Vol 2 (2009)

Published: 2009-10-30

Articles

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    A high number of HIV positive babies are born each year, whereas by highly effective preventive measures, the risk of mother-to-child transmission can be decreased significantly. There are different methods (for example mandatory versus voluntary) for HIV screening in pregnant women, but there are debates on conducting HIV testing by these methods. One of the most important issues in this field is its ethical considerations. Also its limitations cannot be ignored. According to these facts several keywords were searched by search engines such as Web of Sciences, Medline, Google scholar, WHO website. The most relevant and recent articles were chosen.
    Concerning the importance of vertical transmission of HIV, the role of preventive measures, ethical considerations, and the limitations of HIV screening, we recommend HIV testing offer to every pregnant women at the first clinic visit by providing enough information for patient and considering her autonomy. Also policy makers should provide a guideline for this test according to the pregnant women's autonomy, confidentiality, and dignity.

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    Abortion is one of the controversial issues discussed in medical ethics. We can formulate the argument which is put forward by the opponents of abortion as follows: 1) fetus has to be regarded as human being; 2) killing an innocent human being is morally wrong; 3) aborting is an example of killing and terminating a human being's life. So, being engaged in aborting is morally wrong.
    In this paper, I am going to argue that the proponents' argument with regard to the implausibility of categorizing fetus as human being is unjustified and wanting. In other words, the way in which the proponents of abortion talk about the idea of personhood is, inadequate and vague, semantically speaking. The outline of the argument is as follows. The proponents of abortion are confronted with a dilemma. According to the first horn of the dilemma, the proponents have to subscribe to infanticide which is morally wrong, intuitively speaking. According to the second horn of the dilemma, there is a semantic story which needs to be expressed by the proponents with regard to the cut-off point of the concept ‘personhood'. Otherwise, the first premise will not be convincing if raised in favour of the plausibility of committing abortion.

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    Medically provoked death, whether euthanasia or assisted suicide, is a common issue for discussion in various forums, participants coming from widely differing fields of knowledge, among who are, of course, doctors. Substantial legal differences exist in Europe on this issue and in an ever-wider Europe, it is essential, for practical reasons, that legislation be standardised. We would like to propose possible regulations that would provide effective safeguards in the application of euthanasia or assisted suicide.

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    Using human dead body for medical purposes is a common practice in medical schools and hospitals throughout the world. Iran, as an Islamic country is not an exception. According to the Islamic view, the body, like the soul, is a "gift" from God; therefore, human being does not possess absolute ownership on his or her body. But, the ownership of human beings on their bodies can be described as a kind of "stewardship". Accordingly, any kind of dissection or mutilation of the corpse is forbidden, even with the informed consent of the dead or his/her relatives. The exception of this principle is when such procedures are necessary for saving lives of other persons. In this article using the human dead body for medical education, research and treatment is discussed and the perspective of Iranian Shiite religious scholars in this regard is explained.

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    Concerns regarding ethics of psychiatric research were a critical point in research when lots of news was announced about human rights abuses in the Nazi Germany. However, even nowadays, psychiatric research involving people suffering from different types of psychiatric disorders can still be distorted and, rather than fulfilling its promise of improved understanding of psychiatric disorder and its treatment, can result in serious harm to patients who participated in these investigations. This review focuses on some important ethical aspects in psychiatric research.

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    Judgment on rightness and wrongness of beliefs and behaviors is a main issue in bioethics. Over centuries, big philosophers and ethicists have been discussing the suitable tools to determine which act is morally sound and which one is not. Emerging the contemporary bioethics in the West has resulted in a misconception that absolute westernized principles would be appropriate tools for ethical decision making in different cultures. We will discuss this issue by introducing a clinical case. Considering various cultural beliefs around the world, though it is not logical to consider all of them ethically acceptable, we can gather on some general fundamental principles instead of going to the extremes of relativism and absolutism. Islamic teachings, according to the presented evidence in this paper, fall in with this idea.

