Iranian Journal of Medical Ethics and History of Medicine
Year:2020 | Volume:13 | Issue:1|Papers Count:49

One of the most challenging aspects of treatment is when patient seriously refuses the desired by treating physician. On the other hand, refusing treatment is a condition of the patient's right to be aware, but does such a right also imposes a moral obligation on the treating physician or not? This study discusses the diagnosis of Systemic Lupus Erythematosis disease. This article attempts to provide an overview of the ethical considerations for obtaining informed consent for a patient who refuses treatment. In this report, according to the patient's age, it can be concluded that although the patient has the capacity to make decisions, but because her age is below the legal age and does not have the authority to decide, her refusal to receive treatment cannot be accepted and it is necessary to make a decision based on the supreme interests of the patient with the opinion of a qualified legal guardian in this regard, taking into account the scientific aspects.

The "Legal language" has provided a strong supportive argument for right to health advocacy. In such a way that, human rights rules has been established as the most important globalized political value at the heart of the theory and practice of public health discourse. Its power of enforceability guaranties fair distribution of health resources in each country. At the same time, the right to health, the “ Right-claim” which has been identified by international and national documents requires preconditions that will not come true without the proper cultural, social, economic, and political infrastructures, in general the factors shaping the "context of people's lives” . In other words, a legal reasoning for right to health can be followed by an argument for the right to health determinants. Therefore, by adopting an epistemological approach, this paper presents a legal narrative of “ governance for health” . This paper creates a new perspective on the "right to health" debates. Additionally, it provides powerful arguments that health policy should be based on a perception of factors with major impacts on the people health and what have being described as "health hazard", "health protector", and "health promoter". However, this claim for right to health as an "individual enforceable right" is criticized, and there may be theoretical and practical obstacles to the full realization of this human right.

Military psychologists and mental health professionals live and work alongside their potential patients. For the most important concerns of military psychologists are multiple relationships, confidentiality, sudden role shifts and avoiding harm. The purpose of this study was to explore experiences of the military psychologists regarding ethical challenges in the counseling centers of one of the Iranian military forces. This qualitative and content analysis study was performed on 31 military psychologists during 2019. Participants had a master's degree in one of the psychology majors and 5-15 years of work experience. Data were collected by electronic questionnaire, due to access difficulty. The most important challenges of professional ethics mentioned by the participants included boundaries of competence, confidentiality, multiple relationships, and sudden role shifts. The results of this study showed that one of the problems affecting the performance of military psychologists is ethics’ issues and its challenges. Thus, according to this study, to better manage possible ethical challenges for military psychologists, they are suggested to participate in workshops and become acquainted with important ethical decisions and ethical conflicts inherent to military settings, be active in obtaining consultation and supervisions, and involve themselves in self-monitoring programs to consistently make good ethical decisions.

In human communication, the relationship between the patient and the physician is one of the most challenging issues. This relationship is of critical importance in the medical ethics and forms the base of medical measures. Relationship between the physician and the patient brings about mutual trust between them to the extent that it overshadows physician’ s skills. A physician needs to have the art of communication with the patients as well as his information in medical sciences. Damaging this communication leads to lack of efficiency, trust and satisfaction in the treatment of the patient. The authors of this article seek to analyze the major issues of medical ethics in the medical texts based on Mathnawi. Rumi has also made special mention of physicians' responsibilities and ethical duties in the stories of pulmonology, physiology, herbal therapy, routine treatment, and etc. In The story of “ King and Handmaiden” , Confidentiality, Compassion, Kindness, and the expertise of saint against Handmaiden are issues that they are discussing in medical ethics. At the end of the story, audiences unbelievably are evaluating the performance of saint as opposed to the spirit of Hippocratic oath. In the story of “ the old man and the physician” ; deficiency of the communication between physician and patient is very definite. Not building trust and emotional communication in the relationship between the physician and the patient, specifically at the very first time which has happened without semiology has provided the context in which the patient distrust his physician and is not pleased with the treatment process. In the story of "Man who was desperately ill", the physician has hidden the secret and also he has not given a clear and enough explanation for the prescription, therefore the patient's life is endangered.

European tourists in their reports from Guilan in the Qajar era, also have addressed the issue of health and deadly diseases affecting lives of people, such as rice fever, malaria, cholera, and plague in addition to pointing out the numerous social tragedies. From these tourists’ s point of view, the weather conditions, geographical location, livelihood and some living and social habits and behaviors of the people of this land were directly related to the prevalence and spread of these diseases. The epidemic of malaria, cholera, and plague has had a profound effect on the spread of poverty, public discontent, and demographic composition in the Qajar era. The authors seek to answer these questions; from the point of view of tourists and foreign visitors, what factors have caused the spread of epidemics in Guilan during the Qajar era? and what have been the consequences of the pervasive diseases on the human and economic situation of Guilan? The research findings show that the climate of Guilan, abundance of rivers, swamps, food culture, and some other natural factors caused some infectious diseases such as malaria and paddy fields in this province to be much higher than other parts of Iran. In addition to malaria, some epidemic diseases such as cholera and plague have played an important role in the economy and population of Guilan. According to the limited and scattered reports of tourists, in addition to the geographical factor in the spread of these diseases, people's lifestyles and the government's lack of attention to public health and welfare played an important role in the prevalence and spread of these diseases. Economic and social bankruptcy and the government's inability to support the people in Guilan's social movements, such as constitutionalism and the forest have made their mark. The research method in the present study is performed using historical method and descriptiveanalytical studies.

In the late 13th and early 14th centuries, Iran was involved with epidemics such as plague and cholera, affecting the population and economy of the country. The spread of these diseases, on the one hand, was the result of the government's inability to organize health centers and, on the other hand, the inability to prevent these diseases by the quarantine of the borders. The southern borders of the country were one of the most important ways of transmitting diseases. Iran was exposed to these diseases through the Persian Gulf. It was possible that the diseases with origin in Iran transmitted from this waterway to the neighboring countries as well. These diseases were transmitted in two ways. The merchant ships’ entering Iran's ports from India was one way, especially the cities of Calcutta and Mumbai. The other was via the Hajj caravans (pilgrimage) rout. The opening of the Suez Canal and subsequently increase in voyage of steamships, lead to expansion of trade in the southern ports of the country, and frequent and more convenient transportation of the Hajjis (pilgrims). Thus, this also increased the spread of the diseases in that era.

