RESUMEN

Medical ethics and law are essential topics that should be included in medical residency programs. However, surgery training programs in Iran lack a specific course in medical ethics and law, which can lead to patient dissatisfaction with surgical outcomes. This study aimed to assess surgery residents' knowledge of medical ethics and law and suggest improvements for future residency programs. This descriptive cross-sectional study involved 112 surgery residents from six teaching hospitals. A valid and reliable questionnaire comprising 15 items on medical ethics and 12 items on medical law was used to assess participants' knowledge. Most participants were female (31-40 years old), and their mean knowledge score for medical ethics was 3.26±0.53 out of 5, with the lowest score in "futile treatment and DNR orders." The mean knowledge score for medical law was 3.69±0.69, with the lowest score in "surrogate decision-maker." Age did not affect residents' knowledge, but gender did, with female residents demonstrating significantly better knowledge of medical ethics (3.344/5 vs. 3.112/5) and law (3.789/5 vs. 3.519/5). Surgery residents had a relatively favorable knowledge of medical ethics and law, but they require further training in some areas to improve their knowledge. Training should include journal clubs, role-play programs, standardized patient programs, and debates to achieve better results, as purely didactic lectures appear inadequate.

Asunto(s)

RESUMEN

Background and Aims: COVID-19 pandemic led to a need to rapidly vaccinate as many people as possible. Children are an important part of the population with different characteristics which vaccinating them is a matter of great importance as it should be decided considering all aspects and ethics. Here, we present different aspects of COVID vaccination in children including the potential challenges. Methods: We searched on PubMed, Google Scholar and Scopus in this regard, and all of the relevant papers published until June 28, 2021 were included if we could access their full-texts. Results: We found various expert opinions in this regard and tried to summarized them. Saving lives has similar ethical value as preventing evitable adverse event. Accordingly, mandating the children to receive the SARS-CoV-2 vaccine, needs risk-benefit weighing with special consideration of ethical challenges. Conclusion: Considering the vast range of benefits resulted from pediatric vaccination both for the children and the community, implementing the program in a scientific manner and also with the least financial expenses for the families seems to be reasonable and makes it both ethical and moral.

RESUMEN

Cord blood is a rich source of hematopoietic stem cells used to treat many diseases of blood origin. Thus, storage banks were created to store and provide umbilical cord cells. With the development of diagnostic and therapeutic technologies and techniques in medicine, ethical issues have also become more widespread and complex. After the creation of the cord blood banks, efforts were made to address the ethical issues associated with such banks. The present study attempts to identify the ethical challenges in these banks in the published studies. Databases including PubMed, Scopus, Web of Science (WOS), Embase, Proquest, and Google Scholar were searched from January 1996 to January 2021. Then, the ethical challenges of the cord blood bank were extracted from the results section using thematic content analysis. 22 studies were selected based on inclusion and exclusion criteria. The ethical challenges raised in the studies included private or public ownership of the bank, fair access to banking services, informed and voluntary consent, failure to provide sufficient information to individuals about the process, confidentiality of user's information, conflict of interest of bank founders (who are commonly doctors). The findings of this study indicated that there are serious ethical concerns regarding umbilical cord blood banks. Responding clearly to these ethical challenges calls for the attention of policymakers and medical ethics professionals; this will require a clear statement of the various aspects of these banks for society.

Asunto(s)