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    Judgment This study was done in order to evaluate the effectiveness of the revisions made in the course of medical ethics for undergraduate medical students.
    Medical Students of Tehran University of Medical Sciences who took the course of medical ethics in a semester before the implementation of the revision and those who took the course after the implementation of the revision at the beginning and at the end of course responded to two questionnaires (one for evaluating knowledge and the other for assessing their moral judgment). Response rate was between 70 to 93.1 percent.
    Students' knowledge was significantly higher in the semester after the course revision (mean ± SD: 6.12 1.3) in comparison with the semester before the reform (mean ± SD: 3.63 1.7) (P=0.001). Students' knowledge after taking this course showed an increase of about 60% when compared with their knowledge level before starting the course (P=0.001). There was no significant difference in the level of moral judgment before and after taking the revised course of medical ethics while moral judgment level of students in two semester[before (21.21 4.0) and after 15.25 2.87) reform] were significantly different (P=0.02). 
    The revisions made in the course of medical ethics for medical students were effective in improving students' knowledge but could not improve their moral judgment. This could be due to the short length of this course and also the small sample size in this study. We suggest that this study should be repeated with larger sample size and also with other methods of a course evaluation.

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    Incorporating ethics education in curriculum of medical technology students and highlighting the importance of teaching the subject to this particular population in this part of world are our aims. At SIUT we have a school with name of "Zain ul Abidin" school of Biomedical Technology, which is supposed to award B.S. degree in 5 sub-specialties that is hemodialysis, radiology, laboratory sciences, operation theater technology and intensive care technology. This school is affiliated by Karachi University. The students entering in school have done fellow in science (F.Sc.)with pre-medical group, thus have background knowledge of biology, physics, chemistry, languages, religion and Pakistan studies.
    Here for B.S. included in their curriculum are the subjects of anatomy, physiology, biochemistry, microbiology, pharmacology, pathology, Islamiat and English for all and then related sub-specialty topics to each group for example student in hemodialysis group more exposed to nephrology topics etc.
    I planned to add ethics with subjects, which are common to all specialties and designed curriculum.
    Curriculum was approved (after minor changes), from Karachi University and I started teaching ethics to these students. This paper highlights methods and tools of teaching and evaluation and results observed. This will be the first examination in bioethics from medical technologists, at university level in the history of country.
    This is a great achievement in country to start teaching bioethics to medical technologists. Karachi University has implemented the same curriculum to other medical technology schools affiliated with University.

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    One of the most important occupational tensions a physician encounters in his/her practice is the complaints lodged against him/her by the patients. The purpose of this study is examining the complaints against physicians and dentists entering the Medical Council Organization of Tehran in the years ending on 20 March 1992, 20 March 1997 and 20 March 2002 from the viewpoint of number, dispersion and inducing factors.
    The present study was performed as a descriptive and retrospective one with the aid of a questionnaire containing concerned data. Filling in the questionnaire or studying the file was accomplished by a trustee expert of the Medical Council Organization and the data obtained were analyzed after classification.
    During a 3-year period, 832 complaints were lodged against physicians and dentists. The complaints against physicians in the years ending on 20 March 1997 and 20 March 2002 were 70% more than that in the year ending on 20 March 1992. 83.1% of the physicians and dentists of Tehran that were sued had not been convicted until the date of the performance of the study, on the basis of the contents of the files, and had no malpractice from the vantage point of the Medical Council Organization. The most common causes of complaints from the viewpoint of complainers were therapeutic errors (38%), neglect (30.2%), financial affairs (25.4%) and the physicians' lack of skill (17.7%). On the basis of this study, with the increase of the doctor's practice track record and experience more than 15-20 years, the number of the complaints decreases and most of the complaints are against the middle-aged doctors/dentists with 10-20 years of experience.
    Most physicians and dentists of Tehran having been sued have not committed any wrong from the vantage point of the Medical Council Organization experts and a large part of the complaints are a consequence of doctor-patient inconvenient interactions. A behavior based on professional commitment of the physician/dentist vis-à-vis the patient can hinder a major part of complaints.

