Vol 4 (2011)

Articles

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    Nowadays, with development of medical sciences, several ethical challenges have raised which make research more complicated. Observance of student's right in selecting interested research topic and the supervisor, in addition to its positive effect on the research process, will cause satisfaction and quality promotion in the educational system. To observe that issue, during a confidential survey of a number of postgraduate students in 2009, students were asked to confidentially describe any displeasure they might get during their study and research. The most important items included: imposing thesis by a supervisor without informing the student, compulsory assignment of students to a specific supervisor, little time allocated for students by the supervising team who may be selected without students interests, prolongation of the research time, and non-cooperation in publishing the results.
    Establishment of a proper way to transfer student's displeasure or criticism to supervisors and establishing a continuous program for informing research teams including supervisors and students about ethical codes can positively affect the issue.

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    Patients' rights observance is one of the effective measures of patients' satisfaction of health care services. We performed this study at the aim of evaluation of nurses' awareness of patients' rights in a teaching hospital in Tehran.
    This cross-sectional study was conducted in 2010. In this study 156 nurses were randomly selected. Two-part questionnaire was used for data collection. The validity and reliability of questionnaire was determined and then it was distributed between subjects. The data were analyzed by SPSS version 15 using descriptive and inferential statistics. Our results showed that %58.33, %39.10 and % 2.56 of nurses have good, medium, and poor levels of awareness respectively. We observed a significant relationship between nurses awareness and work experience (P=0.008) and concurrent work in public and private hospitals (P=0.01). The most of the nurses (%95.51) were aware of "right to privacy protection and ensure confidentiality of information" and the least of them (%33.97) were aware of "right to receiving necessary information about the health care providers, the rate of tariff and insurance coverage".
    According to our survey it is concluded that implementation of Patients' Right Charter in this hospital is accompanied by some limitations which necessitates promotion of the nurses' awareness about patients' rights. Taken together in order to enhance nurses' awareness special measures and strategies should be considered.

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    Dissection is being jeopardized in the modern medical education. It has unrelentingly faced the lashes of time and has been the scapegoat for numerous convenient curricula reforms and subjective biases. The cadaver is unparallel in establishing core knowledge among the medical community and it needs to be appreciated in a new light in the "cyber anatomy" realm of today.This article elucidates the medical and ethical validity of continuing human body dissection in medicine which outweighs all the prejudices associated with it.

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    Alterations in pharmacy practice from prescription dispensing to more patient-centered relationship intensifies the necessity of clinical decision-making. Pharmacists' knowledge as well as ethical reasoning affects their clinical decision-making. Unfortunately in Iran pharmacy ethics did not develop along with medical ethics and special considerations are of major importance. The study was designed to evaluate pharmacists' attitude toward some principles of bioethics.
    A cross-sectional survey was performed on a sample of Iranian pharmacists attended in continuous education programs in 2010. Based on the pharmacists' attitude toward common ethical problems, 9 Likert-type scale scenarios were designed. A thousand pharmacists were surveyed and 505 questionnaires were filled. For the whole questionnaire the strongly disagree answer was the most ethical answer. On a scale from 1-5 on which 5=strongly disagree, the total score of pharmacists ethical attitude was 17.69 ± 3.57. For easier analysis we considered the score of 1 for agree and strongly agree answers, score of 2 for neutral answers and score of 3 for disagree and strongly disagree answers. The total score in confidentiality for all participants was 4.15 ± 1.45 out of 9, in autonomy 6.25 ± 1.85 out of 9, in non-maleficence 5.14 ± 1.17 out of 6 and in justice was 2.27 ± 0.89 out of 3, however there was no significant difference between men and women in the total score and the score of each theme. The older participants (> 40 years) significantly had lower total score (P< 0.05) as well as the score of each theme (P< 0.05), except for non-maleficence. The work experience showed impact on the pharmacists' attitude toward autonomy and the participants with more than 5 years work experience significantly obtained lower score in this theme.
    Compiling ethical guidelines and improving pharmacy ethics curriculum is highly critical to provide the best pharmaceutical care and to make clinical decisions in critical situations. Therefore further quantitative and qualitative investigations into finding pitfalls and challenges in this issue are highly recommended.

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    In the recent years, the role of a pharmacist has been significantly changed. Traditionally, in the late 20th century, a pharmacist's role was considered as merely dispensing medication to patients. This view however, has been significantly altered, and, today, a pharmacist is supposed to provide patients with information regarding the medication they are to take, as well as on different aspects of their disease. Therefore, one can suggest that some other factors have recently come into play in the daily tasks of a pharmacist such as accountability and authority.
    The current cross-sectional survey is conducted on a cohort of community pharmacists attending a continuing education program. A questionnaire comprised of 26 Likert-type scale questions was designed to assess pharmacists' attitude towards professionalism and its subscales which are defined later in detail. A total number of 1000 pharmacists were surveyed and 560 of them filled and returned the questionnaires. On a scale from 1-5 on which 1 was corresponded with strongly agree and 5 with strongly disagree, the total score of pharmacists professionalism was 92.9 ± 10.4 out of 130. As regards the subscales, in the subscale of accountability 46.8% of participants, in the subscale of altruism 90.1% of participants,  in the theme of duty 85.7% of participants, and in the subscale of working relationship with physicians 84% of pharmacist achieved more than two third of the total score. Only in term of conflict of interest 67.9% of participants scored less than two third (17-25) of the total score. Women obtained significantly higher scores in altruism (P<0.05). Furthermore, there was a correlation between age and the score of accountability and working relationship with physicians; and, the same was observed in regards with work experience with the score of working relationship with physicians. The employment position affected neither our participants' response to the whole questionnaire nor any of subscales.
    Although the total score for professionalism was not dramatically decreased, the significantly low results are alarming and they should be considered more seriously. In order to enhance the level of pharmacists' professionalism, especially in some special aspects, it seems necessary to conduct similar surveys on pharmacy students and registered pharmacists with a more comprehensive questionnaire. Overall, it can be concluded that designing a proper teaching course in professionalism for pharmacy students is of paramount importance if we are to promote professionalism in future pharmacists.