Muslims learned how to build a hospital using the experiences of physicians from other nations, especially Iranians, by modeling at Jundishapur Hospital, and this way set up many hospitals. In addition to building a variety of hospitals, Muslims created efficient structures and organized them based on bosses, deputies, stewards, supervisors, nurses, and the like, who served in different parts of hospitals. In Islamic hospitals, male and female physicians with various specialties treated patients regardless of religion or race. Using a descriptive-analytical approach based on library information, this research seeks to answer the question of how the structure and organization of hospitals in Islamic civilization have been. Findings of the present research verify that hospitals in Islamic civilization had a well-organized and efficient structure, and various medical departments. Findings also indicate that the structure and organization of Islamic hospitals have evolved over time.

The phrase "Academic mobbing" can be described as character assassination or psychological harassment against a colleague. According to many published reports, individuals in any workplace, including the academic environment, may be targets of coworkers' antisocial behaviors such as accusation, humiliation, emotional abuse, and general offences. In addition to personal negative outcomes including decreased job satisfaction, increased occupational stress, and higher risk for anxiety and depression; academic mobbing can lead to decreased efficacy of the organization to reach its targets. Job dissatisfaction leads to decrease effort of faculties in performing educational and scientific activities that has indirect consequences on community. The direct effect of dissatisfaction of faculties would be decreased quality and quantity of educational services to students. Since the first steps to systematically deal with any social issue, including academic mobbing is understanding the nature and characteristics of the situation, the current review tends to introduce and establish the characteristics of academic mobbing as well as the role of the authorities in preventing or resolving the problem.

Jundishapur was built during the Sassanid Shapur era to house Roman prisoners, and a scientific school, especially in the field of medicine was established there. Jundishapur's urban and scientific identity are intertwined with three concepts of Medical knowledge, Syriac, and Christian Christianity. In this research, the establishment of the Nestorian dynasty in Jundishapur, as well as the distinguished position of these physicians in the flourishing of Islamic civilization, has been studied and recognized. Therefore, this issue will be explained and highlighted by analytical descriptive method and relying on library resources. After the rise of Islam and the conquest of Iran, the medical elites of Syriac and Nestorian Jundishapuri; in particular, the Bakhtishoo, Masouyeh, and Maserjuyeh families continued to incorporate the medical traditions of various nations and the translation of Greek medical texts into other languages at Jundishapur Hospital. With the employment of prominent people of these dynasties in the Abbasid Caliphate of Baghdad, human resources, academic, and clinical achievements and the results of centuries of experience of Jundishapur Hospital Medical Center in compiling and translating medical texts have transferred to Islamic civilization by them.

The possibility of mistakes, negligence, injuries and damages in medical activities could give rise to a civil or criminal case. In such cases, resorting to experts' opinion is necessary. Forensic medicine organization has important role in such cases. Therefore, understanding of the criteria used by experts of this organization is important and could give rise to awareness of doctors and reduce their professional failures. This is a practical research with a descriptive and analytical method and its necessary information are collected by documentary studies. This investigation shows that medics normally try to have correct medical diagnosis and select appropriate process, and treat patients through reasonable methods to reduce their suffering and pains. It is possible that medics make a mistake in their diagnosis and treatment. Although the result of medical treatment are not guaranteed always, they have to do their treatment and operation according to reasonable and scientific standards and any recklessness and negligence causes criminal or civil responsibility. Reflection on the medical cases shows that the reasons of medic's conviction can be divided into two categories including pre-treatment and post-treatment factors. Pre-treatment indices contain errors related to diagnosis or choice of treatment.

Moral courage is the ability to overcome fear and performing the right action based on moral beliefs despite the potential danger. Nurses, as moral agents, need moral courage to properly manage moral problems and make a professional commitment to patients. Therefore, the above study was conducted to investigate the moral courage of nurses and related factors. In this descriptive cross-sectional study conducted in 2019, the research population was all nurses working in Baqiyatallah Hospital. After explaining the objectives of the study and obtaining the consent of the research, 220 nurses were selected as available samples. The data collection tool was Sadooghiasl questionnaire. After completing the questionnaire, they completed 187 sample questionnaires. SPSS software was used to analyze the data. The results of the study showed that the mean score of nurses' moral courage was 413. 37 with a standard deviation of 46. 70. Thirty percent had moderate moral courage and 69. 5% had high moral courage. The results of the independent T-test and ANOVA showed that there is a statistically significant relationship between the variable employment status and the moral courage of nurses. Considering the results of this study and the many ethical challenges that exist in the nursing profession, the issue of moral courage and related factors and providing solutions to improve it, should be at the forefront of the health organization and nursing managers.

The aim of the present study was to determine the relationship between sensory processing sensitivity and cognitive-emotional self-regulation by mediating moral characters among students. The study participants were 293 students of different fields and levels of Shiraz University (Medical Sciences and the Ministry of Science) who were studying in the academic year 2018-2019. To measure the variables of study, three high personal sensitivity scales (sensory processing) of HSPS, ethical sources and CERQ-P cognitive adjustment scale were used and to evaluate the proposed research model, structural equation modeling (SEM) was applied by using AMOS software; intermediate relationships were also tested using the Bootstrap method. The results of the structural equation model showed that Cognitive aesthetic sensitivity directly (p <0. 01, β = 0. 67) and also through positive moral characters (p <0. 01, β = 0. 26), predict cognitive self-regulation, positive emotion. In other words, people who better understand the subtle differences in the environment try to change the amount and type of emotional experiences; they are also more successful at doing so. On the other hand, the ease of direct and positive stimulation (β = 0. 31, β = 0. 33) and the mediation of negative moral characters (0 = 0. 01, β = 0. 12) can predict cognitive-emotional and negative emotional self-regulation; in fact, people with low sensory thresholds are less likely to cope with stressful situations and misbehaviors, and use inconsistent emotional strategies. Finally, positive moral sources directly predict positive cognitiveemotional self-regulation (p <0. 01, β = 0. 30), and negative moral sources directly predict negative cognitiveemotional self-regulation (p <0. 01, β = 0. 38).

