فصلنامه اخلاق پزشکی
پیاپی 43 (بهار 1397)

Exposure to cancer causes the physical, psychological and spiritual aspects. Spiritual health coordinates different aspects of human life and it is necessary to adapt to the disease. The present study was conducted to investigate the spiritual health, forgiveness and coping strategies in patients with gastrointestinal cancers. This is a cross-sectional descriptive study. In this study, 45 patients with various types of gastrointestinal cancers referred to the Imam Reza Educational Center of Tabriz University of Medical Sciences in 2018 were evaluated. Ellison Spiritual Wellness Questionnaire, Ray Forgive Questionnaire, and Pargament and Queen's Religious Coping Strategies Questionnaire were used. For data analysis, descriptive statistics, independent t-test and Spearman correlation coefficient were used by SPSS 19 software. The results showed significant correlation between forgiveness and spiritual health (P<0.001, rs=0.61), forgiveness with religious coping strategies (P=0.031, rs=0.73) and spiritual well-being. There was a significant positive correlation with religious coping strategies and Spiritual Health (P=0.001, rs=0.44). All subjects were informed on the content of the study and if they agreed to participate, a written informed consent was obtained. The results of study showed that most patients with cancer have a high spiritual level. Positive emotions resulted in better self-expression. Religious coping strategies lead to delightful emotional experiences and positive emotions in subjects and it will make life satisfying and thanksgiving and full of forgiveness.

The aim of this study was to investigate the Relationship between Spiritual wellbeing and Hereafter Thought with Psychological wellbeing in Mohaghegh Ardabili University Students. A sample of 111 participants was selected from the whole students to Mohaghegh Ardabili University using a random cluster sampling. The tools of this study were Spiritual Wellbeing Scale, Ryff Psychology Well-Being Scale (RPWB) and Hereafter Thought Scale. The following results were obtained in this study shown that there was Positive Relationship between Spiritual wellbeing and Hereafter Thought with Psychological wellbeing and subscales of religious health, transcendence, heatafter, readiness and task flighting predicts Psychological wellbeing. Before completing the questionnaires, first of all, we explain the aim of this research and confidentiality of results for participants, to participate with informed consent. Increasing Spiritual wellbeing and focus on Hereafter Thought and reinforcement of religious tendency in family members, can promote Psychological wellbeing. Psychological well-being is deeply related to the individual’s religious beliefs, which offer a rich source of material to consider the relationship between various dimensions of religious involvement and other facets of psychological well-being. These results provide new insights into how spirituality operates as a fluctuating experience in daily life.

Uncivil behavior in the workplace threats are leading to embarrassing and compromising the health of nurses and patients are the behaviors of organizational climate also threaten and, if it is not considered unpleasant consequences will be. The aim of this study was to evaluate uncivil behavior in therapeutic environments from nurses' Perspective in hospitals in Gonabad city. This cross-sectional study on 182 Nurses in hospitals of Gonabad city in 2017. Data were collected through demographic questionnaire and standard Nursing Uncivility Scale (NIS) by census sampling from nurses in emergency, surgery, internal medicine, obstetrics and gynecology, pediatrics, hemodialysis, Ophthalmology and ENT, ICU, CCU, NICU Wards. Data analyzed using descriptive statistics and statistical tests ANOVA, t-test and Pearson correlation was performed using SPSS 20. The results of the statistical tests were considered to be less than 0.05. The findings of this study showed that total score of uncivil behaviors from nurse's perspective is 2.30 of 5 score in Likert. Most uncivil behavior in nurses interacts with physicians (84.2±0.91) and the lowest in nurses interacting with supervisors (1.97±0.83) was observed. After explaining the objectives of the research and confidentiality of the information, the informed written consent was obtained from participants. Uncivility behaviors among nurses can affect the quality of services provided by them. Therefore, considering factors that lead to uncivility in nursing workplace is necessary.

