مجله ایرانی اخلاق و تاریخ پزشکی
سال دهم شماره 1 (بهار 1396)

The conflict of interest is a situation in which professional judgment and performance in the primary interest and obligation tend to be unduly influenced by a secondary interest. Pharmacy is one of the main rings in the process of providing healthcare services. In this process conflict of interest may occur frequentlywhich occasionally has influence on the professional and moral duties of pharmacists that as a result may put the interst of the patients at risk. Taking care of patients is the first duty of pharmacist and they always must make evry effort to avoid any situations that puts the interests of the patientincluding their health, financial or non-financialposition at risk. The pharmacist must be aware of conflict of interest that exist in the drugstore as well as its effects on their professional and moral responsibilities. They also need to be able to manage them through scientific policy and logical skills. These issues and challenges may happen in terms of the relationship between the pharmacist and patients, other people or organizations, such as the relationship between doctors and pharmacists, pharmacists and pharmaceutical or non pharmaceutical companies, irrational relationship between pharmacists and patients. Although various guidelines for managing conflict of interest have been developed, there is a lack of policy on how to manage conflict of interest in pharmacy. In this study, the situations of conflict of interest and how it affects the professional relations of pharmacist with others was considered and this result was achived that the pharmacy have to be asuitable and appropriate place to give services for patients and the first priority of pharmacists must be the patients’ treatment benefits and interest

Writing treatise on Islah al-Adwiat (Reducing the Side-Effects of Drugs) is one of the most important issues in Islamic medicine. During the first few centuries of Islamic civilization, four important treatises were written on this subject, which established the scientific tradition that formed the bases of the subsequent pharmacological formation. This paper addresses the tradition of writing books on reducing the side-effects of purgatives and it also critically edits and translates the books written by three prominent scholars – Hubaysh b. Atham of Damascus, Qusta b. Luqa of Balbak and Muhammad Zakaria Razi – relying on the surviving manuscripts. The research objective followed by this paper is examining and analyzing the purgatives as an important class in the pharmacological and medical books of the Islamic era.
Almost all books on medicine and pharmacology written in the old medical tradition have a section or a chapter devoted to the detailed introduction of purgatives and counteracting their side effects. Examining these bits, one may trace the main structure of the tradition, which continued for many centuries. Besides, comparing them may provide an appropriate perspective to look at the history of pharmacology. To this end, images of the material included in those books were obtained from libraries and museums, which have housed such books for almost a millennium. Then they were analyzed along with translating and editing.
It may be concluded that pharmacologists belonging to the old medical paradigm would use drugs to treat conditions of bad health caused by changes in the patient’s humors; the drugs, however, would cause some side-effects along with removing humors and residues, leading to a change in the main humor of the body. The pharmacologists; therefore, introduced the drugs, their harms, as well as the best type of the drug to be used and finally suggested some methods in detail to reduce their side effects

Islamic culture has a bright and comprehensive history in human civilization. Based on Islamic teachings the spirit and body are in close relation with a mutual influence on humans’ health. The Holy Qur’an as well as the Prophet of Islam and his successors (peace be upon them) have paid deep attention to both spirit and body. Moreover, according to religious scholars’ decree (fatwa) cleanness and neatness has been mentioned as the main condition for worships to be accepted. The Prophet (PUH) said: “Neatness is half of the faith”. Therefore, efforts to keep the health of both spirit and body are important to Muslims. Although, in ancient time, health and medicine were bined together, later they were divided into three sections including health, clinical diagnosis of disease and treatment. Based on Islamic teachings, Muslim scholars learned medicine and then began to translate some Greek, Seriani and Indian medical knowledge into to Arabic language, which has shaped the golden age of Islamic medicine spanning between the 8th and the 15th Centuries.
Among the Islamic countries Iran had a specific place in the field of medical sciences. Jondishapour was one of the most prominent medical educational centers back then. This article elaborates on the status of medicine based on historical evidence as well as Muslim physicians in the golden age of Islamic medicine.

