Iranian Journal of Medical Ethics and History of Medicine
Year:2019 | Volume:12 | Issue:1|Papers Count:48

Communication with patients is an important issue in nursing meaning that to realize the truth from their viewpoints. This study was performed to compare levels of nurses’ empathy with patients at drug abuse treatment centers (DATCs) and the internal ward of hospital. The present research was a cross-sectional and descriptive-analytic study conducted at two environments of the internal ward and DATCs. A total of 60 subjects comprised research participants and were listed in the study through census method. A two-part scale was used including personal information and Jefferson scale of empathy with verified validity and reliability. Data were analyzed using SPSS16 software. The scores of nurses' empathy with patients recorded in the internal ward and at DATCs were 67. 84± 6. 32 and 79. 73± 9. 21 (out of 100), respectively (P=0. 001). Male nurses (76. 80± 9. 88), married nurses (75. 93± 9. 98), ages of >40 years (79. 1± 11. 12), masters’ degrees (75. 5± 3. 78), job experiences of >10 years (83. 53± 8. 53) and overtime hours of <50 h (80. 61± 9. 9) attained the highest empathy scores with significant differences (P<0. 05). The scores of nurses’ empathy with drugdependent patients at DATCs were higher than those of internal wards indicating that the care of addicted patients in a specialized ward leads to increased empathy. Considering the relationship between empathic communication, educational levels and occupational experience of nurses, it is essential to consider training empathy skills to nursing students from the first semester and to provide in-service training to nurses working at hospitals and centers by nurses of higher educational qualifications and experiences.

Nowadays, transplantation is the final treatment for the patients with end-stage organ dysfunction. Considering the importance of the organ donation and the important role of teachers in raising the knowledge and attitude of a large group of people, the present study aimed to determine the level of knowledge and the attitudes of the teachers in Sanandaj regarding organ donation. This study was a descriptive-analytic (crosssectional). A total of 250 teachers working in the first and second level of high school in Sanandaj city were selected by cluster sampling method in the academic year 2017-2018 and completed the questionnaire on knowledge and attitude towards organ donation. Data were analyzed by SPSS software version 20, independent t-test and ANOVA. The findings of this study showed that 152 (60. 8%) had moderate knowledge and 92 (36. 8%) had high knowledge about organ donation. 166 teachers (66. 4%) had moderate attitude and 81 teachers (32. 4%) had high attitude toward it. 90. 8% of teachers lacked donation cards, while 144 (57. 6%) were inclined to receive a donation card. According to the results, the knowledge and attitude of the majority of teachers were moderate and most of them did not have a donation card. Considering the importance of this effective group in raising the culture and knowledge of students and their families in the community toward organ donation, education and preparing appropriate background for receiving, raising knowledge, and attitudes toward organ donation for the teachers are required.

Several definitions for medical futility has been proposed in the literature. Medical futility is defined as the condition in which an intervention, either for diagnosis, prevention, treatment, rehabilitation or other medical goals, has no benefit for the individual patient. This critical review aimed to increase the understanding of physicians and other healthcare providers on the issue of futility in complementary and alternative medicine (CAM). Our comprehensive search resulted in more than 1000 studies; unrelated studies were excluded by title and abstract screening, then 219 full-texts were read and finally, 118 studies were included. The conclusion concerning whether or not it is morally acceptable to provide a futile treatment in CAM, becomes a controversial issue based on different approaches. Using futile treatments is not acceptable according to the duty-based approach, and the principle of justice. In contrast, the case-based approach and the principle of autonomy of the patient, hold that such treatments could be morally acceptable. Based on utilitarianism, only evidence-based treatments can be morally discussed, and those CAM therapies that have been shown to be futile, should be prohibited; thus health care providers must not offer them to patients since it would be a kind of deceit. We suggest that more comprehensive studies should be performed to clarify the boundary between placebo, nocebo, and futility.

Patient rights is one of the essential rights that should be considered by the medical staff, checking and comparing the attitudes of first and last year medical students to inform the ethical points of service delivery is important. The aim of this study was to compare and evaluate of first and last year medical students' attitude about respecting patients' rights in hospitals of Bushehr University of Medical Sciences. The present study was a descriptive, cross-sectional study carried out by using a questionnaire derived from Patient Right Charter approved by the Ministry of Health. The study population included all the first and last year of medical students of Bushehr University of Medical Sciences. The sample size was 113 and the sampling method was census. By using independent t-test and Pearson correlation, data analysis was performed by SPSS19 software. The attitude of first year students' was 76. 36 ± 13. 90 and among seniors was 71. 63 ± 8. 08, which was statistically significant (p<0. 05). %52 of first and %84 of last year medical students had respectively and relatively favorable attitude regarding patients' rights. There was not statistically significant relationship between students' attitude and demographic factors. First year students had a better attitude among patient rights than the last year students. Therefore, planning to improve the students' attitude of observing patients' rights during the years of study is recommended.

The Zebrafish is a preeminent model organism that, with its most prominent features, has expanded the boundaries of science in many disciplines. Characteristics of this small freshwater fish, with the help of biologists, showed that it has a highly comparable genetic with mammals such as mice and rats. For example, the emergence of new and efficient methods for duplicating and editing the genome has helped to increase the growth of its use in various fields of science, including toxicology, drug discovery, transplant biology, disease modeling, and even aquaculture. Continued maturation and adoption of the Zebrafish model system require the improvement of methods and approaches for the cultivation and management of these fishes in controlled reservoirs, so that, ultimately, research on this fish is more reusable, cost-effective and in a framework for ethics in research. Knowledge and technology transfer from laboratory science, medicine, and aquaculture is a necessary part of this development, which should be in line with ethical standards in science. In this paper, we would consider the ethical and technical principles of working with Zebrafish as a species model in studies of medical sciences.

