The Journal of Medical Ethics and History of Medicine is the official scientific publication of the Medical Ethics and History of Medicine of Tehran University of Medical Sciences. Physicians and health practitioners always deal with ethical issues in the treatment and management of diseases. The advent of new biomedical technologies further complicated the moral and societal issues of medical research and practice. Religious and cultural differences more emphasize the need for nationalizing this knowledge. The Journal of Medical Ethics and History of Medicine (J Med Ethics Hist Med) is an opportunity for healthcare professionals as well as theologians, philosophers, and sociologists to present and discuss their ideas from several aspects in relation to medical ethics and bioethics. In addition, this Journal traces its roots to several aspects of the History of Medicine which further emphasizes on Iranian and Islamic eras.


Current Issue

Vol 15 (2022)

Original Article(s)

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    This study aims to assess the psychometric properties of the Persian version of the Attitudes Toward Plagiarism Questionnaire (ATPQ) among Iranian medical sciences postgraduate students and faculty members. In this study, the ATPQ developed by Mavrinac et al. in 2010 was translated into Persian. After assessment of face and content validity, we distributed the ATPQ draft among 286 Iranian medical science postgraduate students and faculty members. Explanatory and confirmatory factor analysis were applied, and Cronbach's alpha was used to measure the reliability of the ATPQ. All the items of our English version of the ATPQ were approved by the developer of the original ATPQ, and two were revised in the cognitive interview. Construct validity assessment showed that three items were not seriously involved in the extracted factors. The Persian version of the ATPQ had 26 items, five factors and a Cronbach's alpha of 0.81%, and the combined value explained 38.24% of the total variance of this scale. Two new factors of “perceived control” and “attitude toward self-plagiarism” were extracted and incorporated into the Persian version. To conclude, the ATPQ is a valid, reliable, and convenient instrument to determine attitudes toward plagiarism among Iranian medical science postgraduate students and faculty members.

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    Media is an opportunity for health professionals; however, it is not free of threats. Fixing the threats requires professional systematization through developing practical guidelines, which brings us to the goal this study was designed to achieve. The study was conducted qualitatively through literature review, semi-structured interviews, and a focus group discussion with health and media experts, as a result of which 486 codes were extracted and classified into 4 groups. The first group was addressed to media professionals and contained 126 codes in 5 categories: seeking and reporting the truth, harm minimization, integrity, independence, and respect for the rights of others. The second and third groups were addressed to health professionals, the former (150 codes) dealing with formal media, and the latter (190 codes) dealing with cyberspace. These groups were both categorized into 6 categories: scientific demeanor, beneficence, harm minimization,integrity, maintaining the dignity of the profession and professionals, and respect for the rights of others. The fourth group was addressed to the public audience and contained 20 codes categorized into 2 categories: ethics of belief, and ethics of (re-)publishing. Since the study was conducted during the pandemic/infodemic, the proposed codes can help reduce possible conflicts in similar future situations.

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    Breaking bad news to patients is an essential aspect of the physician-patient relationship, but in Iran, this relationship is often disrupted by patients’ families. This study investigates the views of patients' companions on breaking cancer news. In this descriptive-analytic cross-sectional study, we conducted research on 170 cancer patients’ companions and 170 non-cancer patients’ companions. We designed a questionnaire to investigate the subjects’ opinions and used CVI, CVR, Cronbach's alpha and ICC for evaluation. In order to compare groups, we used Mann Whitney, Kruskal-Wallis, Chi-square tests and Spearman’s correlation. Most participants believed that patients should be informed of their diagnosis. Cancer patients' companions were more willing to learn the bad news in case they were diagnosed with cancer and were less likely to choose “despair” as the reason for non-disclosure (71% vs. 44%).There was no difference between the two groups in willingness to break the cancer news to patients, choosing who should be informed first, and the reasons for non-disclosure. Most participants believed the family should be the first to know the diagnosis. In this study, most participants believed that patients should be informed of their diagnosis. However, they preferred to learn about the diagnosis before the patient, which confirms the importance of educating the families about autonomy.

