Iranian Journal of Medical Ethics and History of Medicine

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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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Quality of nursing care services directly influences individuals' health status. Compiling codes of ethics according to the religion and culture of each population could be an appropriate approach in improving quality of health care services especially nursing care. Hence, the most important priority in our national health system is developing ethical guidelines.
For this purpose a task force has been established in collaboration with nurses, physicians, lawyers and clergymen who were expert in the field of medical ethics. The code of ethics for Iranian nurses was drafted in 2010. The draft that included 12 values and 71 regulations of professional ethics were finally approved in the second session of the Ethics Supreme Council of the Ministry of Health and Medical Education on 6 March, 2010.
The values consist of concepts such as maintaining human dignity, adherence to professional obligations, accountability and responsibility, patient privacy, promotion of scientific and practical competence and respect to individual's autonomy.
Also, 71 regulations of professional ethics divided to five sections including "Nurse and Community" consisting of 9 items, "Nurse and Professional Commitments" with 14 items, "Nurse and Clinical Services" with 23 items, "The Nurse and Other Healthcare Providers in Medical Team" with 15 items, and also "Nurse, Education and Research" including 10 items.

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Providing sufficient information for patients and other healthcare clients is necessary to protect their rights in health systems. In this realm, medical librarians, especially in hospital libraries, can play an important role in supporting patients' rights. Professional national and international associations have compiled and promulgated some codes and guidelines in some countries however, there are many shortcomings in this area in our country. This paper aims to review the status of patients' and other healthcare clients' rights in professional codes of ethics of library and information sciences and professional standards of hospital libraries. We hope the results can provide us with an approach for a more strict observance of patients' rights in our country. This paper reviews professional codes of ethics of library and information sciences and professional standards of hospital libraries. We will contemplate on the articles related to patients' and other healthcare receivers' rights. The findings show that providing patients with information is a pivotal element in professional codes of ethics of library and information sciences and professional standards of hospital libraries. Interactive and knowledge-based information (KBI) that is based on improvement of performance and finding clinical solutions (not just education without practical impact) have aided clinical librarians in protection of patients' rights in some countries.Considering the roles of libraries and information centers in collecting, organizing and making accessible the information for their users, librarians and information scientist should make effective utilization of information possible for healthcare clients, while taking into account their specific needs. Therefore, it is essential to compile professional codes of ethics containing the appropriate approach to disseminate information to patients and other healthcare clients, and to define specific roles for clinical librarians in hospitals and medical clinics.

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By the late 1960s, there seems to be a growing number of articles in medical journals on the subject of the distress that many terminally ill patients declared they had gone through due to repeated resuscitations that only prolonged their suffering. This demonstrates that standard protocols of resuscitating any patient who is undergoing a cardiopulmonary arrest may bring about new problems. A review of studies shows that dealing with patients who are in the last days or hours of their life has been a major challenge for healthcare professionals, and making decisions on therapeutic approach is one of the most fundamental skills for healthcare staff. The scientific, ethical, religious and legal dilemmas in this field make decision-making difficult in some cases. In this paper, we reviewed articles published during the past 30 years, through which the views of health care providers including physicians and nurses on the issue of do not resuscitate (DNR) orders in different societies had been studied. The Islamic perspectives have also been discussed in brief. Moreover, DNR guidelines prepared by various countries such as America, Britain and Saudi Arabia have been assessed. For searching the related studies, we used authentic electronic databases and many reliable websites. Some articles were obtained through hand searching of the references of searched articles.The results showed that despite substantial studies, caring teams are still facing the challenge of DNR in different societies. In Iran, considering the religious values and beliefs, the matter needs more deliberation to help the caring teams to deal with the clinical issues. The religious and cultural background call for a national guideline to be adopted based on Iranian-Islamic culture. Education and awareness rising of different groups including patients, general public, healthcare staff, and health policy makers is crucial in all countries all over the world, and particularly in Iran.