The health system requires nurses to participate in ethical decision-making and increase the quality of service provision in the system. Nursing students need to learn ethical analysis skills to be able to deal with the ethical issues in the clinical setting. Therefore, this study was designed with the aim of Comparison of moral reasoning of nursing students and nurses in Meybod city in Facing with dilemmas. This descriptive cross-sectional study and census sampling was conducted on 134 nursing students (66 nurses) and nurses (68 students) in Meybod city in 2017. Data were collected by using Nursing Dilemma Test questionnaire . Spss software version 18 was applied to analyze the data. The mean score of the nurses' moral reasoning was (40/83±5/93) and the nursing students’ moral reasoning was (64/46±6/8). There was a significant relationship between the work experience of nurses and the mean score of moral reasoning (P≤0/05). There was no statistically significant relationship between the mean score of moral reasoning and other demographic characteristics (P≥0.05). The aims of the study and confidentiality of the data were explained to the participants and their written consent for participation in the study was obtained. According to the findings of the study and the need for nurses to be able to substantiate their moral reasoning and the ability of nursing students during their education requires proper educational planning in educational curriculum of colleges and the provision of appropriate strategies and strategies by hospital managers and planners.

Euthanasia or planned ending to the patient’s life by some medical means is a challenging issue of medical ethics. The aim of this study was to evaluate the attitudes of patient entourages toward euthanasia.

This cross-sectional study was conducted on 100 patients’ entourages during the year 2016. Sampling was donned randomly among patients’ entourages hospitalized in the critical and general units of Beheshti Hospital, Qom. Data were analyzed by Chisquare, independent t-test and Pierson correlation test through SPSS 19.

Most participants had an impartial attitude towards euthanasia. Between the total score of attitude towards euthanasia and its subscales including ethical considerations, practical considerations, honoring the life and naturalistic beliefs there was a significant correlation (P<0/05). Between the total score of attitude towards euthanasia and patient's survival there was not a significant correlation (P>0/05).

Written informed consent was obtained from all participants. Additionally, all of them were assured of anonymity of the questionnaires and confidentiality of the information

Most patients’ entourages had an impartial attitude towards euthanasia. This might have been caused by an uncertain position of community in this regard. More in depth ethical, religious and legal debates on euthanasia seem to be required to make people more capable of decision making in this regard.

Thalassemia is an inherited autosomal recessive disease originating from the countries of the Mediterranean region that is deficient globin chain synthesis. Despite medical advances that have been made in the survival of these patients, especially patients with thalassemia major are increased. However, mental health problems - social nature of chronic disease is still the major challenges facing these patients. This study aimed to investigate the spiritual health and its related factors in patients with thalassemia major was performed. This study was a cross-sectional study on 101 patients with thalassemia major in thalassemia major ward of dezful hospital with purposive sampling was conducted in 2015. Data were collected with demographic and spiritual health standard Dolmen and Ferry questionnaire and analyzed by SPSS 18 and statistical analysis ANOVA, T independent, linear regression and Pearson's correlation coefficient with significant level of P<0/05 were analyzed. The mean patient age was 23.22±5.4 which 60.4% were male and %39.6 was female. The average score of spiritual health and self-efficacy subscale 34.58 and 14.68 respectively, which indicates the average level of the subscales. Average of life plan sub scale was 19.8 that is indicative of the high level of this sub-scale. There was no significant relationship between sex and spiritual health (P>0.05). The present study was conducted with the patient's privacy and with written informed consent from patients and without any cost to them. The study showed that the spiritual health of patients with thalassemia major usually is at the average level and according to the relationship spiritual health and well-being of patients is required that steps be taken to improve their health.

According to the numerous problems that pregnant women are likely to suffer during pregnancy and childbirth, they need more services and rights in different ways. so observing ethics and rights of pregnant women according to their medical needs must be concerned. This study was conducted with the aim of assessing a comparative study of satisfaction of midwives and mothers of Adherence to mother Rights in educational Hospitals affiliated to Kermanshah University of Medical Sciences, 2017. This study was a descriptive comparative study and in this study, 200 pregnant women and 100 midwives in hospitals in Kermanshah University of Medical Sciences were selected by ease sampling. Data gathering tool was two types of researcher made questionnaire to midwives and mothers. Data was analyzed by SPSS and descriptive analytical tests. The results of research of exploratory factor analysis showed that 4 main factors identified in this study include: the first factor: received a favorable obstetric services, the second factor: respect the privacy of the mother, the third factor: Respect for the right to choose and decide freely mother, the fourth factor: access to health information is appropriately. Also from the point of view of mothers and midwives between the access to health information and favorable obstetric services appropriately in terms of statistical tests. There is a significant difference (p<0.05). After explanation about the study objectives and ensuring confidentiality of information, the participants’ consent was obtained. Regarding importance of mother rights during pregnancy and the difference between the views of mothers and midwives on access to health information and obstetric services in this study, improve the present situation and classes for justification of mothers and midwives to better the situation should be considered as important.