Emotional intelligence and critical thinking are important factors affecting professional performance and mental health of health care professionals. In this research, the relationship between emotional intelligence and critical thinking is investigated. This is a descriptive-correlational study. The statistical population of this study was all nurses working in hospitals affiliated to one of medical universities located in Iran in 2016. The sampling method was random. Using Cochran formula, 174 subjects were obtained. The main tool for data collection was the Bar-On Inventory and California Critical Thinking Skills Questionnaire. The validity of the questionnaire was confirmed by the professors and reliability was calculated using Cronbach's alpha coefficient for emotional intelligence and critical thinking questionnaire 0. 82 and 0. 79 questionnaire. The mean scores of emotional intelligence in nurses working in studied hospitals were 3. 46± 0. 78 of 5 and the average score of critical critical thinking nurses was 22. 66 out of 34. Also, Pearson coefficient confirmed the significant correlation of all components of emotional intelligence with critical thinking. Among the components of emotional intelligence, social skills have the most positive and meaningful relationship with critical thinking. There is a positive and significant relationship between emotional intelligence and critical thinking of nurses working in studied Hospitals. Therefore, selecting students and employing nurses based on the measurement of emotional intelligence and critical thinking will improve the performance of nurses.

One of the most common ethical issues in nursing profession is moral distress which causes discomfort and impedes nurses proper moral performance, despite having sufficient knowledge. Moral distress disturbs the relationship between nurse and patient which leads to the decreased quality of care. Caring behaviors greatly contribute to improving the quality of care and patient safety. The present study aimed to determine the correlation between moral distress and caring behaviors of nurses in intensive care units of Bandar Abbas hospitals in 2018. This was a descriptive correlational study that was performed on 173 nurses working in ICU and NICU departments of Bandar Abbas hospitals. The data collection tools were demographic information questionnaire, the moral distress scale of nurses of intensive care units, and nursing Caring Behaviors Inventory. Data were analyzed using IBM SPSS 20. Moral distress in nurses in the intensive care unit was in the middle range (1. 75 ± 0. 81 of 4 score). Also, the mean score of nurses' caring behavior was 5. 28 ± 0. 48 of 6 score which was considered as an acceptable level. There was a significant negative correlation between moral distress and caring behavior (r =-0. 150, P = 0. 049). Regarding the importance of moral distress, as well as the role of caring behaviors in improving the quality of care of nurses and satisfaction of patients, it seems necessary that nurses get more familiarized with this concept and attempts to provide solutions for coping and reducing moral distress and improving nurses' caring behaviors.

Smallpox was a dangerous disease that was considered one of the leading causes of mortality and disability in Iran up to Pahlavi II period. Therefore, combatting this disease was necessary. At the beginning of the second development plan (1955) and by founding Combatting Smallpox Service, the efforts for eradicating smallpox became more organized. This organization could overcome a lot of the different geographical and human obstacles and vaccinate a lot of the people every year. So, it could almost controlled smallpox up to the end of this period. In this paper, we investigated combatting smallpox from 1948 to 1967 and addressed its obstacles, approaches and achievements. Accordingly, we answered research questions through content analysis and deductive reasoning. The major sources used were reports released by the state, particularly the reports of Planning Organization and Ministry of Health, as well as old medical magazines.

Ancient civilizations, proportionately to the extent and impact of their culture, used some methods in the field of personal sanitation to prevent infections and general diseases. Studying the indictors of personal sanitation, methods and the aims, in broad lands of Sasanians, would lead us to sanitary treatments of people in this empire. Considering the issue that personal sanitation in Sasanian period (651-224 A. D) was more influenced by the teachings of Zoroastrianism, the study of the Zoroastrian perspective is of the greatest importance in this regard. Personal sanitation in that period included washing with water, soil and gomiz, using special places for washing called Pā dyā w, using napkins, using perfume and combing hair. There were also strict, detailed rules that made personal sanitation difficult and intolerable. Thus, some meges made efforts to change these rules. This paper aims to study indicators of personal sanitation and their applications for more than 400 years during Sasanian period with descriptive analytical method, on the base of literary evidence.

The human moral or, in other words, his human dignity has long been the subject of discussions among various thinkers. Almost all theories that have addressed this issue are in principle the dignity of man and the supremacy of his position in relation to all beings, but what makes a different perspective on this topic is the criterion of this dignity and excellence. Making essential decisions for the fetus, including preserving the fetus or abortion, is one of the main applications of the principle of human dignity and is directly is influenced by its human and ethical status. Two groups of theories have focused on the issue of the dignity of the fetus: secular theories and theories based on religions and schools. The secular ideas, have some attractions that human intuition accepts them to some extent, but none is free of criticism, and the critique of each theory is all remarkableness and worthwhile. Hence, this article, while it is reviewing some of the secular views and the views of religions and schools on the status of the embryo and addressing some criticisms of them, provides the dominant human-being theory of fetus based on Shi'a thought and introduces the valuable position of man from fetal times. Finding the root of human dignity by relying on human thought and without resorting to revelation inspiration is faced to serious challenges. Human embryos, due to the ability to become human, have been at the beginning of being a valuable place that increases the value of fetal age when it increases its age so that it is not worthy of human dignity with God's soul. But because its granting by the Lord on the basis of the religious teaching perception, the egg cell should not only be eliminated, but also should be taken care of and protected due to its potential to become human.

The system of Iranian medicine in the Qajar era was the continuation of the system based on the humors view. Accordingly, the incidence of most diseases was attributed to whole view of the quadruple imbalance of blood, soda, bile, phlegm. Preventive and therapeutic approaches were also carried out in the same cognitive atmosphere. The example of Smallpox disease, indicates such a view in the Qajar era. According to the findings of this research, in Qajar medical literature, the bumps of pus in the skin of is described to be hard, single or non-separated with different colors and was called as Jodri or Smallpox. In terms of cognitive aspects, physicians of Qajar era following former physicians classified Smallpox disease in terms of humor among the hot and wet diseases and described boiling of blood in the body as the cause of this disease. Exposure to this disease was through the two pathways preventive and therapeutic measures. In order to prevent the disease, the necessary orders was recommended by the physicians by “ sette zarurieh” and especially avoidance of several behaviuors. In terms of therapy, along with several types of diets, different kinds of medicines was used to relieve the symptoms and complications of the disease at different body parts. This study is a review, it has been attempted to examine the nature and purpose of the descriptive and analytical method and the therapeutic approach to treating Smallpox disease in medical system of Iranian Qajar era. Required information and data have been created in a desk research.

