مجله ایرانی اخلاق و تاریخ پزشکی
سال پنجم شماره 2 (فروردین 1391)

In the middle age (500–1500), while European countries were struggling with frightening epidemics such as plague, smallpox, tuberculoses, leprosy, and their medical treatments were based on superstitions and fanaticism, scientists such as Avicenna and Rhazes laid the foundation of the golden period in medicine.In the late periods of golden centuries, during the Mogul invasion of Iran, Rashidaddin Fazlollah Hamadani devoted a great deal of effort to preserve the knowledge by foundation of the knowledge city of Rabé Rashidi andDaralshafa (Medical and Health Service College) in Tabriz. Rashidaddin established a successful health management system which was accordance with the current modern health management systems. The objective of this review is to present a clear perspective of a successful Iranian Islamic model of health delivery system 700 years ago.The review was conducted in the form of descriptive bases of original documents with a systemic approach.Findings show a successful management experience in health system in terms of stewardship, resource allocation, provision of health services and financing which appears to be in accordance with the World Health Organization (WHO) declaration in 2000.Promotion of team working, employment of fulltime and part-time physicians, implementation of a fair and functional economic structure, health economic, sustainable financial mechanisms, public insurance, home care provision, and isolation of communicable diseases in hospitals can be considered as examples of a successful Iranian Islamic health management system.It can be concluded that as Iranian health management system is faced with many different challenges, gleaning lessons from successful national historical experiences can play a key role in the establishment of a competent system based on our Islamic and national values and in accordance with modern scientific achievements.

In this paper, the author aims to study orthodox and protestant points of views on human cloning and investigate on their arguments for and against it. Both ideologies have abolished both reproductive and therapeutic cloning and put forward an argument against them. The only liberal view which allows therapeutic cloning, but refrains from explicitly commenting on reproductive cloning, is a cult of protestant religion. It can be concluded that although reproductive human cloning cant be prohibited by account of their reasons, therapeutic cloning can be forbade by the reason of protecting the life right. This perspective shows that there is a fundamental consistency in Christianity's teaching about both kinds of cloning, because this religion prohibited all sorts of it.

Generally, when moral values and ethical principles are concerned, human beings are considered as the sole subject of these fields. It is then concluded that the only living creatures with some privileges and obligation towards their own bodies and also, towards their other human counterparts are humans. An emerging issue, particularly in the past recent three decades, has been the expansion of the ethical community to be inclusive of other living creatures, namely animals. Novel branches of science such as animal ethic are increasingly challenging the traditional view of ethics and aim to include animals in ethical community.In this article, a descriptive study and systematic review of literate was carried out on different aspects of animal ethics and the specific codes applicable to animals was studied in order to shed some light on the animal ethics and on what basis they are subjects to ethical considerations. As animals are proven to have the ability of perception and demonstrated to be able to feel and differentiate good and bad experiences, they are considered as being the subject of ethical considerations. Therefore, human beings should be responsible for their behavior towards animals in different aspects.

In this paper, different definitions of moral conflict and moral dilemma at two levels of recognition and observing moral duties are taken into consideration and some instances of usage of conflict in physiology (conflict of stimulant and goals) and sociology(conflict of roles and norms)are mentioned. Also concepts and constraints used in the moral dilemma, especially the concept of "ought to" and the concept of "Inescapable of wrongdoing" are surveyed in a logical analysis. If in definition of moral dilemma, the concept of “ought to” and “duties” being transformable to “commensurable reasons” and their justificatory values, many of apparent moral dilemmas will be solvable and only if the values contained in the duties, being incommensurable and non-infringement, moral wrongdoing will be inevitable. In this research, it will become clear that why and how proponents of the possibility of moral dilemmas under pressure of logical argument against the possibility of moral dilemmas and criticisms of opponents, in order to provide the necessary features for a genuine dilemma have suggested variety and supplementary definitions of moral dilemmas such as: natural, disjunctive, two shape and prohibition definitions. Natural definition of moral dilemma represents a situation in which the agent sees himself as both a moral duty, while he cant do it well. In disjunctive definition; agent is required to perform either task. In two shape definition (consisting of the "ought to" and "ought not to"), on the one hand the agent ought to do and on the other hand ought not to do the same. In prohibition definition, the agent should not perform any of the two while he has no choice but to do one.

End stage patient control and autonomy are core principles in human bio-medical ethics and key components of end-of-life (EOL) care. Albeit, according to modern medical ethics principles the centrality of the patient as decision maker may not be relevant to culturally diverse groups of end stage people. The purpose of this article is to present results of a literature review of end stage patient control and their family position within the context of end of life support. The review revealed that the interaction between medical control and ethical values in end of life support is multifaceted and unpredictable. According to the recommendations of American College of Physicians/American Society of Internal Medicine End-of-Life Consensus Panel and some other world class medical and ethical societies, culturally effective end of life support includes the following essential elements;•acceptance of and respect for cultural differences among all end stage patients •willingness to negotiate and compromise when world views differ •understanding of one's own values and biases •contact and communication skills that enhance empathy •information of the cultural practices of patient groups should be seen on a regular basis; and •attention that all patients are individuals and may not share the same views as others within their own ethnic groupAccording to the above description, applicants identified five domains of quality end of life support:1.receiving adequate pain control; 2.avoiding inappropriate prolongation of the dying process; 3.achieving a sense of control; 4.relieving burden on loved ones; and 5.strengthening relationships We emphasize that, despite above mentioned points and advices maintaining a sense of control is an essential element in the end of life support for some individuals, further study of the interplay between ethnicity, desire for control, and achieving a good death is needed.

In spite of increasing advances in technology, medical equipments, costs, geriatric population, consideration to ethical and legal issues has increased in nursing profession. This study aimed to explore ethical codes and consideration of ethical issues and severity of ethical distress experienced by nurses at intensive care units.A cross-sectional survey using questionnaire was conducted by a census of nurses in intensive care units in educational and treatment centers of Hamadan.Nurses value most the ethical codes related to responsibility (95.1%), accountability (95.1%), patient support (77.3%), secret keeping (83.4%), and honesty (78.5%). They studied patient rights statement 2.47 times with standard deviation of 2.86. Only 50.3 percent of nurses had education about professional ethics. Nurses had mean of mark in severity of ethical distress 99.34 ±46.61.Severity of ethical distress was moderate in nurses. There was not significant relationship between demographic data and severity of ethical distress. There are more needs to assess for effects and effective factors on ethical distress in intensive care units nurses.

Medical ethics is an interdisciplinary knowledge which increasingly developed during the last 30 years, and nowadays it becomes a part of medical student’s curriculum. Although, the quality of medical education has improved in Iran, but medical ethics teaching has not accomplished effective alteration yet. For deeper and more actual recognition of the challenges of medical ethics curriculum, we interviewed medical ethics instructors in a qualitative study. The data was collected by semi-structured interview with fourteen medical ethics instructors of Tehran University of Medical Sciences in 1389 and analyzed by Mairing content analyzing approach. Results of this study shows weaknesses and challenges in medical ethics curriculum which presented under five themes: comprehensiveness of goals, composing organization, proportion of content, active teaching method, and comprehensive system of evaluation. According to this the existing weaknesses and challenges of medical ethics curriculum can be considered as important obstacles in moral development of students. Considering those challenges, can develop medical ethics curriculum and introduce new models for medical ethics teaching.