فصلنامه اخلاق پزشکی
پیاپی 13 (پاییز 1389)

Privacy of individuals and their rights is the most fundamental concept in human life. Managers and hospital administrators should apply new approaches to protect patient privacy and prevent of patient information disclosure.Management of health provides human health and maintenance of it, moreover it is responding to a consistent need of human rights and privacy of patient. It is an important issue which is dependent on professional ethics. This structure leads to God satisfaction and appropriate provision of human needs. Therefore, attention to professional ethic apply in health system especially in managerial sector is necessary and suitable. Indeed, moral features should be in human behavior to enhance moral values. In this path, serve spiritual replacing to the vanity and selfishness. This article overview the concept of ethics and patient privacy and solitude on the base of a review of relevant literature and survey the role of management in hospitals and health care.

In many countries, there are laws or opinion to decide for critical pediatric patients who admitted to the intensive care unit. In all these approaches, the patient is observed. Also give the patient an opportunity to express His will. It is the moral responsibility to ensure that the patient or his lawyer had the opportunity to express his request. It is also essential that the risks of Heroic treatment and resuscitation and the chance for getting a good result, fully, honestly and without prejudice explained to patient. Although the autonomy of the patient puts the final decision in the hands of parents, it is better to check the information provided to make decisions about the child. After evaluating the capacity and the severity of the child, the parents should be responsible.

Nurses of intensive care units are continuously exposed to ethical tension due to their specific working environment. Distress level of Iranian nurses who work in intensive care units has been less examined so far. Therefore, the aim of this study is evaluating the ethical atmosphere governed on hospital environments from the perspective of nurses employed in intensive care departments.This descriptive study has been accomplished at hospitals associated to the Medical University of Tabriz, in the cities of Tabriz and Maragheh in 1388. The individuals of this research were all nurses employed in adult intensive care departments of mentioned hospitals who were selected through census sampling. The hospital ethical climate survey: This questionnaire has been developed in 1991, by Lenz & Stickland and Waltz and contains 45 options in 5 options Likert-scale, which its options are different from "is always quite true" to "not always quite right". In this questionnaire the minimum score is 45 and the maximum is 225. Statistical software "SPSS", descriptive and inferential statistics were used for analysis of the findings.120 nurses participated in this study. Most evaluated nurses were married women, and had a bachelor's degree of nursing. In addition, the average age of nurses was 32/91±4/57 years old. Total clinical work experience of nurses in nursing was 7/93±4/02 years and the clinical work experience of nurses in intensive care units was 5/34±3/32 years. It was found that 118 (98/3) nurses found the environment in appropriate but only from 2 (1/7) nurse's point of view this environment has been in good (acceptable) level.The results indicate high level of ethical tensions among the evaluated nurses, which calls for more attention of nursing managers.

According to a general classification it should be considered that human beings have organic needs or primary demands and spiritual needs or secondly demands. Moreover it should be noticed that these two groups are not independent to each other, insisting related dependency of these two levels of demands to each other. It means that in many individuals if basic needs not provided, achievement of higher level demand which reveals, self-confidence and social-spiritual enhancement hardly obtained.As social inequalities, make huge limitation for widespread groups of humans to access to their basic needs, is always on important factor for global accessibility to their basic human and social rights. Research demonstrated that early child situation plays key role in important of future individual`s personality and determines their social compatibility and their ability for exploitation of their basic abilities, and scientific improvement and success fullness.In this paper, the effect of health inequalities in patient`s achievement to their basic social rights and the subsequent of this effect on health utility is considered.

Defense of human rights to dignity and honor him. To ensure his protection in times of illness, without any discrimination, age, sexual and financial power is the right clients. Medical stuff is responsible for Preserve and protects these rights. Patients are necessary to respect fundamental rights and the rights of patients, sometimes because of ignorance, neglected by the busy work and medical staff, will be ignored. Present survey which is a cross sectional descriptive- analytic was conducted on 270 medical students of Hamedan in simple randomized sampling. Data collecting instruments were an interviewing form contains demographic information and educational questions regarding patient rights which its reliability and validity were made through the same measurement by two researchers. Data using the software SPSS, using descriptive and inferential statistics were analyzed. Based on survey results mean of training needs score was 10/3±3. High educational need was 31%, medium 53%, and low training need was only 16%, in total. There was not any statistically significant relationship between the training needs of any demographic variables. According to this study, most health personnel awareness of patient rights is low. So, promote awareness in the field of educational planning should be done. Patient Rights is an valuable act, but when it is fully implemented that be performed culturally appropriate, comprehensive attention to the rights of all stakeholders, Identifying barriers, strategies to implement the Charter, and be considered respect the rights of patients as an indicator of the health services center.

Medical students and residents have to improve their practical skills by spending a major part of their training time in hospitals and clinics and will be involved in the patient’s treatment process.Professional groups involved in medical education and health policy maker point that patients refer to university teaching hospitals, means that they have consent with this process. But if we do not consider necessary arrangements, cannot say that the patients act is informed and vulnerable. And patient's understanding of the skills, experience and qualifications of participants in treatment process will not be complete. It should be noted that, there are not any detailed and comprehensive guidelines and protocols on this issue in Iran.In contrast, the ethics of medical research on human subjects have been the subject of much policy development and there are many international and national codes of ethics in research. Although research and education have different goals, but there is an analogy between medical education and research. In both cases the medical team asks patients to participate in a process which may have both individual and social benefits. So there should be a balance between the goods for society and the benefits to individual patient in one hand, and potential harm and risks on the other hand, In addition to respect for patient’s autonomy.From the medical ethics point of view, patients should be fully aware of educational and skill level of medical team, understand the risks and benefits of hospitalization in a university teaching hospital and could access to alternative possibilities. But in current system of medical education, which the governmental health facilities and medical education are fully integrated and almost there is no non-teaching hospital except the private ones, this challenge is very important.It seems that national health system should seek systematic solutions for this problem in an organizational manner. To develop guidelines and standard protocols to assure patients best interests in university teaching hospitals and to clarify the clinical professors and hospital managers’ responsibilities as well as the duties of government and Ministry of Health and Medical education.