In this research, an intercultural comparison between medical students from Iran and England was made to investigate the potential impact of culture on empathy and the relationships between empathy and child birth order in the family. The population consisted of medical students of medical universities from three cities: Tehran (Iran), London and Sheffield (England). The sample consisted of 182 students from two countries (88 Iranian, 94 English) which was selected by convenience sampling method. Data was collected by scale of empathy-student version and researcher made demographic questionnaire. Data was analyzed by using student’ s t-test, MANOVA and Scheffe post hoc test. Results showed that the physician empathy of Iranian medical students is significantly higher than English students (P <0. 01). Also the results showed that birth order of students has a meaningful correlation with their empathy (F=2. 96, P<0. 05). The results of multivariate analysis of variance showed that in the empathy variable, empathic care and self-care is more than English students rather than the patient of Iranian students, but they do not differ in the component of adopting the view. The result of this study reveals the importance of cultural differences and family factors such as birth order on personality factors for instance the physician ability to empathize with patients.

Qajar era is very important in Iranian medical history after Islam. Because physicians gradually got away from Sinai medicine and tried to use western modern medicine. One of the major points about medicine of Qajar era was influence of slang beliefs. The present study based on descriptive-analytic method and library compilation is trying to answer this question: what are the outcomes of slang beliefs’ influence on medicine and treatment approaches in Qajar era? The research's achievements show that the important outcome of these slang beliefs was non-acceptance of modern therapeutic approaches by many people, as they preferred to be treated based on slang beliefs instead of taking medicines and using modern therapeutic approaches.

What are the moral emotions, their functions, how they change and their experiences, and their association to moral actions and moral judgment are among the most important issues for moral psychology researches and moral education. The present research addresses the conceptual and theoretical exploration into the language composition so-called "the regulation of moral emotion", and the explication of the scope and the conceptual meaning by focusing on implications, theories and researches on moral emotions on the one hand, and emotional regulation on the other hand. Documentary research method and reflective evaluation was used towards conceptualization and illumination of moral emotion regulation. These steps included selecting a topic, setting goals and questions, explorative investigations and literature review, choosing a theoretical approach, collecting resources and techniques for reviewing resources, processing, writing, and reporting the research. Results indicated that based on analyzes and existing theoretical and research implications, that this concept has the meaning and necessary logic and It can integrate the research in the field of moral psychology through integrating the moral specific domain of emotion regulation process and draws new horizons for future researches and practices.

Nursing ethics is one of the most basic aspects of nursing profession, which nurses are required to follow the principles receiving nursing care with confidence by patients. This study was conducted to determine the level of moral development of nurses and its contributing factors. This descriptive, analytic study was performed in 2017, study samples were 310 nurses working in educational hospitals of Ardabil University of Medical Sciences. Samples were selected by convenience method. The data was collected using a Kohlberg’ s nursing dilemma test. The questionnaire included six scenarios: newborn with anomalies, forcing medication, adult's request to die, new nurse's orientation, medication error, and uninformed terminally ill adult. The data was analyzed by IBM SPSS 18 using descriptive and analytic tests. In this study, 51 nurses (16. 45%) were in the pre-conventional level, 101 nurses (32. 58%) in the conventional level, 132 nurses (42. 58%) at the post-normal level and 26 nurses (8. 38%) at the level of clinical considerations. Moral thinking mean score was 42. 58 ± 5. 6 and the mean score of the clinical considerations was 21. 53 ± 4. 3. The present study showed that the majority of nurses are in the post conventional and conventional level; but this is less than 50% of all nurses, which shows that the level of moral development of nurses is in the moderate level. It requires further investigation of the causes and related factors and more efforts for improving it.

Scientific research as well as a lot of social and individual effects for human beings has caused many moral problems. The prospect of children building through somatic cell nuclear transfer (SCNT) or human cloning has caused widespread moral concerns around the world. Accordingly, various reports and regulations have been published at the national and international levels that address the ethical principles for research involving human subjects. In this regard, the Belmont report is of particular importance, in which three fundamental principles of human research have been taken into consideration. These three principles are: the principle of "Respect for Persons", the principle of "Beneficence" and the principle of "justice". In the field of this new biotechnology, namely, human cloning with respect to the use of human subjects in it and according to the ethical principles for research involving human subjects, there are three types of discussion: problems of Safety; a particular problem in the field of business Satisfaction and the problem of the exploitation of women. Considering that about 90% of cloning efforts in animals have been encountered with many problems such as abortion, early death, the development of certain diseases and physical defects, etc., it is not wise to use it in humans and it causes certain and unpredictable problems in cloned people.

Medical errors in pediatrics if different from adults. This study aimed to investigate type and frequency of medical errors and the related contributing factors from pediatric residents' point of view. This descriptive and cross sectional study was done in 2016. After determining validity (face and content) and reliability the final questionnaire with 17 questions categorized in six parts was used for data collection. Data were analyzed descriptively using SPSS v. 22. ''Errors of diagnosis or delay in diagnosis' (8. 6)', ''choosing appropriate dose (8. 3) and medication (8. 2)'' had the highest average weights. Fellows of pediatrics (12. 6) and pediatrics’ professors (12. 1) with the highest average weights had the most dominant role in diagnosis and prevention of errors. The most and the least average weights of the errors was reported for urban general physicians and pediatrics’ professors, respectively. Errors could occur at 2-8 AM more likely. Junior residents were the ones with the most chance of doing errors. Medical errors were mostly reported to occur in the group of children (70. 6%) than neonates (29. 4%). Reconstruction and strengthening educational and supervision role of pediatric fellowships and attending with the aim of in time diagnosis and then prevention of medical errors could be considered as a must in teaching hospitals. Holding purposeful educational courses and control of contributing factors like workload, exhaustion, inexperience, etc. are among duties of educational and executive managers.

