Iranian Journal of Medical Ethics and History of Medicine
Year:2011 | Volume:4 | Issue:6|Papers Count:10

Breaking bad news to the patients does not back to a long history and is a controversial issue between patients and physicians.Many physicians are reluctant to breaking bad news to patients and this is not desirable for most patients. For example, in Northern European countries and United States, most physicians usually break bad news to the patients, while in Southern and Eastern European countries or many Asian countries they would not do so. In Iran, physicians prefer to break bad news to patient's family rather than the patient. Cultural differences also influence people's viewpoints about breaking bad news. In Western countries, most people agree with breaking bad news to patients while it is not common in the other populations. Nowadays, the dominant view in the most countries is that it is the duty of the physicians to break bad news to patients. Some advantages of breaking bad news to patients including strengthening the trust between physician and patient, preventing non- maleficence, increasing patients satisfaction and reducing legal action against the doctors There are some exceptions to breaking bad news the most important is serious psychological damage to the patient. Quality and quantity of information that should be released depends on situation of each patient.Breaking bad news needs specific communication skills and physicians must be trained for this purpose.

Despite advances in science and technology, human is not yet capable to produce a material or solution to compensate blood loss or act as blood; this vital material of the body. Blood loss is only recovered through transfusion of blood prepared from donors.Blood safety widely depends on the information obtained from voluntary blood donor. It is his/her ethical responsibility to provide valid information. On the other hand, some ethical issues about the donor and the recipients right should be considered. For this reason, the International Society of Blood Transfusion (ISBT), in 1980, in Montreal, approved the code of Ethics for Blood Transfusion. This code emphasizes on access to safe blood, free blood without need to be substituted, informed consent for blood transfusion, the right not to accept the blood and the right to be informed if they have been harmed. This article attempts to highlight some of the important points in blood transfusion medicine, and ethical aspects of blood transfusion according to the Islamic principles and Iran laws.

The definition of disaster is diverse but certainly the similarity between disaster and normal condition is negligible. The most important characteristic of critical condition is the number of human victims.Therefore each critical condition needs medical intervention and the presence of health care providers is necessary.Health care services are divided into two categories one in normal situation and the other in the critical condition; so the ethical considerations and responsibilities of the health care providers will differ accordingly.Our approach for explaining medical ethics or ethics in health care n critical conditions is two dimensional including the responsibilities of health care providers and ethical problem solving. The second dimension needs systematic approach which is not possible in this article. In the case of the responsibilities of health care providers we may focus on individualized viewpoint or systematic and strategic view point however the later is more complete and acceptable.From systematic viewpoint three important issues should be considered; ethical principles, ethical codes and multi dimensional ethical charter of each organization.In this review we aimed at describing some ethical principles and codes of conduct and the ethical principles of Red Cross and Red Crescent as well.In conclusion, critical conditions are far wider and there are full range of special situations in which no unique solution can be followed. It is necessary to determine the diverse fields affecting the condition and solve the resultant ethical issues in a problem oriented manner. In addition medical ethics should be considered as one of the most important priorities of the Ministry of Health and other related organizations.

Human cloning is one of the most controversial issues in ethics. This paper, with analytic-descriptive method, deals with Kant's principle of ends and permission or prohibition of human cloning from its point of view. According to Kant's principle of ends, any action in which humanity is taken as a means, not as an end, is prohibited. There are different interpretations of taking humanity as an end: to do without one's awareness anything, to respect human's freedom and autonomy, to help his happiness and to respect the humanity of others. According to the Kant's principle of ends our review shows any human cloning in which human being is taken as a means to other ends, is prohibited. Thus human cloning in order to produce many groups of humans with the same genetics and using them in war or excruciating work, to reproduce geniuses, politicians, soldiers, scientists..., produce children with ideal genotype and to replace recently died family, is prohibited. But human cloning in which humanity of produced people is taken as an end is permissible, such as cloning at the purpose of human happiness without limiting their freedom and autonomy, therapeutic cloning for producing tissue and transplant organs, for helping infertile couples and for giving birth to healthy newborns without genetic disorders.