Adolescence is a sensitive period with many threats. The aim of this study was to determine the role of spiritual health, emotion regulation and metacognitive beliefs in substance abuse in adolescents. This descriptive-analytical study was conducted on 230 female and boy students of Torbat-e-Heidarieh high school in academic year 95-94 that was selected by available sampling method. After obtaining informed consent, participants completed the questionnaire of spiritual health, emotional regulation, metacognition, and drug use tendency. Data analysis was using inter regression method. Mean and standard deviation of tendency to substance abuse was 13.61±6.2 spiritual health 86/38±13/20, emotion regulation 42/89±5/58 and metacognitive beliefs 70/23±10/05. Between the tendency to substances abuse with spiritual health and emotional regulation was inverse relationship (p<0/01) and with metacognitive beliefs was direct relationship (p<0/05). The predictor variables predict 25% of the variation of the criterion variable. Before the study, the goal of the study was explained to participants to participate full satisfaction. The research findings showed that the increase of spiritual health and emotional regulation the tendency to substances abuse decrease and with the increasing metacognitive beliefs, the tendency to use drugs will increase. Therefore, attention is paid to the role of these factors in tendency to drug use provides ground for preventive action.

Changes such as globalization and migration, which have been widespread at international level in recent years, have led to increased cultural interactions and the transformation of existing communities into multi-cultural communities. In such a situation, awareness of the cultures governing the various communities, the role of culture in diagnosis, treatment, and symptoms of mental disorders, as well as awareness of the impact of therapist's and client's culture on the therapeutic process is necessary. The purpose of the present article is to study the cultural aspects of ethics in different countries such as East Asia, India, Middle Eastern countries, European countries, the United States of America and Africa. In the present narrative review paper, a systematic study was conducted for full-accessible English papers at 2005 to 2015 years time period using "culture", "ethics", "psychotherapy", "cutularal differences" keywords on PubMed, Science Direct and Google Scholar databases. Of total 116 obtained papers, 24 related papers were studied and analyzed. The cultural differences between different communities are such that ignoring them could lead to a decline in therapeutic performance of therapist and poor treating outcome. Literature review showed that the APA's ethics code forces psychologists to have knowledge and awareness of cultural, individual, and Mutual respect for the fundamental rights, dignity and authority of all human beings. Integrity and honesty in reporting, documenting and citing of resources were observed, The results show that although the therapist may not be familiar with all cultures, the therapist's awareness of his own cultural context, as well as the understanding and acceptance of his cultural differences with the clients, could have contribution in effective advancement of the therapeutic process and improving the quality of the treatment. In addition, there is an extensive need to determine ethical codes proportional to culture of various communities.

Nurses' professional competence depends on adherence to professional ethics. Principles and ethical norms also ensure organizational health. This study investigated the relationship between organizational health and professional ethics of nurses working in teaching hospitals affiliated to Shahrud University of Medical Sciences.

In this descriptive-analytical study, among the nurses working in educational hospitals in Shahrud who had bachelor's degree and higher with a full-scale sampling, 200 nurses entered the study. Data was collected by using Occupational Work Ethics Inventory (OWEI) and Organizational Health Inventory (OHI) questionnaire whose validity and reliability were confirmed in previous studies. Data was analyzed with SPSS 21 software.