Nurses are always exposed to job burnout due to high workload. This research was performed to investigate relationship between need for drama and work context with job burnout in nurses. The study was a descriptive survey. The whole nurses Ardabil city, comprised the statistical population of this research. From this population, 247 nurses were selected by convenience sampling method. For data collection the following questionnaires were used: job burnout questionnaire (Cronbach's alpha coefficient0. 76), work context questionnaire (Cronbach's alpha coefficient 0. 83) and need for drama scale (Cronbach's alpha coefficient 0. 81). For data analysis, descriptive statistics and statistics from Pearson correlation coefficient and multiple regression were used. Results showed that between work context and job burnout (p<0. 01) there is a significant negative relationship and between need for drama and job burnout (p<0. 01) there is a significant positive relationship. The results showed that the relationship between need for drama and work context are two factors that affect the job burnout, which more attention to these indicators can reduce burnout in nurses.

To consider ourselves as "lesser evil" and to consider ourselves "holier" are two different categories in evaluating moral action, that its motivation and success rate vary in each other. After reviewing the justification mechanisms in four real situations involving altruistic act, the present study seeks to examine the validity of the current models of the temporality of justification for moral disengagement in terms of inclusion. In addition to verify the common models for categorizing justifications in two situations as "less evil" and as "holier", this examination aims to clarify the moral behaviors of the moral actor and facilitate ethical judgment in a more analytical space. The participants of the study were 71 undergraduate and postgraduate students at Shiraz University selected in convenience method. In order to evaluate how respondents respond to situations which require altruistic action, four realistic situations of altruistic action were designed. The responses and justifications presented by those who didn’ t cooperate with the altruistic plan were subjected to direct content analysis. In the face of the altruistic plans of those who refuse, their justifications were in accordance with some of the mechanisms mentioned in the background. However, there were two categories of justification that were not understandable with the categories in the literature. These two categories are named according to their core themes, self-oriented justification, and other-oriented justification. The results implied confirmation of Klein and Epleis's distinction of motivation toward lesser evil and holier.

The white coat ceremonies are a recent phenomenon in medical education at the first steps of their education, that use as a symbol to impress upon medical students the importance of professionalism in medicine. This ceremony is known as one of the primary preparations for entrance of medical students to clinical courses. This study aims to investigate the effect of white coat ceremonies on professional ethics and student familiarity with their professional tasks in clinical departments. The present study is a qualitative study on the students' viewpoints regarding white coat ceremony and based on goal-based sampling. The statistical population included 4th-year medical students of Shiraz University of Medical Sciences in 1394. Data collection was done by a mixed method which one part of it was the half structural interview and another part by answering the open questions. Data collection continued to the saturation phase, furthermore; the data were analyzed by content analysis method according to the instructions. Most of the participants in this study considered holding a ceremony before entering the hospital as an important event for the readiness of students to go through a clinical course. The most important positive effects of white coat ceremony were increased students' commitment and accountability, improved interactions with patients, increased motivation and self-confidence, and familiarity with some of the basic principles of professional ethics. A white coat celebration can enhance the students' familiarity with their professional duties and motivations. More studies are needed to better understand the strengths, weaknesses, and shortcomings of this ritual.

One of the main methods of improving patient safety is use of reporting systems and providing facilities for analyzing and preventing mistakes. The aim of this study was to determine the attitude of nursing managers of hospitals affiliated to Kurdistan University of Medical Sciences towards the voluntary reporting system of medical errors in 2015. In this descriptive-analytic study, all managers of selected hospitals in Kurdistan province were enrolled in this study. The data was collected through a valid questionnaire for attitude towards the voluntary reporting system of medical errors. Data were analyzed by SPSS software version 20, independent t-test, chi-square and ANOVA. According to the results of the study, 87. 9% (80 participants) of the managers encountered reporting of errors in their workplace. 68. 1% (62 participants) of the managers had a positive attitude toward the voluntary system of medical errors and 16. 15 % (15 participants) had a negative attitude and 15. 38% (14 participants) were indifferent. According to the results of the research, more than 68. 1 % of managers have a positive attitude towards the voluntary reporting of medical errors and with the necessary measures a suitable platform for launching the voluntary reporting system of medical errors in the treatment centers can be provided.

Physician-patient communication is essential for good medical practice and leads to patient satisfaction and subsequent following of prescribed therapeutics and health promotion. There is limited study on this subject in Iran. The purpose of this study was to evaluate patients' satisfaction of the physician-patient communication and factors influencing it to provide useful information for decision-makers within the health services. This research was an applied field cross-sectional study among hospitals in Tehran. Satisfaction was assessed by 22 questions after obtaining consent from the patients. The level of patient's satisfaction with physician's communication among 1200 patients in order of priority was: medium 63. 4%, high 15. 1%, low 14. 4%, very high 4. 7%, and very low 2. 5%. Mean patients' satisfaction was 76. 35± 13. 99, maximum and minimum satisfaction was 110 and 30, respectively. There was a significant relationship between patient satisfaction and patients' gender, age, marital status, occupation, physicians' age, sex and timely presence of the physician in the clinic and good deal of communication between patient and physician's receptionist. Overall patient satisfaction with the patient-physician communication is medium that is not desirable. Factors such as gender, age, material status, and occupation of patients and age and sex of physician, timely presence of the physician in the clinic and a good deal of communication between patient and physician receptionist had a positive correlation with patient's satisfaction. According to important role of communications' skills in patients' satisfaction, it is necessary to put more emphasis on training and assessment of communication skills of physicians and health care personnel.

Waqf (donation) has a long history in human history and can have a high impact on economics, society, and culture. One of the most influential fields of the waqf is on human health. This study is a descriptive study. In this article, after reviewing the tradition of waqf and charity throughout history, and the experiences of charity in other countries, including the Pasteur Institute of Paris, the role of waqf in establishment and promotion of Pasteur Institute of Iran is reviewed and the benefactors of this institute are introduced. The headquarters of the Pasteur Institute of Iran in Tehran and its branches in Shemiran, Khalid Islambouli, Amol (north) and Hamadan (west) are donated by the charities for diagnosis, production of vaccines, and research in the field of contagious diseases’ control and prevention. In Iran, most cases of waqf on health have been dedicated in the field of treatment, but Pasteur Institute of Iran is a successful example in the field of public health and specialized health services. One of the ways to expand waqf is to explain the effects of these endowments in society. Investigating the role and influence of Pasteur Institute of Iran in promoting public health can be a good explanation of the impact of these endowments in the field of health. It is suggested that Pasteur institute of Iran and its persistent effects be explained to the beneficent, so that some of the future endowments be extended to areas such as public health and diagnostic services.

