Journal of Medical Ethics and History of Medicine

How can physicians’ professional reputation be damaged? Patients’, nurses’ and physicians’ viewpoints

Ali Abdollahi — 2024-04-22

As a rule, physicians’ reputation significantly influences public confidence in the medical profession. Unfortunately, the societal perception of physicians in contemporary Iran appears to be negatively impacted. Therefore, the present study aimed to analyze and elucidate the fundamental causes of this phenomenon.This qualitative study employed content analysis of semi-structured interviews conducted in 2022. The study population consisted of 6 physicians, 6 nurses and 12 patients in the the affiliated hospitals in Kerman University of Medical Sciences selected through purposive sampling. Extraction of the main themes followed the Graneheim and Lundman approach, and data management was facilitated through MAXQDA 20. The study identified five themes encapsulating the causes for damage to physicians’ reputation: physicians' relationship with patients, physicians' relationship with the community, physicians' relationship with the medical profession, challenges within medical practice, and challenges related to medical education. Within these themes, a total of 38 subthemes emerged.The primary drivers that seem to damage physicians’ reputation include: non-effective communication, negative public attitudes toward certain physicians and medical centers due to malpractice, illegitimate relationships of physicians, gaps in physicians’ skills, insufficient education, and ethical lapses.It was concluded that several infrastructural elements negatively impact physicians' reputation. Consequently, it is recommended to monitor the professional behaviors, practices and relationships of physicians, while scrutinizing the medical education system.

The criterion of human dignity in the Quran

Seyed Abdosaleh Jafari — 2024-04-24

In the Holy Quran, a strong emphasis has been placed on the dignity of human beings. There are two verses in the Quran that discuss the differences between humans and other creatures. In this article, we have tried to interpret these two verses using free selection of virtues and goodness as the criterion for human dignity that was obtained in our previous research. In the verse of trust, unlike other creatures, man accepts a trust that informs us about his cruelty and ignorance. However, if we consider this trust as freedom of choice, it can also imply injustice and ignorance alongside justice and wisdom for humans. In the verse of succession, angels tell God that human as vicegerent on earth leads to corruption and bloodshed. God does not deny this, but reminds the angels of the existence of pure ones. If we consider freely choosing goodness the differentiating factor between humans and other creatures the angels accurately refer to the possibility of creating corruption and bloodshed. However, they did not see the value of voluntary goodness compared to their own compulsory goodness.Therefore, by considering freely choosing goodness as the criterion for human dignity, these two verses can be easily interpreted.

The challenges of research in the field of human dignity

Seyed Abdosaleh Jafari — 2024-11-18

Research on human dignity is crucial for understanding the ethical foundations of human rights. Neglecting to address certain pitfalls in this area of research can lead to adverse effects, including the perpetuation of discrimination, the misrepresentation of dignity across different schools of thought, and the weakening of ethical standards in human rights discourse. The present study aims to identify such challenges by analytically examining outstanding research in this field. Our surveys have identified challenges and pitfalls that were categorized into two groups: challenges in the field of materials, and challenges in the field of methods. In terms of materials, researchers may fail to adequately consider the historical and cultural contexts that shape these views, while in terms of methods, they may overlook the diverse perspectives that contribute to a comprehensive understanding of dignity. Consequently, it is imperative for researchers to remain vigilant and avoid these pitfalls to ensure that their work upholds the true essence of human dignity and effectively advocates for the rights of all individuals, especially those from marginalized backgrounds.

Human dignity, minimum and maximum: what is the justification for the difference between male and female Diyah” in Islam?