The Pearson Correlation Coefficient between organizational health and the variables of work ethics (0.664), interest in work (0.562), persistence in work (0.658), human relationships at work (0.611) and participation in Work (0.449) showed a positive and significant relationship at a meaningful level (0.99). Ethical Considerations: After obtaining written permission from the Ethics Committee in Shahrud University of Medical Sciences, expression of research goals, the emphasis on the confidentiality of information and written consent, questionnaires were submitted to the nurses who were willing to cooperate.

The results showed that there is a positive and significant relationship between nurses' professional ethics and organizational health in hospitals. Increasing employee ethics increases organizational health.

Spiritual health and happiness both are of the most important aspects of the psychology and have a significant role in the development of educational purposes. The objective of this research is examination of relationship between spiritual health and happiness among students of Ardabil Nursing Midwifery Faculty.

This descriptive- analytical study was done in 2017 in Ardabil Nursing Midwifery Faculty. The sample size was 90 respondents based on Cochran formula. Data was collected by using Ellison spiritual health and Oxford happiness questionnaires. The results were analyzed by spss18 and descriptive (frequency and percentage) and analytical (person correlation coefficient, independent t- test, ANOVA) statistics methods.

There was a significant positive relationship between spiritual health of students with their happiness (p≥0.001, r= 0/543).The score men of spiritual health got 64.41±5.90 in students and score men of happiness got 86.98 ±14.22. Also, All dimensions of spiritual health had significant relationship with happiness. Ethical Considerations: After explanation about the study objectives and ensuring confidentiality of information, the participants' consent was obtained.

With regard to direct relationship between spiritual health and happiness, instructional managers with planning for students' spiritual health, can provide settings to increase students' happiness.

Since professional ethics are important parts of treatment process, lack of attention to the right principles of using these could lead to many problems including improper and unsuccessful treatment, and also legal dilemmas. Adherence to professional ethics in nursing from patients’ point of view could reveal unclear issues and common errors; therefore, the present study was conducted to examine the degree nurses working in Alzahra Hospital adhere to professional ethics in practice from patients’ perspective.

This is a descriptive-analytical study performed in 2015 among 244 randomly selected patients being discharged from various wards of the Alzahra Hospital. A self-structured questionnaire was used to measure use of professional ethics among nurses. Statistical analysis was performed using descriptive and analytical tests.

The mean age of participants was 45.25±7.1 ranging from 14 to 93. 123 women (50.4%) and 121 men (49.6%) were included. The mean score of professional ethics adherence among nurses from patients’ point of view was 95.6±17.9 ranging from 44 to 125. Based on this result, use of professional ethics was estimated to be excellent among 111 individuals (45.5%), optimal among 96 persons (39.3%) and moderate among 37 nurses (15.2%). Ethical Considerations: participation in the study was optional and informed written consent was obtained from patients to participate in the study. In addition, the information confidentiality of the participants was observed.

The results of this study indicate that observance of the nurses’ professional ethics in the research environment is at an acceptable level and the important causes includes of the educational environment of the research, the provision of educational programs and retraining by the nursing system and continuous monitoring of nursing personnel.

It is necessary to obtain informed consent for any medical intervention, providing adequate, correct, appropriate information to the patient. Currently, the process of obtaining informed consent in our country prior to surgical procedures is limited to a single sheet, and this leaflet often does not describe the specific information of each operation. Therefore, the aim of this study was to evaluate the effect of presenting surgical information sheets on the satisfaction and knowledge of surgical patients.

This was a before and after semi-experimental study. The population of study was a general hospital affiliated to Tabriz University of Medical Sciences in 2017. The Sampling of this study was census and 60 patients were selected. The data collection tool was a questionnaire completed before and after the intervention. Data were analyzed by using SPSS 18 software and paired t-test.

The mean score of the patients' knowledge before the intervention was the provision of surgical information sheets 6.283±1.76. After intervention, they were 8.60±2.65 and there was a significant difference between them (p=0.559). The mean score of patients' satisfaction before intervention was 9.76±2.47, which after intervention was 9.87±2.02 and there was no significant difference between them (p=0.001). Ethical Considerations: Following the explanation of the objectives of the study and the emphasis on confidentiality, the consent of the participants was obtained.