The observance of professional ethics standards' is inherent nature of nursing profession. Observance of ethical standards by them will be an effective factor in improving performance of patient care and affecting the quality of health care. This study was conducted to determine the facilitating and Inhibitory factors of professional ethics from the perspective of nurses. This cross-sectional descriptive study with the participation of 367 nurses in Masjed-e-Soliman hospitals was performed in 2019. The data collection tool was a questionnaire of facilitating factors in the three dimensions of management, individual, and patients and inhibitory factors in three dimensions of management, environmental, and individual care; design, validity, and reliability of the questionnaire was reported by Dehghani. Data analysis was analyzed using SPSS version 22 and statistical tests. From the nurses' point of view, facilitating factors to follow ethics were: sufficient personnel in proportion to the number of patients (64. 6%) in the managerial dimension, proper interpersonal relationship between colleagues and other treatment teams (60. 3%) in the individual dimension; . appropriate treatment of patients with nursing staff (59. 1%) in the patient dimension. The most important inhibitory factors were: lack of attention to the ability and skills of personnel during the division of labor (71. 2%) in the managerial dimension; crowded and busy wards in environmental dimension (69. 6%); shortage of time in the individual and care dimension (66. 4%). In this research, most important facilitating and inhibitory factors for following professional ethics standards in nurses was evaluated. Due to the necessity of observing the standards of professional ethics in nursing performance, the managers of health care organizations can observe the current situation by conducting periodic studies in the field of professional ethics from the perspective of nurses and patients.

Moral sensitivity is the first step in making a moral decision and taking a moral judgment. An effort to promote nurses' moral sensitivity, education of ethical concepts, and using appropriate approaches to teaching ethics is still under discussion. Thus, this study was conducted to determine the effect of virtual teaching of ethical principles through narrative method on the ethical sensitivity of critical care nurses. In this quasi-experimental study, 60 critical care nurses were studied in two groups of test and control in 2 hospitals. The experimental group was taught ethical principles through virtual narrative method. Demographic information and Latezen moral sensitivity questionnaire were completed by nurses on three occasions (before, immediately after and two months after virtual education). Data were analyzed by SPSS 20 software. Results showed that the mean and standard deviation of nurses' moral sensitivity were 61. 53 ± 9. 24 before intervention and (60. 60 ± 7. 76 for the control group, and the association was not statistically significant (p> 0. 05). However, there was a significant difference between the experimental group (77. 50 ± 6. 05) and the control group (60. 83 ± 8. 07 in the first post-test. In addition, there was a significant difference between the experimental and control groups (p <0. 05) in the second post-test. Repeated measure analysis showed a significant difference between the ethical sensitivity scores in the experimental group, but no significant difference in the control group. According to the findings, the nurses' moral sensitivity was moderate at the beginning of the study, but after the intervention, the test group was at a high level and the control group was still at a moderate level. Thus, it is necessary to motivate nurses for recording and sharing their ethical challenges. Accordingly, they can promote their own ethical performance. Furthermore, their narratives can be used for education of other nurses and students of nursing.

The first definition of sexual harassment which comes to mind is a behavior with force and violence. But is sexual harassment restricted to these behaviors? Apparently, sexual harassment comprises of a wide range; a range with rape on its one side (article 224 of the Criminal Code) and using offensive words (article 619 of the Ta’ zirat part of the Criminal Code) containing sexual concept on the other. The conduct and talk which causes harm to someone just because of his/her sex. This concept is consistent with the spirit and purpose of the tort law which is for protection of victims. Moreover, this concept makes our legal system in line with other legal systems’ movement. However, Sexual harassment usually happens without the consent of the victim and by the use of force. But sometimes despite the consent of the victim, this consent is considered null and void since it is the result of duress, fraud, or pressure. Sexual harassment causes different types of damages such as physical or mental which have to be compensated in accordance with the “ no harm” principle. In our legal system, blood money and the sum of money which is paid for the loss of virginity and the criminal relish are considered as different kinds of compensation. Also, mental and moral damage is awarded according to article 1 and 9 of the Iranian Civil Liability Code, and 14 of Iranian Criminal Procedure Code. Knowing legal aspects of this issue leads to respecting of moral aspects. Additionally, in this article, the sexual harassment as well as its related damages and compensations under Iranian law are investigated.

Hospitalization in Intensive Care Units (ICUs) is a very stressful experience for the patient and family and their separation has not been confirmed in any of the studies. At present, ICU visiting is limited that makes several challenges. Therefore, this descriptive-exploratory study, aimed to explore strategies for overcoming the challenges of visiting This was a descriptive-exploratory qualitative study conducted through in-depth semi-structured interviews with 35 participants in educational hospitals of Shahrekord University of Medical Sciences including 6 patients, 9 patients' family members or friends, and 20 nurses during 2018. Interviews were continued until data saturation and then data analysis was performed using inductive thematic analysis approach. Participants stated two main themes for stepping out of visiting-related Challenges. (1) "Reducing the Need to Meet" through "Education about visiting rules", "Improving the Environment" and "Family Interaction" and (2) "Modified Meetings" through "Upgrading the Meeting Behind the windows", "using permanent monitor" and "flexible meeting". The ICU visits in Shahrekord hospitals, are limited like in other parts of the country. However, it is hoped that implementation of the extracted strategies in ICUs will solve many of visiting-related issues and eliminate the conflicting experience of patients, peers, and staff.

In the history of post-Islamic Iran, the Barmaki family is one of the most important families in preparing the background for the transfer of the scientific heritage of ancient times, including medical knowledge to the Islamic period. From the beginning of the Abbasid era, this family penetrated the structure of the political system and after gaining political-economic power and supporting translators and authors of medical works, provided the background for the transfer of a large part of the medical heritage of ancient times to the Islamic period. The main issue of the research is to examine the role of the Barmaki family in the transfer of medical heritage from the beginning of the rise of this family to the assassination of Jafar Barmaki. The research method is descriptive with analysis and library data collection and relies on first-hand sources. The findings indicate that the Barmaki family's interest in ancient medical heritage, the support of the Abbasid caliphs, and the material support of the caliphs and Brahmins for translators and authors of medical works played an important role in the transmission of ancient medical heritage to the Islamic period.

