Volume 17 - Supplement of 11th Annual Iranian Congress of Medical Ethics
IJMEHM 2024, 17 - Supplement of 11th Annual Iranian Congress of Medical Ethics : 1-2 |
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Parsa M. Juridical, Legal, and Ethical Aspects of "Under-the-Table Payments " from the Perspective of Experts and Shia Grand Ayatollahs. IJMEHM 2024; 17 (S1) :1-2
URL: http://ijme.tums.ac.ir/article-1-6917-en.html
URL: http://ijme.tums.ac.ir/article-1-6917-en.html
Assistant Professor, Medical Ethics and History of Medicine Research Center, Research Center for War-Affected People, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abstract: (1101 Views)
"Under-the-table payment" refers to money a physician demands and receives from a patient, in addition to the established and approved medical tariff, typically for medical services such as surgical operations. This study aims to examine the ethical, legal, and juridical aspects of this phenomenon, which has become common among many physicians. This qualitative study is based on semi-structured interviews with 17 experts from various fields, including Islamic jurisprudence, law, professional ethics, philosophy of ethics, medical ethics, health economics, and social psychology. The interviews were analyzed using the conventional content analysis method. Additionally, the opinions (fatwas) of 11 Shia Grand Ayatollahs on under-the-table payments were obtained by posing a specific question to them. The findings from the expert interviews revealed several concerns regarding under-the-table payments, including:
· Disregard for patients' best interests, particularly causing harm to poor patients;
· Undermining trust between doctors and patients;
· Violations of national laws and public policies;
· Promotion of lawlessness;
· Breaches of medical and ethical obligations by physicians;
· Coercion or undue pressure on patients to pay such fees.
Experts emphasized that medicine is a profession in which patients' interests should take precedence over those of doctors, and in this practice, this fundamental principle is violated. Furthermore, in the fatwas issued by the majority of Shia Grand Ayatollahs - particularly those with governmental perspectives - nearly all deemed this practice impermissible, with some explicitly declaring it forbidden (haram). Receiving under-the-table payments is ethically, legally, and juridically problematic, and in some cases, is considered impermissible, particularly for the physicians involved. However, it is generally not considered problematic for patients who are coerced into making such payments.
· Disregard for patients' best interests, particularly causing harm to poor patients;
· Undermining trust between doctors and patients;
· Violations of national laws and public policies;
· Promotion of lawlessness;
· Breaches of medical and ethical obligations by physicians;
· Coercion or undue pressure on patients to pay such fees.
Experts emphasized that medicine is a profession in which patients' interests should take precedence over those of doctors, and in this practice, this fundamental principle is violated. Furthermore, in the fatwas issued by the majority of Shia Grand Ayatollahs - particularly those with governmental perspectives - nearly all deemed this practice impermissible, with some explicitly declaring it forbidden (haram). Receiving under-the-table payments is ethically, legally, and juridically problematic, and in some cases, is considered impermissible, particularly for the physicians involved. However, it is generally not considered problematic for patients who are coerced into making such payments.
Type of Study: Oral Presentation |
Subject:
Health Ethics Congress (11th) - Oral Presentation
Received: 2025/05/6 | Revised: 2026/01/12 | Accepted: 2024/12/22 | Published: 2024/12/22
Received: 2025/05/6 | Revised: 2026/01/12 | Accepted: 2024/12/22 | Published: 2024/12/22
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