The results of this study has been shown that the presentation of surgical information sheet only increased the awareness of patients but did not have a significant effect on overall satisfaction. Therefore, the best and most effective way to provide information with different interventions should be determined in order to increase their satisfaction along with raising awareness.

The purpose of this study is to investigate the effect of spiritual therapy on marital satisfaction among addicts in treatment period.

The research design is semi experimental. In order to achieve this goal, among addicts in treatment period, 30 people (15 people in the experimental group and 15 in the control group) who had the lowest score in the marital satisfaction questionnaire were selected by purposive sampling .Marital satisfaction test was used as pre-test and post-test. Then, 10 sessions for the experimental group on spiritual healing were held each week for 2 sessions of 80 minutes. After the last session, both groups were asked to answer the questionnaires again .Finally, the obtained data were analyzed using covariance analysis.

The results showed that spiritual therapy affects the marital satisfaction among addicts in treatment period, but the effect of this method on marital satisfaction is small. Ethical Considerations: After explaining the goals of the study, informed consent was obtained. The questionnaires were anonymous and convinced participants that their information would remain confidential and results would be published totally.

These results showed that spiritual therapy sessions have an effect on increasing marital satisfaction.

The ethical climate is section of an organizational culture will be affect on ethical dimensions of the employees and their work efficiency. Ethical climate promotion in health care organization would be improved nurses’ behavioures to ethical tension, increase of job satisfaction and decrease of intent to quit to work. The aim of this study was to determine the correlation between nurses’ perception of ethical climate and with nurses’ intent to quit among critical care nurses in the affiliated hospitals of Mazandaran University of Medical Sciences in 2018.

This was a descriptive- correlational and cross-sectional study conducted on 495 nurses employed in critical care units of the teaching hospitals of Mazandaran University of Medical Sciences in 2018 were selected. The subjects were selected by census sampling method. Data collection was carried out using demographic data، Olson moral climate, and intent to quit of Hinshaw Questionnaires. For data analysis, descriptive statistics, Pearson correlation and regression tests were used in SPSS 20 software

The ethical climate with mean (3.78±0.08) was at the desired level, and mean of the tendency to intent to quit on the job (2.93±0.39) was the less than average level. The statistics test showed that they were different significantly ((P<0.001)). And also, linear regression test showed that there is direct and meaningful correlation between them. The ethical climate of the critical care units for decrease intention to quit of job. Ethical Considerations: After familiarizing the participants with the objectives of the research and explaining the confidentiality of the information, participants' oral satisfaction was obtained.

In order to results, nurse managers could be promotion.

The purpose of this study is to Predict Mental Health based on Moral Intelligence and Cognitive Flexibility in Nursing students.

The method of this study is correlational. Statistical population of this study comprised of all nursing students of Guilan University of Medical Sciences in the year 2016, from among this population. 300 students were selected as by using multistage sampling Method. The used tools were Goldenberg General Health Questionnaire, Moral Intelligence questionnaire and Cognitive Flexibility questionnaire. Data analysis was performed through Pearson’s correlation coefficient and regression analysis Under the SPSS 19 software.

The findings proved that there is a positive correlation between moral intelligence and mental health (r=0.32, p<0.01) and there was a significant positive correlation between cognitive flexibility and mental health (r=0.12, p<0.01). Also, regression analysis revealed that 18% of the total variance in mental health is predicted by the Moral Intelligence and Cognitive Flexibility. Ethical Considerations: After presenting the research objectives, emphasizing the anonymity of questionnaires and confidentiality of personal information and getting a written informed consent, the questionnaires were handed to the participants.

The overall results indicate that the mental health of people in the areas of physical, psychological and social is influences ways of Moral Intelligence and Cognitive Flexibility. Therefore, it is suggested that more attention be paid to improving their mental health and their ethical dimension and flexibility.

From propounding of spirituality in the field of health has lasted more than 5 decades, but aspects of this important dimension has remained unknown. This study aimed to present main strategies for realizing spiritual health with Islamic perspective.

In this qualitative study, in order to extract the foundations and theoretical literature of the research, revelatory Islamic sources including the Quranic verses and the Hadiths of the Infallibles as well as the phrases of some scholars were reviewed and then, by analyzing the holy texts using hermeneutic and inductive content analysis methods, strategies to achieve spiritual health were suggested.