Seyed Abdosaleh Jafari — 2024-11-19

Human dignity is discussed in fields such as law, theology and ethics. In human rights and law, dignity is fixed and equal for everyone, but in theology, it can be different based on human actions. The highest human position is obtained through voluntary selection of goodness. However, failure to achieve this does not indicate a complete loss of dignity from a religious point of view, as there are other characteristics that can bestow dignity. The existence of these dignifying factors creates minimum and maximum degrees of dignity, the maximum being discussed in theology, and the minimum in law and human rights. The laws on compensation for harm may lead to the false conclusion that dignity can be purchased, but we must remember that dignity has two dimensions: material and spiritual. While damage to the spiritual dimension cannot be undone, “Diya” has been provided in Islam to compensate for the material dimension. This explains the difference between male and female Diya in Islamic laws. Spiritual dignity is independent of gender, but to compensate for material dignity, higher Diya has been proposed for men as they have a more prominent role in financing the family. In the end, we will discuss that due to the role changes in the society nowadays, the laws will need to be modified.

Contemplating on human dignity: who counts as human?

Seyed Abdosaleh Jafari — 2024-11-18

The fundamental topic in humanities is clearly the study of humans. Neglecting the understanding and recognition of humans can hinder us from achieving generalizable results and may lead us toward arbitrary and group-based decisions. Failure to distinguish between biological species up to the point of denying the objectivity of species, conflicts between nominalists and realists, and limitations of logical definitions are problems that will be addressed in this article.In this study, it is argued that there is no universal definition for human beings as a biological species. Therefore, from a philosophical perspective, the rights and characteristics that are associated with humans in humanities cannot be attributed to human beings as a mere biological species. In an attempt to settle this issue, a minimal shared definition of “human” (as a philosophical entity) that encompasses differences and exceptions has been accepted and recognized.It is evident that an attachment cannot stand on the same level as the essence, and discussions regarding their incorporation should be considered.In this article, it has been concluded that the criteria for the philosophical human are self-awareness and freedom of choice, and offering a definition for “human” will be founded on these two features.

Human dignity: a contract or an abstract?

Seyed Abdolsaleh Jafari — 2024-11-19

Although human dignity has been the focus of many researchers, fundamental debates about its existence have often been ignored. Different views on human dignity and its existence can lead to divergent interpretations of human rights. In this study, we attempted to find an answer to the question of the nature of human dignity by examining and collecting the opinions of experts and analyzing and criticizing them. Our analysis showed that since dignity is linked to human existence and understanding, it has a subjective nature. Subjective existences have different types, including contractual and abstract. Contractual existence finds its way to objective entities through human thought, and it is changeable. An abstract existence, on the other hand, is created by perception of an objective entity in a constant way among human beings. Human dignity is consistent with the contractual type, because simply seeing a human does not bring to mind the existence of dignity and human rights. Once we accept the contractual nature of dignity, we must determine who bestowed this dignity on man. Through investigations, we came to the conclusion that God is the only one that can grant such privilege, and the existence of dignity for humans is a proof of God's existence.

Existence and Manifestations of human dignity: Can a person be deprived of dignity?

Seyed Abdosaleh Jafari — 2024-11-23

The criteria for assigning human dignity have been a subject of debate among researchers for years. Regardless of what criteria are chosen for human dignity, each school of thought must provide a method to identify them in people. The authors of this article consider voluntarily in choosing goodness and virtues to be the criterion. The purpose of this article is to present a method for establishing the existence of this criterion in humans and to examine the various manifestations of acting freely on what is good and virtuous by citing philosophical Islamic sources, especially the Qur'an. In this article, we will first discuss the differences among people regarding the existence of dignity and its manifestations, and move on to investigate the special conditions that can be challenging for allocation of dignity across different schools of thought. Finally, we will examine various Islamic sources to evaluate the methods of identifying human dignity in people. Our investigations show that since concepts such as “right” and “good” are of a subjective nature, there is more than one manifestation for presence of criterion of human dignity, and in practice, no one can be deprived of their dignity.

