مجله ایرانی اخلاق و تاریخ پزشکی
سال ششم شماره 1 (فروردین 1392)

The Iranian model of compensated living unrelated (LUR) kidney donation has achieved some unique success, but there is an urgent need for a structural revision in the program. In spite of these achievements, the program lacks secure measures to prevent the risk of a direct monetary relationship between donors and recipients, and it must be revised in order to be morally justifiable. By presenting the current organ procurement program from living unrelated kidney donation, this paper calls for the revision of the current procurement system. The paper suggests a “non-directed living donation” policy for organ donation from LUR donors based on anonymous donation. Under such a policy, individuals can donate their organs to unknown recipients altruistically and receive compensation.

The practice and study of medicine in Persia has a long and prolific history. The present study examines recorded information on the subject of medicine during the Sassanid period based on Avesta and Pahlavic texts such as Dinkard, Bundahishn, Sad dar Nasr and Sad dar Bundahishn. Moreover, Sassanid medicine was under the influences of neighboring countries such as Egypt and Greece. The Sassanid Empire was the last pre-Islamic Persian dynasty that ruled Persia from 224 CE to 651 CE. In this period Persia witnessed great achievements and progress in medicine as well as in other sciences.

Though there are different definitions for the word “mawt” (death), it seems that the most appropriate one would be the loss of power of the soul over the body, and that is when the soul is separated from the body. There are a variety of religious rulings for a human’s death in Islamic moral jurisprudence, and therefore it is necessary for a jurisprudent to have proper knowledge of the subject, reality, and the criterion for death and life. There are two main theories on the criterion for death and life from jurisprudential and moral perspectives. Some hold that everyone dies of cardiac arrest and others argue that man dies of brain death. It is also necessary to view the arguments presented by each group from jurisprudential and moral perspectives. Advocates of the theory of cardiac arrest support their view through the following reasons: authority of established practice in concept analysis, incumbency of guarding the protected soul, principle of caution regarding people’s lives, and principle of istishab. Authors of the present paper have attempted to provide a critical analysis of the above-mentioned arguments in this study.Advocates of the theory of brain death hold their view through the following reasons: the fetal heartbeat before the soul is breathed into it, possibility of cardiac transplantation and impossibility of brain transplantation, similarity between death and sleep, and signs and symptoms of death, among which two have been accepted: a) possibility of cardiac transplantation and impossibility of brain transplantation and b) signs and symptoms of death.

Documentation of accepted ethical behavior in special settings is one of the strategies employed to foster ethics in organizations. Such documents, known as codes of ethics, vary in different societies according to their cultural and ideological differences. Medical educators have dual professional roles (as physicians and teachers) that sometimes seem ethically incompatible. Therefore, having codes of ethics is essential in this profession. The aim of this study was to develop codes of ethics for clinical medicine educators with an Islamic-Iranian approach. This was a three stage developmental research. First, a comprehensive literature review was conducted. Using content analysis method, the first draft of a code of ethics for clinical medicine educators was prepared. Second, the draft was thoroughly and critically reviewed and revised in experts’ focus group discussion and the 2nd draft was devised. This was further reviewed by a group of 24 experts at the national level (validated) and revised according to their comments, and thus the 3rd draft was prepared to be presented for formal approval process. The final document includes 55 codes of ethics in 18 topics (conscientiousness, accountability, respectfulness, scientific excellence, respect for others’ freedom, equity, patience, religious commitment, modesty, trustworthiness, humility, contentment, relationship with coworkers, attentiveness toward patients, attentiveness toward learners, kindness, confidentiality, and discipline). It seems that extracting ethical concepts from the rich Islamic-Iranian cultural resources is feasible, and provides an appropriate basis for the development of ethical codes for medical educators. Compared to Western codes, such codes may be better accepted in Iranian contexts and will be implemented more readily if the organizational settings are prepared simultaneously.

