Physicians’ attitude toward their ethical responsibility regarding air pollution: a qualitative research
AbstractAir pollution is among the environmental problems that adversely affect people’s health. There is a close relationship between medicine and environment, and as a consequence, there are ethical considerations surrounding the problem of air pollution. The present research aimed to determine physicians’ attitude toward their ethical responsibility regarding air pollution, and their role in reducing it. This was a qualitative research using content analysis, conducted in Tehran University of Medical Sciences. The focus group included 21 physicians with specialties and subspecialties in pediatrics, infectious diseases, pulmonology, gynecology, and midwifery selected through predetermined sampling along with 13 personal in-depth interviews. A number of questions were asked regarding physicians’ ethical responsibility to decrease environmental crises, particularly air pollution.As a result, 4 themes and 20 subthemes were extracted by assessing the focus group and interviews. These four general themes included the role of a physician as 1) an ordinary person, 2) a special citizen and a role model, 3) a professional person with special personal and social commitments, and 4) an administrator of the healthcare system.In the present research, physicians acquired a special attitude toward air pollution. The research population mentioned physicians’ impact as role models for the society, as well as their educational, supervisory, informative, promotional, and administrative roles among their most important obligations regarding air pollution. It is recommended to conduct further studies on physicians’ knowledge, attitude and practice regarding their responsibility toward environmental issues in order to investigate this important matter further.
2. Roemer W, Hoek G, Brunekreef B. Effect of ambient winter air pollution on respiratory health of children with chronic respiratory symptoms. Am Rev Respir Dis. 1993; 147(1): 118–24.
3. Schwela D. Air pollution and health in urban areas. Rev Environ Health. 2000; 15(1-2):13-42.
4. Brunekreef B, Holgate ST. Air pollution and health. Lancet. 2002. 360(9341): 1233-42.
5. Watson BK, Sheppeard V. Managing respiratory effects of air pollution. Aust Fam Physician. 2005; 34(12):1033-6.
6. Del Donno M, Verduri A, Olivieri D. Air pollution and reversible chronic respiratory diseases. Monaldi Arch Chest Dis. 2002; 57(3-4):164-6.
7. Ritz B, Yu F, Fruin S, Chapa G, Shaw GM, Harris JA. Ambient air pollution and risk of birth defects in Southern California. Am J Epidemiol. 2002; 155(1): 17–25.
8. Kai-Chieh Chen E, Zmirou-Navier D, Padilla C, Deguen S. Effects of air pollution on the risk of congenital anomalies: a systematic review and meta-Analysis. Int J Environ Res Public Health. 2014; 11(8): 7642–68.
9. Stieb DM, Chen L, Eshoul M, Judek S. Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis. Environ Res. 2012; 117: 100-11.
10. Bosetti C, Nieuwenhuijsen MJ, Gallus S, Cipriani S, La Vecchia C, Parazzini F. Ambient particulate matter and preterm birth or birth weight: a review of the literature. Arch Toxicol. 2010; 84(6): 447-60.
11. Sunyer J. The neurological effects of air pollution in children. Eur Respir J. 2008; 32(3): 535-7.
12. Ibald-Mulli A, Stieber J, Wichmann HE, Koenig W, Peters A. Effects of air pollution on blood pressure: a population-based approach. Am J Public Health. 2001; 91(4): 571–7.
13. Brook RD. Cardiovascular effects of air pollution. Clin Sci (Lond). 2008; 115(6): 175-87.
14. Bellinger DC. Teratogen update: lead and pregnancy. Clinical and Molecular Teratology. 2005; 73(6): 409-20.
15. Gauderman WJ, McConnell R, Gilliland F, et al. Association between air pollution and lung function growth in southern California children. Am J Respir Crit Care Med. 2000; 162(4 Pt 1): 1383–90.
16. Garza A, Vega R, Soto E. Cellular mechanisms of lead neurotoxicity. Med Sci Monitor. 2006; 12(3): RA57-65.
17. Schell LM, Gallo MV, Denham M, Ravenscroft J. Effects of pollution on human growth and development: an introduction. J Physiol Anthropol 2006; 25(1): 103-12.
18. Rubes J, Selevan SG, Evenson DP et al. Episodic air pollution is associated with increased DNA fragmentation in human sperm without other changes in semen quality. Hum Reprod 2005; 20(10): 2776-83.
19. Nieuwenhuijsen MJ, Basagana X, Dadvand P, et al. Air pollution and human fertility rates. Environ Int. 2014; 27: 9–14.
20. Afroz R, Hassan MN, Ibrahim NA. Review of air pollution and health impacts in Malaysia. Environ Res. 2003; 92(2): 71-7.
21. Wong CM, Atkinson RW, Anderson HR, et al. A tale of two cities: effects of air pollution on hospital admissions in Hong Kong and London compared. Environment Health Perspectives. 2002; 110(1): 67-77.
