kiarash aramesh
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Hinduism and Zoroastrianism have strong historical bonds and share similar value-systems. As an instance, both of these religions are pro-life. Abortion has been explicitly mentioned in Zoroastrian Holy Scriptures including Avesta, Shayast-Nashayast and Arda Viraf Nameh. According to Zoroastrian moral teachings, abortion is evil for two reasons: killing an innocent and intrinsically good person, and the contamination caused by the dead body (Nashu). In Hinduism, the key concepts involving moral deliberations on abortion are Ahimsa, Karma and reincarnation. Accordingly, abortion deliberately disrupts the process of reincarnation, and killing an innocent human being is not only in contrast with the concept of Ahimsa, but also places a serious karmic burden on its agent. The most noteworthy similarity between Zoroastrianism and Hinduism is their pro-life approach. The concept of Asha in Zoroastrianism is like the concept of Dharma in Hinduism, referring to a superior law of the universe and the bright path of life for the believers. In terms of differences, Zoroastrianism is a religion boasting a God, a prophet, and a Holy book, while Hinduism lacks all these features. Instead of reincarnation and rebirth, Zoroastrianism, like Abrahamic religions, believes in the afterlife. Also, in contrast with the concept of Karma, in Zoroastrianism, Ahura Mazda can either punish or forgive sins.
Keywords: Zoroastrianism, Hinduism, Abortion, Religiousbioethics, Pro-life -
The recent efforts for revitalizing traditional Iranian medicine (TIM) have shaped two main streams: The quackery traditional iranian medicine (QTIM) and the academic traditional iranian medicine (ATIM). The QTIM encompasses a wide range of practitioners with various backgrounds who work outside the academic arena and mostly address the public. These practitioners have no solid bases or limited boundaries for their claims. Instead, they rely on making misleading references to the Holy Islamic Scriptures, inducing false hope, claiming miraculous results, appealing to the conspiracy theories, and taking advantage of the public resentment toward some groups of unprofessional healthcare providers. The theories and practices of ATIM, however, can be categorized into two major categories: First, valid and scientific TIM that is aimed to conduct well-designed clinical trials and thereby, supply the evidence-based medicine with new treatments originated in or inspired by TIM. Second, a pseudoscientific part of the current TIM that is based on some obsolete medical theories, especially the medieval humoral medicine, and erroneous accounts of human anatomy, physiology, and physiopathology, mostly adopted from the ancient and medieval medical scripts. TIM has recently established some clinical centers for practicing humoral medicine that is partly pseudoscientific and involves significant risks. This paper suggests that the public health sector has a duty to act against the promulgation of medical superstitions by QTIM and the pseudoscientific medical practices of ATIM, and at the same time, support and promote the valid and potentially beneficial research pursued by ATIM aimed to explore the rich recourses of TIM and thereby enrich the evidence-based medicine.Keywords: Complementary medicine, Iran, pseudoscience, science, Traditional Iranian medicine
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زمینه و هدفبه دلیل حساسیت کمتر چالش های اخلاقی در غالب پژوهش های مشاهده ای به نسبت پژوهش های تجربی، گاهی لزوم بررسی و نظارت بر این طرح ها از سوی کمیته های اخلاق در پژوهش نادیده گرفته می شود. این در حالی است که با توجه به تنوع این پژوهش ها و وسعت جمعیت ورودی به آن توجه به ملاحظات اخلاقی آن از اهمیت ویژه ای برخوردار است. اصول اخلاقی چندی حاکم بر پژوهش های غیر مداخله ای می باشند که در مقاله به شرح بازگو شده اند.روش بررسیبا رویکردی مدیریتی بر موضوع، ملاحظات اخلاقی را می توان در مراحل مختلف پژوهش از جمله سوال پژوهش، گردآوری اطلاعات، ایجاد انگیزه همکاری، مستندسازی و اطلا ع رسانی نتایج پژوهش مورد بررسی قرار داد.