RESUMEN

BACKGROUND: Nursing is a vital element in providing safe and effective care. Forensic nursing is one of the specialties in this discipline which, in addition to creating more satisfaction in nurses, is considered essential in holistic, quality, and safe care. This study aimed to describe the consequences of the presence of forensic nurses in the health system. MATERIALS AND METHODS: This qualitative study was conducted between 2017 and 2018 in Iran. Semi-structured interviews were performed with 18 participant experts in the field of health and law. The interviews were analyzed using the inductive content analysis approach proposed by Graneheim and Lundman. RESULTS: The consequences of the presence of nurses in the health system were summarized into two categories: positive and negative consequences. The positive consequences consisted of improved performance, better legality of nurses, the calmness of nurses, prevention of patients' rights violations, advancement comparable with developed countries, reduced costs, increased accuracy and speed in dealing with forensic cases, improved performance of Iranian Legal Medicine Organization and increased employment. On the other hand, the negative consequences were role conflict with other involved professionals and nursing shortage. Participants included nurses (with different specialties), nurse lawyers, forensic medicines, forensic midwives, a judge, and a medical lawyer. CONCLUSIONS: If planners and policymakers have a positive attitude toward the presence of forensic nurses, we can anticipate better forensic services for clients through the development of systematic educational programs, the formation of forensic teams, and the expertise of this profession can provide many benefits.

RESUMEN

BACKGROUND: Interests in nanotechnology and its application in medical research, diagnosis, and treatment of diseases continuously grow. The study identified the theoretical and practical principles of ethics in developed countries' nanomedical research to be used as the first step of development of a national nanoethics standard or guideline in Iran and developing countries. METHODS: The present study was done between 2012-2016 in Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, which comprised a literature review and a comparative study to describe and compare the nanoethics situation and considerations of nanoethics in Australia, Canada, and USA. RESULTS: The main ethical considerations in the three countries contain two major categories, including firstly, the nature of nanoparticles such as its diversity, rapid development of new and not well-defined nanoproducts and particles and unpredictable side effects of such nanoparticles; and secondly, the application of developed nanoparticles in areas such as justice, privacy protection, patient-physician relations, etc. CONCLUSION: It is controversial to develop an independent nanoethics standard or codes; however, national priorities and concerns, as well as specific nanoethics considerations, should be investigated before deciding to create such standards in each country. Overall, careful considerations have to take into account the justice, privacy protection, the inherent risks of nanomaterials and their possible side effects on patients and other study subjects, as well as considering characteristics of new developed nanoproducts and particles.

RESUMEN

Background: Ethical attitudes and personal values play a significant role in clinical decision-making; however, they have been given limited attention by professionals in laboratory medicine. Studies suggest that individual attitudes are not static and that professionals learn ethical attitudes through a variety of formal and informal learning methods. This study was conducted to investigate changes in the attitudes of clinical laboratory professionals after teaching them ethics and to compare the results among the 3 groups. Methods: Four topics were selected in the field of medical laboratory ethics as teaching materials. A questionnaire including 22 items was designed and validated. Teaching sessions for the 3 study groups were held. All 65 clinical laboratory participants completed the questionnaire before and after the classes. Paired t test and ANOVA were used to assess differences among groups. Results: Significant differences were found in the mean scores of ethical attitudes before and after the educational intervention among the lecture-based teaching group (p=0.016), problem-based learning group (p=0.001), and all participants (p=0.004). However, no significant difference was found between the mean scores before and after the intervention in role-playing group (p=0.623). Conclusion: Teaching by lecturing and problem-based learning was more effective to change ethical attitude of the laboratory professionals than the role-playing method. Thus, we suggest the implementation of teaching ethics using these methods to improve the ethical attitude of clinical laboratory professionals.

RESUMEN

BACKGROUND Organ transplantation is one of the most critical topics in medical ethics that is commonplace in various countries. This study aimed to evaluate the knowledge and the ethical issues surrounding organ transplantation and organ donation among healthcare personnel in Tehran, Iran. MATERIAL AND METHODS In a cross-sectional study performed on 450 healthcare personnel, self-administered questionnaires were used to derive data from individuals. Among the 450 health personnel who received the questionnaires, 377 completed their questionnaires (83.77%). RESULTS The willingness and unwillingness to donate organs among individuals were 47.48% (n=179) and 52.51% (n=198), respectively. Among the individuals who signed the organ donation card, 96.5% (n=55) were willing to donate their organs and 3.5% (n=2) were unwilling to donate their organs. Most of the individuals that were willing (48.34%; n=175) and unwilling (51.66%; n=187) to donate their organs claimed religious support for organ donation (P=0.00). Out of these people, 110 willing people (67.48%) and 53 (32.52%) unwilling people were familiar with the idea of brain death. The individuals who selected cadavers (67.64%; n=255) and brain death (24.4%; n=92) were chosen as the best candidates for organ donation. Most individuals believed that young patients (n=123; 32.62%) and people who had not already had organ transplants (n=90; 23.87%) should be the preferred recipients of organs. Most individuals had learned about organ transplantation from television (30.24%; n=114), newspapers (23.61%; n=89), and the radio (19.89%; n=75). CONCLUSIONS In conclusion, there is a need for more educational programs for the improvement of knowledge and ethical consideration with regard to organ transplantation and organ donation among healthcare personnel.

