT seems to be promising, it's usefulness has been diminished because of difficulties in its application in broad spectrum. Therefore SCNT should be kept under surveillance and use of it must be just limited to very important and critical cases such as medical purposes, as long as all due observations and cautions take into account before implementing.

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The astonishing advances in medical sciences, owing to research in recent decades, have brought about endless advantages for humans, including improved level of health, prevention of communicable disease, and curative treatments. This trend, despite its great benefits, may undermine the principle of respect for human vulnerability and personal integrity, and expose certain risks to target populations or those excluded from investigations. Therefore, the principle of respect for human vulnerability and personal integrity has received attention by policy makers, law makers, human rights activists, and international organizations. It is necessary to cite the important question that arises here is there any contradiction between international documents' demands such as the Universal Declaration on the Human Genome and Human Rights and the legal actions of some countries on the principle and merits of Islamic teaching? If not, what type of activity should be undertaken by legislators in Islamic countries in general, and the Iranian Parliament in particular? An in-depth discussion of the issue reveals the fact that there is no contradiction between Islamic law and the principle of respect for human vulnerability and personal integrity. Therefore, there is room for the national legislative body to take legal actions in order to achieve the objectives of the principle of respect for human vulnerability and personal integrity in medical research and practice as articulated by international instruments such as the Universal Declaration on Bioethics and Human Rights in particular.

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In this paper, the author aims to study orthodox and protestant points of views on human cloning and investigate on their arguments for and against it. Both ideologies have abolished both reproductive and therapeutic cloning and put forward an argument against them. The only liberal view which allows therapeutic cloning, but refrains from explicitly commenting on reproductive cloning, is a cult of protestant religion. It can be concluded that although reproductive human cloning can't be prohibited by account of their reasons, therapeutic cloning can be forbade by the reason of protecting the life right. This perspective shows that there is a fundamental consistency in Christianity's teaching about both kinds of cloning, because this religion prohibited all sorts of it.

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Valuing human being is the foundation of nursing and the essence of care. Specified aspects of the health care are not compatible with the humanistic agenda. Thus, the challenge is to integrate a humanistic approach into nursing. Nursing scientists have tried to solve this problem by developing human centered theories. Internal evaluation of these theories helps decide about their applicability in solving this problem and enhancing a humanistic approach.The aim of this article is to investigate the applicability of some humanistic theories to nurses' practice. The method is critical review of related literature. Data have been gathered by consulting books, searching some data bases, and using some guiding questions. Findings revealed that humanistic nursing theories, transpersonal care, and human development are becoming specifically expanded under the influence of humanism philosophy. In these theories, human being is free and prepared to grow in a mutual interaction with the environment. Nursing flows from its presence along side others and respect for people's potentials, and has a share in human growth. Emphasis on human interactions has increased the scope of applicability for these theories, but some characteristics of these theories, users, and different context necessitate modifying these theories and developing new ones.      

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Recent advances in cloning have offered hopes for disease treatment and resolving some other difficulties related to health, but this technology comes with social, legal, ethical, religious and other questions, and has caused different reactions worldwide. While some countries have enacted legislations on cloning, other countries have no clear law. Many countries and organizations, for various reasons including ethical concerns, have taken strong stand against reproductive cloning, and some even against research cloning. Some refer to the positive results of cloning and are in favor. Overall, most are in favor of cell and tissue cloning for therapeutic reasons and against reproductive cloning. In general, cloning is an important development in genetics and biotechnology that can be both lifesaving and destructive. Therefore, decision makers should be aware of its positive aspects for human health and prevent potential social and ethical problems through appropriate legislation In this paper, we present the opinions of opposers and supporters, and an overview of the position of countries and organizations regarding human cloning.

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Human germ cell engineering is a modern technology researched with the aim of studying perennial hereditary mutations in herbaceous, animal and human generations. It has led to abundant arguments and discords among ethics and law experts. Possible changes in the human genome that are identified - according to deceleration of human genome and human rights - as the heritage of humanity and the fundamental unity of all members of the human family lead to questions about the relations between this technology and the normal process of creation. At first glance it seems that human germ cell engineering may lead to innovations in the ordinary institution of creation and the old customs of reproduction. Pursuing the contrasting viewpoints on human germ cell engineering, we can observe an essential and material concern about "changing God's creation" or "interference in the will of God"."Changing God's creation" is a current term in Islamic juridical and moral literature. It performs the main role in the legal destiny of genetically engineered creations so the assertion of this phrase about a being can lead to its natural prohibition. The majority of Moslem interpreters maintain that creation bears upon man's Godly disposition, which is unchangeable. In this research, adopting a dominant approach, the author thinks that the process of human germ cell engineering is not exclusively a sample for the term "changing God's creation". In this article we will try to analyze the potentials of the subject of change in genetic engineering of the human germ cell while taking into consideration the holy religion of Islam.