یافته هاطراحی پژوهش مرحله گرداوری اطلاعات بسته به اینکه به صورت مستقیم یا غیرمستقیم انجام شود با چالش های اخلاقی متعددی روبروست که مهم ترین آن رضایت سوژه و رعایت اصل رازداری است. بررسی اطلاعات پرونده های بیماران، انجام سوالات خاص با جنبه های اخلاقی، مصاحبه با افراد مبتلابه بیمار ی های جدی و ضبط صوتی و تصویری اطلاعات بیمار مستلزم رعایت جوانبی است تا حریم خصوصی سوژه پژوهش و اصل خودایینی بیمار مخدوش نشود. ایجاد انگیز ه های مالی و غیرمالی جهت ورود سوژه به پژوهش می تواند در مطالعات مشاهده ای نیز با چالش هایاخلاقی روبرو باشد.نتیجه گیریبا توجه به ملاحظات اخلاقی جدی فوق، کمیته های اخلاق در پژوهش باید در بررسی های اخلاقی گام به گام و مرحله به مرحله پژوهش ها را به لحاظ رعایت موازین اخلاقی بررسی و به صرف مشاهده ای بودن مطالعه از مشکلاتاخلاقی آن غفلت ننمایند.کلید واژگان: پژوهش های مشاهده ای، اخلاق در پژوهش، کمیته اخلاق در پژوهشObservational 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 CommitteeKeywords: Observational studies, research ethics, Research Ethics Committee
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The central role of the virtue of compassion in the shaping of the professional character of healthcare providers is a well-emphasized fact. On the other hand, the utmost obligation of physicians is to alleviate or eliminate human suffering. Traditionally, according to the Aristotelian understanding of virtues and virtue ethics, human virtues have been associated with masculinity. In recent decades, the founders of the ethics of care have introduced a set of virtues with feminine nature. This paper analyzes the notion of compassion as a common virtue between the traditional/masculine and care/feminine sets of virtues and shows that compassion is a reunion and merging point of both sets of human virtues. This role can be actualized through the development and promotion of compassion as an important part of the character of an ideal physician/healthcare provider. In addition, this paper argues that the notion of compassion can shed light on some important aspects of the contemporary debates on healthcare provider-patient relationship and medical futility. Despite the recent technological and scientific transformations in medicine, the interpersonal relationship between healthcare providers and patients still plays a vital role in pursuing the goals of healthcare. The virtue of compassion plays a central role in the establishment of a trust-based physician-patient relationship. This central role is discernible in the debate of medical futility in which making difficult decisions, depends largely on trust and rapport which are achievable by compassion in the physician and the recognition of this compassion by the patients and their surrogate decision makersKeywords: Compassion, Virtue ethics, Futility, Doctor-patient relationship, End-of-life care
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پرداخت های غیر رسمی یا زیرمیزی پدیده ای است که اهمیت اخلاقی ویژه ای دارد و به نظر می رسد در برخی از تخصص های پزشکی رایج باشد. این مطالعه با هدف بررسی شیوع و عوامل موثر بر آن انجام شده است. این پژوهش مطالعه ای مقطعی است که بین پزشکان متخصص عمدتا جراح با تخصص های مختلف شرکت کننده در کنگره ها و برنامه های آموزش مداوم توسط پرسشنامه در سال 1392 و قبل از اجرای طرح تحول نظام سلامت انجام شده است. در این تحقیق 257 پرسشنامه وارد مطالعه شد. شیوع دریافت زیرمیزی در بین پزشکان مورد مطالعه که امکان دریافت زیرمیزی را داشتند نسبتا زیاد (8/63 درصد) بود. پزشکان شاغل در بخش خصوصی و نیز پزشکان شاغل در شهر تهران و کسانی که نگرش مثبت به زیرمیزی داشتند بیش تر زیرمیزی دریافت می کردند. به باور پرسش شوندگان، شایع ترین علت، تعرفه های غیر واقعی و شایع ترین پیامد، بالا رفتن هزینه های بیماران بود. متاسفانه، بیش از نیمی از پزشکان یا اعتقاد به غیراخلاقی نبودن زیرمیزی نداشتند یا نظر قاطعی نسبت به این که این عمل غیراخلاقی است ندادند. با توجه به رابطه ی مستقیم بین نگرش پزشکان و دریافت زیرمیزی به نظر می رسد در زمینه ی نشان دادن قبح زیرمیزی به پزشکان نیاز به آموزش وجود دارد. علت شیوع کم تر زیرمیزی در بخش دولتی شاید نظارت بیش تر در این بخش باشد. به نظر می رسد با وضع راهنمای اخلاقی در جهت نشان دادن قبح دریافت زیرمیزی بین پزشکان و اصلاح ساختارهای نظام سلامت از جمله واقعی نمودن تعرفه ها بتوان تا حدود زیادی از بروز این پدیده جلوگیری کرد.کلید واژگان: پرداخت های غیر رسمی، پرداخت های زیرمیزی، اخلاق پزشکیInformal payments in clinics raise ethical concerns in healthcare delivery. This cross-sectional questioner survey aims to evaluate the prevalence and related factors of informal payment in healthcare system in Iran.