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    Environmental ethics has emerged during the early 1970s, when environmentalists started urging philosophers to consider the philosophical aspects of environmental problems. Environmental ethics considers the ethical relationships between humanity and non-human world. The Union of Concerned Scientists, a group of over two thousands scientists, has concluded that climatic change is beyond dispute, and already changing our environment. Environmental instability portend ill for public health and well-being. This paper attempts to apply ethical theories to support environmental concerns and provides moral grounds to preserve the earth's environment. This article documents consensus among environmental philosophers as given by synthesis data provided via survey among articles, websites, and books by the keywords: environment, ethics, health and crises. The field has come to exert significant influence over a large number of human science disciplines in relation to environmental sustainability and human wellbeing. Environmental ethics focuses on the possibility of the identification of human ego with nature, means the larger ecological self deserves respect, too. Environmental ethics expands the boundaries of ethics to include the nature and considers its sustainability to ensure human wellbeing. This study emphasizes mainly on a brief history of environmental ethics and its protection against damage. Environmental changes and extreme weather events in plus to species distinction and a growth of diseases are impossible to hide and ought to be impossible to ignore. The health decline associated with various forms of these changes is continuing. It raises crucial issues about environmental justice.

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    In the past decade, the human genome has been completely sequenced and the knowledge from it has begun to influence the fields of biological and social sciences in fundamental ways. Identification of about 25000 genes in the human genome is expected to create great benefits in diagnosis and treatment of diseases in the coming years. However, Genetic technologies have also created many interesting and difficult ethical issues which can affect the human societies now and in the future. Application of genetic technologies in the areas of stem cells, cloning, gene therapy, genetic manipulation, gene selection, sex selection and preimplantation diagnosis  has created a great potential for the human race to influence and change human life on earth as we know it today. Therefore, it is important for leaders of societies in the modern world to pay attention to the advances in genetic technologies and prepare themselves and those institutions under their command to face the challenges which these new technologies induce in the areas of ethics, law and social policies.

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    Scientists undoubtedly owe their great advance and knowledge in biomedical research to millions of animals which they use every year in often-times extremely painful and distressing scientific procedures. One of the important issues in scientific research is to consider ethics in animal experimentation. Since this is a crucial issue in the modern era of medical research, in this paper, we have provided some guidelines (most of which have been adopted from Guidelines for Ethical Conduct in the Care and Use of Animals provided by American Association of Psychologists) which could be useful for researchers to design studies on a variety of animals.

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    Pharmacy is an ethical profession. The aim of this study was to investigate the history of pharmacy ethics in Iran. In the ancient Persia, medical and pharmaceutical ethics were related to religious rules, and everybody had to respect it. The ethical rules were similar to some current pharmacy ethics. During Islamic era, the pharmacy ethics were edited according to the Islamic rules. After introduction of European pharmacy into Iran, the pharmacy ethics did not change and was regarded as before. By presentation of bioethics and medical ethics in recent years, new activities are carried out for better manipulation of their rules in health professions including pharmacy.

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    Theologian Seyed Esmaeel Jorjani (1041-1136), titled Zeinoddin and known as Jorjani, is one of the most famous Iranian physicians. Almost one thousand years ago, he did valuable compilations in the history of medicine and many of his medical views are, to a great extent, in line with the recent views. His most famous work is Zakhire Kharazmshahi. His innovations and practices in various branches of medical sciences are quite new and unique. Jorjani was very efficient in surgery and, in his main book Zakhire, he introduced different methods and instruments of surgery in a way that it shows his dexterity and depth of experience. He explained methods of stopping severe hemorrhage by casting them with plaster, treating the obstruction of air canals by tracheotomy, curing the difficulty in urination by catheterization, the exact method of removing apophasis and stitching the spot after cutting and paring in polyp surgery in full details.

    Jorjani also wrote about cancer, its difficulty of treatment, the necessity to avoid inciting it, and the impact of early treatment. In Zakhire, he pointed to the relationship between exophthalmos and goiter, and the relationship between outgrowth of thyroid and increase in heart rate; this way, he came to understand about the pathologic toxic reactions of thyrotoxicosis.

