مجله ایرانی اخلاق و تاریخ پزشکی
سال چهارم شماره 3 (خرداد 1390)

Illnesses and their treatment, pharmacy and pharmacology, medical equipment, hygiene and health related topics, health economics, preventative measures, lab equipment and supplies, human resource service delivery models, education and training of health care professional, and associated areas of law are collectively referred to as the health care system. At times it is even difficult to separate health care from social injuries and civil conditions, since these can pose direct or indirect threats to individuals’ health. As health policy makers, managers and professionals demand and encourage the observance of ethical considerations in providing health care, neglect of the legal aspect of the health care system can bring about unethical phenomena that necessitate legal measures. The present paper aimed to determine whether the general traditional legal classifications, that is, jurisdiction and sovereignty, apply to the health care system, and if so, which of the two it falls under. What further highlights the significance of answers to such questions is the fact that they are closely connected to regulations of the health care system. It could well be that some companies in the health industry have a negative effect on the ethical conduct of physicians and other health care professionals, as due to their commercial nature and structure, these companies are dominated by rules of business, and this exerts limitations on their observance of ethical considerations.This study investigated a number of such seemingly legitimate situations and the problems associated with them, hoping to eliminate legal conflicts and promote ethics in the process of providing health care in the society.

During the Qajar era, most cities, including Esfahan, suffered poor hygiene conditions due to an overall lack of hygiene facilities. Esfahan was a big city that faced a shortage of hospitals, pharmacies and physicians, and this meant that large numbers of people would die as a result of outbreaks of communicable diseases. The new government, therefore, began a series of actions with the purpose of promoting hygiene in the city, including establishment of new hospitals, systematizing pharmacies and physicians, mass vaccinations, improvements in the hygiene condition of public places such as bathhouses, eateries, inns and slaughterhouses. For the most part, such measures resulted in a growth of population during those years.The present paper aimed to shed light on the hygiene conditions prevalent in the city of Esfahan during the first Pahlavi period by using historic documents, newspapers and other sources available. It employed a library research method along with comparison and analysis of existing sources, original ones in particular. To this end, the required data was initially collected and then organized and analyzed, and this historical research was ultimately structured based on the inferred results.

Moral distress is a psychological phenomenon whose effects on people’s functions can be considered as a subject of study. Although moral distress exists in numerous professions, research dedicated to this phenomenon has proved that due to the nature of the nursing profession, it is a familiar source of stress for most nurses. Nurses are more often than not faced with moral dilemmas in the workplace, and suffer moral distress as a result. The present paper aimed to study the history of moral distress, its definitions, consequences and coping strategies through library and online research, and although it attempted to investigate the phenomenon of moral distress in general, its focus has mainly been on moral distress in the nursing profession. A thorough understanding of moral distress and its negative and positive aspects is believed to raise awareness and lead to improvements in nurses, and educate them on appropriate coping strategies to help reduce their emotional suffering.

Observing patients’ rights in health care services plays an important role in improving and adjusting the doctor-patient relationship and is therefore of great significance in health systems management. Considering the role it plays as an important philosophical part of modern ethics in ethical and social functions, empathy has received much attention in various areas of research such as psychology, behavioral studies, neurosciences and psychiatry. The present study will first offer an overview of the history of empathy and its positive effects on the interactions between doctors and patients, and then move on to propose strategies to promote empathy in doctor-patient relationships. Empathy plays a significant role in patient empowerment and satisfaction, and therefore studying its effects on teaching medical ethics as a factor that can positively influence the doctor-patient relationship can provide all, including organizations such as the Ministry of Health and psychology and counseling centers, with valuable guidelines to promote mental health, from prevention to treatment.

Throughout 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.

Admitting medical errors is one of the professional obligations of physicians that unfortunately involves numerous challenges. The present paper aimed to investigate the attitude of surgery faculty and residents towards medical error disclosure and factors affecting it. In this cross-sectional descriptive and analytic study, a self-administered questionnaire was distributed among all faculty and residents of the department of general surgery of the teaching hospitals of the Tehran University of Medical Sciences. The response rate was 84.1% (53 out of a total of 63). Tendency to make minor and major errors among the respondents was 39.6% and 49.1% respectively, and 71.7% declared that the most significant factor hindering error disclosure was fear of litigation. Only 16.7% (8) had disclosed their most recent medical errors to their patients, 25% (2) of whom had to face legal action.There seems to be a clear distinction between the doctors’ inclination to disclose their medical errors and what actually happens in their practice, the most important reason being their professed fear of litigation. Considering the need in the majority of physicians for appropriate training on the subject of medical errors and communication strategies, it seems that in order to resolve this issue, changes need to be made in the current system for error management so as to provide professional support for physicians who make medical errors, and doctors should receive the necessary training on ethical principles and patient communication strategies.

Nurse's ability to communicate with patients is essential for the effectiveness of the nursing process. This factor is more significant in the case of adolescent patients. Appropriate communication between adolescent patients and health care staff is crucial, since it contributes to the patients disclosing important personal information, and helps nurses communicate necessary information, viewpoints or skills through health promotion measures. The present study aimed to draw a comparison between nurses’ and hospitalized adolescents’ understanding of the significance of the nurse-patient relationship and the observance thereof. In this cross-sectional study, 175 nurses and 180 hospitalized adolescents (12-18 years of age) were selected through simple random sampling respectively, all of whom met the criteria necessary to enter the study. The data was collected from children’s hospitals affiliated with the Tehran University of Medical Sciences, and the data collection tools were self-report questionnaires. Data analysis was performed using the SPSS statistical software.Findings of this study showed that there was a significant statistical difference between the understanding of nurses and hospitalized adolescents regarding the importance of the nurse-patient relationship (P=0.019) and its observance (P0.001), and the nurses scored a better understanding than adolescent patients in both cases. This paper also investigated the priorities of each group regarding the significance and observance of the nurse-patient relationship. The results showed that nurses viewed explaining the necessary follow-up care after discharge as the most important part, while adolescent patients believed that proper verbal communication and being listened to patiently were of great significance. Both groups seemed to observe proper verbal and non-verbal communication according to the results of this paper.The findings of this research proved that nurses can be directed to achieve the less observed objectives that are viewed by adolescent patients as significant in order to eliminate the obstacles in proper nurse-patient relationship.

Ethical research and theories assign great importance to the role of intention in passing moral judgments about individuals’ actions. The doctrine of double effect is among ethical disciplines that differentiate between controversial medical situations such as end of life care or abortion, and intentional, premeditated damage, in that they consider the former impermissible and the latter permissible under specific circumstances. The present paper was conducted to investigate the role of intention in judging a person’s actions, and to provide empirical evidence for the doctrine of double effect. 200 students were asked to evaluate the morality of two situations: in the first situation, one person needs to be killed so that five other persons can be saved. In the second, the killing of one person is the side effect of saving five others. Data analysis was performed based on frequency, averages and ANOVAs using SPSS statistical software version 16. The analysis indicated completely different responses to these two situations: in the first situation most respondents (62.3%) considered the act of killing the one person unethical, while in the second situation the majority of respondents (60.6%) considered the act that would result in the one person getting killed as ethical. The findings of the present paper highlighted the role of intention in passing moral judgments and provided empirical evidence in support of the doctrine of double effect. This research also demonstrated that the attitude of theorists about the role of intention in moral judgments is consistent with the moral sense of ordinary people.