Due to the great importance that the nurses health and job engagement have in the health of their, colleagues and patients, this study aimed to investigate the the relationship between work-family conflict and work ethics with mediating role of job stress in nurses. The design of this study was descriptive and correlation cross-sectional design. The study population included all male and female nurses working in hospitals and clinics in the Gachsaran city during 2016-2017 . To select participants, cluster sampling method was used. A total 150 nurses were selected. To collect information from the Carlson et al work - family conflict questionnaire, work ethics questionnaire of Gregory. C. Petty (1990) and revised French et al. nursing stress scale was used. The results showed that there is a negative significant correlation between job stress with work ethic (P

Today, due to the highlighted the importance of respect for the human dignity, and increasing awareness of patients, traditional methods of ethics training cannot meet the educational needs. In this cross-sectional study, the effect of medical ethics workshops on knowledge and attitudes of 40 fourth years medical students was studied. A pre-post questionnaire on the measurement of the importance of the medical ethics components, the self-assessment of ethical knowledge, behavior and professional ethics was presented. There was a significant difference between the mean score of the importance of the medical ethics components (questionnaire number 1) before and after the workshop (p = 0.002); but in the case of self-assessment of moral behavior (P = 0.64) and self-assessment of professional ethics compliance (p = 0.48), there was no significant difference between the mean score of students before and after the workshop. The analysis of log-books indicated that students understand, topics of confidentiality, informed consent, and breaking bad news; but issues such as empathy, respect for the patient's emotional state, interaction with a patient suffering from AIDS, informing the patient about the disease and the course of the treatment, accepting a mistake from the doctor, and apologizing to the patient were inadequately addressed by the students. Ethics training is not sufficient just at the beginning of the clinical course; it must also be trained actively in the hospital and on the patient's bedside.

In evolution and innovation program of medical education which has been announced to the medical universities of the country since 2015, as a part of the health sector reform in IRAN, promoting professionalism is one of the emphasized subjects. This study aimed to evaluate activities conducted in this university to promote professionalism. In this descriptive research, all activities performed in Babol University of Medical Sciences in the years 2015 and 2016 in order to achieve the objectives of professionalism were recorded in a data collection form. The subject, target group, the extent of each activity, and outcomes were recorded and compared with data related to years before 2015. Totally, 19 major activities have been recorded to promote professionalism in this university in these two years. Sixteen activities (84.2%) have been implemented after medical education reform of IRAN. The extent of activities was calculated as 10088 person-hour and most of these major activities (12 activities, 63.2%) was attributed to achieve the objective of "implementation structural and program requirements, an organized system for need assessment, pathology and improvement of the values of ethics and professionalism". After implementation of medical education reform in IRAN, Babol University of Medical Sciences has adopted multiple new activities to promote professionalism in this university.

Patients have the right to make decision about their medical care. Thus, all the available information regarding decision-making should be provided for them. In surgical context, informed consent is essential for therapeutic relationship between patient and surgeon and sustains mutual trust and shared responsibility for decision making. Thus before surgery, the surgeon should describe available treatments, benefits and harms of them to the patients. So the patient can make a correct decision. In this cross-sectional study, 200 patients underwent gynecological surgery in a hospital in Shiraz during 2014 were recruited. The questionnaire which was used in this study had three parts. The validity and reliability of the questionnaires were evaluated using expert panel and SPSS software. In this study, there was no significant association between age, marriage status, job, home place, emergency or elective surgery and the amount of informed consent. There was significant difference between patients with primary school education and patients with higher education. Patients’ participation in decision making was 57%. Patients’ information about their rights in hospital and the amount of reading informed consent form were poor. This survey shows that the amount of informed consent obtained from patients is poor. So, we should consider some changes in content and obtaining informed consent.

Today, organizational commitment has been considered as a global concept in human resource management and organizational development. Lack of commitment and low level commitment results in negative outcomes for the individual and organization. One of the important factors influencing organizational commitment is the ethical climate of the organization.The aim of this study was to determine the correlation between ethical climate of medical emergency technicians and their organizational commitment in Kerman University of Medical Sciences. A descriptive analytical design was used in this study. The sample consisted of 103 technicians working in Kerman Emergency Medical Center. The instruments used in this study included a demographic questionnaire, Ethical Climate Questionnaire, and Organizational Commitment Questionnaire. Data analysis was performed using Pearson’s correlation, t-test, and descriptive statistics. The result of this research indicated that there is generally a positive and significant relationship between ethical climate and organizational commitment (R:0.39, p:0.001) Also, there was a positive correlation among professionalism, caring, rules, independence climate, and organizational commitment (p:0.01).Findings of this study could be used as a guideline for researchers and managers alike who endeavor to improve organizational commitment. Managers can help improve the ethical climate and as a result of organizational commitment by providing solutions, such as training and planning to institutionalize the ethics of the organization.