By the end of the nineteenth century some countries that had trade relations with Iran established a quarantine stations at the southern ports. This was due to the spreading of cholera and pestilence especially in those regions as well as to a significant number of casualties. Later quarantines were adapted as a tool of colonial influence in order to pressurize the Iranian government.In fact the quarantine was placed in critical frontiers caused a lot of problem for both the governments and people scattering quarrels in frontier quarantines and excessive letters between Iran and England.In this review we aimed at surveying documents and papers remained from the past. Also in this review more attention has been paid to some issues which involve reasons of setting up quarantine stations in Iran and the resulted problems for government, frontiersman and pilgrims.

The aim of this study was to explore experiences of family members of patients confronting brain death diagnosis and the request for organ donation.A qualitative study was designed focusing on content analysis. Data collection process included 38 unstructured in- depth interviews with relatives of 26 brain death patients who were candidate for organ donation and field notes.Sampling method began as purposive and continued as theoretical until saturation.Five main themes were extracted from the current dataset that indicated family experiences and perceptions of brain death concept while being informed. The themes were included internal conflict, internal barriers against external realities, imminent sense of loss and grief, surrender and acceptance.The results showed that facing the diagnosis of brain death for relatives and family members is a condition surrounded by many challenges, ambiguities and conflicts that is become more complicated when emotional responses related to grieving and defensive psychological reactions emerge. So it is recommended before any organ request, at first medical team provide conditions for brain death acceptance. Respecting family members experiences and their perceptions about the situation will resolve their internal ambiguities and conflicts. At this situation requesting organ donation seems to be rational.

Caring for dying patient is one of the painful events and a tough experience for nurses. Care of dying patient according to his/her cultural norms is one of the principles of nurse's professionalism. Therefore identifying and explaining the daily experiences of nurses in cultural care of dying patients would help in determining caring standards. Due to the lack of such studies, the aim of this study was to explain the nurses' experiences in the care of dying patients.This study is a qualitative investigation with content analysis method.Eighteen nurses working in teaching hospitals of Tehran were selected by purposeful sampling method from 2010 to 2011. Data were collected through semi-structured face to face interviews. Content of the interviews were transcribed and analyzed by content analysis.The findings were classified into two themes of cultural exposure and cultural skills. Understanding of family presence and family bereavement were two sub-themes of cultural exposure. Cultural skills consist of 3 sub-themes i.e., preparation for telling bad news, facilitating facing death and solacing family members.Regarding our results, in order to meet patients and their families expectations in a respectful manner, nurses awareness of cultural norms of the dying patient and his/her family seems to be necessary. It would be an important step in reforming and improving nursing performance and professional development.

Evaluation of the factors related to the patients' complaints against medical staff, especially doctors and efforts towards its reduction affects patients' satisfaction of health care system. The main purpose of the present study was to determine the factors related to the patient`s complaint against doctors with the verdict of Medical Council of Kerman.This study was a descriptive, analytical and practical evaluation, assessing 250 documents related to the patients' complaints of doctors in Kerman Medical Council during 2004-2009.The most reasons of complaints (%73.2) were carelessness and disrespecting scientific and legal standards, and obtaining funds out of legal standards (%9.3) respectively. In the case of issuing vote, the most opinions (%31.7) were innocence and suspended and barred from prosecuting (%22.9) respectively. Most complaints were of ophthalmologists and private hospitals. There were significant relationship between the reason of complaint and issued out (P<0.01, c2=53.706) and the reason of complaints and field practitioners (P=0.026, c2=49.27). No significant relationship between issued out and the type of hospital was found.Regarding the results, respecting scientific, and legal standards, and decreasing financial relationships between doctors and patients is an effective way in reducing patients' complaints of physicians. Improvement in physicians' patients' relationship by explaining the disease condition, its risks and treatment options to patients are effective in reducing patient's complaint against physicians.