مجله ایرانی اخلاق و تاریخ پزشکی
سال هشتم شماره 3 (شهریور 1394)

During their professional life، physicians may face demands for procedures that do not entail significant medical benefits for the applicants، but rather originate from cultural and common considerations of the society. In such cases، physicians are sometimes forced to ignore cultural concerns in order to fulfill their ethical and professional responsibilities and provide healthcare services based on patients’ interests and beneficence. This can create ethical challenges and lead to physicians’ inability to act on their patients’ requests. One case in point is the request for hymenorrhaphy. In this article، we aimed to discuss the different opinions، ethical considerations and legal issues concerning hymenorrhaphy، and to investigate the Islamic aspects of the problem. In view of all existing debates and considerations، it appears that the reconstruction of hymen is an ethical and professional measure in certain situations.

According to the principle of respect for autonomy، which is one of the essential precepts of medical ethics، patients are entitled to the right of self-determination for a hypothetical future when they may lose the decision-making capacity. Thus، when still adequately competent to make decisions، a person can prepare a document and predict their therapeutic options and state their wishes for the possible time of lack of decision making capacity، or assign a surrogate who will make the best decision considering the attitudes and interests of the patient. This document، called advance directive، has advantages and disadvantages، and has been investigated from different perspectives. The present study addresses this new issue through non-systematic internet and library review of resources، and aims to investigate some aspects of this subject and examine the possibility of its naturalization from certain viewpoints، particularly from the Islamic perspective. In Islam، life is highly respected and physicians are obliged to do their best to protect human life. In cases where patients refuse the suggested treatments، even when it harms them fundamentally، the physician is obliged to respect their wishes for several reasons. Nevertheless، physicians should avoid any direct measure that may end up in the patient’s death. As regards advance directives، the patient no longer has the capacity to make decisions and has done so formerly، which may be in conflict with the physician’s responsibility to save the patient’s life under present circumstances. In such cases، despite a preliminary injunction، there is no reason to extend the patient''s right to the time of their consciousness. Therefore، based on the religious principles observed in Iran، acting on the patient''s previous decisions can only be valid as long as they do not conflict with the physician’s responsibilities. Furthermore، advance directives currently do not have a place in our legal system and the recognition of such documents is contingent upon further studies، including legal and cultural reviews.

Truth-telling is considered as an important topic of modern discussion regarding the physician-patient relationship. The present study examined the behavior of physicians in disclosing the truth to patients. For this purpose، a total of 161 cancer specialists were selected using the simple random sampling technique. Research instrument consisted of a 24-item questionnaire based on expert opinion and the review of related literature. The results of item prioritization indicated that the participants ranked the following two items as highest in terms of attitude: «It is the basic right of patients to know about their condition»، and «Relatives'' participation in disclosing the truth to patients is rather beneficial». Research results also showed a positive and significant correlation between attitude and truth-telling tendency. Furthermore، multiple regression analysis by SMART-PLS software demonstrated that perceived behavioral control (self-efficiency) has the greatest impact on physicians'' tendency toward truth-telling. The prediction power of planned behavior theory in predicting physicians'' truth-telling behavior was established at 92 percent. Based on these findings، it is recommended to employ experts and adopt relevant guidelines to train novice physicians. Moreover، Iranian health officials are advised to take corrective measures to improve physicians'' attitudes and subjective norms.

Moral sensitivity is an attribute that enables people to recognize moral conflicts، forms their perceptions of complex situations، and makes them aware of the ethical consequences of their decisions. Moral decision-making and identification of related motives is an integral part of the nursing profession. Many factors are involved in nurses’ sensitivity to professional ethics، and the present study aimed to survey professional moral sensitivity and associated factors among the nurses in West Golestan province of Iran. This cross-sectional descriptive study was conducted in 2014 on 288 nurses employed in public health centers affiliated with West Golestan University of Medical Sciences through convenience sampling. Research instrument was a demographic data questionnaire and the Moral Sensitivity Scale for Nurses. Data were analyzed by SPSS 16. Descriptive statistics and a significance level of P<0. 05 were used for data analysis. A total of 229 (79. 5%) of the study subjects were female. The mean age of the study population was 31. 2 ± 6. 4 years، and their moral sensitivity score was 63. 48 ± 13. 9. The level of moral sensitivity was reported as low in 51 subjects (17. 7%)، moderate in 182 subjects (63/2%)، and high in 53 subjects (18/4%). The highest rating pertained to application of professional knowledge (mean rank=4. 83). Results of the Spearman correlation test showed a significant relationship between the nurses’age and their professional moral sensitivity (r=0. 152، P=0. 005). Moreover، the Mann-Whitney U test showed a significant difference between nurses’ professional moral sensitivity and history of participation in ethics workshops (P=0. 001). The moral sensitivity of nurses in West Golestan province was established as moderate، indicating the importance of attention to professional ethics and raising nurses’ awareness of sensitive moral issues related to their profession.