The most important factor in interpersonal relationships is trust. Trust in the physician-patient relationship is key and essential. Understanding the factors that affect trust is a prerequisite for trust. These factors vary in different societies. So we need to identify these factors and provide a single criterion for measuring them. Therefore, because we need a tool to measure these different factors in the context of culture and society, the purpose of this study is to determine the factors that influence public confidence in physicians to provide the necessary evidence for making appropriate instruments in Iran. The first step was to investigate the factors affecting patients' confidence in physicians during a library study. Then, during interviews and numerous discussion sessions, nineteen factors influencing public confidence in physicians were provided. Then, to determine the content validity, twenty experts evaluated the transparency, relevance and importance of the factors. Content validity ratio (CVR) and content validity index (CVI) were measured. CVR value for each of nineteen factors was 0. 42, therefore content validity of the tool was significant with P. value 0. 05. CVI value was 0. 944 and content validity of the tool was confirmed. Factors affecting public confidence in physicians in Iran include 19 factors extracted during this study and can be used as factors for assessment of public confidence in physicians. Factors affecting public confidence in physicians in Iran include 19 factors extracted during this study.

Over the past years in the literature of medical ethics about the doctor-patient relationship, patient's rights have been greatly considered, but the other side of this relationship is not concerned, and the physician’ s obligations have been highlighted. The two meanings are understood from the concept of physicians’ rights; their rights in conflict with the patient rights’ and the right to self improvement. We want to review the causes of this neglect and its complications. The reasons for not paying attention to the physician’ s rights include: traditional beliefs about the power imbalance in doctor-patient relationship, lack of emphasis in the four principles of medical ethics, lack of supportive structures, customer-orientation in medicine, and hyper medical professionalism. Continuing this neglect creates complications that include: physicians’ work-life imbalance, symbolic violence in their society, burnout of physicians, forgetting the principle of gratitude and ultimately, the lack of respect for patients' rights. Consequently, the discourse of medical ethics fails to achieve its primary goals.

According to the important role of family factors in people quality of work and the importance of correct emotional relationship of medical staff in patients' satisfaction and spirits, the aim of the present study was to investigate the relationship between perceived intimacy from the main family and work-family conflict with empathy and addiction to work in the medical staff. This study was a description of correlation type. The statistical population of this study included all the medical staff of medical centers in Bojnourd city in the 2018-19 year. Among them 250 person were selected by available sampling method. For data collection we used main family health Questionnaire, work-family conflict questionnaire, Lamonica empathy scale, and work addiction questionnaire. To analyze the data of this study, Pearson correlation coefficient and regression analysis were used. In order to analyze the data, SPSS software (version 25) was used. The results of Pearson correlation showed that perceived intimacy from the main family had a positive and significant correlation with empathy and negative correlation with addiction to work. Also, the results indicated that there is a significant correlation between work-family conflicts with empathy, but there was not a significant correlation between work-family conflicts and addiction to work. The results of the present study indicate the role of family system and its internal conflicts on empathy with patients and work addiction in hospital staff, which emphasizes the need to pay more attention to the improvement of quality of family life of health care staff.

Adherence to professional ethics based on spiritual intelligence is conducive to patient welfare and satisfaction. The purpose of this study was to determine the relationship between professional ethics and spiritual intelligence of Kerman University of Medical Sciences' students. In this descriptive co relational study, 150 undergraduate medical students were enrolled in the census. The tools used were spiritual intelligence and professional ethics questionnaires. Data were analyzed by SPSS version 22 using independent t-test, one-way ANOVA, and Pearson correlation coefficient. The mean and standard deviation of professional ethics score was 57. 72± 6. 2 and the spiritual intelligence of students was 73. 97± 12 12. 3. The lowest score of professional ethics was in the area of responsibility and the most in sympathy with others. There was also a significant positive relationship between professional ethics scores and students' spiritual intelligence (P = 0. 001). This means that by educating and enhancing students 'spiritual intelligence during their studies, one can expect to increase students' professional ethics during clinical work and professional communication with the patient. To this end, teachers' emphasis on aspects of ethical applied education, especially during clinical education, as well as honoring spiritual patterns as the foundation of ethical education during college education seems necessary.

Gene therapy entails the introduction of specific, functional genes into cells for therapeutic or preventive purposes. This process may be used in vitro or directly in vivo. One of the novel methods of gene therapy and genome editing that has been introduced in recent years and have made great changes in the field of genetic engineering and biotechnology is CRISPR-Cas gene-editing system. This system is faster, cheaper, more accurate and efficient than another genome editing one, such as TALEN and ZFNs. As with any other emerging process, the ethical concerns and challenges associated with the genome editing methods including the potential application of this technique for nefarious purposes, such as, bioterrorism, harmful mutations to the living being, and disrupting ecological balance. This review was prepared using the databases of Science Direct, Pub-Med, SID, Scopus, Web of Science, and then, the selected papers were fully reviewed and information was extracted and summarized. According to the ethical and legal considerations surrounding the processes in gene therapy, it is expected that appropriate conditions will be provided to make the best use of gene therapy and to reduce concerns and possible abuses. The purpose of this review was to investigate ethical issues of the genome editing and gene therapy with an emphasis on the CRISPR-Cas system.

Medical error is one of the most important ethical and legal issues that sometimes occur when a variety of health care practices are provided by healthcare professionals. Due to the necessity of medical error disclosure and lack of adequate personal and organizational support in this field, this study investigates strategies for facilitating error disclosure as well as increasing the variety of supportive measures from the perspective of residents. This was a descriptive cross-sectional study with statistical population including all residents of Shiraz University of Medical Sciences. The sample size was obtained using Morgan table as 248 participants. Data were collected using a researcher-made questionnaire (with descriptive and valid reliability) and analyzed by SPSS software using descriptive and inferential statistics. In this study, increasing support facilities for medical error disclosure (mean 4. 38) was the most important factor, and increasing the lawfulness and transparency of activities in the medical setting (mean 4. 32) was the second factor affecting the promotion of medical error disclosure. Also, medical liability insurance (mean 4. 80) was the most important supportive measure. The fear of legal and judicial consequences was reported as the most effective factors on the error concealment and having experienced lawyers and cultivation effects of mass media declared as the way out. In the present study, although most residents agreed with medical error disclosure, but due to the wide range of risk management problems that affect error disclosure, they found it necessary to establish a support system. Given the teamwork in health-care delivery, support should be given to all members of the treatment team.

