alireza parsapour

human right with a long history of appreciation, indicating that governments should guarantee the highest possible level of access to health and provide health-care serivces with no discrimination based on nationality, race, gender, language or religion. The present study explored this topic using an analytic-descriptive approach. We reviewed related laws, policies and other available documents with the aim to investigate the ethico-legal aspects of Afghan refugees' and immigrants' access to health care and the challenges in in this regard within the Iranian health law system. According to the results of this study, the Iranian health law could be interpreted to include all Afghan immigrants in the country’s public health system as a legal commitment. In addition, while basic and primary health coverage is available for all Afghan immigrants in Iran, provision of other medical and rehabilitative health services to documented and undocumented immigrants follow different methods. In order to alleviate the current situation, we recommend strategies such as supporting policy changes intended to register undocumented immigrants, which naturally results in an increase in their access to health care.

The right to access health services as a part of fundamental human rights, affected by the conditions and facilities of governments and the international status, has always faced challenges. Despite the clarity of the general policies and upstream documents in the Iranian health system regarding the need to provide immigrants and refugees with health services and Iran’s membership in the relevant conventions, the implementation of the provisions of these documents is not consistent and complete for various reasons, including the inadequacy of laws related to immigrants and refugees and the incorrect implementation of some existing laws. The first draft of the ethical guidelines for providing health services to immigrants was prepared by the research team using the results of a review of relevant documents as well as a qualitative study and finalized according to the opinions of the participants in a panel of experts. In this draft, after explaining the values and ethical principles governing the provision of services to Afghan immigrants, the suggested guidelines and assignments were presented to the main stakeholders involved, including the policymakers and macro planners of the health system, institutions and centers providing health services, professionals and health service providers, professional organizations, civil society activists, media and non-governmental organizations,  and medical research and education authorities and researchers.

Defensive medicine is performing actions that have no medical indication and benefit for the patient (positive defensive medicine) or refraining from performing risky actions that have a medical indication and benefit for the patient (negative defensive medicine). These actions are carried out by the physicians with the sole motive of protecting themselves against complaints or tensions such as the protest of the patient or colleagues and usually cause physical, psychological, or economic harm to the patient or the institution that pays the treatment fee, such as insurance organizations. It can have consequences in terms of the quality of care and the efficient use of limited health resources. Factors such as the physician’s concerns about lawsuits and proceedings may lead to defensive behaviors. This study presented suggestions for the management and prevention of such behaviors, including three main categories related to the strategies for the reformation of the patient complaint handling system, social strategies for the management and prevention of defensive medicine, and managerial-organizational strategies. These strategies are based on the findings of a mixed-methods research including an unsystematic review of resources and a qualitative study conducted using semi-structured interviews. The results have been discussed by the Medical Ethics Committee of the Academy of Medical Sciences of Iran.

Medical ethics is an applied branch of ethics that deals with ethical challenges in medical and health environments, and its related topics have a long history, but its education as an academic subject in universities has received a lot of attention in the last 40 years. In recent years, medical universities have made extensive efforts to expand medical ethics education, which has been accompanied by significant progress, but given that the modern medical ethics education system is a growing and nascent structure, more research is needed. Therefore, this study aims to assess the status of the medical ethics education system at Tehran University of Medical Sciences to identify its gaps so that the current situation can be improved with proper planning.

The type of this research is descriptive quantitative-qualitative and it was collected from December 2018 to September 2019 at Tehran University of Medical Sciences. First, the educational curriculum of 165 educational levels at Tehran University of Medical Sciences was reviewed and described in terms of the existence of a medical or professional ethics course in the educational curriculum. Then, a semi-structured interview was conducted with the 13 professors in charge of teaching this course in all faculties, and content analysis was performed to describe and identify the obstacles in its effectiveness.

The results showed that in 53% of the educational levels, there was no separate medical or professional ethics course in the educational curriculum and the most educational coverage of this course took place in the faculties of medicine, dentistry, nursing and midwifery. The obstacles in the effectiveness of teaching this unit were categorized into five main themes of educational curriculum, hidden curriculum, teaching methods, teachers and education management.

The results show that the content of curricula needs to be revised and education should be inclusive. Creating a coherent educational organization and monitoring the hidden curriculum are other issues that should be considered to increase the effectiveness of this education.