The aim of this study was to evaluate cyber-ethics skills and behaviors of students of Shiraz University of Medical Sciences (SUMS) using descriptive and survey research. Three categories of students of Shiraz University of Medical Sciences was selected as statistical population in this study including medical, dentistry, and bachelor of nursing and midwifery in academic year of 2016-2017. A group of 200 students were selected using a simple random sampling method for the study. Data analyzed using SPSS software (22) and descriptive and inferential statistics. Results showed that students' cognitive skills and ethical behaviors are lower than acceptable level. Also, there was no significant difference between students based on demographic characteristics e. g. gender, field of study and educational level regarding their skills and ethical behaviors.

The purpose of this research is to investigate association between social influence, productivity, and performance among researchers of medical ethics field. This research was done using common methods in scientometric studies with the method of co-author and network analysis. The statistical population of the study consists of all articles published in journals in the field of medical ethics, which were indexed in the database of web of science in the period of 1978-2017. A total of 14, 231 articles and 20, 845 researchers were surveyed. Data analysis was done using UciNet and SPSS softwares. Research findings based on the social influence that calculated for each researcher. The study of relationship between social influence and performance showed that there is positive correlation between performance and degree centrality. However, there is a negative correlation between performance and closeness and betweenness centrality. Also, the relation between social influence and productivity showed that there is a positive and significant correlation between social influence and productivity indices. The results showed that the researcher who have a good status in terms of performance, have a high social impact. In addition, researchers who have a high degree centrality are in a favorable position in terms of productivity and performance.

Undesirable experience as "moral distress" is one of the major issues faced by nurses when making moral decisions. The spiritual dimension is one of the dimensions that influences their moral distress; therefore, this study was conducted with the aim of determining the relationship between spiritual health and the moral distress of nurses working in the emergency departments. In this descriptive-analytic study, 140 nurses working in the emergency departments of the educational and medical centers of Hamedan participated by census sampling. Data were collected through a three-part questionnaire, including demographic information, Paloutzian and Ellison spiritual health questionnaires and Corly moral distress questionnaire. The data was analyzed by Chi-square test and Pearson correlation coefficients using SPSS software, version 16. The mean age of participants was 31. 9 ± 7. 31 years. The spiritual health score and moral distress of most nurses were moderate. A negative and significant correlation was observed between spiritual health and the severity of nurses' moral distress, (r =-0. 200, p = 0. 05), meaning that the higher the nurse's spiritual health score, the lower their moral distress. The results indicate that spiritual health is an effective parameter in reducing moral distress in nurses, so it is suggested to pay attention to spiritual's dimension in promotion of nurses' health.

Dementia is a major health problem due to the high costs of treatment, high prevalence in the elderly, severe consequences, and the imposition of physical and psychological stresses on families of the patients. Occupational therapy is one of the most important approaches among many technologies employed for helping the patient and reducing the burden of healthcare for patients. This applied study aimed to investigate the ethical and legal aspects of occupational therapy technology in the elderly with dementia using qualitative methods. The study population consisted of 12 specialists and practitioners in the field of dementia and elderly services in the country. Data collection was carried out by interviewing the expert subjects. The results of this study showed that beneficence/non-maleficence, autonomy/informed consent, maintaining dignity/respect for persons, concern for equality and justice in accessing services, legal support for technology use, need for the principle of discretion, and patient confidentiality, and proper technology utilization are seven major ethical and legal challenges in occupational therapy technology in the country. According to the results, lack of insurance coverage for occupational therapy technology and the lack of access to this service for the elderly are major barriers to its application and the Ministry of Health must provide the initiatives for its implementation across the country and place it in the elderly service package.

The physicians of the Bukhtishu dynasty first entered the Abbasi court with the aim of practicing medicine; but soon after, thanks to their medical knowledge and skills, they gained a lot of power and wealth and became involved in power relations at court. Although they were able to gain a high position in the Abbasid court; but their position was constantly unstable, and sometimes they were at the peak of power and sometimes at the bottom of humiliation. Therefore, the present study, with a historical method and a descriptive-analytical approach, seeks to answer the question: what factors have been effective on the relationship between the physicians of the Bukhtishu dynasty and the Abbasid Caliphate? The claim of the research is that the need of the caliphs for treatment provided the background for the entry of the doctors of Bukhtishu dynasty to the caliphate system and strengthened their presence in the court. Factors such as the success of these physicians in medicine, the power of the caliphs in supporting them; other threats from courtiers also fluctuated the status of these physicians. The findings of the study indicate that physicians with the benefit of medical knowledge had such an effect on the caliphs that they were considered as one of the main actors in politics, so they play an important role in the removal and installation of caliphs, poisoning and killing of them. They could pave the way for their conditioned person to come to power by abandoning their treatment; they were also degraded, imprisoned, and sometimes exiled or even killed.

Perhaps, the most appropriate translation proposed for euthanasia is the painless and piteous killing. According to the existence of effective components in committing a crime, it is considered as complicity in murder and the consent of victim does not affect the nature of criminal act and the criminal liability of person depriving the life. One of issues related to this killing which is disagreed is the edict that person who is obliged to save life related to passive type of euthanasia does not perform this killing and there must be difference among its different types and conditions. The primary reasoning of the edicts indicate that duties whether difficulty or not must be done but, according to the rule of negation of difficulty and hardship, obligation to these edicts in cases of hardship is cancelled. The articles of this rule include obligatory duties to disuse. However, from the view of jurists, it is not general that euthanasia corresponds to some juridical sub-principles indicating the permission of suicide in some conditions, although this is criticized and rejected. Two rules of hardship and beneficence are those believed to help prove the hypothesis by attaching to the rule of negation of hardship and difficulty. But, it is clear that it is not so. In feasibility study of this rule with the rule of no harm, they are proved by the murder illegality and the mentioned rules cannot govern the primary reasoning of depriving the life Therefore, euthanasia is not allowed at all.