The study was carried out in 2013, prior to the implementation of the government' Health System Reform among physicians with different specialties. The questionnaire were distributed among the participants during the congresses and continuing medical education programs.
In results; of the total specialist physicians, 276 returned the questionnaires. The response rate was 81.17%. and out of 276 returned questionnaires 257 fulfilled the inclusion criteria. The prevalence of informal payments, among the physicians who were susceptible to receiving informal payments, was relatively high (63.8%). The physicians who practiced in the private sector, as well as physicians who practiced in Tehran and those who had a positive attitude towards the informal payments, received more informal payments. From the viewpoint of the respondents, the main cause of informal payments was unrealistic/unfair tariffs and the main consequence of informal payments was the rising costs of patient care.
This study showed that, unfortunately, more than half of the participants did not believe or did not decisively consider informal payments as unethical. This confirms the importance of physicians education about the unethical practice of informal payments. However, compare to private sectors, more supervision in public sector may be the main cause of less prevalence of informal payments in public hospitals.
InConclusionDeveloping ethical guidelines to prevent informal payments as well as more realistic and fair tariffs would help to decrease the incidence of informal payments.Keywords: Informal payment, under the table payment, medical ethics, health reform -
BackgroundFee splitting is a process whereby a physician refers a patient to another physician or a healthcare facility and receives a portion of the charge in return. This survey was conducted to study general practitioners (GPs) attitudes toward fee splitting as well as the prevalence, causes, and consequences of this process.MethodsThis is a cross-sectional study on 223 general practitioners in 2013. Concerning the causes and consequences of fee splitting, an unpublished qualitative study was conducted by interviewing a number of GPs and specialists and the questionnaire options were the results of the information obtained from this study.ResultsOf the total 320 GPs, 247 returned the questionnaires. The response rate was 77.18%. Of the 247 returned questionnaires, 223 fulfilled the inclusion criteria. Among the participants, 69.1% considered fee splitting completely wrong and 23.2% (frequently or rarely) practiced fee splitting. The present study showed that the prevalence of fee splitting among physicians who had positive attitudes toward fee splitting was 4.63 times higher than those who had negative attitudes. In addition, this study showed that, compared to private hospitals, fee splitting is less practiced in public hospitals. The major cause of fee splitting was found to be unrealistic/unfair tariffs and the main consequence of fee splitting was thought to be an increase in the number of unnecessary patient referrals.DiscussionFee splitting is an unethical act, contradicts the goals of the medical profession, and undermines patients best interest. In Iran, there is no code of ethics on fee splitting, but in this study, it was found that the majority of GPs considered it unethical. However, among those who had negative attitudes toward fee splitting, there were physicians who did practice fee splitting. The results of the study showed that physicians who had a positive attitude toward fee splitting practiced it more than others. Therefore, if physicians consider fee splitting unethical, its rate will certainly decrease. The study claims that to decrease such practice, the healthcare system has to revise the tariffs.Keywords: Fee splitting, Iran, kickback, medical ethics
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History of attitudes toward death: a comparative study between Persian and Western culturesIn his seminal book on the historical periods of Western attitudes toward death, Philippe Aries describes four consecutive periods through which these attitudes evolved and transformed. According to him, the historical attitudes of Western cultures have passed through four major parts described above: Tamed Death, Ones Own Death, Thy Death, and Forbidden Death. This paper, after exploring this concept through the lens of Persian Poetic Wisdom, concludes that he historical attitudes of Persian-speaking people toward death have generally passed through two major periods. The first period is an amalgamation of Aries Tamed Death and Ones Own Death periods, and the second period is an amalgamation of Aries Thy Death and Forbidden Death periods.