Improvement of staffs’ productivity through job ethic promotion is the most important challenges in new millennium. Therefore, this research aimed to determine the relationship between job ethics and staffs’ productivity in Tehran University of Medical Sciences. This research was a descriptive-analytical cross-sectional study conducted in 2016-2017. The research population was all of the staff of Tehran University of Medical Sciences. The sample size calculated 375 by Cochran formula according to staff of the hospitals and university schools. The research tool was Cullen and Victor’s job ethnics and Hersey and Goldsmith’s staff productivity questionnaires. The data was analyzed by SPSS software version 22, and used average and standard deviation for descriptive results and parametric tests, for example Pearson and Multivariate Linear regression. There was significant correlation between staff’s productivity and their job ethics and its dimensions. Also, organizational justice had the more and righteousness had the less correlation with staff’s productivity. Moreover, the staff's gender had significant correlation with their productivity, but the age and educational degrees of the staff had negative significant correlation with their productivity. Ultimately, 86% of staff’s productivity variations were impressed by their job ethics and its dimensions. To increase productivity of staff, establishment of safe organizational climate, development of personal ethics, and consideration of ethical issues by managers and supervisors is suggested.

Stressful ethical situations are considered as one of the problems of nursing profession, which disrupts the competence of simultaneous application of knowledge, skills, attitudes, and values in patient care. Since clinical nurses are more exposed to ethical distress due to their nature of job, especially in in critical care and psychiatric wards, this study was conducted to analyze the relationship between three dimensions of moral distress. In this descriptive-correlational study 545 nurses from Tabriz educational centers were selected by census method in 2013-2014. The moral distress scale (MDS) questionnaire was distributed among partcipants and data was collected during nine months. Data were analyzed by SPSS V13, descriptive statistics, Chi-square test, and Kendall's tau-b correlation coefficient. According to the findings, the mean of moral distress was 141.89 ± 29.6 (in the intermediate range). Chi-square test showed the relationship between the dimensions of moral distress (the relation between patient's ignorance, decision-making power, and professional competence) (P

Nurses in the intensive care unit face a variety of ethical issues that can lead to moral distress. Nurses need moral courage for correct moral performance in a state of moral distress. The aim of this study was to investigate the relationship between moral courage and moral distress in nurses. The descriptive-analytic study of correlation type which aimed to investigate the relationship between moral courage and moral distress in nurses. A total of 310 nurses from special units of educational hospitals in Kerman were selected by census method. The tools Sekerka's moral courage and Corley's moral distress were used to collect data. Data were analyzed by descriptive and analytical tests of SPSS version 24. Mean score of moral courage of nurses was 42.71 ± 9.67. Moral courage was the highest in moral agent. The mean of moral distress was 56.03 ± 18.21 and the most moral distress was in the dimension of errors. There was a significant and negative relationship between moral courage and moral distress (R = -0.166; p = 0.003). Moral courage was different in position, type of department, and marital status. Moral distress differed only from type of department. The results of study indicated a significant and negative relationship between moral courage and moral distress. Strengthening the moral courage of nurses plays an important role in controlling and reducing moral distress. Therefore, nurses can reduce their moral distress by reinforcing moral courage and, instead, increasing the quality of care for patients.

Maintaining the privacy is one of the most fundamental rights of the patients, based on the need for respect to human dignity. Considering that today's students are tomorrow's nurses who are directly involved with patients during and after their education, it is necessary to review their performance regarding the privacy of patients. Therefore, the present study aimed to investigate the privacy practices of patients among trainees and interns of the Faculty of Nursing and Midwifery of Bushehr University of Medical Sciences. This was a descriptive analytical and cross-sectional study. A total of 283 nursing and midwifery students of Bushehr University of Medical Sciences who had the necessary features to enter this study were selected by consensus method. The data collection tool was privacy questionnaire made by Heidari (2000), which validity and its reliability was confirmed. Data analysis was performed using SPSS software version 23 as well as statistical tests (T-test and ANOVA). The results of this study showed that the average score of patient's privacy was 09.24 ± 11.97. Also, student's performance in the area of personal, human, and in general the patient privacy was approximately good, and there was a significant difference between the average performance of trainees and interns in the domain of human (p-value = 0.002) and, in general, the privacy the patient (p-value = 0.018). There was a significant difference between the demographic factors of the educational level, ethnicity and occupation of students with practice of patient's personal privacy. Since the student's performance regarding the privacy of the patients was good, the administrators and clinicians should plan and take the necessary measures to maintain the present situation.