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Justice is one of the main principles of ethics in the healthcare system, and its establishment at macro level depends on formulation of appropriate policies by policy-makers and healthcare providers. Health care policies and payment and reimbursement systems have a significant impact on health systems’ efficiency and cost control. In this paper, payment and reimbursement policies and their impact on financial incentives will be reviewed moreover, financial policies in the national health care in Iran and related challenges will be mentioned in brief. There is no doubt that none of the payment and reimbursement policies is perfect and each of them has the potential to put caregivers or health care providers financially at risk. Therefore, policy-makers should select a combination of the best approaches, considering socioeconomic factors, in order to provide a maximum coverage of health services and ensure fairness in the health system. Efficient payment and reimbursement approaches should undoubtedly preserve the rights of all parties in a fair and logical manner. Current national policy shows that a high percent of health care expenditures are financed through out-of-pocket payments, and therefore appropriate policies should be adopted to lighten this burden. Considering the accelerated trend toward the Family Doctor Plan in big cities in Iran, the present paper would be helpful for many health care providers, physicians and other health care professionals.

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It has been over five decades since the concept of “spiritual health” was first introduced in academic texts, and although many studies have been conducted on the subject, there exists no consensus on its definition and components yet. Nonetheless, this concept has been an inextricable part of Islamic Theology, which is more than several hundred years old. Therefore, it can be asserted that observation and analysis of the lifestyles of Muslim scholars may shed some light on this seemingly complex concept. This analytic-descriptive article was designed to provide a straightforward definition for spiritual health and explore its different components from the viewpoint of Ayatollah Hassanzadeh Amoli, a renowned Shiite scholar. In this article, spiritual health refers to the health of the soul and is related to both material soul and the body itself. The Ayatollah puts special emphasis on the importance of living a healthy lifestyle and on the health of the material soul in order to promote spiritual health. In this article, we endeavor to conduct a thorough analysis of the lifestyle and views of Ayatollah Hassanzadeh Amoli.

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Abortion of the disabled fetus is among the challenges of medical ethics, and decision-making in this respect is subject to a major controversy between Islam and Western philosophies. One reason is skepticism about the continued existence and evolution of the human soul after death, which has resulted in legitimacy of abortion of disabled fetuses in the West. Islam and Islamic philosophers, however, attribute great importance to the soul and its evolution, and therefore in decisions related to such embryos all aspects of the body and soul are considered, with more emphasis on the latter. Some issues that are raised in the Islamic worldview include: What is the reason behind embryonic defects? And does a disabled fetus also suffer from a defect in the soul?The present paper is a descriptive-analytical non-systematic review that uses a data collection approach. Regardless of the issue of ensoulment, the study intends to examine the evolution of the spirit (nafs) in the fetus during various stages of life (vegetative, animal and human) based on Mulla Sadra and Imam Khomeini's perspectives. It also aims to conduct a philosophical investigation into defects in creation and to find the answer to the important question of whether the soul of a disabled fetus is also imperfect. Findings of this study show that based on Mulla Sadra’s views, all living things have been created in the best and most perfect form. The disabled fetus is not an exception and therefore has a perfect soul, but the appearance of the soul in a malformed body is defective. The imperfection may have two causes: first, a wrong choice made by the soul of the disabled fetus in the world before this one, i.e. the Zar world, although the concept is among the unfolded mysteries of creation unfathomable by human knowledge second, effect of the genes and/or the environment, regardless of the choice made by the soul of the disabled fetus in the world of Zar.However, since decision making regarding abortion of disabled fetuses is still a matter of controversy in medical ethics, further studies from the perspective of Islamic philosophy seem necessary to help resolve the issue and provide ethical guidelines based on Islamic principles.