This paper explores the main differences and similarities of these two historical trends through a comparative review of the consecutive historical periods of attitudes toward death between the Western and Persian civilizations/cultures. Although both civilizations moved through broadly similar stages, some influential contextual factors have been very influential in shaping noteworthy differences between them. The concepts of after-death judgment and redemption/downfall dichotomy and practices like deathbed rituals and their evolution after enlightenment and modernity are almost common between the above two broad traditions. The chronology of events and some aspects of conceptual evolutions (such as the lack of the account of permanent death of nonbelievers in the Persian tradition) and ritualistic practices (such as the status of the tombs of Shiite Imams and the absolute lack of embalming and wake in the Persian/Shiite culture) are among the differences.Keywords: History of medicine, Death, Western culture, Persian culture, End of life -
The nature of the doctor-patient relationship as a keystone of care necessitates philosophical, psychological and sociological considerations. The present study investigates concepts related to these three critical views considered especially important. From the philosophical viewpoint, the three concepts of "the demands of ethics , ethical phenomenology and "the philosophy of the relationship" are of particular importance. From a psychological point of view, the five concepts of "communication behavior patterns" (including submissiveness, dominance, aggression, and assertiveness), "psychic distance", "emotional quotient", "conflict between pain relief and truth-telling", and "body language" have received specific emphasis. Lastly, from the sociological perspective, the three notions of "instrumental action", "communicative action", and "reaching agreement in the light of communicative action" are the most significant concepts to reconsider in the doctor-patient relationship. It should be added, however, that from the sociological point of view, the doctor-patient relationship goes beyond a two-person interaction, as the moral principles of doctors and patients depend on medical and patient ethics respectively. The theoretical foundations of the doctor-patient relationship will finally help establish the different dimensions of medical interactions. This can contribute to the development of principles and multidisciplinary bases for establishing practical ethical codes and will eventually result in a more effective doctor-patient relationship.Keywords: doctor-patient relationship, philosophy, psychology, sociology, orbital parameters
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BackgroundInformal payments to health care providers have been reported in many African, Asian and European countries. This study aimed to investigate different aspects of these payments that are also known as under-the-table payments in Iran.MethodsThis is an in-depth interview-based qualitative study conducted on 12 purposively chosen clinical specialists. The interviewees answered 9 questions including the ones about, definitions of informal payments, the specialties and hospitals mostly involved with the problem, how they are paid, factors involved, motivation of patients for the payments, impact of the payments on the health care system and physician-patient relationship and the ways to face up with the problem. The findings of the study were analyzed using qualitative content analysis method.ResultsSix topics were extracted from the interviews including definitions, commonness, varieties, motivations, outcomes and preventive measures. It was revealed that under-the-table payments are the money taken (either in private or public portions) from patients in addition to what formally is determined. This problem is mostly seen in surgical services and the most important reason for it is unrealistic tariffs.ConclusionRegarding the soaring commonness of informal payments rooted in underpayments of health expenditures in some specialties, which deeply affect the poor, the government has to boost the capitation and to invest on health sectors through supporting the health insurance companies and actualizing the health care costs in accord with the real price of the health care delivered.Keywords: Informal payments, Health care, Iran, Qualitative research
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In Western literatures, “conflict” is a general term that refers to discord between two or more entities. In Islamic jurisprudence, however, in addition to the term “conflict” (Taāruz), there is another term which is called tazāhum. The two terms, however, have different definitions. Conflict between two concepts, for instance, indicates that one is right and the other is wrong, while tazāhum does not necessarily have to be between right and wrong, and may appear between two equally right concepts. Moreover, conflict exists on a legislative level, while tazāhum is a matter of obedience and adherence, meaning that in practice, both sides cannot continue to coexist. Conflict of interest is a known term in Western literatures, and according to D.F. Thompson, it refers to a situation where professional judgment regarding a primary interest is improperly and unjustifiably influenced by a secondary interest. Taking into account Thompson’s definition and the distinction between “conflict” (Taāruz) and “tazāhum”, the English term “conflict of interest” translates to “tazāhum of interest” in Islamic jurisprudence as it refers to a person’s action without reflecting right or wrong, and simply concerns priority of one interest over another. The resolution to tazāhum in Islamic jurisprudence lies in two principles: the principle of significance and the principle of choice. For instance, in case of conflict (the Western term) or tazāhum (the Islamic term) between the interests of patient and physician, the patient’s interest should be the main concern based on the principle of significance. Although Western literatures propose methods such as disclosure or prohibition in order to resolve conflict of interest, the foundation for these solutions seems to have been the principle of significance.Keywords: conflict, conflict of interest, Taāruz, Tazāhum