How can we determine that death has occurred? To answer this question, two points should be noted. First, in order to determine the incidence of death, there should be a standard for determining the occurrence of death; secondly, we need to determine certain clinical tests to determine whether the criterion has been met. In this article, we first introduce different criteria that are presented in different definitions of death, and then offered arguments against each of them. Cardiopulmonary and brain criteria are also introduced and criticized. The basic objection in these definitions is that they see death as an event. At the end, it will be argued that biological death, contrary to conventional wisdom, is a process, not an event. Based on this understanding of death, we provide a definition that addresses the problems of other criteria and shed new light to some issues related to death such as euthanasia and brain death.

It is a widely held belief that "health care" is an old concept. As one of the most important institutions dealing with this issue, the hospital has been treating human beings throughout human civilization. But historical studies show that, in the pre-modern era, the hospital was not for the treatment of patients. Its function was as a nursing home for the poor and patients. In this article, we attempt to examine the reasons for this in two ways. We first examine the socioeconomic conditions that led to this function for hospitals in the middle ages. We then show that the treatment of patients at that time was based on humorism and classification medicine, which was not only considered the hospital as a place of treatment but also considered it as a barrier to treatment. Therefore, the hospital served as a hospice for the elderly and disabled, and veterans.

Capacity, positive attitude, and proper nurses' function in dealing with death are greatly influenced by their religious beliefs. An important religious variable, the type of internal religious orientation (Implementing religious beliefs in all behaviors and practices) and the external (Using Religious Beliefs to Achieve Material Objectives). The purpose of this study was to investigate the relationship between religious orientation and nursing students' attitude towards death. The study had a cross-sectional correlational design, where 202 students from all nursing students were selected by random sampling in the academic year of 2017-2018. Data were collected via Allport Religious Orientation Questionnaire and the Standard Scale of Attitude toward Death (DAP-R) which were completed by participants after confirmation of validity and reliability and obtaining written consent from participants. Data were analyzed by SPSS version 18 software and independent t-test and Pearson correlation coefficient. Participants included 51. 5% females, the average age was 21. 7 years, 89. 6% single, 95. 5% undergraduates, 53% resident of the dormitory, 94. 6% Shiite, and 50. 5% had experience of seeing death. The average score of internal religious orientation was higher than that of the outside; and it was the same in both sexes. The difference between the mean score of internal orientation and the active acceptance of death was a positive correlation (P <0. 001) and with avoidance of death, it had a significant negative inverse correlation (p= 0. 01/0. 17); Exterior orientation with fear of death and acceptance by escape had a significant positive correlation (P <0. 001); the difference in mean score of both religious orientations was not significant in terms of gender, marital status, and religion (P>0. 001). The difference between fear of death and avoidance of death and acceptance by escape based on gender, and in terms of admission or escape, having experience of seeing death, had a meaningful relationship (p=0. 01). While there was no significant relationship between attitude toward death and family death experience (P>0. 001). Findings show the type of religious orientation of nursing students and its relationship with people's attitudes toward admission or escape from death; as the effective factor affecting the health of individuals and the quality of providing care for dying patients.

Obtaining informed consent is for protection of patients' rights. The aim of informed consent is not decreasing physicians' responsibility. Informed consent assists the patient in making a decision concerning their care, improve their satisfaction, and decrease legal litigations. This study examined patients' attitude toward the quality of informed consent and its challenges in educational-clinical settings. Current qualitative research was simple content analysis. Semi-structured interviews were conducted with 15 hospitalized patients who were selected by purposeful sampling method considering type and severity of the disease, gender, age, and satisfaction or dissatisfaction from the management. The data was analyzed using MAXQDA 2007 software. Primary codes and categories were extracted then the findings were presented based on the main. Five themes were extracted from the data: "meaning, importance and status of consent in medicine", "consequences of obtaining consent", "the role of patient and therapist in the process of informed consent", "challenges of making informed consents" and "facilitators in the process of informed consent"; all could define and compile the main theme “ doctor, patient, and procedural elements, three pillars of informed consent” . Inadequate explanation to the patient, signing the form prior to read it, lack of trust to the practitioner, disregarding patients' psychologic needs and stress and obtaining the consent by someone other than the physician was among the main reported challenges of informed consent. Correction and standardization of obtaining informed consent's culture requires knowledge about current situation followed by training, enforcement, supervision, encouragement, and punishment. Collaboration of health care team needs comprehension of necessity and importance of this issue and its consequences.

In general, there are four types of policies in the world in relation to the issue of abortion, based on five basic approaches such as social, feminist, liberal, population-based, and religious-based. Each of these approaches provides a solution to the conflict between mother's rights and the right to life of the fetus, so based on the first three perspectives, abortion is permissible and based on the fourth view, it can be permissible or not and finally according to the religious view (Islam and Christianity) the abortion is forbidden. In the present paper, we tried to answer the main question by using the descriptive-analytical method, why in some of these approaches the right of the mother is preeminent, but in others, the right to life of the fetus proceeds? It seems that the way of Islamic legal system seems to be more logical, because in Western countries the rights of parents are always prioritized in the conflict between the rights of children and their parents. However, in the legal system of Islam, in addition to the moral orders, there are some principles that are anticipated to prevent the conflict of the rights of these two groups and the unequivocal predominance of one on another.

The mutual trust in a social relationship is essential to adjusting that relationship under ethics and law. The functionality of legal and ethical rules can be trusted to create a good, orderly and just relationship when the parties can trust each other under the protection of such rules. The first legal documents in Iran required the practitioner to obtain the respect and trust of the society in himself and his colleagues, and then made clear his obligation under it. In subsequent reforms, such obligation stood as they were, but the values of “ trust” and “ respect” were not mentioned. It seems that “ trust” and “ respect” of physicians in a society is the good will of these professionals which supports the efficiency of the treatment on one hand, and the conscious cooperation of the patient on the other. This matter is dependent on the physician’ s effort in respecting the patient’ s boundary and staying true to the physicians own technical and professional obligations. This article emphasizes the necessity this inseparable relationship, and the analysis of legal obligation in the light of such higher ethical values.