In recent decades, the concepts of healthy lifestyle and healthcare choices have been the subject of focus by healthcare policymakers. Together with financial, mental, and ethical reasons for citizens to have a free hand as far as their healthcare, numerous arguments based on the social aspects of healthcare have also been made by proponents of the necessity to limit these options by government, believing that in addition to personal consequences, an individual's healthcare choices have social ramifications as well. On the other hand, the definitions of the concept of freedom along with the impressionability factor of the individual's healthcare choices to government and society are other parameters that affect government policy in this area. By looking at the meaning of freedom from both the functional and opportunity creating standpoints, we have attempted to demonstrate that the optimal definition of freedom in the healthcare system is a responsibility based freedom in which it is although limited by the government, a person still maintains his individuality. According to the findings of this study, without establishing the necessary prerequisites by government and society, the freedom and equality of individuals in healthcare choices is meaningless. In this context, the special role of government is to create a balance between the individual rights and public interest as well as to cultivate responsible and well-informed citizens to protect themselves and others, building a society that would not allow the withdrawal or disregards of the right to freedom.

The necessity of governing ethics is desirable in the work environments and is universally accepted. Ethical performance is based on the ethical criteria that employees are expected to adhere to. The purpose of this study was to determine the relationship between ethical educational needs and ethical efficiency in health workers of Sistan province. This is a descriptive correlational study. Data of 377 healthcare providers of Sistan rural areas were collected through a multi-stage cluster sampling method. Information was collected with a valid and reliable questionnaire. The data were analyzed by SPSS 19 software using descriptive correlation, independent t-test, one-way ANOVA, and Pearson correlation coefficient. The results showed mean score of the need for ethical education of health care providers was relatively high (with respect to the maximum of the score), and the ethical performance of health care workers was low. There was also a significant and inverse relationship between score of ethical educational needs and ethical performance of health care providers (P >0. 05). Based on the results, there was a significant and inverse relationship between ethical educational needs and ethical performance of health care providers. Providers who had a higher level of information and less educational needs had higher ethical performance. So, implementation of educational programs based on ethical educational needs is recommended for increasing ethical performance of health care providers as they are first-line practitioners who interact with people and health care clients.

Increased patient satisfaction can promote patient's compliance with prescribed treatments and improve patients' health. The aim of this study was to determine the patients' satisfaction with nurses in surgical departments of Imam, Razi, and Golestan hospitals of Ahvaz city in 2018. In this descriptive-analytic study, patients over 18 years of age with at least 3 days of hospitalization were studied. Data including age, sex, marriage status, level of education, type of illness, hospitalization time, number of hospital admissions, and health status were collected through a demographic form. Patients' satisfaction with nurses was obtained by the satisfaction questionnaire of nursing services. Chi-square, one-way analysis of variance, Kruskal-Wallis analysis, Mann-Whitney test, and Spearman correlation coefficient were used to analyze by SPSS software. Patients' satisfaction in Imam, Razi and Golestan hospitals were 78. 25± 12. 09, 68. 30± 11. 24, and 58. 09± 17. 42, respectively. Highest level of patients' satisfaction was with Razi hospital nurses (Pvalue<0. 05). There were no significant difference between patients of different hospitals regarding age, marriage status, place of residence, hospitalization history, and education level (P-value>0. 05). With increasing age, having a history of admission, an increase in the duration of hospitalization, the patients' satisfaction score decreased significantly (P-value<0. 05), but there was no significant difference between the patients' satisfaction by marriage status, place of residence and level of education (P-value>0. 05). It is suggested that effective strategies for increasing patients' satisfaction be applied through more care and attention of more sensitive people. Also, increasing awareness of the community about the duties of patients, nurses, and medical staff is recommended.

Organizational culture is defined as prominent values and a set of key characteristics govern the organization. Paying attention to the importance of organizational culture increases staff’ s productivity and job satisfaction. Therefore, the aim of this study was identification, counting and classification of organizational culture components based on Islamic-Iranian values by synthesizing approach and looking at health care organizations. First, 892 indicators were identified and counted by application of Pearson and English databases and using organizational culture, Islamic – Iranian culture, indicators, component, and health care organizations as key words, consideration of inclusion and exclusion criteria, field literature review, data entry into Excel software. Then using Delphi method and opinions of seven cultural elites in Tehran University of Medical Sciences, and after performing 11 stages, repetitive indicators in terms of meanings, concepts, and examples were merged and grouped into 39 components. Moreover, the extracted components were divided into three levels of organizational culture and the application of the components of each level in organizations were presented. Therefore, it is recommended the final components and application of each of them be used as an organizational charter in Tehran University of Medical Sciences.

Communication skills are recognized as an essential part of nursing services and as they are faced with an extended range of referees, they have to communicate with them in a specific way. This study was performed to determine the communication skills of nursing staff of pediatric wards with their colleagues. This descriptive-analytic study as cross-sectional was performed on 110 nursing staff of pediatric wards from Persian Gulf’ s hospital during 2019, in Bushehr, Iran, by using census sampling method. Data collection tool was a communication skills’ questionnaire including demographic part and items for self assessing communication skills of nurses with their colleagues. The validity and reliability of the questionnaire were confirmed in previous studies. Data were analyzed by SPSS software using independent t-test, Pearson correlation and one-way ANOVA at the significant level of 0. 05. The mean score of professional communication was 54. 33 ± 7. 26 which was relatively significant. Scores of professional communication were not statistically associated with age, work experience, educational degree, employment status, type of responsibility, interest to job and marital status. The results showed statistically significant relationship between the mean scores of professional relationship with workplace (p <0. 013) and shift work (p <0. 020). The highest professional communication score was 58. 83 in the nursing office and the lowest score was 50. 21 in the pediatric emergency department. The Pearson correlation between age and work experience was positive with the mean score of professional communication, and the highest score of professional communication was related to staff working in shift work. According to the findings of the present study, the status of professional communication among nursing staff of pediatric wards was relatively desirable and therefore, based on the results, it is suggested that nursing authorities and planners plan and endeavor to enhance nurses' professional communication.

Efforts of the medical staff are to provide efficient, desirable, and high quality services to patients. However, medical treatments are not immune to error and mistake. So, occurrence of injury following medical managements is inevitable, an issue that could lead to a lawsuit against the medical staff. In such cases, resorting to experts' opinion is necessary. Therefore, knowledge about effective indicators in sentencing can increase awareness of the treatment staff in addition to reduction of traumatic behaviors. Reflection on the medical forensic cases shows that the reasons of medic’ s conviction can be divided in two categories including pre-treatment and post-treatment factors. Errors after entering the treatment process indicate posttreatment index. Breach at the end of treatment, not doing (lack of) treatment in the appropriate place, mismatch or mistake of used techniques, and fault or blunder are the most important issues related to this index. The present study intends to examine the effective criteria in sentencing medical staff in a descriptiveanalytical manner based on expert opinions' of medical malpractice cases.