Asunto(s)

RESUMEN

Organ transplantation is a new issue in medical science. It is an important achievement and a sign of the progression and ability of medical centers around the world. Governments, populations, the medical community and people involved in culture, art, and media all have a decisive role in the culture of organ donation, which is the only way to guarantee that the healthy organs of a brain-dead person can continue to work and save the lives of people in need of organ transplantation. The brain death phenomenon and its possible application in organ transplantation, while offering new hope for the salvation of a number of patients, has led to many ethical, cultural, and legal issues. Ethical issues in organ transplantation are very complicated due to many social factors such as religion, culture, and traditions of the affected communities. The ethical and legal points of removing organs from the body of a living or cadaveric source, the definition of brain death, the moral and legal conditions of the donor and the recipient, and the financial relationship between them and many others, are all critical issues in organ transplantation. While there may be no available explicit solution to these issues, they should be rigorously considered by the experts. Efforts to systematically eliminate barriers and solve problems in organ transplantation, can not only reduce the costs of maintaining brain-dead patients and encourage patients that need organ transplantation but can also prevent immoral and illegal activities. In this paper, we have reviewed the most important and current challenges in organ transplantation with a view to the ethical considerations, and we have suggested some strategies to extend it in Iran.

RESUMEN

Organ transplantation is an effective process that prolongs the lives of individuals suffering from incapacitating conditions. The aim of this study was to evaluate the view point of medical students in Iran regarding ethical aspects and knowledge on organ transplantation and donation. The participants included 165 medical students from different faculties of Shahid Beheshti University of Medical Sciences, Tehran, Iran. They were assessed using a reliable questionnaire that examined their ethical aspects and knowledge regarding organ transplantation and donation. All data analyses were performed using Chi-square and analysis of variance tests with SPSS software. Results showed that main sources of respondents' knowledge on organ transplantation and donation were TV, 51.52 % (n = 85) and Internet, 19.39 % (n = 32). 91.51% (n = 151) of the respondents understand and 8.48% (n =14) do not understand the concept of brain death. 49.69% (n = 82) of the respondents were willing to donate their organs. A brain death donor was selected by respondents as the best option for organs transplantation (72.12%; n = 119). The respondents selected young patients as the preferred recipients of an organ (69.69%; n = 115). There was no correlation between gender, age, educational level, marital status and attitude towards organ transplantation. From the results, there is need for an organized educational planning for medical students in ethical issue and knowledge on organ and tissue transplantation.

Asunto(s)

RESUMEN

Background: The honorable medical profession is on the verge of being reduced to a business. Evidence suggests that professionalism is fading and today's doctors are faced with value-threatening problems and gradually begin to forget their main commitment as medical professionals. Many of the problems faced by doctors are rooted in non-professionalism. Mere education in the science and practice of medicine produces an inefficient medical workforce and leads to the formation of a distorted professional identity. In the past decade, educational innovations targeting the formation of desirable professional identities have been presented and are considered a vital part of medical education for the development of professionalism. The present study was conducted to examine the relationship between the formation of professional identity and professionalism. Professionalism education is essential in the formation of a desirable professional identity. Methods: This review article was done in 2015 through searching databases, such as PubMed, Elsevier, Google Scholar, Ovid, SID, and IranMedex, using keywords of professionalism and professional identity, and medical education. Among the 55 found articles, 30 were assessed and selected for review. Results: The formation of professional identity is a process with the following domains: professionalism, and development of a personal (psychosocial) and a cultural identity, which is derived from the unification of professional, personal, and ethical development. The main components required for the formation of a desirable identity are, therefore, rooted in the dimensions of professionalism and professional development. The need for teaching professionalism has a reciprocal relationship with the formation of professional identity. Conclusion: There is a reciprocal relationship between formation of a desirable professional identity and development and strengthening of professionalism. Modern medical education should be designed to develop professional identity, and professionalism acts as an essential part of its curricula throughout the entire course of a doctor's education, with the aim of acquiring a desirable professional identity.