Medication errors are among the most common medical errors that place patients at risk، and their prevalence is considered a measure of patient safety in hospitals. Using the experiences and opinions of experts is an important source of information for developing strategies to prevent medication errors. The aim of this study was to define strategies for the prevention of medication errors in hospitals of Hamedan University of Medical Sciences. This qualitative study was conducted on 10 nurses with experience of working in various hospital wards، selected through purposive sampling using the maximum variation technique. Semi-structured interviews were used to collect record and transcribe the data، which were then typed and stored on the computer. The collected data were analyzed using content analysis. After combining similar cases، we were able to develop 11 main categories، 43 sub-categories، and 3 themes: human factors، administrative principles and organizational structures. Our findings present the experiences of nurses regarding strategies related to the prevention of medication errors. Proper planning، coordination of human resources within wards، development of a comprehensive system to monitor prescription charts، suitable hospital equipment and favorable environmental conditions are some factors that can prevent the dangerous and perhaps irreversible consequences of medication errors.

In recent years، the general consensus is that medical education should comprise ethics courses focusing on clinical decision-making skills and professional ethics in order to institutionalize a set of values in physicians. The purpose of this study was to evaluate the internal and external qualities of the medical ethics curriculum from the perspective of students. This was a survey research on a study population of 157 medical students who were taking the medical ethics course. A sample of 113 students were selected by simple random sampling، and data collection tool consisted of two researcher-made questionnaires. In this research، the internal quality of the curriculum was evaluated according to the following 9 elements as proposed by Francis Klein: objectives، content، learning activities، learning strategies، instructional material، resources، grouping، time، location، and evaluation. The external quality of the curriculum was assessed based on Kirkpatrick’s model with attention to students'' views on achievement of course objectives in terms of knowledge، skills and attitudes. Data analysis was performed using descriptive statistics (mean and standard deviation) and inferential statistics (one-sample t-test). Based on the findings، the students viewed the internal quality of the medical ethics curriculum as undesirable in terms of the above-mentioned nine elements. Students also believed that the external quality of the ethics curriculum was at an average level in the knowledge and attitudes components، and undesirable in the skills component. Overall، our findings indicate that from the perspective of students، the quality of the medical ethics curriculum is low and the course needs to be reviewed and redesigned.

Confidentiality has long been protected in criminal law as an important ethical principle. With regard to the issue of sexually transmitted diseases، however، health care providers are faced with certain challenges. On the one hand، it is their obligation and duty to respect patient confidentiality، and on the other hand، the possibility of transmission of infection to sexual partners is a rather significant phenomenon. Therefore، health care providers have a crucial role in terms of the conflict of interests and legal duties with respect to sexually transmitted diseases. Medical mandatory reporting to state authorities accompanied by personally identifiable information of the infected person is another controversial issue in the field of confidentiality، which will be discussed in this article by studying various trends in statutes and precedents. It seems that throughout the world، there are two major trends in this respect: in some states، principles of confidentiality are observed even if the patient is infected by sexually transmitted diseases، unless it is inevitable for the safety of third parties such as sexual partners in a narrow implementation of Acts. States like Iran، France and Thailand are examples of such governments. In some countries، however، partner notification and compulsory notification by personally identifiable information of patients are mandatory for epidemiologic reasons. The United States، Australia and Ukraine are some of the countries that fall within this category. In Iranian legal system، the duty to respect confidentiality is emphasized and partner notification cannot be considered as a legal duty and therefore it is not legally permitted. Merely in emergency condition and under a narrow interpretation of law and by resort to patients informed consent، necessity and explicit law permission، breaching of confidentiality is justified.