مجله ایرانی اخلاق و تاریخ پزشکی
سال ششم شماره 5 (آذر 1392)

Moral dilemmas caused by modern diagnostic and therapeutic advances in medical science have increased the need to address medical ethics a hundredfold. Medical ethics is a «science»، so the method needs scientific work. In order to achieve the objectives of any science، we need to define and resolve the ambiguities surrounding it. Notwithstanding the definitions presented in conjunction with the science of medical ethics، still some issues remain unclear about it. An important part of our knowledge consists of the answers to what things are، and that is nothing but definitions. Definitions comprise the bulk of our perceptions and therefore need to be employed. This review article is the result of a descriptive study. The data were collected through studying credible textbooks and searching internet resources and related articles. While emphasizing the need to clarify the definition of science and characteristics of logical definition، this paper evaluates some of the definitions of medical ethics and by showing their weak points، notes that there is a need for a logical definition of this science and the necessary consideration

Patient''s refusal of treatment is the rational consequence of informed consent and is considered among the patient''s rights but can lead to patient harm or harm to others، or damage to the health care system. Major ethical challenges in the field of treatment refusal arise from capacitated patients. This paper mainly examines theoretical issues related to this group by reviewing books on jurisprudence، philosophy and bioethics، especially textbooks that include moral philosophers'' perspectives، the views of experts in bioethics and jurisprudential considerations related to this issue. These views sometimes are very different or in conflict with each other. Based on different schools of philosophy or ethics، our encounters with patients who refuse treatment can range from abandoning patients on the one hand to treating them at any cost، even by coercion or deception on the other hand. According to Islamic perspectives، people have no right to harm themselves، but because of the authority that each person has on his or her body، this does not mean that compulsory treatment is permitted; it means that caregivers must try to persuade patients to accept treatment، and must not cooperate with them to harm themselves and to discontinue treatment specifically.

Abortion is a challenging issue. It is proposed as a problem in medical philosophy and medical ethics texts. In dealing with abortion، graduate medical students may be influenced by different situations، or make a decision according to their conscience. Therefore they should acquire a satisfactory level of ethical development to deal with these issues during their years of education. Some things that are important for education on abortion are law، religious and moral reasoning، understanding the moral reasoning of people who request an elective abortion and related ethical philosophies. If health providers want to make the right decision and manage the patient suitably، they should be aware of the moral reasoning of the abortion applicant، religious moral reasoning، legal issues، and the ethical philosophies related to elective abortion، so they can do the best thing when dealing with abortion applicants. Sometimes the abortion applicant or the health provider thinks that abortion is an ethical action، but according to religion and the philosophy of ethics it is not. Therefore supporting health may be warranted by educating medical students on ethics as well as religious rules and legal issues.

Self-citation is a behavior that is seen to varying degrees in researchers، research centers and medical journals. The question is whether self-citation is moral or not. This is a descriptive and analytical study (library and document research). Two main keywords (self-citation and ethics) were used for searching databases. In addition، efforts have been made for moral evaluation of self-citation by review articles from databases، ethical-codes and related guidelines. When self-citation is employed to drive readers to a better and easier understanding of an article، it is acceptable and even necessary، but when it is done mainly to increase reference to one’s articles، it is non-essential. Since unnecessary self-citation could mislead researchers and policymakers، bring false prestige for individuals، institutions and magazines، and create unhealthy competition among researchers، it is immoral. Moreover، forcing authors to use an article as reference without a scientific reason is wrong and unethical practice. Modification of evaluation methods for researchers، magazines and research centers to eliminate self-citation and also appropriately informing them about the ethical aspects of unnecessary self-citation could be effective in reducing this phenomenon. It is recommended to observe and inform the rate of unnecessary self- citation among authors، research centers and journals.

Do not resuscitate order (DNR) is one of the most challenging issues in end of life care. The attitude of health care providers has an important role in legalization of this procedure. The aim of the present study was to investigate the viewpoints of nursing students on DNR orders. One hundred and eighty six nursing students from Tabriz University of Medical Sciences (TUOMS) and Kurdistan University of Medical Sciences (KUMS) participated in the present study. Data collection was performed by Attitude on DNR Order Questionnaire that consisted of 25 items. The results showed that nursing students have a negative attitude toward many aspects of DNR orders، had many misconceptions about this procedure and tended to acquire more information about it. Also، students reported a negative attitude about passive euthanasia and reported that cultural and religious factors are important in their attitude toward DNR orders. Moreover، there was no statistical difference between the attitudes of nursing students from these two universities with two different cultural and religious backgrounds (P > 0. 05). Considering the lack of knowledge of nursing students about DNR orders it is suggested that nursing students should be educated on the subject. Due to little research evidence conducting further studies is recommended.

Moral intelligence is one of the dimensions of intelligence that can provide a framework for the proper function of man، and be used as a predictor for people’s conduct. Nurses’ performance is of great importance because of the moral and human nature of their profession، and their adherence to ethical principles improves the nursing care quality as well as organizational performance. Therefore، the present study aimed to assess moral intelligence in nurses. This cross-sectional study was conducted on 400 nurses from teaching hospitals in South Khorasan. Participants were selected through census method. Data were collected by Lennik & Kiel’s moral intelligence questionnaire، and data analysis was performed using SPSS 16 software and descriptive and analytical statistics tests. The results suggest that the nurses’ moral intelligence score was 4. 35 ± 0. 56 (range: 1-5). There was a direct and meaningful relationship between moral intelligence and age and years of practice (P < 0. 05). Optimal levels of moral intelligence suggest the importance that nurses attribute to moral values، and can also be an indirect manifestation of their moral conduct in healthcare environments.

Medical ethics is a set of moral values that apply principles and responsibilities to the practice of medicine and is a fundamental part of medical education. The current study investigated the effectiveness of the medical ethics curriculum and the best method for its implementation from interns’ point of view. The current cross-sectional descriptive study was carried out in July 2012. The research tool was a questionnaire developed in the medical ethics department and handed to all interns. The validity and reliability of the tool was confirmed using content validity and internal consistency (α= 0. 72) methods respectively. Data was analyzed using SPSS software and reported by the use of descriptive statistics، particularly mode، as a measure of central tendency. Seventy-one interns (60%) responded to the questionnaire، 54% of whom were female and 55% in the second internship year. In response to the achievement rate of expected outcomes such as the extent to which the educational objectives have been reached، and the suitability of content with the needs felt in real clinical situations، modes were all ranked in the ategory of «low». The modes of the responses to the stressfulness of different ethical situations were mainly ranked in the category of «high». To assess the best methods for teaching knowledge as well as medical ethics skills and attitudes، the following were the mode of interns'' responses: group discussion (38%) for teaching the basics، and presentation of a case with the solution (70%) for teaching clinical ethics. The most appropriate methods of student evaluation were considered patient management problem and performance evaluation in the ward by 25 (36%) and 21 (31%) of interns respectively. The current study showed the effectiveness of medical ethics curriculum was low and the students requested presenting this course in a more practical way. It would appear that a two unit theoretic course does not have the efficiency to modify students’ attitudes and behavior to encounter challenging ethical situations، and therefore fundamental changes are suggested.