22. Wong TW, Lau TS, Yu TS, et al. Air pollution and hospital admissions for respiratory and cardiovascular diseases in Hong Kong. Occup Environ Medicine. 1999; 56(10): 679-83.
23. de Leon AP, Anderson HR, Bland JM, Strachan DP, Bower J. Effects of air pollution on daily hospital admissions for respiratory disease in London between 1987-88 and 1991-92. J Epidemiol Community Health 1996; 50(Suppl 1): s63-s70.
24. Atkinson RW, Bremner SA, Anderson HR, Strachan DP, Bland JM, de Leon AP. Short-term associations between emergency hospital admissions for respiratory and cardiovascular disease and outdoor air pollution in London. Arch Environ Health. 1999; 54(6): 398-411.
25. Bickerstaff K. Risk perception research: socio-cultural perspectives on the public experience of air pollution. Environ Int 2004; 30(6): 827-40.
26. Parsons R. The potential influences of environmental perception on human health. Journal of Environmental Psychology. 1991; 11(1): 1-23.
27. Elliott SJ, Cole DC, Krueger P, Voorberg N, Wakefield S. The power of perception: Health risk attributed to air pollution in an urban industrial neighborhood. Risk Analysis. 1999; 19(4):621-34.
28. Slovic P. Perception of Risk. Science. 1987: 236(4799): 280–5.
29. Brunekreef B, Beelen R, Hoek G, Schouten L, Bausch-Goldbohm S, Fischer P. Effects of long-term exposure to traffic-related air pollution on respiratory and cardiovascular mortality in the Netherlands: the NLCS-AIR study. Res Rep Health Eff Inst. 2009; (139):5-71.
30. Bradley EH, Curry LA, Devers KJ. Qualitative data Analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res. 2007; 42(4):1758-72.
31. Strauss AC, Corbin JM, editors. Basics of Qualitative Research, 3rd ed. USA: SAGE Publication; 2008.
32. Sutton J, Austin Z. Qualitative research: data collection, analysis, and management. Can J Hosp Pharm. 2015; 68(3): 226-31.
33. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research. 2005; 15(9): 1277-88.
34. Leung L. Validity, reliability, and generalizability in qualitative research. J Family Med Prim Care. 2015; 4(3):324-7.
35. Lorenzoni I, Pidgeon N. Public views on climate change: European and USA perspectives. Climate Change. 2006; 77: 73–95.
36. Rahman SA. Religion and Animal Welfare-an Islamic Perspective. Animals (Basel). 2017; 7(2):11.
37. Abdul Rahman S, Aidaros H. Islam and animal welfare with special reference to cruelty to animals during transport and slaughter. Animals. 2012; 28: 27–30.
38. Izzi Deen MY. Ethics of Environment and Development: Global Challenge, International Response [dissertation]. USA. University of Arizona; 1991.
39. Anonymous. World Health Organization. http://www.who.int/globalchange/publications/climatefootprint_report.pdf (accessed on 2017).
40. Louis ME, Hess JJ. Climate change: impacts on and implications for global health. Am J Prev Med. 2008; 35(5):527-38.
41. Remoundou K, Koundouri P. Environmental effects on public health: an economic perspective. Int J Environ Res Public Health. 2009; 6(8): 2160-78.
42. Anaker A, Nilsson M, Holmner A, Elf M. Nurses' perceptions of climate and environmental issues: a qualitative study. J Adv Nurs. 2015; 71(8):1883-91.
43. Poumadere M, Mays C, Le Mer S, Blong R. The 2003 heat wave in France: dangerous climate change here and now. Risk Anal. 2005; 25(6):1483-94.
44. Pearson D, Walpole S, Barna S. Challenges to professionalism: social accountability and global environmental change. Med Teach. 2015; 37(9): 825-30.
45. Prasad V, Thistlethwaite W, Dale W. Effect of clinical vignettes on senior medical students' opinions of climate change. South Med J. 2011; 104(6): 401-4.
46. Dhillon VS, Kaur D. Green Hospital and Climate Change: Their Interrelationship and the Way Forward. Journal of Clinical and Diagnostic Research. J Clin Diagn Res. 2015; 9(12):LE01-LE05.
47. Harris N, Pisa L, Talioaga S, Vezeau T. Hospitals going green: a holistic view of the issue and the critical role of the nurse leader. Holist Nurs Pract. 2009; 23(2):101-11.
48. Anonymous. Code of ethics. www.icn.ch/about-icn/code-of-ethics-for-nurses (accessed on 2017).
49. Anonymous. Ethical guidelines. http://mehr.tums.ac.ir/ShowCode.aspx?CodeID=9&lang=fa (accessed on 2017).
50. Anonymous. Ethical guidelines. http://mehr.tums.ac.ir/ShowCode.aspx?CodeID=130&lang=fa (accessed on 2017).