Journal of Medical Ethics and History of Medicine最新文献

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.

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.

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.

Moral disengagement is a set of cognitive mechanisms through which a person violates his/her moral standards without losing his/her dignity. Therefore, a tool has been designed to measure moral disengagement in nurses. This study aims to determine the psychometric properties of the Nursing Moral Disengagement scale. In this methodological study, 440 nurses working in hospitals of Mashhad were selected by the availability sampling method. The translation was carried out using the forward-backward method. The final version of the tool was psychometrically tested for validity (exploratory and confirmatory factor analysis) and reliability (internal consistency and relative stability). Four factors were extracted in the exploratory factor analysis, and since the factor loadings of all the tool items were higher than 0.3, they were all retained. The tool's general fit indices indicated the model's confirmation and optimal fit. Cronbach's alpha and relative stability coefficients for the whole questionnaire were 0.90 and 0.89, respectively. The study results showed that this tool has good validity and reliability and can therefore measure behaviors related to moral disengagement in nurses, so that appropriate interventions can be designed to reduce these harmful behaviors.

Compliance with patients' rights by medical sciences students requires an understanding of the patients' rights charter. This study aimed to assess the awareness of medical sciences students regarding the patients' rights charter. A descriptive cross-sectional study was conducted, involving all final-year medical sciences students at Alborz University of Medical Sciences, Iran (n=370). Samples were selected using convenience sampling, and data were collected through a questionnaire designed to evaluate awareness of the patients' rights charter. The study included 269 students. The results indicated that over half of the students possessed a moderate level of awareness about the patients' rights charter. Analysis of specific domains revealed that the right to access services had the highest percentage, while the right to personal autonomy had the lowest percentage of awareness. Furthermore, analysis of variance revealed that medical students exhibited the highest level of awareness. Given the moderate level of awareness among medical sciences students regarding the patients' rights charter, it is essential to design and implement plans to enhance their understanding of patients' rights.

Conscience is defined as the cornerstone of ethics and is considered a valuable asset. There is, however, little evidence about how Iranian nurses perceive conscience. The purpose of this study was to psychometrically evaluate the Persian version of the Perception of Conscience Questionnaire (PCQ) in Iranian nurses. In this cross-sectional and descriptive study, a psychometric evaluation of the PCQ was conducted on Iranian nurses in 2022. A total of 300 nurses participated in this study to validate the PCQ. At first, the initial translation and determination of face validity was done, and content validity was assessed using the Content Validity Index and Content Validity Ratio. Reliability was determined by intra-class correlation coefficient and Cronbach's alpha coefficient. The construct validity of the PCQ was determined by exploratory factor analysis, which led to the extraction of five factors of warning signal, valuable asset, spiritual power, burden and conscience outcomes from the initial 14 factors of the questionnaire. Reliability of the whole questionnaire was calculated to be 0.80 using Cronbach's alpha. While an intra-class correlation coefficient of 0.58 indicated average stability, the five-factor construct of the PCQ showed good validity and reliability. Therefore, our findings proved that this tool is suitable for assessing Iranian nurses' perception of conscience.

In the years following its outbreak in 2019, COVID-19 changed the health-care system structures, the context of professional activity, and nurses' moral performance. The present study aimed to examine the moral distress and moral courage of Iraqi nurses during the COVID-19 pandemic. This cross-sectional and correlational study was conducted in 2021 on 168 nurses selected by convenience sampling methods. Data were collected by self-reported instruments including a demographic questionnaire, the Professional Moral Courage (PMC), and the Moral Distress Scale (MDS). Data were analysed using descriptive statistics, the Spearman, Mann-Whitney and Kruskal-Wallis tests, and SPSS version 22. Most nurses showed a moderate level of moral distress (98.80%) and a high level of moral courage (99.40%). The dimension of multiple values had the highest mean (12.45 ± 1.47) and endurance of threats had the lowest mean (9.15 ± 1.79). There was a statistically significant correlation between moral distress and moral courage (P = 0.007, r = - 0.2), and moral distress and the dimensions of endurance of threat (P < 0.001, r = - 0.26), going beyond compliance (P < 0.001, r = - 0.037), and moral goals (P < 0.001, r = - 0.173). A statistically significant relationship was also found between moral distress and work shift, position and gender (P < 0.05), and between moral courage and position (P < 0.05). We concluded that nurses need more organizational support in terms of protective facilities, job security and organizational incentives to be able to show ethical behaviors.

To deliver effective medical services and establish trust and psychological security in patients, care providers must prioritize ethical principles. Developing a comprehensive clinical education program for learners, along with specific ethical guidelines, and implementing managerial and executive interventions necessitates a thorough understanding of the ethical challenges within this field. This qualitative study aimed to elucidate the ethical issues faced by otolaryngologists. Sixteen otolaryngologists participated in the study, selected through purposive sampling. Data were gathered through semi-structured interviews, and the analysis, conducted through conventional content analysis, revealed eight main categories and 38 subcategories encapsulating the identified ethical issues. The primary categories encompassed ethical issues faced by otolaryngologists concerning patients and companions, education, communication with the treatment team, physicians' rights, medical tourism, medical advertising, cultural considerations, and managerial challenges. resources and treatment approaches in alignment with Iranian cultural norms, address conflicts between treatment and education, and implement sound management plans to uphold rights of the treatment team. Additionally, the study suggests the necessity of ethical advertising programs and the strategic promotion of therapeutic tourism.

One of the critical aspects in discussing human dignity is the establishment of its criterion, a standard unique to humans. This criterion should effectively create a fundamental and structural distinction from other creatures. Initially, our focus was on the endeavors of biologists to differentiate the human species from others, emphasizing the physical aspects. However, physical and genetic differences lack the necessary characteristics to serve as a criterion for dignity. Subsequently, we explored the notion of this criterion in human behavior. Yet, given that behavior stems from human thought, it proves unsuitable as a criterion for dignity. Thus, our quest led us to explore human wisdom. However, since wisdom, like other abilities, serves as a tool for improved living and is present to some extent in other animals, it proves inadequate as a criterion. We have determined that the distinguishing characteristic lies in the power of choice or free will, setting humans apart from other living beings whose behavior is solely instinctual or driven by needs. Consequently, free choice forms the foundation of dignity, assigning value to the chooser based on the choices made.