All children have a right to benefit from health facilities, goods and services and be protected from physical or mental violence, injury or abuse, and neglect or maltreatment. Some groups of children need special support to enjoy their rights. The aim of this paper is to review Iran’ s laws and policies on the protection of children’ s right to health. The method of this descriptive and analytical study was content analysis of international and national law and reports related to children’ s right to health and the current situation of Iranian children. The data was collected from academic literature and official webpages of United Nations and Iranian government’ s organizations. Realizing citizens’ right to health and protection, Iran’ s laws respect the right of vulnerable groups of children to special support. Moreover, to protect Iranian children from health risks and maltreatment, there are several deterrent laws. Iranian laws on children often are consistent with international human rights laws. However, not all of them are adequately and completely implemented. To promote the health of children, weaknesses in the implementation of laws should be identified and removed.

Despite the peak of medical knowledge in the Abbasid period, the presence of famous medical families in the Abbasid court, translation and writing of medical works, attention to nutrition and health in the court of the Abbasid caliphs, the expectation of long life and quality was created for the Abbasid caliphs. However, all these possibilities were not used much by the caliphs, and if they had not been killed in the war, they would have died of disease, even at a young or middle age. This research is performed using library sources and descriptive-analytical method. According to the findings of this study, the urgent need of the Abbasid caliphs for "treatment" had caused physicians to be present in the court of the caliphs with great benefit of wealth and even power. Revelry, the unjustified lifestyle in having fun and spending a lot of time in the harem leads to the suffering from of some Abbasid caliphs in their age Young or untimely due to some incurable or incurable diseases that caused their premature death. Finally, among the 37 Abbasid caliphs, 30 of them were killed in internal or external wars and conflicts. The remaining number died of disease, despite the establishment of a coherent system of health and treatment and having all the medical facilities of their time. Therefore, despite the provision of medical facilities for the Abbasid caliphs, the wrong lifestyle and full of excesses in having fun has caused them to fall ill and eventually die.

The long-standing interaction of philosophy and medicine has assumed to be as follows: great physicians have been also philosophers, so there is a relationship between medicine and philosophy. In this paper, based on philosophical modeling, essentials of interaction for medicine and philosophy are presented. First, brief descriptions of two models of medicine-philosophy interaction are presented: Galen and Avicenna. Then, the distinct and innovative model of Fakhr Razi-that has been seriously neglected-will be descried. Galen believes “ The best doctor is also a philosopher (logic and ethics)” . The logic helps physician to provide accurate diagnosis while the physician-patient relationship is regulated by ethics. Avicenna concerns more with the epistemological foundations of medicine, the position of medicine in the classification of knowledge and the importance of theory of medicine. He argues that philosophical debate on fundamental medical concepts is neither useful for medicine nor philosophy. Fakhr Razi's model can be described as Socratic Method, that is, understanding through dialogue based on questions and answers. His book called “ Sharh Kulliyyat al-Qanun fi al-Tibb” (Commentary on Canon of Medicine) is philosophical reflection on basic concepts of medicine and It could be considered as of one of the first texts in medical philosophy. The main goal of his philosophical reflections seems to provide a deeper understanding of medical knowledge and its application in practice.

Modern infertility treatment methods, along with favorable results, sometimes bring about unfavorable consequences. Multiple pregnancy is one of those consequences that puts the health of mother and life of fetus in danger. Fetal reduction, namely removing one or more fetuses with aim of preserving pregnancy and also certain preventive measures such as transfer of fewer fetuses into uterus of mother in each cycle of In Vitro Fertilizations (IVF), is one of solutions to tackle this unfavorable consequence. In a number of legal systems, along with a permission to conduct fetal reduction, precise provisions on the number of transferable fetuses are enacted. A comparative study of fetal reduction in countries in which there is an experience of legal encounter with this issue shall open a horizon for the legislator and policy makers in the field of health in Iran, where there is no consistent laws or regulations in this context, so that they adopt an appropriate approach to the problem. It seems that a fetal reduction permission, limiting regulations on the number of transferable fetuses, and proper insurance coverage embody an appropriate legal system in the context of fetal reduction.

This study seeks to identify one of the pioneers of traditional clinical medicine named Abdullah Azdi and his medical dictionary. This research is an analytical study. The focus of the search was on two keywords, Abdullah Azdi and Kitab al-Ma'ma, but the scope of the search included all appropriate terms such as: medicine, Bu Ali Sina, traditional medicine, medical dictionary, ethics, and medical law. Data were collected and analyzed using comprehensive library software (version one), Islamic History Library, Islamic Iran History and reputable national and international centers. The main purpose of the forthcoming research, on the one hand, is to identify and introduce points about life and beliefs, as well as Abdullah Azdi's specialized knowledge in the field of medicine, and on the other hand, to introduce his book, which is in fact a dictionary called "Kitab al-Ma'a". The researches of this research show that Abdullah Azdi was one of the students of Ibn Sina and the companion of Abu Rihan al-Biruni. In addition of being expert in clinical medicine, he was an ethical and professional physician and in every part of his book, he observes the Shari'a. The use of specialized medical terms indicates that he was surrounded by medical knowledge.

Professional ethics is one of the most important topics in medicine that educators or professors play an important role in teaching and measuring it. The present study was designed and conducted to evaluate the observance of professional ethics among surgical assistants of educational hospitals of Ahvaz Jundishapur University of Medical Sciences in 2019 by self-assessment method. This study was a cross-sectional study. Each of the assistants completed a standard questionnaire that included the variables required for the study. The sample was selected according to population of surgical assistants in the general and orthopedic departments, who entered the study using census sampling method and were equal to 47 people. Of 47 participants, 29 were assistant general surgeons and 18 were orthopedic surgeons. Observance of professional ethics was acceptable. There was a significant relationship between knowledge and communication skills and assistants in both general and orthopedic departments (P <0. 05). There was a significant relationship between professional ethics and assistants in both general and orthopedic departments (P<0. 05). Respect for others with a mean of 1. 66± 6. 0, had the highest mean rate. Also, interpersonal and social skills with an average of 2. 17± 4. 48, had the lowest mean. Considering that inclusion of professional ethics in laws and regulations is one of the important and vital factors in growth and development of ethics, institutionalization of professional ethics in strategic plan should be considered by policy makers and structure, training and evaluation of professional ethics be reviewed.