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    Ethical decision-making and professional behavior are essential skills in nursing profession, hence educational programs should be designed to enable future nurses to tackle problems related to ethical decision-making. This descriptive, correlational and analytical study aimed at determining the ability of Iranian nursing students to make ethical decisions as well as relationship between such decisions and professional behavior. The present study used census to select 140 freshmen from the School of Nursing and Midwifery of Tabriz University of Medical Sciences, Tabriz, Iran. Data collection tools included a demographic questionnaire, the Nursing Dilemma Test (NDT) comprising two indices of “nurse’s principled thinking” and “practical consideration”, as well as the Nursing Students Professional Behaviors Scale (NSPBS). The mean scores obtained were 41.3±5.7 for “nurse’s principled thinking”, 21.3±3.7 for “practical consideration”, and 119.07±11.79 for professional behavior. Relationships of professional behavior with “nurse’s principled thinking” and “practical consideration” were insignificant (P>0.05). According to the present study’s findings, nursing students’ weakness in applying ethical concepts to decisions and professional behaviors was due to a gap between scientific material learned and clinical practice. Hence, novel training strategies and programs should be designed to reduce such theory-practice gap

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    Role modeling is one of the most influential components of teaching professional behaviors to nursing students. The Role Model Apperception Tool (RoMAT) was designed in the Netherlands to measure role modeling behaviors in clinical educators. The aim of this study was assess the psychometrics of the Persian version of this tool.In a methodological study, the Persian version of the RoMAT tool was developed using the forward-backward translation method. Face validity was confirmed through cognitive interviews, and content validity was done by a panel of 12 experts. Construct validity was assessed through exploratory factor analysis (n = 200), and confirmatory factor analysis (n = 142) was evaluated after the tool was completed online by undergraduate nursing students. Reliability was confirmed using internal consistency and test and retest methods. Furthermore, ceiling and floor effects were assessed.The two components of "professional competencies" and "leadership competencies" emerged with a cumulative variance of 62.01%, a reliability with Cronbach's alpha of 0.93 and 0.83, and an intraclass correlation of 0.9 and 0.78, respectively. It was concluded that the Persian version of the Role Model Apperception Tool is a valid and reliable tool and can be used to investigate the role modeling behaviors of clinical instructors of nursing students.

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    In intensive care units (ICUs), patient privacy is of particular importance due to the structure of the ward environment and the critical situation of the patients. The aim of this study was to identify the dimensions of patient privacy in ICUs. For this purpose, a descriptive-qualitative-exploratory study was performed. The data collection methods included observations and interviews, which were handwritten and analyzed using qualitative content analysis with a conventional approach. A total of 27 participants were selected based on purposeful sampling and with maximum diversity of health-care providers and recipients. The study environment was the ICUs of two selected hospitals affiliated to the medical sciences universities of Isfahan and Tehran, Iran. The data were analyzed into 4 classes and 12 subclasses. The classes included physical, informational, psychosocial, and spiritual-religious privacy. Findings of the present study identified hidden layers of patient privacy as a multidimensional concept that is influenced by various factors. In order to provide holistic care, preparing the grounds for patient privacy ‎and familiarizing the staff with its various dimensions seem necessary.