RESUMEN

In emergencies and disasters, ethics are affected by both personal and organizational factors. Given the lack of organizational ethical guidelines in the disaster management system in Iran, the present study was conducted to explain the personal factors affecting ethics and ethical behaviors among disaster healthcare workers. The present qualitative inquiry was conducted using conventional content analysis to analyze the data collected from 21 in-depth unstructured interviews with healthcare workers with an experience of attending one or more fields of disaster. According to the data collected, personal factors can be classified into five major categories, including personal characteristics such as age and gender, personal values, threshold of tolerance, personal knowledge and reflective thinking. Without ethical guidelines, healthcare workers are intensely affected by the emotional climate of the event and guided by their beliefs. A combination of personal characteristics, competences and expertise thus form the basis of ethical conduct in disaster healthcare workers.

Asunto(s)

RESUMEN

Although medical professionalism is a fundamental aspect of competence in medicine and a distinct facet of physicians' competence, evidence suggests that the subject of professionalism is not taught or assessed as part of medical students' curricula in Iran and many other countries. Assessing the knowledge of medical students and physicians about medical professionalism seems to be helpful in identifying the weaknesses of training in the field of professionalism and devise plans for future training on the subject.The present cross-sectional, quantitative, observational, and prevalence study recruited 149 medical interns, clinical residents, physicians, and professors working in hospitals selected through stratified random sampling using a questionnaire designed by the researchers and confirmed for its validity and reliability. The results were analyzed by Stata at a significance level of 0.05.Out of 149 cases, 61.64% were male with the mean age of 30.81 years. A total of 66 participants (44.29%) (95% confidence interval [CI]: 36.44%-52.44%) had heard and 83 (55.70%) (95% CI: 47.55%-63.55%) had not heard the term "medical professionalism" before the study. After adjusting for potential confounders, age and degree did not have statistically significant difference in assessed knowledge of medical professionalism, but sex had (mean difference: 5.88, P = 0.045), and the mean of the female was significantly higher than that of the male participants. The mean percentage of correct answers was 47.67.The present study demonstrated that the medical professionals working in the national healthcare system have an unfavorable theoretical knowledge about medical professionalism in Iran; although this does not indicate that their practices are unethical, it should be noted that one of the prerequisites of possessing a high level of medical professionalism and for establishing a proper relationship between the medical community and the patients is to have a proper knowledge of this concept. Improving behaviors and performances in medical professions requires adequate training on the concepts of medical professionalism and consequently the assessment of the levels of professionalism achieved in medical professionals.

Asunto(s)

RESUMEN

A major debate in medical ethics is the request for futile treatment. The topic of medical futility requires discrete assessment in Iran for at least two reasons. First, the common principles and foundations of medical ethics have taken shape in the context of Western culture and secularism. Accordingly, the implementation of the same guidelines and codes of medical ethics as Western societies in Muslim communities does not seem rational. Second, the challenges arising in health service settings are divergent across different countries. The Quranic concept of idle (laghw) and its derivatives are used in 11 honorable verses of the Holy Quran. Among these verses, the 3rd verse of the blessed Al-Muminun Surah was selected for its closer connection to the concept under examination. The selected verse was researched in the context of all dictionaries presented in Noor Jami` al-Tafasir 2 (The Noor Collection of Interpretations 2) software. "Idle" is known as any insignificant speech, act, or thing that is not beneficial; an action from which no benefit is gained; any falsehood (that is not stable or realized); an entertaining act; any foul, futile talk and action unworthy of attention; loss of hope; and something that is not derived from method and thought. The word has also been used to refer to anything insignificant. The notes and derived interpretations were placed in the following categories: A) Having no significant benefit (When medical care does not benefit the patient (his body and/or soul and his life in this world and/or the Hereafter), it is wrong to proceed with that medical modality; B) Falsehood (Actions that fail to provide, maintain, and improve health are clearly futile); C) Unworthy of attention (An action that neither improves health nor threatens it is wrong and impermissible).