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    As medical ethics indisputably needs to consider patients' religious beliefs and spiritual ideas, one can suggest that hospitals are responsible for not only patients' rights and dignity, but also for her/his religious concerns and expectations.
     The current study is designed shed some light on the patients' view of the implementation of religious law in Iranian hospitals, specifically, the right of patients to be visited and delivered health services by professionals from the same sex. This protocol is proposed by the Ministry of Health and Medical Education of the Islamic Republic of Iran as a response to the increasing demand for implementation of the religious law by Iranian patients.
    This research is a cross-sectional study which was conducted at four teaching general hospitals in Tehran, Iran. The data was collected by the means of a questionnaire distributed to 120 women who were admitted to different wards of the hospitals. These women were asked to express their opinion of the implementation the Same Sex Health Care Delivery (SSHCD) system in Iranian hospitals. All analyses were performed with the use of SPSS software, version 16.0.
    The results indicate that half of the hospitalized women believed that being visited by a physician from the same gender is necessary who advocated the implementation of SSHCD in a clinical setting; and most of their husbands preferred their wives to be visited exclusively by female physicians.
    This study highlights the view of the Iranian patients towards the issue and urges the Ministry of Health and Medical Education of the Islamic Republic of Iran to accelerate the implementation of this law.
    SSHCD is what the majority of Iranian patients prefer, and, considering patients' rights and the medical ethics, it should be implemented by Iranian policy makers.

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    In this project, we aimed to revise the medical ethics curriculum at the School of Medicine, Tehran University of Medical Sciences, in order to promote the level of students' ethical awareness and enable them to make ethical decisions.
    Ideal and long term educational objectives were set to determine directions for future reforms and to provide a baseline for future evaluation of the project. However, based on limited available recourses, the first stage of the reform was planned and implemented with a 3 years scope. In revising the curriculum, which was done according to the Harden's ten questions, we focused on moral attitude and ethical reasoning skill in addition to academic knowledge base  by using methods such as case discussions, portfolio, and clinical ethics rounds. The revised curriculum was implemented during the first semester of the 2006-2007 academic year for the first time.
    The student feedback indicated that the new curriculum was successful in increasing the students' awareness of ethical issues and enabled them to understand and accept their professional obligations.
    Revising the curriculum and its evaluation should be considered as an ongoing process. The present project was a successful experience that motivated faculty members to pursue the next steps of improving the curriculum on medical ethics and proved to be convincing for the authorities and policy makers to support it.

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    The main purposes of the present study were to see how the term "euthanasia" influences people's support for or opposition to euthanasia; and to see how euthanasia attitude relates to religious orientation and personality factors.
    In this study two different euthanasia attitude scales were compared.
    197 students were selected to fill out either the Euthanasia Attitude Scale (EAS) or Wasserman's Attitude Towards Euthanasia scale (ATE scale). All participants filled out 50 items of International Personality Item Pool, 16 items of the The HEXACO openness, and 14 items of Religious Orientation Scale-Revised.
    Results indicated that even though the two groups were not different in terms of gender, age, education, religiosity and personality, mean score on the ATE scale was significantly higher than that of the EAS. Euthanasia attitude was negatively correlated with religiosity and conscientiousness and it was positively correlated with psychoticism and openness.
    It can be concluded that analyzing the attitude towards euthanasia with the use of EAS rather than the ATE scale results in lower levels of opposition against euthanasia. This study raises the question of whether euthanasia attitude scales should contain definitions and concepts of euthanasia or they should describe cases of it.

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    Medical ethics is an indispensible and challenging aspect of clinical practice. This is particularly prominent in the field of organ transplantation. In this paper, initially, a clinical case with brain death that ended up as an organ donor will be presented. Following the presentation, important moral challenges which initially formed medical ethics and some highlights of it in organ transplantation will be discussed in detail. The impact of complex modern influential factors that might interfere with the practice of medical ethics in this field such as patients' vulnerability, financial temptations, and legal regulations will be also dealt with. Finally, we shall propose practical guidelines aiming at improving the practice of medical ethics in the emerging issue of organ transplantation.

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    Accompanied with various opinions across cultures, truth telling is a major debate in bioethics. Many studies have focused on attitudes toward truth disclosure. We intend to review several relevant research studies, and discuss the issue through a clinical case consultation.
    It seems that while "the right to know" is emphasized in bioethics, in some cultural contexts, health professionals fear communicating bad news. The patients may not receive information directly, because it is believed that the truth may make the patient feel hopeless and unable to cope with the problem. Nevertheless, some believe that sharing information may strengthen a trusting relationship between patients and medical professionals.
    Extensive efforts are in process in some societies to make patient rights to know the truth as a natural part of medical practice. However, in some cases, the principles of respect for patient autonomy require us to accept patient's refusal to know the truth, with the provision that he assigns someone to receive information and make medical decisions on his behalf. In conclusion, it is suggested that healthcare professionals should not act on a unique presumption in all cases and they should explore what the real interest of patient is, in order to respect individual autonomy.