Futile medical care is considered as the care or treatment that does not benefit the patient. Thus, perception of the clinical team regarding futile care is of great importance and it has an important role in the quality of nursing care and health of clinical team. This study aimed to determine the relationship between perception of nurses regarding futile medical care and their caring behaviors toward patients in the final stages of life admitted to intensive care units. This correlational, analytical study was performed on 181 nursing staff of the intensive care units (ICUs) of health centers affiliated to Mazandaran University of Medical Sciences, Mazandaran, Iran. The data collection tool included a two-part questionnaire containing demographic characteristics form, perception of futile care questionnaire, and caring behaviors inventory. To analyze the data, statistical tests and central indices of tendency and dispersion were used. Pearson’s correlation coefficient, partial correlation, t-test, and ANOVA tests were performed to assess the relationship between the variables. Findings illustrated that the majority of nurses (65.7%) had a moderate perception of futile care. In addition, it was only the mean working hours per week among the demographic variables that had a statistically significant relationship with perception of futile care (P

Organizational culture affects the values, traditions, and norms of an organization. Therefore, the organizational behavior means how much an organization acts ethically. The cultural environment affects the formation of the organizational climate and, behavior. There are some deficiencies in the standards of organizational culture. This study aimed to review different aspects to accredit hospitals culturally in Shiraz University of Medical Sciences and consisted of two stages: First; the initial qualitative study was done by interviewing the experts who were selected purposely and held focused group discussion sessions to recognize the different aspects of cultural validation and develop an cultural accreditation manual for hospitals. Second stage was an evaluation of the hospitals in Shiraz University of Medical Sciences according to the cultural accreditation manual. Among 17 targeted hospitals, passed the training course of identifying indicators and volunteered to participate in the survey, 11 hospitals which had performed self-evaluation according to their manuals entered the survey. Seven main subjects and 17 sub-titles were derived from the first qualitative study. The subjects included considering religious laws demanded by patients and those patients’ accompaniers, patient satisfaction, staff satisfaction, consideration of ethical rules, dress codes, cultural activities of the hospital, and environmental neatness of the hospital. The evaluation of the above factors ranged from 0-1. The hospitals, total scores were from 0.68 to 0.78. Findings suggest capability of the indicators for hospital cultural evaluation. The qualitative study ranked the hospitals in every aspect.

Increasing attention to individual liberties in last decades, has led to considering respect to patients autonomy and involvement in making medical decisions as a critical ethical principle. In spite of a general emphasis on the Importance of the mentioned principle, there is a wide controversy about the logical limitations of respect to patient's wishes and preferences in medical decision making. While a significant number of theoreticians believe in necessity of considering rigid limitations for respect to patient's autonomy, others emphasize on respect to patient's absolute and unconditional right of self-determination. This article explains and analyzes each group's main arguments and finally suggests a functional and logical approach to the principle. This method helps avoidance of disadvantages of unconditional respect to patient's preferences while considering autonomy as an important ethical maxim.

Patients with advanced, progressive, non-curable, or hardly cured illnesses, found themselves in a situation where therapeutic measures have no effect in improving their condition and health status and they are gradually pushed toward death. Care provided to the patient, during this period, is known as end-of-life care which include life-sustaining treatments and palliative care. Life- sustaining treatments are such that give patient the chance for living longer but inflict lots of suffering upon the patient. While in palliative care, the patient probably survives for a shorter period, but suffers less. The question is whether the patient can choose between the two methods? Considering the Jurisprudential rule of “the necessity to safeguard human life”, most of the Muslim Jurists believe that the patient cannot rule out the first method (i.e. life- sustaining treatment). This study first examines the evidence of the rule, and explained the viewpoints of the Muslim Jurists about choosing between these caring methods, and proves that, despite accepting the rule, it is limited by the rules of “no hardship“ (la haraj) and “prohibition of detriment”(la zarar) and moreover the rule of “the domination”(saltanat). However, it can be said that, regarding the evidence of rule “the necessity to safeguard human life”, patients who are at this stage are excluded from the subject matter of this rule.

