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Amir Hossein Mardani, Mohamad Hasanpour, Shahla Khosravi , Alireza Parsapour , Amir Ahmad Shojaee ,
Volume 79, Issue 9 (12-2021)
Abstract

Background: The approach of medical ethics training courses at Tehran University of Medical Sciences to change the attitude and promote medical ethics knowledge of learners has challenges. This study aims to identify the challenges in teaching medical ethics at Tehran University of Medical Sciences.
Methods: This is a qualitative study with semi-structured interviews conducted in April 2018 at Tehran University of Medical Sciences. Using purposive sampling, 23 participants were selected from the clinicians and faculty members of medical ethics and medical students. Data were analyzed by the content analysis method.
Results: The challenges of teaching medical ethics from the participant's point of view are classified into three themes: 1- Hidden curriculum 2- Necessity of completing medical ethics education program 3- Executive and managerial macro factors. The results showed that medical ethics training courses are not effective for changing students' behavior and their moral decision-making. There are substantial shortcomings in the current curriculum in terms of content, format, and implementation that make it unresponsive to ethical needs and concerns. Teaching medical ethics should be turned into a longitudinal theme. The duties and missions of the Department of Medical Ethics at the university are not well understood. The Department does not act as a strong executor and supervisor of medical ethics in interaction with higher authorities to pursue the requirements of effective ethics education and to ensure the implementation of ethical codes. There is no effective mechanism for evaluating the ethical performance of activists and students and giving feedback to them. There is insufficient organizational support for students' complaints and reports about the misconduct and unethical behavior of faculty or staff.
Conclusion: The effectiveness and efficiency of medical ethics courses to change the behavior and attitude of learners are not acceptable. Dealing with the existing challenges requires the efforts of the Medical Ethics Department to make maximum use of available resources and interact effectively with other academic departments.

Sepehr Sahraian , Alireza Parsapour, Amir Ahmad Shojaee ,
Volume 80, Issue 6 (9-2022)
Abstract

Background: Medical ethics is an applied branch of ethics that deals with ethical challenges in medical and health environments, and its related topics have a long history, but its education as an academic subject in universities has received a lot of attention in the last 40 years. In recent years, medical universities have made extensive efforts to expand medical ethics education, which has been accompanied by significant progress, but given that the modern medical ethics education system is a growing and nascent structure, more research is needed. Therefore, this study aims to assess the status of the medical ethics education system at Tehran University of Medical Sciences to identify its gaps so that the current situation can be improved with proper planning.
Methods: The type of this research is descriptive quantitative-qualitative and it was collected from December 2018 to September 2019 at Tehran University of Medical Sciences. First, the educational curriculum of 165 educational levels at Tehran University of Medical Sciences was reviewed and described in terms of the existence of a medical or professional ethics course in the educational curriculum. Then, a semi-structured interview was conducted with the 13 professors in charge of teaching this course in all faculties, and content analysis was performed to describe and identify the obstacles in its effectiveness.
Results: The results showed that in 53% of the educational levels, there was no separate medical or professional ethics course in the educational curriculum and the most educational coverage of this course took place in the faculties of medicine, dentistry, nursing and midwifery. The obstacles in the effectiveness of teaching this unit were categorized into five main themes of educational curriculum, hidden curriculum, teaching methods, teachers and education management.
Conclusion: The results show that the content of curricula needs to be revised and education should be inclusive. Creating a coherent educational organization and monitoring the hidden curriculum are other issues that should be considered to increase the effectiveness of this education.

Keihan Mostafavi, Fariba Ghorbani, Mojtaba Mokhber Dezfuli , Mahdieh Hazrati , Ehsan Alibeigi , Nafise Mohamadizade,
Volume 80, Issue 8 (11-2022)
Abstract

Background: Considering the high death rate of patients on the transplant waiting list, one of the most important ethical challenges of organ transplantation is the lack of transplant organs and different approaches to cover it.
Methods: The ethical issues of organ transplantation have been frequently reviewed recently.
Results: Currently, there are 4 sources for organ transplants, which are: a) organ transplant from animal to human b) transplant from a living donor c) transplant from a brain-dead donor d) transplant from a cardiac-dead donor or donors without a heartbeat, and tissue engineering research continues to prepare a transplantable organ. Each of them has its own limitation and specific consideration. In Iran, organ procurement from brain-dead donors and living donors are the most important sources. Many approaches have been considered to increase the number of procured organs from brain-death cases in the world, but have not yet been able to reduce the gap between supply and demand. Therefore, since the 1980s, the program of organ transplantation from cardiac death (donors with irreversible cardiac arrest) in the world has been reviewed again. Based on the classification of cardiac arrest patients, they are placed in two general categories: uncontrolled and controlled. In a controlled condition, death is predictable, and organ removal is possible by eliminating planned medical interventions and patient support. But in the uncontrolled state, death occurs accidentally, which is more likely to prolong the duration of hot ischemia. Italy's organ donation group has recently introduced type 6 deaths in patients on ECMO, which is mentioned as a semi-controlled group. This group is called donors with abnormal blood flow versus brain-dead donors with normal blood flow. In this study, ethical considerations for organ donation from NHBD were discussed. Regarding the procurement of organs from non-heart beating donors, there are many ethical considerations that include both the donors and the recipients. Considering that the clinical conditions of the brain-dead donors are sometimes very unstable, cardiac arrest may occur before organ harvesting. In these cases, donation after cardiac death is an option.
Conclusion: It is necessary to regulate the ethical considerations for organ procurement from NHBD


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