مجله دیابت و متابولیسم ایران
سال چهارم شماره 1 (پیاپی 8، پاییز 1383)

In modern biomedicine, there is an increasing speed of development of new ideas and technologies and, consequently, increasing speed of new applicable knowledge. The rapid advances in medicine and biotechnology during recent decades, is accompanied with important discussions about new questions and dilemmas in the field of professional ethics. The increased recognition of ethical problems has contributed to the emergence of medical ethics as a new, cooperative and collaborative discipline in the world. This article provides an introduction to main issues in modern medical ethics. It is a review of a great deal of books and articles which are published in the recent years. Some of the issues discussed include: physician-patient relationship, consent and informed decision-making, issues before birth, and end of life issues. Ethical issues in organ transplantation, biotechnology, assisted reproduction, medical research, clinical ethics education, and resource allocation are also reviewed briefly. This intensive review of the basic issues in contemporary medical ethics is aimed at providing health care professionals a basic knowledge about ethical issues within their clinical practice.

The increased recognition of ethical problems has contributed to the resurgence of ethics in relation to health care, and to the emergence of medical ethics as a new collaborative discipline in the world. The growing trends in biomedical technologies have been associated with increasing discussions about ethical aspects of the new knowledge in different societies. Advances in genetics, stem cell research, and organ transplantation are some of the medical issues that have raised important ethical and social issues in different countries. Given the special attention that has been paid toward moral ethics in Islam, an emphasis on ethics has been also voiced by medical and religious professions in Iran. In the recent decade, great strides have been made in biomedical ethics, especially in the field of education, research, and legislation. In this article, a brief history, and some of the activities in the field of medical ethics that are carried out have been reviewed. Results & Establishment of the National Committee for Medical Research and Regional Committee of Ethics for Medical Research, and compiling the National codes of ethics in biomedical research are the main early activities carried out during 1990s. A comprehensive strategic plan for medical ethics in the national level has been introduced in 2002. After implementation of this plan, considerable activities are being carried out that most important related activities will be also reviewed in this paper.

In recent decades, traditional medical ethics which is confined to certain commands and prohibitions, is substituted by modern medical ethics which deals with problems such as euthanasia, abortion, organ transplantation, etc. and tries to find proper ethical solutions. These solutions wittingly or unwittingly are rooted in certain philosophical foundations. The philosophy of medical ethics constitutes the basic part of medical ethics which tries to clarify the right and wrong in practice in various subjects of medicine and health care. Philosophy of ethics, on the one hand, makes an analysis of the principals of ethical theories and on the other hand, it offers some criterions for ethical actions as to what is good or bad. Four principles have been proposed in the West as clues to make decision about medical ethics which are as follows: autonomy, beneficence, nonmaleficence, and justice. However, some questions or interpretations may arise concerning these principles in various cultures and schools of thought. Evidently there is a different between the philosophical foundations of the Western thought with that of Islamic one concerning ethical decision-making in medicine. Thus it is necessary to explain the philosophical position of medical ethics in Islam which can be realized only through the exchange of views between philosophers and physicians. The authors of this article try to explain the effect of different outlooks in philosophy on ethical decision-makings of physicians with special reference to the necessity of formulating the comprehensive principals of Islam in this field.

In the recent years, new medical technologies and their probable misusing have emerged public concerns about medical ethics. Medical ethics is a practical discipline that provides a structured approach for identifying, analyzing, and resolving ethical issues in clinical medicine. In this study we reviewed some new methods of teaching medical ethics in other countries by searching in internet and literature books. Two key features related to the teaching of medical ethics are actively involving students in the learning process instead of merely lecturing about ethical principles and assessing how students apply their knowledge of ethical principles in simulated and actual situations. In many countries such as Iran medical schools attempted to address medical ethics issues in formal ethics classes. It is clear that the traditional method is no longer sufficient to meet the needs of practitioners and societies and new methods particularly those emphasizing active learning, individual participation, group interactions, and a process-based approach, should be developed and implemented. In addition, a concerted effort to improve education in medical ethics will benefit the medical profession and the patients served there by. Therefore, we recommended policy makers of medical ethics education to change the traditional method with regard to modern methods; witch is used now in the world.

Clinical trial is the standard method to assess efficacy of a medical intervention. Because of its experimental nature, meaning that subjects are exposed to an intervention with uncertain outcome and according to historical evidences of criminal researches, clinical trial is of something of a lightning rod for ethical concerns. Ethical issues surrounding clinical trials are very pervasive and in many respects, they are as important as the Methodological issues. Patients place a great deal of trust in clinical investigators and often participate in trial when the chance of personal benefit is low. The clinical investigators must continue to earn this trust by demon storable commitment to ethical standards. In this article after reviewing the appropriateness and necessity of clinical trial and its required methodological characteristics, ethical issues consisting importance of protocol, informed consent, study on vulnerable subjects, compensation, conflict of interest and responsibility of ethical committees in evaluation of clinical trial will be discussed. To assess efficacy of a medical intervention, clinical trial is ethicly not only inevitable but also necessary. However it doesnt reduce necessity of attention to the participants rights.