Plague is a bacterial infection that is transmitted to other animals and humans through rodents and their infected fleas and is a common disease between humans and animals. This disease has a long history in Iran. The spread of this disease is very wide and almost all parts of Iran have experienced it, however, data on how it occurs in the country is very limited. A plague occurred in Iran in 1246 and 1247 AH, which resulted in huge casualties. In this research, using library resources and documents and in a descriptive-analytical method, the cities affected by this disease and ways and the causes of its transmission have been studied. The result of the research revealed that except for a few other provinces, all Iran and even the holy shrines were involved with it. Simultaneous outbreak of other chronic diseases, outbreak of dangerous type of pulmonary plague, neglect of quarantine and escape to other areas have been the most important factors in the prevalence of this disease.

Good and healthy communication between physician and patient is cornerstone of a complete medical care that has long been considered in sociology. From the classical point of view, the physician-patient relationship as a unique relationship encompasses a wide range of cultural and social influences. Electronic health record not only has facilitated the treatment and diagnosis process, but also has promoted the health care system by organizing patient records; however, it alters the physician-patient relationship process culturally and it will create new ethical challenges. Based on current findings and analyses Opinions of health experts about the cultural and communication dimensions of this technology, the electronic health record, despite its effectiveness, easy and convenient diagnosis, awareness of other physicians' diagnosis, earlier and better treatment, has cultural obstacles such as security, reduction of emotional and face-to-face actions, and fear of social stigma. Having a suitable cultural context and information and awareness can affect development of health technology. The results of this study, which have identified the role of culture on physician-patient relationships in context of using electronic health record, shows that building trust in patients and changing cultural conditions through education and improving system security can increase the efficiency of this system in health care processes.

The health system needs nursing managers with moral reasoning ability to increase the quality of care in the system by adopting an effective leadership style. The aim of this study was to investigate the relationship between moral reasoning ability and leadership style of nursing managers of medical centers affiliated to Jiroft University of Medical Sciences. The present study was a descriptive-correlation cross-sectional study that was conducted in 2020. The population of study was all employed nursing managers, among whom 124 participants with a bachelor's degree in nursing and higher were included in the study by census sampling method. Data collection tools were demographic questionnaires, “ Cherisham moral reasoning” and “ Hershey and Blanchard leadership style” . Descriptive and inferential statistics and SPSS software version 19 were used to analyze the data. The results of the study showed that the mean score of moral reasoning of nursing managers is (48. 10 ± 7. 04) which is higher than the mean score of the test. Also, the dominant leadership style of managers was selling leadership style 59. 68%. The highest average of ethical reasoning of nursing managers was related to participating leadership style (48. 44± 7. 35). There was no significant relationship between moral reasoning ability and leadership style of nursing managers (P >0. 05). According to the results of the study, it is recommended to strengthen nursing managers 'efforts to strengthen transformational leadership styles in their managerial behaviors in order to improve leadership effectiveness and increase nurses' job satisfaction and observe ethical decision making.

Turnover and moral distress are considered as one of the challenges in health care systems. Nursing leaders are one of the factors influencing the thoughts and behaviors of nurses in organizational environments. The aim of this study was to determine the relationship between ethical leadership, moral distress and the turnover intention of nurses working in hospitals affiliated to Kerman University of Medical Sciences in 2019-2020. The research method was descriptive-correlation. A total of 130 participants were enrolled by stratified sampling method from 3 hospitals. Data were collected using demographic information questionnaires, Ethical Leadership in Nursing, moral distress, and turnover intention. Then data were analyzed using descriptive and inferential statistics by SPSS software version 16. The results showed that ethical leadership and all its components were at the desired level. Also, moral distress and intention to leave were moderate. There was a significant negative correlation between ethical leadership and all its dimensions with the turnover intention and moral distress. Also, there was a significant positive correlation between the variables of turnover intention and the moral distress. Therefore, considering the significant relationship between ethical leadership, moral distress, and the turnover, by adopting this type of leadership approach by nursing managers, moral distress and the turnover intention among nurses can be reduced.

Regarding how to make decisions on the revelation of medical errors done by colleagues, investigation of physicians' points of view particularly those in educational settings could help the improvement of circumstances to which we encounter medical errors and thus respecting patient's rights. This cross-sectional descriptive study was conducted through a researcher-made questionnaire after performing face and content validaty and determination of internal and external reliability. The viewpoint of 40 attending physicians and 112 medical residents from different specialties about their inclination to disclose errors, the results of disclosure, the factors influencing on nondisclosure, and the factors decreasing medical errors were asked. Data were analyzed using SPSS v. 21. Mean scores of 15. 2± 1. 3 for attending and 12. 56± 2. 05 for residents regarding the dimension of "inclination to disclose others' medical error"; and mean scores of 7. 55± 0. 677 for attending and 9. 09± 2. 01 for residents in terms of "inclination to NOT disclose" were differed significantly (p<0. 001). Participants declared the head of medical department/ward as the best authority for managing and dealing with medical errors as the best approach for disclosure of the errors through attendance of the senior physician accompanied by the physician who has made the error. Urban general physicians, nurses, and firstyear residents were reported with the most frequency of the errors. The data can be used for the promotion of the patient's rights and the perspective of the medical team when encountering errors done by a colleague, rightfully, and protectively. Building cultural, legal, and social contexts will be the mission of the educational-medical settings aimed at making possible a scientific and skillful error disclosure.