Infertility has been the main problem of infertile couples in history. However, infertility is solved with modern methods’ in recent decades. Embryo donation is one of the methods to infertile couples. In this method, sperm and oocyte of legal and religious couples are inoculated in the lab and the fetus is given to other legal and religious couples. However, people and doctors have doubts to agree or disagree with the views of contemporary jurisprudents. Then, the legislature passed the law of donating embryos to infertile couples in 2003. Although at the time, this law was very useful. However, there are shortcomings because of the brief writing of the law. The child's confidentiality to the fetus has not been determined. In this paper, the rights of Shia jurisprudence books and their adaptation to the opinions of the jurisprudents articles regarding the confidentiality of the embryo donation are discussed. Concluding different opinions from medical ethics and jurisprudential comments and laws, confidentiality of the mother’ s womb to the child was proved. All provisions of the foster mother also runs. The confidentiality of the father will also be accepted according to several conditions.

In the Qajar era, European countries deployed many doctors accompanied by their military, religious, and political groups to Iran consistent with their political goals and interests. Meanwhile, the role of France was more and more significant than the rest of European countries. This essay aims to introduce French physicians, to express the performance of French physicians in Iran during the Qajar period, to introduce the activities and extent of the influence of French physicians on the medicine of the Qajar period, and to examine the elements that advance the presence of French physicians in Iran during the Qajar era. This research was conducted using library resources and descriptive-analytical method. The findings indicate that the influence of French medicine on the developments of modern medicine in Iran was very significant, to the extent that the modern medicine was based on French physicians in Iran. Overall, the French effects on medicine in Iran can be found in two forms: establishment of the hospital and clinics and the formation of a health council. In addition, French physicians took important steps in the field of medical education such as ophthalmology, surgery, microbiology, vaccination, writing medical books, and quarantine to prevent communicable diseases. Therefore, French physicians, unlike other European countries, which only improved their health status, also evolved in the history of Iranian medicine. Finally it must be said the Qajar community was well-received by French medicine and physicians; Because both the Qajar court and the community were in need of medical care and the French government needed a comprehensive medical presence in Iran to achieve its political and economic goals.

Imamate jurisprudents, consider Damie as a little rupture in the flesh while Motalaheme is a deep one. Hence, the place of the two injuries is the same but the depth of the rupture in Motalaheme makes the difference. This difference has been identified in Clause “ b” and “ p” of article 709 of the Islamic Punishment law. Furthermore, their historical understanding of the anatomy of this injury led to the concept of rapture in the flesh because they believe in order for the bleeding which is constituent of Damie, rupture in the flesh is necessary. However, contemporary anatomy explains that rupture in the flesh is not necessary for bleeding. Bleeding can occur through derma and hypoderm of the skin. This analysis adds on the hypothesis of the historicity of their definitions of the two injuries. With a descriptive-analytic approach and library study, we prove this hypothesis and make modification of their definitions on Damie and Motalaheme.

The concept of Islamic medicine, which differs from traditional medicine and even Muslims’ medicine, has become more and more popular in recent years in Iran, especially in religious cities. In the present article, we have addressed the extremist approach of the claimants of Islamic medicine (which considers itself a competitor of modern medicine and traditional medicine). Our theoretical basis for the ethical criticism of this approach has been the principlism of "Beauchamp and Childers". Thereby, we have attempted to challenge the clinical position and medical performances of extremists in the Islamic medicine on the basis of four principles of "justice, autonomy, beneficence, and non-maleficence". Then, we have concluded that the claim of the Islamic medicine cannot, in the present circumstances, satisfy the principle of distributive justice. It also violates patients' autonomy by making unfair judgments and fears about modern medicine. It is very prone to harm clients by refusing scientific evaluation of medicines and therapies and lacking a valid certification system. Accordingly, we particularly challenged the attribution of this process to Islam. This attribution may cause serious damage to the religious beliefs of the clients.

Smallpox is one of the most dangerous and contagious diseases that have killed many people throughout history. Attempts to prevent and treat the disease have always been a concern of physicians and some government officials. In the Qajar era, attempts were made for a modern-style inoculation, but it failed because of its incompatibility with the culture and beliefs of the community and the fundamentals of traditional medicine. In the first Pahlavi period, despite the adoption of laws on free, public and compulsory inoculation, there were no desired results due to some problems. The present study seeks to study the obstacles and problems of inoculation in Iran during the first Pahlavi era and the government's actions with a focus on Isfahan city and its functions using descriptive-analytical method. It also seeks to answer the question of what caused failure of the government to cope with smallpox despite considerable efforts? The results of this study show that although the government's measures to enact free and compulsory public inoculation laws, employing inoculation doctors and threatening and penalizing offenders reduced the number of smallpox patients in Isfahan, however, there were problems such as the unawareness of the people and their refusal to inoculate, the lack of cooperation of several villages’ headman with the inoculation officers, the violation and negligence of some inoculation, and the lack of sufficient funds and health facilities. These problems made smallpox disease still prevalent and caused children’ s mortality.

Patient safety is one of the basic principles of health care and its evaluation and promotion are one of the main goals of the health system development plan in Iran. Therefore, the present study was designed to determine the status of patient safety culture in nursing staff of three hospitals, A and B, Shahrekord and C Borojen hospitals. This was a descriptive-analytical study performed from September to February 2018 and 359 eligible nurses were evaluated based on a multi-stage sampling method based on Patient Safety Culture Questionnaire. The collected data were analyzed by descriptive and inferential statistics using SPSS 20 software. The mean age of participants was 23. 33 ± 7. 79 years. The overall score of patient safety culture was 123. 23 ± 16. 15 for nurses, with the lowest score being 8. 40 ± 1. 86 for communication channels as well as feedback and informing others about errors 8. 72± 2. 23 reported. Also, there was no statistically significant difference between different dimensions of patient safety culture and overall score in three hospitals (p> 0. 05). Leadership is a key element in prioritizing patient safety. How to respond to mistakes determines the hospital safety culture. To promote a good hospital safety culture, the fear of being blamed for mistakes must be eliminated and the atmosphere of open communication and continuous learning must be implemented in the hospital.