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Recent advances in life-sustaining treatments and technologies, have given rise to newly emerged, critical and sometimes, controversial questions regarding different aspects of end-of-life decision making and care. Since religious values are among the most influential factors in these decisions, the present study aimed to examine the Islamic scholars’ views on end-of-life care. A structured interview based on six main questions on ethical decision-making in end-of life care was conducted with eight Shiite experts in Islamic studies, and was analyzed through deductive content analysis. Analysis revealed certain points in Islamic views on the definition of death and the persons making decisions about end-of-life care. According to the participants, in addition to conventional criteria (‘urf) such as absence of heartbeat and respiration, the irreversible cessation of human voluntary acts (as a sign that the soul has control over the body and the faculty of thinking) are considered to be the criteria in establishing death. The participants also recognized physicians as the main authorities in verifying signs of death. Furthermore, it was emphasized that life preservation and continuation of care must be sensible, and the patient can request not to have death-prolonging procedures started or continued. In the view of participants, patient’s autonomy cannot be the sole basis for all measures, but Islamic ethical and jurisprudential principles should be relied upon to make correct and sensible decisions whether to continue or stop terminal patients’ care. Final decisions should be made by a team of experts, and physicians must be at the center of such a team. Finally, we suggest that a guideline in keeping with Islamic norms on human life and death, purpose of life, God’s will, boundaries of man’s authority, and the physician’s ethical duties and obligations should be developed.Keywords: Islamic views, secular views, death, life, terminal patient
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Monetary compensation for human eggs used in research is a controversial issue and raises major concerns about women’s health and rights, including the potential of exploitation and undue inducement. Human eggs are needed for various types of studies and without payment, it would be impossible to procure sufficient eggs for vital research. Therefore, a solution seems necessary to prevent exploitation and resolve other ethical concerns while ensuring sufficient supplies of human eggs for research. A brief review of legislation in different countries shows the existing diversity and controversy over compensating human egg donation for research purposes. While in more economically developed countries procreative liberty and consumer orientation seem to be defensible, in some developing countries, where concerns about exploitation exist, adopting a more regulated approach to assisted reproduction is more prudent and wise. Egg sharing is a program that has been proposed to solve both the ethical problems of purchasing eggs and the shortage of human egg supply for research. In developing countries, however, regardless of whether the egg sharing or the monetary compensation model is adopted, some steps should be taken to guarantee the ethical nature of this practice. These steps include ensuring the existence of independent institutional review boards (IRBs), confirming the validity of all steps in the process of obtaining informed consent, and ensuring the existence and viability of independent supervising and auditing bodies.Keywords: egg donation, research ethics, purchasing human eggs, compensated egg donation
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The goal of this study was to assess attitude towards plagiarism in faculty members of Medical School at Tehran University of Medical Sciences. One hundred and twenty medical faculty members of Tehran University of Medical Sciences were enrolled in this cross-sectional study. They were asked to answer to valid and reliable Persian version of attitude towards plagiarism questionnaire. Attitude toward plagiarism, positive attitude toward self-plagiarism and plagiarism acceptance were assessed. Eighty seven filled-up questionnaires were collected. Mean total number of correct answers was 11.6±3.1. Mean number of correct answers to questions evaluating self-plagiarism was 1.7±0.4 and mean number of correct answers to questions evaluating plagiarism acceptance was 1.4±0.2. There was no significant correlation between plagiarism acceptance and self-plagiarism (r=0.17, P=0.1). It is essential to provide materials (such as workshops, leaflets and mandatory courses) to make Iranian medical faculty members familiar with medical research ethics issues such as plagiarism.Keywords: Attitude, Medical faculty member, Plagiarism
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پرستاری یکی از ارکان مهم سیستم های خدمات بهداشتی - درمانی در هر کشور است. خدمات پرستاری می تواند به طور مستقیم بر پیامد سلامت و بیماری و شاخص های مرتبط با آن موثر باشد. تدوین کدهای اخلاقی متناسب با فرهنگ و مذهب جامعه راهکار مناسبی جهت بهبود کیفیت خدمات پرستاری مورد انتظار ذی نفعان می باشد. در دهه های اخیر پرداختن به مقولات اخلاق و تدوین راهنماهای اخلاقی از مهم ترین اولویت های حوزه ی سلامت در کشور ماست و آیین اخلاق پرستاری نیز در این راستا و با هدف ارائه ی چارچوب و راهنمای تصمیم گیری های مبتنی بر اخلاقیات در پرستاری تدوین شده است.