In its broad sense, health encompasses a wider area than simply physical health. It includes mental, social and spiritual health as well. There is evidence that a child inherits from his parents not only genetic traits but also morality and acquirable traits epigenetically. This means that the parents, especially the mother, have a double responsibility towards their children. In the Islamic literature there are general recommendations regarding choosing a spouse, as well as norms of fertilization, and time of conception; these could be explained today as epigenetic factors in shaping a child’s personality. Some specific recommendations are as follows: Refraining from marrying an ill-humored woman; remembering god at the time of fertilization; and avoiding intercourse at special places, times, states and situations, which would have negative influences on a person’s psyche. Although these cannot be explained on the basis of experimental criteria, their effect on the health of the fetus is worth studying using appropriate methodology. Influence of maternal health on child health in terms of environment, genetics, and epigenetics are the areas that will be explored more by research in Islamic and new scientific resources.

Modern medical ethics, in particular the principle of Non-Maleficent, advises the medical staff to avoid any harm to the patient. Islamic jurists, using religious texts and sources, have introduced rules that are applicable in many areas of life. Among these rules, is the rule Non-Harm, that in this article to review this rule and its applications in medicine. In addition to discussions of the documents, a better understanding of the words "Darar" and "Dirar" and deny or forbid the word "La" at the beginning of the base document, is one of the major issues and disputes. Organ transplants, family planning and birth control, responsibility to protect the health, need to see a doctor for treatment, civil responsibility for doctors in the treatment, responsibility for custodians of society for the control of AIDS, are the problems affecting today's health systems that the rule of No Harm is flowing in them.

Professional ethics is a part of the ethics of the individual component of each discipline. Whether it is in the field of medicine from the viewpoint of the Quran and the traditions, or how this context is discussed, is the focus of this article. With reference to the most important principles of the principles governing the medical education system, we are going to explain these principles. The applied method is descriptive and with a Quranic-narrative approach. In addition to reviewing some verses of the Quran, the most important issues were considered as the principles of professional ethics, especially in relation to the medical profession. However, there are also other research projects that can be done. Consideration of the articles and resources that are relevant to this discussion has been considered for further research. In order to investigate the ethical principles governing the relations between students and students in the field of medicine, first, with an interpretive look at each verse, the ethical propositions of the constituent and the contents and orientations of each verse were extracted and then the lead role was included. Also, the concepts, orientations, and leadership role of each verse were extracted. The most important things to note are: 1- Extracting ethical verses based on the study of contemporary interpretations, 2- Extracting the concepts and moral themes expressed in the interpretations, 3- Finding the connection between ethical concepts, 4-Addressing the leadership role of each of the ethical concepts, 5-Categorization of common subjects and subjects of verses.

Substantial concerns about the research integrity in Iran have caused research misconducts to be issue for studies. But adequate recognition about causal factors is a necessary part of clear and explicit policy in order to manage the research misconducts and supply the research integrity. This study attempted investigating the available evidence on the reported research misconducts in the Iranian research and its causal factors. Therefore, 30 studies on the Iranian research misconducts were studied. The detected factors to research misconducts based on the reported evidence included: 1. Structural factors such as publication pressure, scientific promotion policies, research funding and job preservation; 2. Organizational factors such as research environment, regulatory-control activities on research and teaching research activities; 3. Personal factors such as research skills, degree orientation, financial benefits, understanding and moral judgment. The analytical model of causal factors was designed. Therewith, cultural and situational factors have received less attention in the literature and they have major focus on the obvious types of research misconduct (data fabrication, Falsification and Plagiarism), especially plagiarism.

The emergence of different types of economic relations and the desire of professionals to earn more income has led to new challenges such as conflicts of interest in the dental profession. The community expects dentists to prioritize the health and the interests of their patients in their professional activities. In this regard, one of the most important dilemmas is the confrontation between the professional duties of dentists and their profit. Business goals being preferred rather than providing specialized knowledge services by dentist is a major concern, which can lead to patients’ distrust. Fee splitting, Self-referral, receiving gifts from the patient and industrial companies are among the most significant type of conflicts of interest in the profession, which are discussed in this article in the form of four clinical cases.