Health care workers especially medical groups are worthful human capital, that each community’s life depends on. Compensating for the shortage of human resources for health care requires huge time and budgets. The evidence shows that in recent years, Iranians migration trend, especially the highly educated class, have been increasing, unfortunately, most of these people do not intend to return. In this article, while analyzing the situation, the factors affecting the migration of the medical groups and its consequences are presented, and futurology and forecasting are emphasized.

Today, 25% of diseases in the world are directly or indirectly caused by environmental problems. The present study attempts to clarify physicians’ moral responsibility in this regard and the roles they can play to decrease environmental problems. It also evaluates their attitudes towards and performance of these roles. The clarification of this issue paves the way for interventions through effective education or policy-making, as well as directing useful research.

A questionnaire was developed based on the results of qualitive study. The questionnaire assessed physicians’ awareness, attitude, and performance with regard to their environmental moral responsibilities.

Physicians with longer work experience had better performance. Those who worked in offices or at universities had also better performances compared to those working in hospitals. Physicians with more awareness had better performance, especially those who had acquired this awareness through books and educational workshops. The source of information was an effective factor on the gap between physicians’ attitude and performance scores those who had acquired information from books had the narrowest gap and those who had received information from social networks had the widest gap between attitude and performance scores.

The health system and the environment and its problems are intertwined and greatly influence each other. Thus this interrelation and the necessity of being concerned and having moral sensitivity were explained.

The approach of medical ethics training courses at Tehran University of Medical Sciences to change the attitude and promote medical ethics knowledge of learners has challenges. This study aims to identify the challenges in teaching medical ethics at Tehran University of Medical Sciences.

This is a qualitative study with semi-structured interviews conducted in April 2018 at Tehran University of Medical Sciences. Using purposive sampling, 23 participants were selected from the clinicians and faculty members of medical ethics and medical students. Data were analyzed by the content analysis method.

The challenges of teaching medical ethics from the participant's point of view are classified into three themes: 1- Hidden curriculum 2- Necessity of completing medical ethics education program 3- Executive and managerial macro factors. The results showed that medical ethics training courses are not effective for changing students' behavior and their moral decision-making. There are substantial shortcomings in the current curriculum in terms of content, format, and implementation that make it unresponsive to ethical needs and concerns. Teaching medical ethics should be turned into a longitudinal theme. The duties and missions of the Department of Medical Ethics at the university are not well understood. The Department does not act as a strong executor and supervisor of medical ethics in interaction with higher authorities to pursue the requirements of effective ethics education and to ensure the implementation of ethical codes. There is no effective mechanism for evaluating the ethical performance of activists and students and giving feedback to them. There is insufficient organizational support for students' complaints and reports about the misconduct and unethical behavior of faculty or staff.

The effectiveness and efficiency of medical ethics courses to change the behavior and attitude of learners are not acceptable. Dealing with the existing challenges requires the efforts of the Medical Ethics Department to make maximum use of available resources and interact effectively with other academic departments.

Conflict of interest in the health system is a serious issuethe various aspects of which must be assessed.The purpose of this article is to describe the importance and underlying factors involved in managing conflict of interest in the healthcaresystem.

Existing data fromarticles and documents were used for analysis and preparation of this article.

The types of interests, influencing factors,and misconceptions dealing with conflict of interest are described in detail.

Conflict of interest has many dimensions thus finding a simple solution is not always possible. It is recommended that rules and regulations for management of conflict of interest be passed and implemented in the country.

Codes of ethics are a set of moral standards based on a value system widely accepted by members of a profession. In order to choose the right course of action and resolve potential ethical challenges, these codes will need to be developed so that ethical values can be identified and prioritized. Medical ethics covers all areas of medicine, and surely, rehabilitation is not an exception. This study aims to codify the ethics of the rehabilitation profession while considering the cultural and religious issues in Iran. For this purpose, we used a qualitative research method, including literature review, questionnaire, targeted interviews, content analysis, group discussion, and code extraction. The results were categorized into seven sections: “respect and empathy”, “autonomy”, “offering responsible care and reducing suffering”, “doing the right thing”, “beneficence”, “privacy and confidentiality”, and “social responsibility”. The development of ethical codes for rehabilitation determines moral norms in order to protect the rights of people who need rehabilitation services. These codes can also be used as a guide to the ethical challenges of the profession.