RESUMEN

INTRODUCTION: Respecting patients' rights is an essential component in health care. Passing a regulation is not a guarantee for the protection of patients' rights. This article aimed to assess patients' awareness of the contents of the Patient's Bill of Rights in Iran and to determine if they had received a service compatible with their rights charter. METHODS: This is a descriptive study in 202 hospitalised patients. A questionnaire was used, and associations between variables were examined using Pearson's correlation test. The significance level was p < .05. RESULTS: The patients' ages ranged from 18 to 87 years of age, 33% were male and 79% were married. Patients' knowledge was lowest regarding the need for consent for the treatment process and was highest regarding the patient's right to know the expertise of the treatment team. The mean of patients' knowledge was 77.56%. As for patients' exercising their rights, the highest score belonged to the patient's right for attending doctors and treatment team's confidentiality; the lowest score belonged to the right to receive necessary information about probable complications, other treatment options and participation in the final selection of treatment method. The mean score of patient satisfaction was 8.06 (out of 11). There was no significant relationship with their education level or the number of admissions. CONCLUSION: Health-care professionals can provide care based on patients' rights, and their knowledge of patients' rights needs to be evaluated. Educational programmes, leaflets, booklets and posters can be helpful in this regard. In addition, professional organisations and the Ministry of Health need to be more sensitive to this issue.

Asunto(s)

RESUMEN

BACKGROUND: Providing health services is described as an important moral measure, since its major aim is to ensure the welfare of the people who need treatment and care. Moral sensitivity is the ability to identify the existing moral problem and understand the moral consequences of the decisions made on the patient's part. Physicians are always exposed to moral distress due to various circumstances. OBJECTIVES: In this survey, we evaluated moral sensitivity and moral distress among physicians and the relationship of these ethical factors on them. Hence, we assessed y relationship between moral sensitivity and moral distress in physicians will facilitate their sound management so as to provide high-quality and safe health services. Moreover it will confirm proposed theories regarding this subject. MATERIALS AND METHODS: This cross-sectional descriptive-analytic study aimed at investigating the relationship between moral sensitivity and moral distress among 321 specialist physicians working in hospitals affiliated to Tehran Medical Universities in Tehran. The samples were selected through two-stage random cluster sampling method. A three-partite questionnaire comprising of demographic characteristics, moral distress, and moral sensitivity was used for collecting data which then were analyzed using SPSS-20. RESULTS: There was a negative significant relationship between moral sensitivity and moral distress frequency; there was a positive significant relationship between moral sensitivity and moral distress intensity. Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress. CONCLUSIONS: Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress.

RESUMEN

Spousal abuse is a serious social problem, which includes a variety of physical, emotional, and sexual violence. Many studies conducted on this subject in different countries show that the actual severity of this problem is far greater than it seems at first glance. Because legal medical centers are the main places where victims are referred, 500 abused victims who were directed to these centers during 2012 were asked to fill out preplanned forms and the collected data were analyzed using analytic methods. The results showed that the average age of the women was 32 years, and their husbands' average age was 36 years. Most of the women had high school diplomas and they were living with their husbands and children. Most of the subjects were housekeepers and had married through their own choice and personal interest. In most of the cases, the initial instance of physical abuse occurred in the first year after marriage, and the head and face were the most frequently injured parts of their body. In a high percentage of cases, the partner was drunk, addicted, or had a history of mental illness. A significant relationship was found between alcohol and drug abuse with domestic violence in this study.