Truth telling is relaying the appropriate information to patients so that they can make informed decisions about their care and treatment. Truth encompasses all aspects of personal health. Due to inadequacy of research on the subject, the present study was conducted aiming to examine the phenomenology of truth telling based on nurses’ experiences.A phenomenological qualitative approach was used in the year 2011-12 in a teaching hospital in Tehran. A sample of nurses was chosen based on the purposeful sampling method. Sample size was dependent on the data saturation with a total of 14 participants at the end. Data gathering was done using deep interviews, and the data was later analyzed through Celasi method.Findings based on the nurses’ experiences of truth telling were extracted in 12 sub concepts and two main themes of reinforcing factors and obstacles to truth telling. According to these findings, nurses need to be informed of the patients’ conditions and be familiar with the appropriate methods and techniques for communication and transmission of bad news to patients in order to provide the best care, and this contributes to improvement of the performance of nurses.

Moral distress is considered as an important issue in nursing. Nurses participation in ethical decision making and taking deliberate action are facing them with many ethical challenges in their work environment. Confronting those challenges can lead to moral distress.This descriptive study was conducted to determine moral distress and its contributing factors from the perspective of oncology nurses in Tehran teaching hospitals in 2011.Data collection was done through a demographic questionnaire, the Moral Distress Scale – revised (MDS-R) and a questionnaire on moral distress related factors administered to all oncology nurses with inclusion criteria.Findings showed that nurses reported a high level of moral distress overall. The highest level of moral distress was associated with giving inadequate information to patients about informed consent and carrying out a physicians’ order for unnecessary tests and treatments. A significant correlation was found between oncology nurses’ age, their work experience and employment status with moral distress. Institutional factors such as managers’ support, nurses’ autonomy and having determined duties had the greatest effect on moral distress from oncology nurses’ view. Oncology nurses commonly encounter situations that are associated with high levels of moral distress, and therefore strategies need to be developed in order to mitigate moral distress.

Biotechnology is a high technology that is bound to play an important role in the future world due to its wide range of applications in different parts of industry, agriculture, medicine, environment and so on. In our country special attention has been paid to biotechnology as a strategic technology. While the production and consumption of genetically modified organisms (GMO) products is witnessing an upsurge in the world on account of the value of cultivation and production, Iran does not have a noticeable share in this field.Food and agriculture organization (FAO) has predicted that food preparation for the 9.1 billion world population in 2050 will require a 70 percent increase in food production throughout the world and a 100 percent increase in food production in developing countries. Report of the International Service for the Acquisition of Agri-biotech Applications (ISAAA) indicates that biotechnology can be a key solution to the growing demand for food in the world. The development and operation of targeted biotechnology in compliance with all aspects of biosafety and bioethics will cause food production and productivity to increase. Naturally, this depends on culture making, production and commercialization of GMO products and changing the society’s consumption pattern.Jurisprudential views of consumption of GMO products, however, will lead us to bioethics-related issues and proper use of such products. In this study the views of grand jurisprudents were pursued about various aspects of direct and indirect consumption of GMO products in the form of four questions. All of the grand jurisprudents permit consumption of GMO products, and some do so with reservations: that they do not entail losses in the present and future, and that product information be truthfully disclosed to customers. This paper reports the responses received, and discusses the bioethical aspects of the views of grand ayatollahs.

Professionals who provide assisted reproductive technology (ART) services may be approached by patients who have no chance of success of treatment, or can even be harmed during the requested futile treatment. In such cases, what is the moral duty of those who provide treatment services, in particular the physicians? Does the mere request on the part of the patient free the doctor from his/her professional moral responsibilities? On the one hand, principles of individual autonomy and beneficence require the doctor to provide the patient with necessary treatments regardless of the results and consequences. On the other hand, the principle of non-maleficence requires the physician not to impose any harm on the patient. In addition, due to the limitation of resources, doctors are obliged to allocate them to those patients who have a better chance of recovery and use them in cases in which the probability of resource waste is low. However, does this sit well with the principle of justice, especially where the patient is willing to pay all the costs of his/her treatment? Whose interest does the doctor have to prioritize, the patient’s, that of the child resulting from ART, or the society’s? Given the above points, moral training of the team providing treatment services seems necessary so that they acquire the essential skills to make the right decisions in difficult situations such as those mentioned above.