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    Both western and eastern civilizations have linked moral teaching with theology followed by philosophy. New-knowledge-seekers about natural world, were called ‘natural philosophers'. There was a paradigm shift during industrial revolution in western world which culminated in modern science. The word "scientist" was coined during the 19th century. The paper examines whether natural philosophers could be called ‘scientists'? A short history of philosophical paradigm shift is given. Although written moral and "ethical principles" were in vogue from the time of Hammurabi (1750-1795 BC), the phenomenon of bioethics is very recent. Bioethics is a bridge among different sciences and a bridge to the future. The question is: Is bioethics, by itself, science? The present paper is concerned with the quality of bioethics and about the nature of science during the next 30-50 years. Science is value-free but bioethics is value-loaded. Science does not proclaim any value whereas bioethics underlines the moral life and its value to survive. The paper examines two issues: Can science be bioethics-friendly? and (ii) Can bioethics be science-friendly? It appears that both science and bioethics are incompatible. We need to develop a new system of knowledge to include/infuse the bioethical-notion of values in (into) science. Such a move may necessitate the development of an alternate but new model. Bioethics is not a science-discipline. A new term to replace science is needed. Elevating bioethics as an academic science may create job openings in India. 

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    The apparatus invented by Dr. Luigj Benusi in 1943, in Tirana, was a practical application of the Kowarsky technique and Ambard laws, helping in determining blood urea levels and very important to a variety of diseases, mainly kidney disorders.
    The apparatus was invented and prepared from very simple laboratory materials, such as glasses, test tubes, corks and volumetric cylinders. Technologically, it was based upon the determination of blood urea through hypobromite, and, among the advantages of the apparatus of Benusi, were its extreme simplicity, the smaller amount of blood needed for producing results (2 milliliters), as well as an easiest way to clean up and to manage the apparatus from a practical point of everyday use.   

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    Background: Informed Consent concept has been recognized in all patient care fields. The contents and wordings of the informed consent are still being debated and experimented. Dental care services have considered the role of informed consent since 1980's, after some legal claims of malpractices.
    Methodology: A cross-sectional analytic study was undertaken involving 375 senior dental students and fresh graduates in their house job. A self-administered questionnaire explored their knowledge, attitude and practices regarding the need and importance of informed consent in dental services. The study instrument was designed keeping in view the content of courses in dental education and international standards. The questionnaire was pre-tested on a small group for assessing the suitability and validity of the responses. 
    Results: The data was entered in SPSS version 16 and cross-tabulated through it. Most of the respondents (87%) were aware of the concept of informed consent, 6.9% considered it unnecessary and 21.9% were not practicing it. Invasiveness of dental procedure was found to be directly related to the need of including informed consent. Major justification for presence of informed consent was to protect the dentist from any legal proceedings.
    Conclusion: Dental professionals were aware about the informed consent as a step, but were unaware about its precise significance, content application and practice.

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    Euthanasia is one of the controversial topics in current medical ethics. Among the six well-known types of euthanasia, passive voluntary euthanasia (PVE) seems to be more plausible in comparison with other types, from the moral point of view.
    According to the Kantian framework, ethical features come from 'reason'. Maxims are formulated as categorical imperative which has three different versions. Moreover, the second version of categorical imperative which is dubbed 'principle of ends' is associated with human dignity. It follows from this that human dignity has an indisputable role in the Kantian story. 
    On the other hand, there are two main theological schools in Islamic tradition which are called: Ash'arite and Mu'tazilite. Moreover, there are two main Islamic branches: Shiite and Sunni. From the theological point of view, Shiite's theoretical framework is similar to the Mu'tazilite one.
    According to Shiite and Mu'tazilite perspectives, moral goodness and badness can be discovered by reason, on its own. Accordingly, bioethical judgments can be made based on the very concept of human dignity rather than merely resorting to the Holy Scripture or religious jurisprudential deliberations. 
    As far as PVE is concerned, the majority of Shiite scholars do not recognize a person's right to die voluntarily. Similarly, on the basis of Kantian ethical themes, PVE is immoral, categorically speaking.  According to Shiite framework, however, PVE could be moral in some ethical contexts. In other words, in such contexts, the way in which Shiite scholars deal with PVE is more similar to Rossian ethics rather than the Kantian one.