Ethical climate is an important part of organizational culture which affects all aspects of individual characteristics and its improvement in health care centers causes better response of nurses to moral stress and ultimately promotes the quality of medical services. The aim of this study was to determine the nurses' perception of the ethical climate governing in clinical environment in the teaching hospitals of Shahrekord University of Medical Sciences in 2018. This study was a descriptive-correlational study performed on 300 nurses by purposive sampling method. Two questionnaires used for data collection included demographic information and Olson ethical climate questionnaire. Data analysis was performed using linear regression and mean (SD) tests and by SPSS version 20. The results of the study showed that the overall score of moral climate in the participants was 3. 79 ± 0. 67. The highest and lowest ethical climate scores in this study were related to the dimension of nursing managers (3. 86± 0. 74) and physicians (3. 58 ± 0. 79), respectively. Also, a significant relationship was observed between variables such as years of experience and age with the dimensions of the ethical climate (p<0. 05). According to the score of ethical climate obtained in this study, which is less than some studies conducted in this field in Iran. Considering the importance of the ethical climate and the consequences of defects in this issue, it is necessary for hospital managers to make appropriate plans to set up a favorable ethical climate on clinical environment in their most important priorities.

Evaluating clinical performance of nursing students as a resource to determine educational needs and decision-making is essential to change the educational environment and improve the quality of education. The aim of this study was to evaluate the professional behavior of nursing students in the clinical environment with the Small Scale Professional Assessment Tool (P-MEX). This descriptive cross-sectional study was conducted with the participation of 86 nursing interns of Ahvaz University of Medical Sciences in 2019. Data collection tools were demographic information questionnaire and P-MEX Cruess evaluation form. The validity and reliability of this instrument was evaluated by observers and was determined with Cronbach's alpha coefficient of 76%. Data were analyzed using SPSS software version 20 and descriptive statistics, independent t-test, analysis of variance, and post hoc test. In professional skills, most participants in the first stage were 51. 2% at the average and expected level and 48. 8% above the expected level, and in the second stage, most were 84. 9% at the average and expected level and 15. 1% higher than they were as expected. In this study, based on the evaluation scores in two stages, although the average total clinical skills scores of most students were within the expected range of the 4-point Likert scale, the skill scores were lower in the special wards. Therefore, for the full development of professional skills, it is necessary to develop appropriate methods of planning and training in the field of professional behaviors.

Privacy is a basic principle of humanity and one of the most important fundamental rights of every human, that adherence to it is required particularly in health care organizations. The purpose of this study was to evaluate privacy level of elderly patients in educational and medical centers of Ahvaz Jundishapur University of Medical Sciences. This cross-sectional study was performed on 230 elderly patients hospitalized in internal and surgical wards of educational and medical centers of Ahvaz Jundishapur University of medical sciences. Data were collected by a researcher-made questionnaire. The questionnaire was prepared in two dimensions of psychological with 11 questions and physical with 18 questions. Validity of the questionnaire was evaluated by experts and professors. Results showed that 62. 2% (143 people) of the patients were female and the rest were male. In terms of adherence to privacy, 47. 13% of women and 51. 75% of men evaluated it as high and 13. 79% of women and 20. 28% of men evaluated it as poor. The level of privacy in terms of gender of the patient, nurse, and the physician in charge were statistically different (P-value<0. 05). However, there was no significant difference between adherence to privacy and age and occupation of patient before retirement, marital status of nurse, and physician in charge (P-value> 0. 05). Training of nurses, physicians, personnel, and health care providers to enhance privacy of elderly patients and reinforce supervisory performance of managers and authorities is necessary.

Moral sensitivity is one of the important criteria in the principles of professional ethics and psychology is the theme of some of its dimensions, thus the aim of this study was to explain meaning of moral sensitivity by emphasizing on its psychological dimensions from the perspective of operating room treatment staff. In this quantitative research, a semi-structured and in-depth interview was conducted with a total of 11 operating room treatment staff. Content analysis was carried out by Strauss and Corbin method. Output of the recent study includes three themes of environmental variables, individual and interpersonal events and problems, and the reciprocal rights of the patient and medical staff. Dimensions of moral sensitivity included degree of respect for the client's independence, level of awareness about how to communicate with the patient, level of professional knowledge, experience of moral problems and conflicts, use of ethical concepts in moral decisions, and honesty and benevolence. Our observations revealed difference between views of the staff from various dimensions of "moral sensitivity" with what is actually mentioned in the texts. To the extent that many of the interviewees perceived moral sensitivity as something that offends them personally.

The National Medical Ethics Film & Photo Festival was held in February 2020 and ended with the registration of 487 works which 80 films and 36 photographs of them were finally selected and peer reviewed. The present article focuses on the films of this festival and tries to explain the experience of attracting, selecting, and judging films through the design and holding a festival by using action research method. The article, also, tries to analyze the selected films (50 documentaries, 20 short films, and 10 unspecified films) from medical ethics point of view. In this way, the thematic adaptation of the selected films with 16 topics declared by the festival has been used. One of the obvious findings of this study is the difference between the views of filmmakers and experts on medical ethics. This difference becomes more significant when we see that the number of films related to the 16 topics declared by the experts is one less than the number of the films that the filmmakers made and submitted to the festival on the 7 topics neglected in the text of the call. It seems that the camera of filmmakers in the field of medical ethics mainly focuses on the commitment of professionals and the vulnerability of patients. On the other hand, considering the number and variety of films in the festival, another finding of this study can be considered as the possibility of using short and documentary films to teach some concepts of medical ethics to medical students.

One of the main issues in hospitals is evaluation of efficiency and effectiveness. For this purpose, several indicators are presented, which are known as functional indicators. If the performance of hospitals depends on the patient's demographic characteristics, overlooking effect of hospital indicators, as an effective factor at a higher level on the patient rights, may lead to inaccurate conclusions about these relationships. In such cases, where the data are intrinsically multilevel, the use of multi-level statistical models for this type of data is useful. Samples were collected from eight hospitals of Tehran University of Medical Sciences during 2013 in a two stage cluster. Data on patient rights and demographic information were collected from 375 patients by a questionnaire. The patient's rights rate was measured by multivariate statistical analysis and factor analysis. Two-level linear regression models were used to examine the relationship between patients' rights and some demographic information. The first level was demographic factors and the second level was hospital factors. The results showed that rate of considering patients' rights in hospitals were in moderate level. About 16% of the variance of the dependent variable of patient's rights, which was significant, is due to variations at the higher level of the hospital and other variations at the individual level. Furthermore, variables of bed occupancy, complaint rate, and hospital escape rate at the higher level (Hospital) have a significant impact on the patient's rights.