با توجه به نیاز کشور در این زمینه، با بهره گیری از نظرات صاحب نظران حوزه ی پرستاری و اخلاق پزشکی و تشکیل کارگروه های مختلف، این آیین در سال 89 تدوین شد. آیین اخلاق پرستاری ایران با 12 ارزش و 71 آیین اخلاقی - حرفه ای در دومین نشست شورای عالی اخلاق پزشکی وزارت بهداشت، درمان و آموزش پزشکی مورخ 16 اسفند 89 به تصویب نهایی رسید. این آیین در 12 مورد به مفاهیم ارزشی نظیر حفظ شان و کرامت انسانی، پایبندی به تعهدات حرفه ای، پاسخگویی، حفظ حریم خصوصی بیماران، ارتقاء صلاحیت علمی و عملی و احترام به استقلال فردی می پردازد. هم چنین، در این مجموعه «پرستار و جامعه» با 9 بند، به پرستاری مبتنی بر جامعه، سلامت افراد و نقش پرستار در بحران می پردازد؛ «پرستار و تعهدات حرفه ای» با 14 بند، پرستار را در تیم حرفه ای و وظایف حرفه ای وی ترسیم می کند؛ «پرستار و خدمات بالینی» با 23 بند، پرستار را در عرصه ی ارائه ی خدمات بالینی و تصمیم گیری های مراقبتی یاری می دهد؛ «پرستار و همکاران تیم درمانی» با 15 بند، ارتباط پرستاران با همکاران، مدیران و مسئولیت های مدیران را بازگو می کند؛ «پرستار، آموزش و پژوهش» با 10 بند دستورالعمل های اخلاقی در حوزه ی آموزش و پژوهش، ارتباط استاد و دانشجو را ارائه می دهد.
کلید واژگان: اخلاق زیستی، کدهای اخلاقی، حرفه ی پرستاری، ارزش ها، پرستارQuality of nursing care services directly influences individuals’ health status. Compiling codes of ethics according to the religion and culture of each population could be an appropriate approach in improving quality of health care services especially nursing care. Hence, the most important priority in our national health system is developing ethical guidelines.For this purpose a task force has been established in collaboration with nurses, physicians, lawyers and clergymen who were expert in the field of medical ethics. The code of ethics for Iranian nurses was drafted in 2010. The draft that included 12 values and 71 regulations of professional ethics were finally approved in the second session of the Ethics Supreme Council of the Ministry of Health and Medical Education on 6 March, 2010. The values consist of concepts such as maintaining human dignity, adherence to professional obligations, accountability and responsibility, patient privacy, promotion of scientific and practical competence and respect to individual’s autonomy. Also, 71 regulations of professional ethics divided to five sections including "Nurse and Community" consisting of 9 items, “Nurse and Professional Commitments" with 14 items, "Nurse and Clinical Services" with 23 items, "The Nurse and Other Healthcare Providers in Medical Team" with 15 items, and also "Nurse, Education and Research" including 10 items.Keywords: code of ethics for nurses, nursing profession, nursing values, professional ethics -
کرامت انسانی (human dignity) در طول تاریخ از سوی ادیان و مکاتب فلسفی مطرح شده و مورد تاکید قرار گرفته است. این مفهوم ریشه هایی نظری در مکاتب و ادیان باستانی، سده های میانه و دوران مدرن دارد که از مهم ترین آن ها می توان به منشور کورش، فلسفه ی رواقی، آرای اندیشمندان دوران رنسانی، Locke، Kant و اعلامیه ی جهانی حقوق بشر، و نیز تاکید بر کرامت انسانی در ادیان ابراهیمی اشاره کرد. کرامت انسانی با دو وصف ذاتی و غیرقابل سلب بودن مشخص می شود و اگر چه تعریف جامع و مانع و همه پذیری برای آن ارائه نشده است، همان ویژگی ای دانسته شده است که مبنای حقوق اساسی انسان می باشد. در حوزه ی اخلاق زیست - پزشکی کرامت انسانی در دو بعد فردی و جمعی مطرح می گردد. کرامت انسانی در بعد فردی آن مطلق و در بعد جمعی - که به واسطه ی تعلق و انتساب به انسانیت به دست می آید - نسبی است. مفهوم کرامت انسانی ناظر به تمامی اصول اخلاق زیست - پزشکی است و خط قرمز استدلال ها و استنتاج های اخلاق زیست - پزشکی را مشخص می نماید. در حوزه هایی نظیر اخلاق در پژوهش، اخلاق در مراقبت های آغاز و پایان حیات، و اخلاق در سلامت عمومی، کرامت انسانی دارای دلالت ها و الزامات صریح و روشنی است، نظیر: عدم استفاده ی ابزاری از رویان، جنین و بدن انسان، عدم کالاانگاری و خرید و فروش آن ها، حق زندگی و مرگ توام با کرامت در مراحل پایانی زندگی و حق برخورداری از مراقبت های پایه ای سلامت برای تمامی اقشار جامعه.