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    Professionalism has been recognized as an essential component of inter-professional collaboration (IPC), and hence this study aimed at exploring elements of inter-professional professionalism (IPP) affecting IPC among surgery teams. This qualitative study had been conducted from 2019 to 2021. Fifteen participants in surgery teams including surgeons, anesthesia nursing, and surgical technology nursing at hospitals of Shahid Sadoughi University were contributed to this study. Data was collected through semi-structured interviews and analyzed through inductive content analysis, an approach introduced by Lundman and Graneheim. Data analysis process included the following: (i) Developing verbatim transcription of interview, (ii) Extracting semantic units and classifying them under the top compact unit, (iii) Summarizing and classifying the compact units and selecting appropriate labels for them, and (iv) Sorting subcategories according to their similarities and differences. Two hundreds and forty-two codes, five sub-categories, two categories, and a theme entitled "reciprocal accountability in IPP” were extracted. The barrier category was named “weakness in accountability to team-based values" and the facilitator category was called "responsibility of maintaining empathetic relationship within the IP team".Development of IPP and professional values (e.g., altruism, empathetic communication, and accountability to individual’s and team’s roles) can facilitate collaborative processes among different professions.

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    Emergency medical technicians (EMTs) are very likely to leave the profession due to their obligation to work in critical situations such as the COVID-19 pandemic. This study aimed to investigate the relationship between the ethical work climate and the intention to leave the service among EMTs. In this descriptive correlational study, 315 EMTs working in Zanjan province were surveyed using the census method in 2021. The research tools included the Ethical Work Climate and the Intention to Leave the Service questionnaires. Data were analyzed using SPSS software version 21. We found the mean (SD) score of the organization's ethical work climate to be 73.93 (±12.53), and the intention to leave the service 12.54 (±4.52), which are at a moderate level. A statistically significant positive correlation existed between these variables (r = 0.148, P = 0.017). Also, there was a statistically significant relationship between age and employment status among the demographic variables, and the ethical work climate and the intention to leave (P < 0.05). Our findings indicate that ethical work climate is one of the influential but less noticed factors that affect the performance of EMTs. Therefore, it is suggested that managers implement measures to develop a positive ethical work climate to reduce the tendency to leave the service among EMTs.

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    The present study aimed to compile and develop a professional guideline for health-care providers in Iran regarding cyberspace usage. This was a mixed-methods study, conducted in three phases. In the first phase, the principles of ethics in cyberspace were collected through a review of the literature and available documents, and were then subjected to content analysis. In the second phase, the views of experts on medical ethics, virtual education, information technology and medical education, as well as clinical sciences experts and representatives of medical students and graduates were evaluated using the focus group method. In the third phase, the draft was evaluated by various stakeholders. Finally, after receiving the comments, the necessary modifications were applied to the guideline.The professional guideline for the use of cyberspace by health-care professionals comprised 30 codes in 5 domains, including the general regulations domain, care and treatment, research, education, and personal development.This guideline presents the various ways professionalism can be maintained in cyberspace interactions. Adherence to the principles of professionalism in cyberspace is required to protect and preserve the public trust in health-care professionals.

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    The quality of care crisis (QCC) is one of the most crucial crises the modern medicine is confronting, as the existential and psychological needs of patients have not been addressed and satisfied. Several attempts have been made to find solutions for QCC, e.g., the Marcum's recommendation to make physicians virtuous. Most of the existing formulations for the QCC have regarded technology as one of the causes of this crisis and not part of its solution.Although the authors agree with the role of technology in creating the crisis of care to some extent, in this article we try to present the crisis of care so that medical technology is an important part of its solution. For this purpose, we analyzed QCC from the philosophical perspectives of Husserl and Borgmann and put forward a novel proposal to take account of technology in QCC. In the first step, it is discussed that the role of technology in causing the crisis of care is due to the gap between the techno-scientific world and the life-world of the patients. This formulation shows that the crisis-causing role of technology is not inherent. In the second step, it is tried to find a way to integrate technology into the solution to the crisis. In the proposed reframing, designing and applying technologies based on focal things and practices make it possible to develop technologies that are caring and are able to mitigate QCC.