Three parts including foundations (12 components), prerequisites (3 components), and promotion strategies of spiritual health (10 components) were extracted. The first part explains three main harm factors of sin, lust, and hatred that endangers community spiritual health and both personal and community spiritual health requires Purity of heart and avoid them. Believing in God and Prophets and Divine Parents; and acting on their recommendations; paying attention to the health and disease; hope, patience and trust in God are considered as the prerequisites for spiritual health, and based on them, theoretical strategies to promote spiritual health was presented. Ethical Considerations: In this study, trusteeship was observed in reporting and citating of the texts.

The best sources are Quran and the teachings of the infallibles and the best doctors are infallible imams and divine ones. Thus, providing the ground to practice on these strategies is recommended to realize and promote spiritual health utilizing quantitative and qualitative methods at individual and community levels.

In order to minimize ethical problems in the work of psychologists, the code of ethics have established rules for psychologists' behavior by specifying ethical codes. Examining the code of ethics in other countries is helpful in determining the weakness points of the ethical codes of an association in which a psychologist works. The purpose of this study is to compare the code of ethics in three countries of Iran, United States and Germany.Materialsand

First, the professional code of ethics in all three countries were extracted from their relevant organizations. In the second step, their differences and similarities were examined in terms of the code structure. Finally, all three code of ethics were analyzed in terms of content and executive procedures.

The structural analysis of the code of ethics showed that the introduction and general principles are common in all three code of ethics. In the German code of ethics, a separate section is devoted to the ethical codes for research and publication, and other ethical codes, which have been raised in other two code of ethics in the form of ethical standards, are listed in the separate section under the heading "Psychology in practice". Also, the content comparison of code of ethics showed that general principles of the Iranian and United States code of ethics point to ideal goals that areunderpinned by ethical standards and, in their turn, are not enforceable rules, while in the German code of ethics, the general principles are the conditions and regulations that a psychologist has for have a professional identity in the German Professional Psychologists Association.EthicalConsiderations:Integrity and honesty in reporting, documenting and citing of resources were observed.

The differences between the codes of ethics can be explained by the difference in the research priorities of the relevant organizations, multicultural and multi-national of these countries and the differences in their technological advances.

Students' spiritual compatibility can play an effective role in adapting them to the health of the future. In this regard, considering the multiplicity of factors affecting spiritual adjustment, the relationship between spiritual intelligence and spiritual compatibility of students has been investigated.

A cross-sectional correlation study was conducted on 178 students of Borujen nursing faculty who were selected through census sampling. The data gathering tool was a threepart questionnaire for demographic information, Badiae et al., Spiritual Intelligence Questionnaire, and Spiritual compatibility Questionnaire for Rasoul and colleagues. The data were analyzed by SPSS 16 software and analyzed by descriptive and analytical statistics.

The Pearson correlation coefficient between spiritual intelligence variables and spiritual consistency of students showed a positive and significant relationship (r=0.6, p<0.05). The mean of total spiritual intelligence in students was 3.63±0.3 (1-5) and the average total spiritual compatibility was reported in students 4±0.8 (1-5). Also, the results showed that spiritual intelligence of students is a predictive factor for their spiritual compatibility (p<0.05, r2=0.36). Ethical Considerations: All participants were assured to participate in the study of written consent and about the anonymity of the questionnaires and the confidentiality of their information.

According to the results, students' intellectual intelligence could be increased with increasing their spiritual consistency. To further increase the students' spiritual intelligence it is necessary to plan the dimensions of belief thinking, ability to interact with problems and spiritual self-awareness and address ethical issues through training and periodic reviews by educational managers.

The purpose of the Patient’s Rights Charter is Defending patients' rights and ensuring that they are adequately taken care. Awareness of the charter of rights and the provision of conditions is so important for demand of healthcare users for these rights. Therefore, this study was conducted to the study of relationship between awareness of patients and amount of demand for patient’s rights charter in Zabol city’s hospitals in the first six months of 2017.