Medical ethics faces several challenges in different aspects of education, research, and treatment in medicine and healthcare practice. Design and implementation of a national strategic plan can pave the way for the development of a roadmap in various countries to strengthen ethics and address these challenges. To create a comprehensive plan compatible with the Iranian healthcare system, a multidisciplinary team of main stakeholders compiled a national strategic plan of medical ethics following several focus group discussion sessions and two workshops (2014-2017). Ultimately, the plan was confirmed by the Supreme Council for the Medical Ethics of the Ministry of Health and Medical Education. The current paper is a national report of the process and the medical ethics strategic plan in Iran. We have also tracked signs of progress and achievements in the country. In conclusion, this valuable effort has led to significant success in the implementation of medical ethics in clinical medicine, medical research, and education by using all the resources in our country. The participation of all the stakeholders, especially healthcare professionals in this way is required.

The advances in science and technology in recent decades, especially in medical sciences, have raised new ethical challenges. Hence, professional organizations in the field of medical science are trying to develop regulations in the field of medical ethics to help medical science professionals in making the best decisions in different circumstances and moral dilemmas. The organizations also try to monitor their performance using those regulations. On the other hand, due to the specialization of medical science as well as the complexity of communication between these disciplines, there is a growing need for regulations to answer questions and resolve the challenges of each discipline. Certainly, scientific societies, due to benefit from relevant specialists, are the best reference for the development of specialized guidelines, one of which is the Iranian Society of Asthma and Allergy (ISAA). The aim of the current study was to develop codes of ethics for ISAA members, using a qualitative study. Generally, the ISAA codes of professional ethics consists of general and specific sections. In order to compile the general section, the upstream medical documents, including the patients' rights charter in Iran, the research ethics guidelines approved by the Ministry of Health and Medical Education (MOHME), ethical codes from the international societies of asthma and allergy, the general codes of professional ethics of the Iran Medical Council and the Islamic jurisprudential rules and the statute law of the country were used. To develop specific sections, we interviewed the experts in the field of Asthma and Allergy about the ethical challenges they had ever faced with. The ISAA codes of professional ethics developed in five chapters, entitled "Ethical Guidelines for the Mangers and Director of the Society, General Guidelines, Specific Guidelines, Ethical Guidelines for Research and Education, and Procedure for Supervision on the Professional Behavior of the ISAA Members", and approved by the board of directors of ISAA.

Conflict of interests in social interactions is inevitable. Policymakers try to manage it in a way that it does not serve as a breach of trust. This article presents some of the ethical implications of the physician-patient relationship, conflict of physicians with drug companies, and conflicts in medical research.

The dental profession has a special place of trust in the society, and dental clinicians must adhere to ethical standards in all dental procedures. Ethical conduct is one of the main expectations of individuals from this profession. The aim of this study was to design and develop dental ethical codes for national implementation in Iran.

  This qualitative study was performed using directed content analysis method and purposive sampling.Data were collected until saturation through 15 semi-structured face-to-face individual interviews and two expert panels with academic staffs from dental faculties in Tehran, Iran.

Data were classified into five principles and 90 codes. The principles included consideration of patients’ interest as a priority, respect for human dignity and patient autonomy, confidentiality of patient information, the excellence of knowledge and skills, and building trust.

The ethical codes for Iranian dentists were drafted considering Islamic teachings and the prevailing culture. Some codes were exclusively developed for the cultural atmosphere of Iran especially on topics such as interaction with patients previously treated by other dentists. Some codes addressed the principles of consultation and continuing the therapeutic communication with such patients. Some items have not been considered in codes released by other associations, such as religious considerations in Islamic cover and alcohol consumption that were taken into consideration in this draft. These codes can serve as a guide for professional practice of dentists. It seems that these sets can help us reach the standardized code.

This research reviews the scientific productions of the field of biomedical ethics based on articles published in Iranian scientific journals in Farsi (Persian language). The findings showed that from 2003 to 2017, researchers have published 1238 Persian articles in this field. The average annual growth rate of published articles is 23.17 percent, but this growth has been declining since 2013. The citation rate of articles (0.4 per article) suggests a small impact. Shahid Beheshti University of Medical Sciences and Tehran University of Medical Sciences with the publication of 36% and 33% had the largest share in the publication of articles, respectively. Biomedical ethics research was interdisciplinary and researchers from the medical, nursing, and law sciences played a major role in compiling and publishing them. The topics such as medical ethics, medical education, and Islamic ethics were, repetitive subjects in articles, respectively. Only 22% of these articles referred directly to funding provided by universities and research centers.