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    One critical tactic that leads to a better understanding of the ethical status of dentists is to assess their ethical attitude by using an appropriate scale. This study aimed to design and evaluate the validity and reliability of the ethical attitude of dentists scale (EADS).This study was conducted based on a mixed‐method design. The first qualitative part of the study was conducted in 2019 and the items of the scale were produced from the ethical codes compiled in a previous study. In this part, the psychometric analysis was conducted. The reliability was evaluated by Cronbach's alpha coefficient and intraclass correlation coefficient. Factor analysis was used to assess the construct validity (n = 511), and the following three factors were extracted with a total variance of 48.03. (1) Maintaining the standing of the profession in relationships. (2) Providing dental services while maintaining trust in the profession, and (3) Providing information for the benefit of the patient.In confirmatory factor analysis, appropriate values were obtained for the goodness of fit indices, and Cronbach’s alpha was 0.68 - 0.84 for the various factors. Based on the results mentioned above, this scale showed an appropriate validity and reliability for measuring the ethical attitude of dentists.

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    In order to lessen health inequalities, the obstacles to health equity will need to be identified. This study aimed at investigating the barriers to access to health-care services from the medical ethics point of view. Data were collected through a qualitative study by performing semi-structured interviews. Purposive sampling was used to recruit participants involved in health provision and/or management. Content analysis was done using MAXQDA software. Overall, 30 interviews were conducted. The content analysis of the interviews identified two themes including “micro factors” and “macro factors”, five sub-themes including “cultural, financial, geographical, social and religious barriers”, and 44 codes. Based on our findings, differences in individuals’ perceptions, cultural control, religious beliefs and social stigmas create cultural barriers. Financial barriers consist of the financial connection between service recipients and service providers, insurance premiums, and inadequate coverage of health-care services. The most important geographical barriers identified in our study were differences in urbanization, inequality in various geographical areas, marginalization, and inequality in resource distribution. Finally, differences in the level of income, education and occupational diversity were among the social barriers. Given the wide range of barriers to access to health-care services, a comprehensive plan covering various dimensions of health equity should be implemented. To this end, innovative and progressive strategies emphasizing the principles of equity and social equality should be developed.

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    The professional quality of life of pre-hospital emergency technicians has been adversely affected during the COVID-19 pandemic. The present study was performed to investigate the professional quality of life and resilience and their relationships in pre-hospital emergency technicians of Kermanshah Province, Iran during the COVID-19 pandemic.This cross-sectional, descriptive correlational study was conducted on 412 pre-hospital emergency technicians in Kermanshah Province in 2020 using the census method. Data collection tools were the Stamm Professional Quality of Life Questionnaire and the Emergency Medical Services Resilience scale.Pre-hospital emergency technicians experienced moderate levels of the professional quality of life dimensions and high/acceptable levels of resilience. There was a significant correlation between resilience and the dimensions of the professional quality of life.The results of the regression test showed that resilience had a significant effect on all three components of the professional quality of life. Therefore, the use of resilience enhancement strategies is recommended to improve the professional quality of life of pre-hospital emergency technicians.

Review Article(s)

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    Due to the high value of human life, the occurrence of even one error that leads to death or complications is of great consequence and requires serious attention. Although significant efforts have been made to ensure patient safety, serious medical errors continue to exist. This study aimed to identify the factors associated with the recurrence of medical errors and strategies to prevent them through a scoping review.Data were gathered through a scoping review of PubMed, Embase, Scopus, and Cochrane Library databases during August 2020. Articles related to factors influencing the recurrence of errors despite the available information, as well as articles related to measures taken worldwide to prevent them, were included in study. Overall, 32 articles were selected out of the 3422 primary papers. Two main categories of factors were identified as influential in error recurrence: human factors (fatigue, stress, inadequate knowledge) and environmental and organizational factors (ineffective management, distractions, poor teamwork).The six effective strategies for preventing error recurrence included the use of electronic systems, attention to human behaviors, proper workplace management, workplace culture, training, and teamwork.It was concluded that using a combination of methods related to health management, psychology, behavioral sciences and electronic systems can be effective in preventing the recurrence of errors.

Case Report(s)

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