Global distribution of diseases in recent years has shown that health problems are no longer limited to the geographical borders of a country but are a global. Establishing international research collaboration has been highlighted as an appropriate strategy for confronting health problems. The possibility of exploitation of human subjects and also research capacity in developing countries particularly by pharmaceutical companies has caused concerns about the nature of such kind of research collaborations. In many countries general ethical guidelines help researchers and ethics committees to deal with the issue. However lack of expertise in general as well as ethical guidelines to address externally-sponsored research in particular, exposed human subjects to greater harm and has ignored ways of guarantying their benefits. Methods and In view of experiences of clinical trials which have been conducted in Africa and Asia by developed countries, this paper focuses attention of researchers and health policy makers on externally-sponsored researches. By reviewing the international ethical guidelines, the paper argues for the development of national ethical guidelines in order to protect human subjects as well as national interests.

While the results of genetic research have increased our medical knowledge, promoted health and treatment of illness, some unique ethical problems arise about this type of research. Genetic information is often considered "special", or different from other kinds of medical information because of its close association with individual identity, which is due in part to the common assumption that genes are determinative of human health and characteristics. Thus there is potentially risk of harmful events genetic research participants including stigmatization or discrimination by employers and insurers. In addition, the fact that genetic information about an individual reveals information about relatives, creates new and complex ethical issues, particularly regarding privacy and confidentiality. Given the importance of this subject, we searched PubMed, Medline and Ovid for some keywords such as "genetic research" and "ethics" during the recent decade. We compiled the article by reference to valid searched articles and some books. Results & Informed consent, confidentiality, ownership of genetic information, family/cultural considerations, storage and future use of genetic samples, counseling and supervision contrivances are some respect important general ethical concerns which this paper discuss about briefly

In recent years, many progresses have been confirmed in the field of medicine. Transplantation is one of the instances which have had rapid improvements. Human and nonhuman organs and tissues, embryo, fetus and even the human stem cells have been used for transplantation. The researches in this field have lead to the more functional and new methods. Regarding the ethical problems would prevent the future dangers of human being and society. The researchers’ duty is to respect all of the ethical points associated with the transplantation. In this article, the researches on corps, samples of human tissues and especially in embryo and fetus have been discussed. For compilation of the article, we searched articles by means of PubMed, Medline, and Ovid and so we concerned some books. Results & In transplantation researches on corps, the patient’s consent in advance (before death) or the relatives consent is important. In Islam respect to the dead Muslim is highly insisted. In human tissue researches the reason of tissue collection, kind and amount of it, research use and non-beneficence use of the research results have to be significantly considered. In recent years, the researches on embryo and fetus have been attenuated. This kind of research despite of its advantages has brought many ethical questions in consent acquisition, viability or non-viability of the embryo and fetus and the permission of research confirmation. In this review article it has been tried to regard all of the current ethical problems in this field, wishing this article to be a guide for more extensive researches.

Human embryonic stem (hES) cells have the unrivaled ability to differentiate into any specialized cell type. Significant attention is currently directed to the biological and therapeutic capabilities of these cells for developing novel treatments for acute and chronic diseases including heart disease, diabetes, Parkinson's disease, Alzheimer's disease, multiple sclerosis, spinal injuries and cancer. However, these technologies have posed profound ethical issues. Ethical challenges are largely based on concerns for safety, efficacy, resource allocation, and methods of harvesting stem cells. Fundamental points in the issues are the human dignity and human rights, the concept of the moral status of human embryos, concerns about commercialization of stem cells and oocyte donors, and slippery slopes towards reproductive cloning. The use of hES cells for research is currently high on the ethical and political agenda in many countries and international organizations such as UN, UNESCO, and WHO. Many countries allow strictly regulated research on human embryos. The purpose of this paper is to describe the scientific background to the current ethical and legislative debates about the generation and use of human stem cells, and to give an overview of the ethical issues underlying these debates. The successes and limitations of mammalian reproductive cloning are itemized. For compilation the article, we searched particulary in Pubmed and Ovid for keywords of " cloning", "stem cell research", "ethics", etc. Considered articles which were published during recent ten years.Results and This review hopes to bring the reader closer to the science and the ethics of this new technology, and what the implications are for the medical practitioner. This review also discusses the legal status of ES cell research in the world with special attention paid to the Islamic perspectives.

Medical students at all levels of experience, encounter learning opportunities in a wide variety of clinical settings. There are some ethical dilemmas a student may face and possibly carry the burden throughout his file. Most of formal medical ethics teaching focuses on dilemmas that students may face in their future practice, rather than the ethical problems they encounter as medical students. Several studies suggest that students’ clinical experiences constitute an informal or hidden ethics curriculum, which can undermine their developing professionalism. In this article, we discuss some ethical dilemmas of medical education and also some solutions for them. Results & In order to promote a setting that is satisfying to the student, to the faculty, and most importantly, to the patients, we have proposed ethical notes for medical students about informed consent, protecting patient confidentiality and managing ethical concerns.