The criminal responsibility of physicians and assistants is a complex area of medical law. The purpose of this study was to investigate the responsibility of medical residents and medical students in performing diagnostic and therapeutic measures with case study of forensic medical files in Fars province from 2012 to 2017. In this study, 63 plaintiffs' cases were assessed, including 33 males (52. 4%) and 30 females (47. 6%). Most of the complainants were illiterate and under-graduate, and the least frequent was at doctoral level. Regarding the physical condition of the plaintiff (patient), the highest frequency was related to death ( 73%). Most of the complaints were from treatment group (95. 2%) and physicians (4. 8%). In terms of field of study, the field of obstetrics and gynecology (44. 4%) included more complaints than other fields. In total, 26 (41. 3%) cases were finally acquitted and 37 (58. 7%) were convicted. The most common type of failure was neglect (91. 9%). In this study, the highest frequency of associate education was related to senior resident (11. 1%). Based on the results of the present study, medical errors were made by trainees (interns) and residents, specifying the criminal responsibilities of medical students and residents for errors and omissions and explaining their findings. Educational materials in each course are of particular importance. Additionally holding forensic courses and defining the legal and criminal responsibility for medical students are important for the improvement of treatment quality.

A study on the adaptability of the patient's admission process with ethical standards has a significant role in reducing the misconduct of the medical staff and increasing the satisfaction of patients. Hence, by the study of the patient's admission process in the Neurosurgery ICU and the identification of its personnel faults; we are going to provide a platform for excellent service to patients. This study is a qualitative study. It had done with the In-depth interviewing with 28 staff of the Neurosurgery ICU of Loghman Hospital during the winter of 1396 (December2017-March 2018). The data is collected and analyzed with triple coding: open, selective, and axial. "The lack of ethical sensitivity to nursing profession and its importance" is a general tag for seven categories of functional status of ICU staff: the use of staff with insufficient professional competence, the impact of staff tastes in professional relationships, irrational expectations, lack of communication skills, the inability to admission new patients and work in other health centers. Accordingly, "the lack of moral sensitivity to the profession and its importance" in the ICU staff is a central phenomenon that results from neglect of the importance of developing transparent processes for various activities in the ICU, as well as the lack of professional training. This will make the ICU staff ignore the implementation of the defined standards, and subsequently the decline in the quality of health care services in ICU.

Writing treatises and books on ethics and morality is one of the most important topics in medicine history. Teaching and learning medical knowledge and skills was a common one in the golden age of science in Islam, too. The scholars of that period considered the ethical points of view as an important fact in their medical profession. The present article reports the behavior and ethics of physicians based on the review on the first book in this field, "Adab al-Tabib". This book, which can be called the Encyclopedia of Medical Ethics, represents standpoints of the prominent Islamic scholar, Ishaq bin Ali Al-Ruhawi. In this paper, it was intended to summarize the main points of professional behavior and ethics among physicians. Due to the wide-ranging and comprehensive nature of the book, only a few pertinent topics were reviewed. Those topics include the necessity and concept of politeness; the behavior and commitment of physicians towards themselves, patients and society as well as the behavior of nurses, attendees and tips on how to train and examine medical and pharmacy students. Al-Ruhawi in this book, declares that the first necessity of medicine is the true faith and belief in God and the doctors are the guardians of the body and soul. Commitment to medical education, nurses and pharmacists’ role in the management process, physicians’ communication skills suggesting of learning other sciences such as philosophy and more important point, strong relationship of body and soul, are the strengths of Adab-al-Tabib that Ruhawi intended to improve quality of medical services by reviewing them.

Nowadays, social networks play a remarkable role in human societies. Instagram, as one of the most influential platforms, along with other functions, has become a place for the marketing and advertising of economic undertakings. Advertisements on Instagram are different from other forms of advertising. The market-driven nature of this network will create many legal challenges in the relationship between professions and consumers. Goods (such as medicines and herbal medicines) and health services (such as medicine, dentistry, and pharmacy) are related to the health of consumers. It is evident that any negligence on the part of the profession can cause serious harm to consumer’ s physical and mental health. This article assesses the evolution of the relationship between the professional and the consumers. It discusses the ethics of Instagram marketing and health problem, along with reviewing the legal protection of consumer’ s health in the-related goods and services using an analytical-descriptive method. The results of this paper show that violating consumer rights on Instagram can lead to four types of liability (criminal, legal, disciplinary, and ethical) for the offenders. In this way, the support of the legislator and the responsible authorities is essential for increasing the quality of this protection.

One of the issues that today is considered in the moral system and jurisprudence of Imamiyah is the issue of fertility, it has considered the issue of postnatal fertility, which, if it can be considered legitimate, will have many effects. This is considered the subject of dispute between jurists and ethics scholars. In this regard, by examining the existing evidence and considering the ethical approach to the subject, this subject can be considered legitimate and, therefore, this study will examine its effects. However, the aspects of this method have not ambiguity in terms of medical sciences, but from a moral and jurisprudential point of view, there are complexities and ambiguities that require adequate accountability according to the current requirements of human societies. Therefore, this subject is considered to be a useful category as well. Naturally, since science is responsible for maintaining public order and organizing private relationships, scientific processing seems to be necessary. In this research, the concept of good legal and legal jurisprudence approach to postdeath reproductive effects such as ownership of gametes based on the element of consent (explicit or implicit), custody (based on family solidarity and child abuse) and will (declaration of consent and the will of the gamet frozen by the gamet player) will be dealt with.

Direct-to-consumer genetic testing are marketed directly to customers and provides people access to their genetic information without necessarily involving a healthcare provider or health insurance company. Such tests can be helpful in managing and monitoring people's health, but the ethical and legal issues related to these services are completely new and require a comprehensive consideration. The present paper studies the challenges of such tests by analyzing information collected through the library method. Expanding the scope of such tests, it seems more important than ever the need to educate on such tests, build an appropriate infrastructure, the regulatory systems and designing a framework for DTC-GT companies.