Observational studies raise less ethical challenges in comparison to interventional studies. As a result, sometimes, the necessity of Ethical Review of these studies has been neglected. Generally, there are several ethical considerations in each step of observational studies in managerial approach that have been discussed in this paper. These steps include research question, design of study and protocol, collecting information, Inducements, documentation and communication of study results. The most important ethical considerations of information collection are obtaining informed consent from research subjects and maintaining confidentiality which menans that respect for privacy and autonomy of research subjects are very important, especially during the use of health records, interview with sever patients and research on incompetent patients. Investigator can provide a motivation for research subjects, but an inappropriate inducement is not acceptable. Because of these Ethical considerations, each observational study should be reviewed by Research Ethics Committee

Genetic research was initially limited to the screening and diagnosis of known hereditary diseases. After the completion of the Human Genome Project (HGP), studies became concerned with the diagnosis and treatment of many non-communicable diseases threatening the public health. Aside from this, genetic engineering, in its new form, is also concerned with the development of recombinant medications, genetic enhancement, and genetically modified organisms and their applications. The climax of these achievements is the advent of transgenic creatures. These are organisms with a genetic makeup different from their natural one created through biotechnology. Transgenic products have become more popular in recent years, especially in agriculture and livestock sectors. At the same time, genetics and biotechnology are trying to keep pace with modern advancements. Genetic modifications have resulted in larger yields in agriculture and livestock as well as the development of new medications and vaccines. Despite the large profits that genetic engineering and transgenic organisms can bring for us, they may pose dangers in certain fields. Furthermore, there are ethical concerns about the application of these technologies.
The present study attempted to address the ethical issues in new genetic technologies and analyze them with regard to the four principles of bioethics. For this purpose, keywords were first looked up in scientific sources and the data were classified; ethical considerations were then analyzed in the light of the four principles of bioethics.
In the results section first the merits of such products for humanity and their contributions to saving the limited available resources are pointed out; subsequently, potential threats in some fields are addressed, along with considerations about the mass production and consumption of genetically engineered products, autonomy of individuals, the importance of raising awareness about the pros and cons of genetically modified organisms (GMOs), and their labeling. Finally, equity is addressed, and general benefits and harms, costs and effectiveness are discussed.

One of the most important occupational tensions a physician encounters in his/her practice is the complaints lodged against him/her by the patients. The purpose of this study is examining the complaints against physicians and dentists entering the Medical Council Organization of Tehran in the years ending on 20 March 1992, 20 March 1997 and 20 March 2002 from the viewpoint of number, dispersion and inducing factors.The present study was performed as a descriptive and retrospective one with the aid of a questionnaire containing concerned data. Filling in the questionnaire or studying the file was accomplished by a trustee expert of the Medical Council Organization and the data obtained were analyzed after classification.During a 3-year period, 832 complaints were lodged against physicians and dentists. The complaints against physicians in the years ending on 20 March 1997 and 20 March 2002 were 70% more than that in the year ending on 20 March 1992. 83.1% of the physicians and dentists of Tehran that were sued had not been convicted until the date of the performance of the study, on the basis of the contents of the files, and had no malpractice from the vantage point of the Medical Council Organization. The most common causes of complaints from the viewpoint of complainers were therapeutic errors (38%), neglect (30.2%), financial affairs (25.4%) and the physician's lack of skill (17.7%). On the basis of this study, with the increase of the doctor's practice track record and experience more than 15-20 years, the number of the complaints decreases and most of the complaints are against the middle-aged doctors/dentists with 10-20 years of experience.Most physicians and dentists of Tehran having been sued have not committed any wrong from the vantage point of the Medical Council Organization experts and a large part of the complaints are a consequence of doctor-patient inconvenient interactions. A behavior based on professional commitment of the physician/dentist vis-à-vis the patient can hinder a major part of complaints.

Abstract: One of the fundamental issues in the ethics of medical researches is cost-benefit assessment which consists a main part of related codes. This article is aimed to propose a model for ethical assessment of researches with judgment about their costs and benefits.After reviewing related materials and our experiences and discussions with experts, we proposed a model for ethical assessment of costs and benefits of medical researches. It seems that there can be a complex table that shows the potential influenced groups such as patients, researchers, their families, society, and. .., and in the other side of the table, we can see the aspects of such influences, including physical, economical, psychological, social, spiritual, political, and so on. So, the authors designed a table showing the above mentioned types of influences, for using in ethical assessments of the costs and benefits of medical researches.Because of the complexity that exists in various aspects of the costs and benefits of a research, the researcher can not accomplish this analysis alone. It reveals the philosophy of the composition of the research ethics committees. The proposed table of this article will help the researchers and ethical committees for implementation of the above mentioned principles in research activities.