Evaluation of medical ethics education using the CIPP model: a study on the perspectives of medical students

Amirhossein Alirezaie — 2024-11-23

Many medical schools are adopting varied teaching strategies to enhance students' understanding of the humanitarian aspects of their specialties. This study evaluated medical ethics education at Kerman University of Medical Sciences (Iran) from the students’ perspectives using the CIPP model.A cross-sectional study involving 136 clerkship medical students used convenience sampling and a validated, researcher-made questionnaire based on the CIPP model. The questionnaire, divided into context, input, process, and product sections, assessed the achievement of the program's goals, requirements, implementation, and outcomes of the medical ethics training program.The results revealed that the product domain scored the highest (79.17±21.82), while the input domain scored the lowest (54.30±29.00). The medical ethics program successfully communicated ethical concepts and enhanced students' understanding, excelling in the product domain. However, it requires improvements in the context, input, and process areas, such as aligning materials with cultural norms, and boosting students.It is hypothesized that the medical ethics program at Kerman University of Medical Sciences is robust and aligns well with the CIPP model standards. While the program excels in educational outcomes, there is room for improvement in the context, input, and process dimensions. This study offers pivotal insights for advancing and refining future medical ethics programs.

Professional ethical challenges and suggested strategies in nursing: a qualitative study

Arezoo Ghavi — 2024-11-23

Professional ethics are important to support the ethical decision making of nurses and to respond to the current challenges in healthcare. This study was to explore professional ethical challenges and the strategies to address the ethical challenges in clinical in a Muslim country. This study used an exploratory descriptive qualitative approach. Two focus groups and semi-structured individual interviews were conducted, and data were analyzed using thematic analysis. Participants shared their experiences and perceptions of professional ethical challenges and suggested strategies. Nine ethical challenges were identified: 1) Less patient-centered care; 2) Giving bad news to the patient and family; 3) Ethical decision making about no treatment, no mechanical ventilation, and no resuscitation; 4) Not considering patients’ culture in nursing care; 5) New technologies and challenges related to overuse; 6) Health information as an ethical challenge for managing and using large patient datasets; 7) Nursing in disasters or crises and the challenge of respecting ethical principles; 8) Palliative care for patients; and 9) Fear created moral distress. Study findings highlight ethical challenges that nurses have in clinical practical and the strategies that can be used.moral distress. The findings underscore the ethical challenges faced by nurses in clinical practice and suggest strategies for addressing each challenge in Iran.

Are Iranian patients willing to receive clinical information and participate in treatment decisions?

Mobin Mohammadi — 2024-12-25

This study examined the extent to which patients are willing to receive medical information about their health status and participate in medical decision-making. It also assessed the patients' satisfaction with the amount of information provided to them and their involvement in treatment decisions. Additionally, the study evaluated differences between patients' and their companions' perspectives on the necessity of informing patients about their health status. This cross-sectional study included 110 eligible patients, who were interviewed using a developed and validated questionnaire.The results revealed that Iranian patients exhibited a relatively high tendency to seek information and participate in medical decision-making. This tendency was more pronounced among women, married individuals, and patients hospitalized in private hospitals. Additionally, the companions' inclination to inform patients about their clinical condition was lower than the patients' own desire to be informed. The study concluded that doctors should create an appropriate environment for informing patients and facilitating their active participation in decisions.Furthermore, the decision regarding the extent of information provided to patients should be left to the patients themselves.

Developing an Ethical Guideline for Making and Using Audiovisual Recordings of Patients in Iran

Mahboobeh Khabaz Mafinejad — 2024-12-25

Introduction: Widespread use of smartphones among health care professionals, and increasing audiovisual recording of patients with the aim of clinical and non-clinical purposes has emerged serious ethical, legal and social issues. To address such issues several guidelines have been developed in many countries. However, providing a practical and easily accessible ethical guideline with respect to national values seems necessary. Therefore, we developed an ethical guideline for making and using audiovisual recordings of patients with special attention to Iranian culture, social principles and Islamic commands.
Materials & Methods: This study was conducted at Tehran University of Medical Sciences in 2017-2019 and the guideline was developed through four phases: Literature review, focused group discussions, Expert panels, Assessing stakeholders’ views.
Results: The final draft of this guideline consisted of 43 items of "General Regulations" and 25 items of "Specific Regulations". The "General Regulations Section" covered the considerations before, during and after audiovisual recordings of patients. The "Specific Regulations Section" included ethical principles on audiovisual recordings of children and adolescents, cadavers, and patients with impaired decision making capacity as well as the ethical issues on broadcasting the recordings on public media.
Conclusion: Developing an ethical guideline for making and using audiovisual recordings of patients with respect to social, cultural and religious considerations will be helpful to address the emerging ethical, legal and social issues in this regard.