Asunto(s)

RESUMEN

BACKGROUND: Researchers have regarded moral distress as a major concern in the health care system. Symptoms associated with moral distress may manifest as frustration, dissatisfaction, and anxiety and may lead to burnout, job leaving, and finally, failure to provide safe and competent care to patients. Proper management of this phenomenon can be fulfilled through study of its causes at different levels of health services and taking necessary measures to solve them. OBJECTIVES: This study aimed to determine the status of moral distress in physicians practicing in hospitals affiliated to Medical Sciences Universities in Tehran. MATERIALS AND METHODS: This cross-sectional study was carried out using the Standard Hamric Scale to collect data after modification and evaluation of its reliability and validity. A total of 399 physicians responded to the scale. Data analysis was performed using descriptive and correlation statistics with respect to the variables. RESULTS: Results showed that the frequency of moral distress of physicians was 1.24 ± 0.63 and the intensity of moral distress and composite score of moral distress were 2.14 ± 0.80 and 2.94 ± 2.38, respectively. A significant negative correlation existed between age and frequency and composite score (r = -0.15, P < 0.01 and r = -0.16, P < 0.01, respectively) as well as years of experience and composite score (r = -0.11, P = 0.04). Moral distress composite score in adults specialists was higher than pediatricians (P = 0.002), but lower in physicians participated in medical ethics training courses compared to those not participated. CONCLUSIONS: Physicians may encounter moral distress during their practice; therefore, the common causes of distress should be identified in order to prevent its occurrence.

RESUMEN

BACKGROUND AND AIM: Electrical burns are associated with significant morbidity and mortality, which are usually preventable with simple safety measures. METHODS: We conducted a retrospective study of non-lightening electrocution deaths in Tehran, Iran, between 2002 and 2006. RESULTS: Of 295 deaths, 285 investigated were accidental. The remnants were suicidal. The age range was 11 months to 75 years with a mean age of 28.99 + or - 12.58 years. Two hundred seventy-nine victims (96.6%) were males. The upper extremity was the most frequently involved contact site in 185 deaths (66.3%). No electrical burn marks were present in 16 (5.4%) cases. Workrelated accidents were responsible for 188 cases deaths (63.9%) and home accident for 85 cases deaths (28.8%). Deaths were caused most frequently by touching an electrical cable (95 cases, 32.2%). There was an increase in electrocution deaths in the summer (119 cases, 40.3%). One hundred seventy-nine cases (60.7%) were dead on the scene of death and 94 cases (31.9%) were dead on arrival at hospital. The unique findings of our study include 10 cases (3.4%) of suicidal electrocution and a high rate of workrelated accidental electrocution among Afghan workers. CONCLUSION: Death rates from electrocution among all medico-legal deaths were found to be lower in our study than in previous reports, most of them were work-related and preventable. Workers and their employers should be educated to avoid such accidents with safety measures.

Asunto(s)

RESUMEN

OBJECTIVES: Dentists, like other doctors, can face punitive and legal consequences if patients are not satisfied with the dental treatment. The purpose of this study is to provide a database for dental malpractice claims in Tehran. METHODS: We conducted a retrospective study of dental malpractice claims In Tehran, between 2002 and 2006, based on the decisions of expert committees in medical malpractice cases by Tehran's Legal Medicine Organization and Islamic Republic of Iran's Medical Council. RESULTS: During these 5 years, 412 decisions related to dental malpractice were made. The majority of complaints were in fixed prosthodontics and oral surgery and also most of them concerned the private sector. Most of the cases were against general dentists. In the 56.7% of clinical cases and 40% of non-clinical cases of malpractice claims, dentists were found faulty. CONCLUSIONS: Like all other medical staff, dentists are under the obligation to comply with the legal rules in the country they practice. They also have to consider ethical principles as well as the acceptable standards and protocols of diagnosis and treatment. These data can alert them to the need for greater care and ethical professionalism when treating their patients.

Asunto(s)