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It is universally acknowledged that death is a complex concept and different factors such as complicated philosophical ideas, contradictory descriptive approaches, and diversity in interpretations add to this complexity. Although a thorough understanding of the notion of death is important for everyone, this concept is of crucial importance to health care providers as they face enormous ethical challenges in the course of their careers. A few instances are controversial issues such as brain death, euthanasia and end-of-life care, where it seems essential to define a set of robust criteria for death. On the other hand, it can be argued that death is not a scientific concept and only different branches of medicine can provide a framework to clarify the subject of death. Therefore, it could be argued that theological approaches may shed some light on this concept. In this article, we aim to extract ontologic components of death mentioned in the Holy Quran, and will move on to propose a set of 12 criteria for death. This may help provide a clear understanding of the concept from the point of view of the Holy Quran, although more research is warranted to further illuminate this complex subject.

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In recent decades, advancements in genetics and medical technologies have made it possible for clinicians to diagnose and sometimes treat fetal abnormalities in early gestational stages. This issue presents numerous ethical challenges for parents, doctors, ethicists, jurists and other professionals in terms of the continuation or termination of such pregnancies. A non-systematic review was performed to extract the main ethical codes that should be considered when offering counseling to pregnant mothers of fetuses with congenital anomalies. Moreover, since the attitude toward the status of such fetuses in the world of creation can strongly affect ethical decision-making, we attempted to investigate the issue further by offering some Islamic perspectives on the subject.Considering Islamic principles in offering ethical advice to Muslim parents of fetuses with congenital anomalies will help them make an informed and more appropriate decision in serenity. We hope the results of this study will facilitate ethical decision-making in health care and related disciplines, and thus help us deal properly with the issue of disabled fetuses.For future studies, it is recommended to compile related ethical guidelines based on Islamic principles to investigate various aspects of the issue.

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Abortion has remained a subject of intense controversy in medical ethics, particularly in the case of malformed fetuses. Review of the existing literature on the issue indicates that there are two main challenges in this regard: firstly, the question as to whether a malformed fetus has the right to live, and secondly, the fate of the soul (vegetative and animal) after induced abortion.This descriptive research presents different viewpoints in order to investigate the aforementioned questions in Mulla Sadra’s philosophy with a focus on the “right to live”. The results of the study demonstrate that according to Mulla Sadra’s theory, all fetuses possess potential human souls even if they are extremely malformed or disfigured. He considers the fetus a vegetable with the potential to convert into a human. Based on this ideology, which encompasses both creation and resurrection, the malformed fetus has the right to live. The assumption is founded upon Mulla Sadra’s Theory of Substantial Motion, which implies that abortion may influence the evolution of the soul in the limbo period (intermediate state) after abortion and might even affect its resurrection. It can be concluded that in the Iranian society, which has an Islamic background, theological views should be considered in decisions about abortion. It should be mentioned, however, that philosophical approaches alone cannot be relied on for decision-making regarding the abortion of a malformed fetus. Furthermore, interdisciplinary contributions are indispensable to a thorough analysis of this controversial issue so that the ethical challenges surrounding abortion in such cases can be overcome.

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In recent years, there has been a significant increase in the rate of cesarean section in Iran. Physicians can have an active role in controlling this rate as they are truthfully consulted and followed by the general public. The Iranian Ministry of Health and Medical Education has also adopted new policies to control the national cesarean rate. The present study aims to determine the knowledge and attitude of medical residents towards elective cesarean section versus normal vaginal delivery (NVD) in 2015.

In this cross-sectional study, residents of four major fields of specialty (obstetrics and gynecology, pediatrics, general surgery and internal medicine) were interviewed using a researcher-made questionnaire. The face and content validity and reliability of the instrument were determined, and data analysis was performed using SPSS version 21.