A comparison between the impacts of lecture and game based teaching on moral sensitivity among nursing students

Tayebe jalali — 2024-12-25

Effective educational strategies are crucial for developing moral sensitivity in nursing students. Traditional lecture-based methods may lack engagement, prompting the exploration of game-based approaches. This study compares the impacts of game-based and lecture-based teaching on nursing students' moral sensitivity.In this quasi-experimental study, 46 fourth-semester nursing students from Rafsanjan University of Medical Sciences participated. The control group received traditional lectures, while the intervention group engaged in game-based learning focused on moral scenarios in eight 90-minute sessions.Of the initial 46 students, 42 completed the study. Both groups had similar demographics. Post-intervention, the game-based group showed a statistically significant increase in total moral sensitivity scores (P = 0.017). Additionally, they scored higher in “experience of ethical problems and conflicts” (P = 0.044) and in “sincerity and benevolence” (P = 0.007) compared to the lecture group. It was concluded that game-based teaching methods significantly enhance moral sensitivity among nursing students compared to traditional lectures, particularly in areas related to ethical conflicts and benevolence. Future research should focus on the long-term effects and integration of game-based learning in nursing education.

Navigating ethical dilemmas in complementary and alternative medicine: a narrative review

Mohammad Sadegh Adel Mehraban — 2024-04-27

Complementary and alternative medicine (CAM) is a rapidly growing industry, with millions worldwide seeking these treatments for various ailments. While many CAM therapies have shown promise in improving health outcomes, there are also ethical challenges associated with them. In this article, we explore some of the most pressing ethical issues in CAM, including informed consent, justice in accessibility, and evidence-based therapies. This survey provides a comprehensive overview of the ethical issues in CAM and offers practical guidance for health-care providers navigating these complex issues. By understanding the ethical dilemmas in CAM, health-care providers can offer their patients safe and effective care while maintaining their professional and ethical obligations.

Tools for assessing professional identity in health professions education: A scoping review

Zahra Sadat Tabatabaei — 2024-12-23

Due to the complexity and multidimensional nature of professional identity assessment in health professions education, it is essential to establish appropriate criteria. Therefore, we conducted a scoping review to explore the current knowledge in this process and map the directions for future research. The present review was based on the five-step framework of Arksey and O’Malley. Eligible articles were examined using descriptive analysis of studies on the characteristics and psychometrics of the tools for professional identity assessment and their underlying theories. After an extensive search, 9,924 studies were identified, 162 of which were selected for full-text review, and finally, 17 articles qualified for inclusion in the study. For the most part, the target group consisted of studies on nursing and medical students. In 14 of the included studies, tools and psychometric properties were mentioned. Most professional identity assessment tools were designed or developed based on identity theories, particularly the social identity theory and Kagan’s constructive-developmental theory, which were used more often than others. This scoping review will help researchers to choose or develop reliable and valid tools under clear conceptual and theoretical frameworks to assess the formation and development of professional identity in health professions education.