One of the most important sources in Islamic traditional medicine is the hadiths remaining from infallible imam and the first condition for using the hadiths especially in medicine is the exact and correct understanding. The systematic and accurate understanding on fulfillment of certain conditions and applying the rules of understanding are based on the features like various aspects of semantic, generalization and encumbrance, generality and particular meaning, firm and similar ayat, abrogating and abrogated in one hand, the narrative transition from time to time and various historical vicissitudes and as a result of various damages like distort spiritual and literal, paraphrase, ambiguity, ijaz, forging and etc. in narrations of the infallible Imam. In understanding of medical traditions, the evidence attached is used more among the rules of understanding. This study analyzed the attached evidence and studied about how they are used in understanding of traditions.

Medical ethics is an old science. Some of its issues have historical precedence, and others are modern challenges, and have emerged with advances in technology. One of such historic but newly emerging challenges is "bi’natijeghi-e-pezeshki (futile treatment)", which is defined as the treatment that cannot achieve its goal. This term entered medical literature as "medical futility" in late 1980s. Based on this investigation, it can be concluded that this term should only be used when the desired outcome following medical procedure and the outcome sought by the medical team and patient/family (patient's health) is unlikely to be realized. There are various equivalents for this term in our country (Islamic Republic of Iran), including "bi’fayedegi-e-pezeshki (medical uselessness)", "bi’houdeghi (frivolity) in medicine", and even "inappropriate treatment". The present article aimed to find a suitable Persian equivalent for this concept. The use of interpretations such as "frivolity" or "uselessness" may cause misunderstanding between patient/family and the medical team, and can ruin the trust between patient/family and the medical team. Thus, the best alternative to this English term appears to be "bi’natijeghi-e-pezeshki (futile treatment)".

Bioethics is an interdisciplinary course which includes public health. The public health is a general concept dealing with ethical, spiritual, cognitive, and physical issues. Ethical health is part of bioethics. This paper analyses the discourse between feminism and Islam regarding the influence of gender on ethics. Considering influence or lack of effect of gender on ethics is the most important difference in Islam and feminism. The essence of the difference is in ontology and epistemology principle of both views. Islam considers God as decisive ethic and ethical behaviours while feminism considers human as ethic decisive. In Islam, gender does not play role in origin of humanity and does not cause perfection or imperfection and strength or weak of being human. However, gender influences ethic and ethical behaviours and causes difference in ethical behaviours between man and woman. But, .in feminism view, gender does not affect not only humanity origin but also ethical issues and behaviours. feminism granting ethical similarity between men and women overlooks ethic-gender roles leading to creation of a system that makes man and woman responsible for and tends to Bigender by proposing gender similarity between men and women ; this attitude has unethical outcomes and affects ethical health. This paper aimed to explain Islamic view (Quran and traditions) and outcomes of feminism view about gender effect on ethic along with investigating different sects of feminism.

Medical ethics in a reductive look can be handed to physician’s ethics and then call a physician who adheres to medical ethics attributed to the moral virtues. Moral virtues are counted to be about 137 in the teachings of Shiite, most of which are not related to the practice of medicine but nearly eighty virtues are linked to the practice of medicine. This number is too much to be handled in a paper and analyzed by verses and hadiths. Therefore, we should take two steps: 1-Limit the virtues of physicians 2- Analyze the virtues of physicians. Believe and practice the virtues emphasized in the teachings of Shiite leads to a monotheistic look to the practice of medicine and provides physicians with a different and transcendental worldview. This insight that stood upon the teachings of the Quran and hadiths by Imams (AS) considers the practice of medicine a divine relation and then shows the communication between a physician and others. The current paper analyzes the divine relation of the physician and its impact to the practice of medicine. First literature review performed to find three most virtues. Then Factor analysis method was used and therapeutic virtues were limited to thirteen virtues. Then library study and focus group discussions were used to analyze the selected therapeutic virtues. The practical conclusions is that if we consider medical ethics practice based on virtue, and define and interpret virtues based on the teachings of Shiite, then we will get to a monotheistic view in the practice of medicine that distinguishes Shiite medical ethics monotheistic feature and the secular one, and helps to link between faith and morals.