کلید واژگان: کرامت انسانی، اخلاق زیستی، اخلاق پزشکی، مراقبت های آغاز و پایان حیاتThroughout history, various religions and schools of philosophy have viewed human dignity as an important issue and a topic of discussion. The theoretical roots of this concept lies in ancient philosophies and religions, in Medieval as well as Modern periods, the most significant of which may be the Cyrus Cylinder, Stoicism, teachings of philosophers of the Renaissance period and of thinkers such as Immanuel Kant and John Locke, the Universal Declaration of Human Rights, and Abrahamic religions. Human dignity is infallibly referred to as being intrinsic and inviolable, and although there is no one comprehensive, inclusive and universally accepted definition for the term, it is fundamentally the characteristic that lies at the core of the basic rights of humans. In biomedical ethics there are two different dimensions to human dignity: the dignity of the individual and the dignity of humanity as such, and while the former is considered to be absolute, the latter is relative, as it is realized simply by belonging to the human race. Human dignity applies to all the principles of biomedical ethics, and sets the standards for all manners of reasoning and inference in this field. In areas such as research ethics, ethics of beginning of life and end of life care, and public health ethics, human dignity has clear requirements and implications, for instance regarding issues such as unethical uses of the embryo, fetus, and the human body for commercial purposes, the right to live and die with dignity near the end of life, and the right to basic indiscriminate health care.Keywords: human dignity, bioethics, medical ethics, beginning, end of life care -
چگونه مردن، به خصوص در سال های اخیر نسبت به گذشته، با توجه به پیشرفت های علوم پزشکی و امکانات طولانی کننده ی حیات بیماران مفهوم جدیدی پیدا کرده و بر اهمیت آن افزوده شده است. درد و رنج بیماران از یک سو و هزینه های سنگین درمان که بر بیماران یا خانواده ها و نظام سلامت تحمیل می شود از سوی دیگر، بحث اتانازی را در بین افراد مطرح می نماید. در این بررسی نظر بیماران بستری در بیمارستان های دانشگاه علوم پزشکی تهران در ارتباط با اتانازی ارزیابی شده است. این مطالعه در نیمه ی دوم سال 88 در بیمارستان های دانشگاه علوم پزشکی تهران انجام شده است. ابزار مورد استفاده پرسشنامه ای بود که در آن 4 بیمار فرضی مطرح شده و پس از آن سوالاتی پیرامون آن ها به صورت سه گزینه ای طرح شده بود تا نگرش بیماران در موضوع مورد مطالعه سنجیده شود. از 110 بیمار انتخاب شده 105 نفر در مطالعه همکاری کردند (response rate =95. 45%) که 60 نفر از این افراد مذکر و 55 نفر مونث بودند. این افراد بین سنین 17 تا 70 سال بوده و 40 درصد تحصیلات دانشگاهی داشتند.در مطالعه ی انجام شده از بین 4 نوع اتانازی، تنها اتانازی غیرفعال داوطلبانه مورد موافقت بیماران بود. در بررسی های انجام شده 5/69 درصد از کل بیماران با انجام این نوع اتانازی موافق بودند و میزان مخالفت 1/18 درصد بود. درحالی که دیگر انواع اتانازی به طور واضح مورد مخالفت بیماران بود. از بین متغیرهای بررسی شده (سن، جنس، مذهب و سطح تحصیلات) فقط متغیر بخش بستری رابطه ی معنی داری با نگرش بیماران نسبت به اتانازی داشته است. نتایج حاصله نشان دهنده ی موافقت بیش تر بیماران در بخش داخلی با انجام اتانازی نسبت به بیماران بستری در بخش جراحی است. این امر می تواند به دلیل ازمان بیماری و طولانی شدن بیماری ها در بخش های داخلی نسبت به بخش های جراحی باشد. ماهیت مزمن بیماری های داخلی و درگیری بیش تر بیمار با بیماری خود می تواند بر روی نحوه ی نگرش وی به مساله ی اتانازی تاثیر بگذارد که این امر با مطالعات مشابه مطابقت دارد.کلید واژگان: اتانازی، نگرش بیماران، بیماران مرحله ی انتهایی