Introducing the ethical cycle model for resolving ethical conflicts in medical practice: addressing challenges in treating pandemic patients

Ensieh Madani — 2024-12-24

Ethical dilemmas are among the most important ethical problems in medicine. With the advent of COVID-19, the moral problems of physicians have taken on new dimensions as the specific features of this disease pose additional ethical challenges that require particular solutions. One common way to solve ethical dilemmas is to use ethical decision making models. One of the most recent models in ethics of technology is the “ethical cycle” developed by Ibo van de Poel. By describing and comparing several models, this paper examines the application of the ethical cycle to physicians' ethical problems and medical ethics. This model can help solve complex problems in consultations and ethics committee meetings because it is comprehensive and covers various aspects of the discussion.In this model, first the ethical problem is formulated and analyzed and then the potential options for action are proposed.Subsequently, by referring to ethical theories and professional codes of conduct in the medical field, as well as applying the method of "reflective equilibrium," an ethical decision is reached. This decision is specific to each case and may not necessarily be the best solution for other individuals or situations

Ethics and healthcare in the older adult population

Aryan Ayati — 2024-12-23

Aging is a natural process involving the loss of several abilities, including cardiovascular, neurologic, musculoskeletal, and social capabilities. In addition to the usual needs, older adults face specific physical and mental challenges. Considering the increase in life expectancy and the large percentage of older adults in most populations, societies should be prepared for the ethical challenges associated with high-demand older generations. A search was conducted across the three main databases: PubMed, Web of Science, and Scopus. Next, 57 qualitative studies were selected to evaluate the ethical concerns and solutions in providing healthcare and treatment for older generations. Two independent researchers screened and assessed the studies, and the results were reported. Our findings showed that the main concern of policymakers and healthcare planners should be observance of principles such as autonomy, dignity, and fair and balanced distribution of medical resources while not prioritizing others over older adults due to their age. The elderly have specific needs, and considering their increasing prevalence and physical and emotional fragility, countries should be prepared to meet their rapidly growing needs.

Ethical considerations in prevention and management of non-communicable diseases: a narrative review

Elnaz Shahmohamadi — 2024-12-30

In recent years, alarming trends in non-communicable diseases (NCDs) have grown into some of the most important health concerns worldwide. The present research attempts to address the controversial approaches to the practical function of medical ethics while critically reviewing the main concepts of ethical considerations in NCD prevention literature. After refining the searched documents, we integrated related concepts and research, particularly emphasizing ethical considerations in NCD management. All four functional areas of NCD prevention (general health policymaking, social interventional, primary prevention, and secondary prevention) are affected by parallel associated factors of health determinants: environmental modification, lifestyle improvement and physiological characteristics, respectively. In addition to the practical aspects of implementing a response to NCDs, a variety of ethical considerations should be taken into account. For instance general policies, equity in care, interventional programs, and clinical/research data protection. A comprehensive, holistic approach considering all the involved parties can accommodate the wide spectrum of needs and continuum of management for NCDs.Creating an ethical procedure structure in public health systems can provide insight into managing the challenges posed by NCDs to health systems and assist in systematically confronting ethical problems in the management of NCDs.

Ethical analysis of a case of treatment refusal: respect for patients’ autonomy in the context of the Iranian clinical environment

Afsaneh Sadooghiasl — 2024-12-23

Refusal of treatment is a challenging issue in clinical ethics, especially in the context of pregnancy care. However, respect for patient autonomy remains a fundamental ethical principle, as outlined in codes of conduct and patient rights within healthcare services.The aim of this case presentation was to critically analyze a clinical ethics case within the Iranian context using an ethical framework. A theory-based framework was used that integrates the principlism approach, based on prima facie moral norms, with the moral development theories of Lawrence Kohlberg and James Rest to analyze this case. Mrs. M, a 38-year-old pregnant woman with acute myeloid leukemia, chose to continue her pregnancy until 32 weeks, despite medical advice, before starting her cancer treatment. The decision, influenced by the significance of her first pregnancy after costly infertility treatments, presented a complex ethical dilemma. The patient's autonomy was respected by the medical team, and treatment was delayed until the pregnancy was terminated at 33 weeks, ensuring both maternal and fetal care. The case underscores the ethical challenges of balancing patient autonomy with medical beneficence, highlighting the importance of trust and informed consent.

Ethical considerations and challenges associated with euthanasia in laboratory animal research

Raheleh Rafaiee — 2024-12-22

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