The Cronbach’s alpha coefficient was 0.77. A total of 108 residents with the mean age of 32.89 participated in the study. Of this number, 53 reported at least one personal experience of childbirth (their own or that of their wives) with a satisfaction rate of 9.5 and 6.3 out of 10 for NVD and cesarean respectively. The mean score of the domains of "knowledge", "attitude" and "function" were 3.5, 3.6 and 3.3 (out of 5) respectively. There was a meaningful correlation between the variable of "sex" and the domain of "knowledge", "specialty" and all three domains, and "methods of delivery" and the two domains of "attitude" and "function". 34.3% of the residents chose "mandatory public education of pregnant women" as the first step to decrease the cesarean rate.

It can be concluded that educating pregnant women should be the main strategy for decreasing the cesarean rate in Iran. Considering the significance of medical specialists’ "knowledge", "attitude" and "function” with regard to the method of delivery chosen by pregnant women, it is recommended to develop specialty educational programs in line with the policies of the Iranian Ministry of Health to decrease the cesarean rate

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Despite all recent advancements in medical sciences and the related technologies, the concept of death still remains obscure. It can be asserted that as death includes both physical and spiritual dimensions, medicine alone is not capable of fully illuminating its different features. Therefore, inter-disciplinary collaboration between different branches of science such as Quranic studies, humanities, and philosophy seems necessary in order to shed some light on this hitherto undiscovered subject. Through description of what the soul experiences before and during death, such collaborations may even enrich the knowledge and broaden the minds of physicians who are capable of the analysis of physical changes caused by death. This insight can promote the ethical decision-making process as well as the provision of end-of-life care and spiritual support in different stages of death. The current research, as a library literature review, endeavors to provide a descriptive view of death from a medical perspective, and then, a Quranic depiction of its different stages through an analysis of verses and quotations from the holy Quran and Islamic scriptures whose primary focus is the process of dying. The final discussion section presents some similarities and differences observed between viewpoints and raises questions which can be considered as being of great practical importance in terms of provision of necessary end-of-life spiritual support. We hope that further research in this field can better clarify the issues raised in this article so that practical measures aiming at the provision of Quran-based spiritual end-of-life care are designed and implemented.

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The Declaration of Helsinki is one of the most important international documents in medical research ethics on human subjects which has been revised 7 times and the last revision was in 2013. Researchers must be informed of the principle of Helsinki declaration and the latest changes in order to respect the rights of participants in medical research. In this study, the last version of the declaration are compared with the previous version (2008). The evaluation of the changes and challenges of the final revision can be helpful in modification of the ethical codes of our country. The 2013 version included a number of important changes; it has been categorized into more clear and detailed sections. So this version has a better structure and more practical as well. The 2013 version places more emphasis on vulnerable groups and includes a separate section on the compensation and treatment of injuries due to research. The revised version of the Declaration of Helsinki also emphasizes obtaining of the informed consent (even in researches on material or data contained in biobanks) and post-trial access.

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Ethics of care are the central core of nursing values and a fundamental concept in the nursing profession. Since the outlook of nurses on ethics can affect the quality of care, the present study was conducted to investigate the attitude of nursing students to codes of ethics for nurses, their commitment to ethics of care, and academic dishonesty in Abadan School of Medical Sciences. 

This descriptive analytical study was performed among 150 nursing students of Abadan School of Medical Sciences by census sampling in 2016. After giving their informed consent, the students completed the questionnaire designed by McCrink in 3 sections: 1) demographic information, 2) attitude to ethics codes, commitment to ethics of care and neutralization behaviors, and 3) outlook on academic dishonesty. Data were analyzed using descriptive statics, chi-square test and Pearson’s correlation coefficient in SPSS version 21.

The results showed that the students had the most positive attitude to ethics codes and commitment to ethics of care, and the most negative attitude to neutralization behaviors. Less than half of the participants had a negative outlook on academic dishonesty. Moreover, about 40 percent of the students reported academic dishonesty among their classmates. Ethics codes are moral values in academic and clinical settings and should therefore be considered as major components of initial nursing education programs. Additionally, it seems necessary to make efforts in order to change nursing students’ attitude toward academic dishonesty.

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