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 Practically, scientific foundations illustrate that the embryo plays a main role in the related technical scenarios. Considering this fact, if technical researches orientated to human subjects, essential legal and juridical arguments will be generated. This article aims to offer a new analysis about moral and juridical nature of human embryo and the associated parental relationships. Adopting this idea that the embryo before 4^th month has no human dignity, the author attempted to present a parental relationship based on ownership and material value. Although the author believes that this idea is built on the legal foundations, it primarily seems that the adopted idea will be faced to moral challenges. From the stand point of this article the concept of the material value of the embryo absolutely refers to an intrinsic value and it doesn’t necessarily relate to financial treats. On the other hand, according to the main pure content of the Islamic juridical rule of Taslit, it illustrates that the right of ownership has been limited by different restrictions .

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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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Considering and preserving patients’ human dignity is one of the most essential moral obligations in the medical and nursing professions. Indeed, respecting patients’ human dignity is the essence of nursing care which is frequently emphasized by national and international nursing standards.This study was conducted based on the qualitative approach, using an interpretive phenomenological method, which aimed to explore the meaning of patients’ dignity preservation based on nurses’ lived experiences. Using purposeful sampling method, a sample of 12 participants was chosen and the data were collected through 16 individual, in-depth and semi-structured interviews. The transcribed interviews were analyzed based on the hermeneutic approach using the analysis method proposed by Diekelmann, Allen and Tanner (1989). The mentioned interviews continued until no new meanings emerged and until the researchers were satisfied with the depth of their understanding. Through fusion of the horizons of the participants’ lived experiences and the researchers’ pre-understandings, the extracted meanings of patients’ dignity preservation emerged as: “respecting the equal human essence”, “providing professional patient-centered care” and “respecting the rights of patients’ companions”.The findings revealed that it is essential to respect the patients’ and also their companions’ rights and recognize the humanness and individuality of each patient for preserving and promoting patients’ dignity and providing more dignified care at the bedside.

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The nature of human dignity is among the most basic queries about the essence of humanity, and research in this area can produce results that may be applied to various health related topics. There is a need for defining comprehensive criteria for the bio-human in order to protect human rights and other values that are attributable to human biology.The present paper first attempts to determine whether abstraction is the base of human dignity, as opposed to contraction. The authors argue that the former may not be the case, as dignity is value-based and therefore implicates moral orders. Such issues cannot be abstracted from external existence, so one can assume contraction to be the base of human dignity. In that case, contraction requires a contractor or an origin for contraction. Self-contracted values are invalid and worthless, and by the same token, external existences are incapable of dignity. Therefore, a stable contractor is required to justify stability and the native essence of contracted dignity, and only God can be that stable, conscious, senior contractor.Among the criteria for dignity, the authors focus on those essential characteristics that differentiate humans from other organisms, and argue that these could be considered as the basis for dignity.

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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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The criteria for human dignity are among the most important topics associated with the concept. Some related questions are what makes man worthy of dignity, and what properties make him more dignified than other creatures? Although biological classifications of species should be considered in humanities, research on dignity must focus on differences that are fundamental and separate humans from all other species. Morphological, genetic and communal differences cannot be the criteria for dignity, and behaviors are subject to individual outlooks. This manner of reasoning guided scholars to categorize humans on the basis of wisdom, but the author of the present article believes that wisdom cannot be the criterion for dignity. There is a degree of intelligence and wisdom in other creatures that is not sufficient to make a fundamental differentiating factor. Like other faculties, wisdom may be regarded as an instrument for a better life. The authors believes that the “authority” to choose (that is, free will) is the essential difference between humans and other creatures because the latter are driven only by their structures or needs. This authority enables people to choose between good and bad or desirable and undesirable, and shapes most human values. Consequently, this authority creates the basis for dignity and any given type of choice passes its value on to the chooser.

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This study aims to investigate the effect of personal and organizational factors on nurses’ generosity in knowledge sharing. For this purpose, a questionnaire was used to gather the required data from the nurses in Beheshti Hospital of Yasouj. The data were then analyzed using descriptive tests (SPSS Software) as well as structural equation modeling (Smart PLS Software). The following factors were found to influence nurses’ generosity in knowledge sharing respectively: organizational culture (&beta: 0.25 T: 5.02), supervisory (&beta: 0.10 T: 4.63), and human resources management (&beta: 0.05 T: 4.36). Some personal factors affecting nurses’ generosity in sharing knowledge included: willingness to help others (&beta: 0.32 T: 4.18) and trust in colleagues (&beta: 0.16 T: 3.02), respectively, but the effect of nurses’ perceived self-efficacy on their generosity in knowledge sharing was not significant (&beta: 0.08 T: 0.54). It can therefore be concluded that both personal and organizational factors are effective on nurses’ generosity in sharing knowledge, although the former appears to have a greater influence.

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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.