This is a cross-sectional descriptive-analytic study that was performed on 400 patients referring to hospitals in Zabol city in 2017. Data were collected through two questionnaires, including demographic characteristics and questions related to awareness of the patient's charter and the amount of demand. Gathered data were analyzed using SPSS 22 and independent t-test and one-way ANOVA.

The results of the present study showed that the mean score of patients' awareness was 7.9±1.08.99 and was at weak level. Also, the mean score of patient’s demand was 3.85±0.87, which was at a weak level. The results also showed that there was a significant relationship between the level of education, marital status, gender, place of residence with the level of awareness of patient’s rights charter and the amount of demand. Ethical Considerations: Before completing the questionnaires, first of all, we explain the aim of this research and confidentiality of results for patients, to take part in informed consent.

This study shows that that different levels of demand for Patient’s Rights Charter have a significant direct correlation with Patient’s Awareness of right , so that the awareness of patients referring to hospitals in Zabol city was poor in the contents of the charter of patient rights as a result, their demand was low. Therefore, it is suggested that each of the five aspect of the charter be prepared separately, and in time of reception patients, this information should be provided in writing to patients and referring.

Unethical behavior in the health sector entitledas widespread moral hazardandhave high share in the health system’s growing costs in the world. Presentstudy aimed to analyze the moral hazards of distribution medicines in pharmacies and the financial burden on insurance organizations.

Present cross sectionalstudywith reviewing the prescriptions provided to the two maingovernmental and private pharmaciesand usingindividual's disease information, moral hazards categorized in three separate branches. First category was the irrational prescribing the medication, second, the rate of drugs that are exposed to expire period and third category was tear off a leaf from the insurance booklets and writing some formal medications. Then with analyze the data, assessing the financial burden of moral hazards on medical insurance organizationswasconducted.

Irrational prescriptions had the mostprevalencebetween the observed moral hazardsandwere more frequented in public pharmacy. Irrational prescriptions cost was significantly higher in general physicians prescriptions than specialists. Also cost of moral hazards in public pharmacy was significantly higher than private one. The additional financial burden on insurance organizations was estimated 120 million Rialsin a month. Ethical Considerations: Gathered data was usedwith considering confidentiality and informed consent was taken from participants.

Financial burden assessment of moral hazards addition to confirming the importance of ethics in health systems and among health service providers in medicine section, represent the probability of control a large part of the health care system costs by promoting ethics.

The issue of euthanasia has been a matter of ethical medicine since the away times in the field of ethics, and have serious advisers and opponents. Their attitudes are based on the philosophy of "right" and "the right to life" and "the right to die", and on the other hand, the opposition, based on the principles The philosophy of "duty-oriented" or "philosophy of virtue." According to the philosophy of "the right", the discussion of "the right to choose easy death" or "euthanasia" in people under the age of 18 years is also raised and In 2014 Belgium acknowledged that there were many controversies about it, including the right to choose, the right to choose, the ability to withstand this responsibility and eligibility. Enough to do this.

In this article, a narrative review based on the searches of the words "Euthanasia" and "Children" on Iranian and foreign sites, including google scholar & Pupmed, between 2011 and 2017, as well as review of articles, articles and articles on "Children's Rights" in domestic sources, attempts to gather content and It has been analyzed

In the review, it was determined that socio-religious differences, religious, ethical and customary doctrines, and the attitude towards the "right" issue in the issue of euthanasia in children under the age of 18 years were very high in different countries, and at the same time different from the issue of euthanasia in adults. Particular complexities. Ethical Considerations: Honesty and non-profit in the report of texts and resources, reference to valid sources and attempts to avoid any bias. This research is carried out at a personal expense without any financial support or central affiliation.

Euthanasia license generally, and for people under the age of 18, should be considered in particular, regardless of individual rights. Also, attention to principles such as respect for the autonomy of individuals due to limitations and specifics of it in different countries, cultures and religions, and the complexity of the issue under discussion, alone and without regard to the principles of profitability, lack of financial and justice to decide on this issue It is not enough and, like many moral challenges, it needs to be more explicit and comprehensive in order to arrive at acceptable solutions with more varied analytical approaches.