Patients as one of the most vulnerable groups are at serious risks, of different aspects involve physical - psychological and social factors, therefore their overall health as an important part of legal topics has become an important issue. The purpose of this study was the patient's perspective of the hospital's rights.A cross-sectional study was conducted among 400 inpatients of educational medical centers using questionnaire. After the clustering of centers based Specialties, At least one cluster was selected from each group randomly; finally, seven centers were selected. One Sample- t Tests, ANOVA and Linear Regression in SPSS -19 were used for data analysis.Fifty tree point two percent of the patients (213 cases) were men and 46.8 %(187cases) women and Patient's average age was 49.8. Mean scores of Components of patient rights were followed: care questions (ideal score: 17) 10.9, Diet Care (ideal score: 6) 1.7, Environmental Health (Ideal score: 24) 18.9 and Privacy and Mental Health (Ideal score: 17) 10.6. From the perspective of patients, their rights in the fields of healthcare, environmental, and mental health (except for taking care of diet) were respected at an acceptable level. Significant relationship was not found between gender and age of patients compared with their views of their rights; however. Average scores on indices, sectors and at various hospitals were also significantly different. Consideration to diet in patients is very important and it seems necessary. Satisfaction of patients of their rights can show that patients are unaware of their rights. Dissatisfaction in patients with more knowledge can confirm that. Representation of the Rights Charter to Patients admitted and explains its provisions on the first day of admission, while a positive effect on patient's health, can prevent the displacement of the argument.

This study was done to identify patient satisfaction about the way in which bad news is transferred to patients with malignancy. 48.7% of caretakers and 56% of patients were satisfied with the information provided by the health personnel. 54.6% respondents in the Children’s hospital and 74% in the Cancer Institute expressed satisfaction with the manner in which the news about the disease had been conveyed to them. 96% of patients in the Cancer Institute and 80.3% of parents in the children’s hospital agreed that the way in which the bad news about their disease or their child’s illness was broken to them, conformed to their ethical standards.

Truth Telling has been found as one of the most important issues in physician patient communication. Therefore all of the physicians are concerned with this matter in some way. Disclosure or reticence of the truth has also caused ethical or legal problems. So correct approach to this issue is very important. Truth – telling is more important especially in some diseases such as cancer because it has a meaning as same as death in many cultures. It seems stage of cancer, social culture, socioeconomic condition, intelligence, education and some other factors affect patients, view and duration of practice stage of disease and some other factors influence physicians, opinion the main goal of this plan is to determine the attitude of patients and physicians about truth telling to cancer patients. this study is a descriptive one that has been performed in Omid hospital in Isfahan. The bulk sample was considered 50 physicians and 150 patients. The sampling method was non probability for physicians and non-probability (sequentional) for patients. The tool of gathering the data were two standardized questioner’s (every include 22 questions) asking about attitude. Gathering data was analyzed by SPSS software. All of the questionnaires were analyzed. About truth telling to early stage cancer patient %88 of patients and %90 physicians were agree and %78 patients and %72 physicians were agree with truth telling to terminal stage cancer patient. Both of physicians and patient were agree with frankness in telling the diagnosis, no effect of patient socioeconomic condition on truth telling and telling the truth immediately after diagnosis. In both group view doctor is the best person for telling the cancer diagnosis. The best place in patients, view is doctor office and in physicians, view is a quiet and undisturbed room. The majority of idea in both groups was giving the complete information to cancer patients about diagnosis, prognosis, treatment and side-effects of treatment. Noticing the obtained results in our society culture, the majority of patients regardless of age, sex, marring state level of education, job condition and incoming, and the majority of physicians regardless of age, sex, marring state, having relative with cancer and medical experience had positive attitude about truth telling to patients in different stages of cancer. So it seems it is one of the essentials to tell the truth based on a correct method.

This study was done in order to assess the appropriateness of elevators of public/private buildings located in Mazandaran province. This was a cross-sectional study done in summer 2010. Examined buildings were randomly selected when there were many samples, however, all were assessed if were unique or less than 4 such in the cities. A check list was developed according to governmental standards. Content validity was obtained by consultation with experts and consumers. Reliability was tested by "test-re-test" method (using Pearson correlation Coefficient, r 0.77). Thirty five hundreds buildings in 4 categories (educational, health care related, community services, residential and leisure places) were assessed with 4 items regarding the function and services to provide. Items were included: presence of sliding doors, enough space of lift for accommodating at least one wheelchair, appropriate height and place of the order button in/out of the elevator, palpable button for use by blind handicapped. Scales for evaluation were as; existed/none existed. Data entered the SPSS (16) software to analyze. One thousand and three hundreds and ten community service (CS), 1010 residential / leisure places (RLP), 830 health care related buildings (HCR) and 350 educational buildings (EB) were evaluated. In 93% of CS, 94% of RLP, 92% of HCR and 83% of EB, the mentioned criteria were not met. Despite the existence of a dedicated legislation for comply; the vast majority of elevators were not suitable for the disabled. Needed corrections are necessary and essential.