Journal of Medical Ethics and History of Medicine最新文献

Decline in compassionate care is potentially linked to moral distress and fostering different aspects of organizational citizenship behavior can reduce the outcome of moral distress. This study aimed to determine the mediating role of organizational citizenship behavior in the relationship between compassionate care and moral distress among nurses. For this purpose, a correlational study design using structural equation modeling was employed. Between December 2023 and March 2024, 300 nurses were selected through convenience sampling from hospitals in Fars Province, southern Iran. Data were collected using the Organizational Citizenship Behavior Questionnaire, the Compassionate Care Questionnaire for Nurses, and the Moral Distress Questionnaire. Data analysis was conducted using SPSS version 22 and Smart-PLS software. Our findings showed that compassionate care, combined with the mediating role of organizational citizenship behavior, significantly impacted moral distress (t = 2.442, P < 0.015, β = -0.071). Pearson's correlation coefficients showed that compassionate care had a positive and significant relationship with organizational citizenship behavior (r = 0.444, P < 0.001) and a negative and significant relationship with moral distress (r = -0.353, P < 0.001). It is therefore recommended that managers in clinical systems focus on training nurses who exhibit appropriate organizational citizenship behavior in health-care settings.

This study examines the role of physician attire in building patient trust compared to other professional behaviors, identifying key attire-related factors that influence this trust. The study consisted of two parts. In the first part, patients and their companions participated in in-depth interviews to identify factors affecting their trust in doctors, including appearance. The findings from these interviews were used to create a survey questionnaire. In the second part of the study, 120 patients and their companions from two teaching hospitals were surveyed about the importance of doctors' attire and professional behaviors identified earlier. Qualitative interviews revealed three trust-building themes: general behavior (honesty and kindness), providing information (about diseases and necessary measures), and appearance (white coat and cleanliness). Quantitatively, 120 participants rated providing information (81%) and honesty (74.2%) as the most important factors in building trust, with appearance rated as very important (40%) but less critical (P < 0.001). White coats were prioritized over hygiene and clothing cleanliness (P < 0.0001), while 37.5% noted that tattoos or bright clothing reduced trust. The findings show that several factors are more important than the type of a doctor's attire in maintaining the patient's trust, and the dress code should prioritize safety and infection prevention.

This cross-sectional study, conducted in 2023 on 386 ICU nurses from hospitals affiliated with Tehran University of Medical Sciences, investigated the relationships between moral resilience, moral distress, and second victim syndrome. Participants were selected through simple random sampling, and data were collected using Rushton's Moral Resilience Scale, Hamric's Moral Distress Questionnaire, and Burlison's Second Victim Scale. Analysis was performed using descriptive statistics and Pearson's correlation in SPSS v24. The results showed a significant positive correlation between second victim syndrome and moral distress, indicating that increased second victim experiences were associated with higher moral distress. There was also a significant negative correlation between moral resilience and second victim syndrome, confirmed by regression and structural equation modeling. However, no significant correlation was found between moral resilience and moral distress. Overall, the study highlights that second victim syndrome contributes to moral distress, while moral resilience acts as a protective factor. It is recommended that targeted interventions - such as resilience training, peer support groups, professional debriefing, and organizational mental health initiatives be imple- mented to mitigate these psychological challenges in high-stress ICU environments.

The contemporary world is profoundly shaped by technological progress. Among the advancements of our era is the proliferation of artificial intelligence (AI). AI has permeated every facet of human knowledge, including medicine. One domain of AI development is the application of large language models (LLMs) in health-care settings. While these applications hold immense promise, they are not without challenges. Two notable phenomena, AI hallucination and AI drift, pose setbacks. AI hallucination refers to the generation of erroneous information by AI systems, while AI drift is the production of multiple responses to a single query. The emergence of these challenges underscores the crucial role of the philosophy of medicine. By reminding practitioners of the inherent uncertainty that underpins medical interventions, the philosophy of medicine fosters a more receptive stance toward these technological advancements. Furthermore, by acknowledging the inherent fallibility of these technologies, the philosophy of medicine reinforces the importance of gentle medicine and humility in clinical practice. Physicians must not shy away from embracing AI tools due to their imperfections. Acknowledgment of uncertainty fosters a more accepting attitude toward AI tools among physicians, and by constantly highlighting the imperfections, the philosophy of medicine cultivates a deeper sense of humility among practitioners. It is imperative that experts in the philosophy of medicine engage in thoughtful deliberation to ensure that these powerful technologies are harnessed responsibly and ethically, preventing the reins of medical decision-making from falling into the hands of those without the requisite expertise and ethical grounding.

Artificial intelligence (AI) has the potential to revolutionize healthcare, but is unlikely to fully replace human doctors. This paper explores the limitations of AI in healthcare, focusing on three key areas: lack of embodiment, limited understanding of meaning in everyday language, and the inability to exercise judgment and clinical reasoning. Recognizing these limitations enables us to use AI to enhance our capabilities rather than allowing it to substitute humans. Following this philosophical examination of AI's limitations, I will argue that the question of whether AI will replace doctors is a misleading one. Instead, this framework advocates for synergistic human-AI collaboration in health-care settings. It necessitates the development of hybrid entities: a physician-AI partnership and a patient-AI interface. The overarching objective is to effectively address the core mission of medicine, which is providing optimal treatment and compassionate care for all patients. This hybrid model must proactively mitigate the risks of AI integration, such as exacerbation of existing health-care challenges and potential dehumanization of patient care. Within this framework, key objectives include: reducing medical errors, fostering humane doctor-patient relationships, mitigating the trend of medicalization, and ultimately improving overall public health outcomes.

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.

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.

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.

Widespread use of smartphones among healthcare professionals necessitates the availability of accessible ethical guidelines that consider cultural and social contexts. This study aimed to develop an ethical guideline for the use and documentation of audiovisual recordings of patients in Iran. The study was conducted in three phases: (I) a literature review, (II) focus group discussions, and (III) expert panel sessions. Participants were selected based on their willingness to participate in focus group meetings and a minimum of five years of experience in the field. Conventional content analysis was used for the focus group discussions, while directed content analysis was applied to the expert panel sessions. The guideline comprises two sections: "general ethical considerations", which includes 43 items, and "specific ethical considerations", which contains 18 items. The "general ethical considerations" section addresses ethical issues to be considered before, during, and after making audiovisual recordings of patients. The "specific ethical considerations" section focuses on ethical principles related to audiovisual recordings involving children and adolescents, cadavers, and patients with impaired decision-making capacity. This ethical guideline aims to address emerging ethical and legal challenges and to ensure that healthcare professionals' behaviors align with established ethical principles and societal expectations. Furthermore, it can serve as a valuable resource for developing assessment tools and training students in clinical settings.