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Euthanasia is one of the controversial topics in current medical ethics. Among the six well-known types of euthanasia, passive voluntary euthanasia (PVE) seems to be more plausible in comparison with other types, from the moral point of view.According to the Kantian framework, ethical features come from 'reason'. Maxims are formulated as categorical imperative which has three different versions. Moreover, the second version of categorical imperative which is dubbed 'principle of end's is associated with human dignity. It follows from this that human dignity has an indisputable role in the Kantian story. On the other hand, there are two main theological schools in Islamic tradition which are called: Asharite and Mutazilite. Moreover, there are two main Islamic branches: Shiite and Sunni. From the theological point of view, Shiite's theoretical framework is similar to the Mutazilite one.According to Shiite and Mutazilite perspectives, moral goodness and badness can be discovered by reason, on its own. Accordingly, bioethical judgments can be made based on the very concept of human dignity rather than merely resorting to the Holy Scripture or religious jurisprudential deliberations. As far as PVE is concerned, the majority of Shiite scholars do not recognize a person's right to die voluntarily. Similarly, on the basis of Kantian ethical themes, PVE is immoral, categorically speaking. According to Shiite framework, however, PVE could be moral in some ethical contexts. In other words, in such contexts, the way in which Shiite scholars deal with PVE is more similar to Rossian ethics rather than the Kantian one.Keywords: Kantian ethics, Shiite ethics, Euthanasia
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Using human dead body for medical purposes is a common practice in medical schools and hospitals throughout the world. Iran, as an Islamic country is not an exception. According to the Islamic view, the body, like the soul, is a "gift" from God; therefore, human being does not possess absolute ownership on his or her body. But, the ownership of human beings on their bodies can be described as a kind of "stewardship". Accordingly, any kind of dissection or mutilation of the corpse is forbidden, even with the informed consent of the dead or his/her relatives. The exception of this principle is when such procedures are necessary for saving lives of other persons. In this article using the human dead body for medical education, research and treatment is discussed and the perspective of Iranian Shiite religious scholars in this regard is explained.Keywords: Cadaver, Ownership, Islam, Iran, Transplantation
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Abstract: All schools of Islamic jurisprudence regard abortion as wrong and forbidden and allow abortion only before the stage of ensoulment, if the continuation of pregnancy would endanger the mother''s life or put her into intolerable difficulties. In this article we describe and assess the viewpoint of Shiite jurisprudence toward abortion. Using a selected collection of related references, and discussion describes with experts, this article the abortion in Shiite jurisprudence.In the Shiite jurisprudence, the ensoulment occurs after about 4 months. Before this stage, all Shiite authorities regard abortion as forbidden (Hiram) unless if continuing the pregnancy would put the mother''s life in real danger or will be intolerable for her. But after that, they regard abortion as Hiram, unless in conditions in which continuing the pregnancy results in dying of both mother and fetus, but abortion will save the life of mother. However, the Shiite authorities have not accepted to legitimate abortion in unwanted pregnancies and even in pregnancies resulted from adultery (Zina) or rape.The debate over abortion is still controversial as ever. There are some important and notable related Fatwas that make jurisprudical basis for some new and problem solving legal acts, showing the inherent and valuable flexibility of the Shiite jurisprudence in dealing with such important issues. Some related issues, such as the priority of saving the life of mother after ensoulment can be referred to jurisprudical authorities for more assessment.
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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.
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