Iranian Journal of Medical Ethics and History of Medicine
Year:2013 | Volume:6 | Issue:3|Papers Count:10

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.

Presumption of innocence is one of the fundamental principles of criminal law that has its roots in moral and religious principles. Presumption of innocence is consistent with human nature, and special attention has been paid to it in Islam. For this reason it has been included in our constitutional law as well as in the constitutions and ordinary laws of other nations, and this indicates its significance. In Shiite jurisprudence there are two major theories on the responsibility of physicians as “daman al- tabib”. Most jurists (famous) consider the physician responsible even if he or she has committed no fault. Only a minority of jurists (lessknown) consider the physician to have no responsibility. Islamic criminal law believes the physician to have absolute liability, although medical practices have become more sensitive than in the past and medical incidents have increased as a result of new technology and new methods of treatment. The present study intends to adopt a new approach to rules and principles of jurisprudence, and study the necessity of using them according to the requirements of time in solving everyday problems. Moreover, the study seeks ways to prevent the regression of those rules. Therefore, it seems essential that the golden principle of presumption of innocence be applied to physicians as the manifestation of God's healing, and more attention be paid to it.

Ethical decision making is an important issue in medical professional ethics. Recent advances in medical sciences and development of new ethical issues in medical ethics have added to the importance and specific complexities of this issue. In fact, ethical decision making is a manifestation of moral values in practical work. In this study, the ethical decision making process in medical ethics has been reviewed in Amir al-Mu' minin Ali (A.S.)’s views in Nahj al-Balagha. Therefore, the issue of ethical decision making in various scientific articles and resources were studied and examples of ethical decision making, its components and its determinants in Nahj al-Balagha were analyzed. In Ali (A.S.)’s word, the ethical decision-making components include knowledge and insight, trust, counseling, adherence to moral values, objectivity, commitment to justice, responsibility, privacy, confidentiality, obedience to law, monotheistic belief and human dignity. In Nahj al-Balagha, the barriers to ethical decision making include: the inability to predict and evaluate the probable consequences, hastiness, being overcome by feelings and financial incentives. In conclusion, according to Ali (A.S.)’s views, physicians’ decisions can be ethical when they perceive their profession not as a means of financial gain, but rather as a moral responsibility, and consider both human and divine rights in their professional practice.

In this article, we aim to discuss one of the essential concepts of medicine. As a rule, such studies attempt to clarify the philosophical principals of medicine, whereby the act of medic can be regulated based on his clear perceptions of the principles of his knowledge.In this article, we will evaluate the concept of causation in medicine from a philosophical point of view and through historical review, and we aim to clarify the significance of such concepts in clinical decisions.Medicine is an academic discipline dedicated to learning about illnesses and their causes, curing ailments and promoting social as well as individual health.There are four general paradigms in the world of medicine, and accordingly four definitions of causation.Along the line of these thoughts are the views of modern philosophers such as rationalists, empiricists and post-modern philosophers. In this article we will look at these four medical paradigms and consequently the four definitions of causation.Hippocratic paradigm, with representatives such as Hippocrates, Ibn Sina and Galen, was the first paradigm in medicine to presuppose a rationalistic and realistic view about causation. Biomedical paradigm acquires an attitude similar to logical positivism, seeing causation as a real concept that is true and is provable not through intelect, but by experience. Within this paradigm, a critical clinical approach is specially noticeable according to which causation is not a real and necessary concept, but a mental, unprovable concept that is abtained through symmetry-based association, repetition and statistics.Finally, in the post-modern hermenutical paradigm, discussions of scientific causation and biological and mechanistic topics are replaced by ethical discussions about humans; thus the causation is marginalized and loses its relevance.

Providing ethical health care without considering the priorities from the viewpoints of all care providers is unachievable. Priority setting in health systems is an essential part of policy making and also in ethical dimensions of this system. Nurses are one of the key persons in health systems and due to their encounters with patients are involved in ethical decision making on a daily basis. Sound ethical reasoning and decision making without adequate knowledge will result in moral distress and also will have negative impact on patient’s right.The aim of this study was to investigate nursing ethics priorities on a national level. For this purpose a structured questionnaire consisting of 20 topics was developed by the research team and was sent to nurses in university teaching and social security organization hospitals. Based on the collected data the 10 first ethical priorities in nursing ethics were: nursing ethical values, nursing ethics education, ethics in nursing management, health care provider’s rights, relationship between nurses, patients and their families, patient’s rights, ethical decision making, truth telling and confidentiality, ethical aspects of nursing education and nurses’ relationship with each other.

Organizational justice is of great importance particularly for hospital personnel, and job stress has the potential to put their health at risk. The purpose of this study was to determine the relationship between organizational justice and job stress among the personnel of a hospital in Isfahan.In this correlation study, the samples consisted of 150 personnel that were working in a governmental hospital in Isfahan. Samples were selected through convenience sampling in 2012. Data were gathered by personal data questionnaire, Niehoff organizational justice questionnaire and job stress questionnaire. Data were analyzed by descriptive and analytical statistics.Results showed that job stress among hospital personnel varied from 48.6% (moderate) to 39.4% (mild) and 12% (severe). Moreover, findings showed there was a relationship between organizational justice in the domain of interactional justice and job stress among hospital personnel (r=-0.18, P=0.03).According to the findings, it is essential to pay attention to the concept of organizational justice in hospitals in order to decrease job stress among the personnel.

In recent years, the financial relationship between the physician and the patient and some issues such as informal payments for health care have arisen as an unethical but common problem in many countries, including the Islamic Republic of Iran. Such issues are a threat to the professional reputation of physicians, and can have their own causes in different parts of the world. This study attempts to assess the causes of informal payments and the manners in which they are done in the hospitals of the Kerman Province in Iran in 2012.This study was carried out using qualitative research methods, and semi-structured interviews. Structured interviews were conducted on a purposeful sample of 45 participants including patients, providers and policy makers in the Kerman province in Iran in 2012. This study was authorized by the ethics committee of Kerman University of Medical Sciences, and the consent form was completed by all participants. In this study the participants were asked questions regarding reasons for informal payments, and data were analyzed using content analysis.There are several reasons for making informal payments, which include cultural, legal and quality factors. A number of reasons for asking informal payments by providers were discovered, including those related to tariffs, structural factors and ethical factors as well as to demonstrate the skill and competence of service providers.Most of the reasons discovered for informal payments in Iran are similar to other countries in the world.They showed that inadequate funding of the health systems and inadequate formal payments to providers are the most important supply-side factors leading to informal payments. Given that qualitative studies usually cover potential reasons only, further studies are needed to investigate the matter more extensively.

One of the key strategies in the students’ process of learning is being affected by role models. Recognition of the spiritual strategies of role model instructors for when nursing students are exposed to threats and obstacles to spiritual growth can enable nurses to deal with such situations. This study was conducted to investigate the experiences of nursing students about the spiritual strategies of role model instructors in the role modeling process.In this qualitative study, 22 nursing students were selected based on purposive sampling in 2012. Data were analyzed through conventional content analysis. Data from three focus group discussions (n=20) and two individual interviews with nursing students were collected from five nursing schools in Tehran.Spiritual strategies for role modeling were classified in two main categories: religious beliefs establishment and commitment to ethics.The use of teaching strategies based on spirituality by role model instructors in hidden curriculum was an expression of their religious beliefs in the face of the challenges and obstacles that nursing students confront in their profession, and these strategies helped the spiritual growth of nursing students. It is therefore recommended to promote spiritual development in nursing education, and employ the spiritual strategies of role model instructors to encourage the spiritual growth of nursing students, on whom public health depends.