Iranian Journal of Medical Ethics and History of Medicine

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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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Moral necessities in the field of children’s cancer are among the most important issues in medical services. The present study was conducted to explore this issue based on a case discussed during the medical ethics round in Tehran Children's Medical Center. A 13 year-old girl diagnosed with left ovarian cancer 5 years ago stated that she had not been informed about the disease and the type of surgery by her family, doctors and the medical staff. The family even denied the child’s disease, but she was struggling to adapt to the situation and eventually recovered after chemotherapy and surgery. Findings of the present study showed that through observance of moral necessities, health workers can assist children suffering from cancer and their families to better adapt to the situation. This is possible by providing supportive resources to these children as well as their families

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Severe combined immunodeficiency (SCID) is an inherited primary immunodeficiency syndrome characterized by a profound deficiency in T-lymphocytes and variable defects in the B-lymphocyte number. The present study aimed to evaluate the ethical aspects of the clinical management of children with SCID. This report is based on the case of a 6-month-old male infant with SCID diagnosis presented during the Medical Ethics Grand Rounds in the Children's Medical Center in Tehran, Iran.

The patient had a positive history of recurrent infections and frequent hospitalization. His parents were consanguineous and came from a low socioeconomic level of the community. He was the fourth child of the family. The first and second children were healthy girls, while the third child was a boy with a history of numerous problems post vaccination who had eventually died of widespread infections. The physician had recommended bone marrow transplant, but the parents had been directed by a neighbor to visit a religious healer.

Timely management of severe combined immunodeficiency can reduce complications and improve the patients’ quality of life. The need for early screening tests is therefore ethically justified, although ethical issues surrounding the subject should not be overlooked. Instances of these issues include: neglecting the scientific criteria necessary to conduct the tests the economic burden imposed on the family of the child failure to provide sufficient information to parents and ignoring their consent to conduct testing and treatment lack of equitable access to diagnostic and treatment facilities and lack of attention to the child’s autonomy. It should, however, be noted that in certain cases, healthcare providers could perform their management activities with an ethical and supportive approach, taking into account all physical and psychological needs of infants with severe combined immunodeficiency, as well as those of their families

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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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This article has no abstract.