فصلنامه اخلاق پزشکی
پیاپی 48 (بهار 1402)

Proponents of the school of neurodeterminism, based on new findings from neuroscience, believe in the illusion of free will in man and claim that all individuals are under the control and dictatorship of their brains. Do we really have free will? Is free will an illusory abstract concept or a real quality in man? What is the definition of human free will in light of the new findings of human knowledge? The answer to these questions is important because the denial of free will means the denial of any criminal responsibility and in general the denial of the existence of the rules of criminal law in the normative order of society. This perception can turn into anarchy. The present article seeks to provide a convincing answer to the rejection of the skepticism introduced by the school of neurodeterminism and to redefine free will by examining the interdisciplinary approach of law, ethics and cognitive neuroscience.

This research is of theoretical type and the research method is descriptive-analytical and the method of data collection is library and has been done by referring to documents, books and articles.

Ethical Considerations: 

In order to organize this research, while observing the authenticity of the texts, honesty and fidelity have been observed.

Consciousness is central to the definition of free will; Consciousness is self-awareness, which awareness (in the narrow sense) and arousal are the necessary means for its realization.

Free will includes a range of substantive and necessary elements in a coherent and inextricably linked sequence: motivation includes intention and delibration (in the words of Islamic philosophers, imagination, acknowledgment and enthusiasm) and determination includes the potential for preparation, awareness of intention and action. With these words, free will can be defined as follows: An intrinsic ability to perform conscious behavior based on purpose and reflection, which is realized in a range of elements from motivation to action.

The right to health is among the most important human rights. This right can be influenced by certain factors such as the data induced through advertising. Therefore, legal systems have always taken approaches towards prohibiting or restricting the advertisements that endanger health. Throughout history, tobacco companies have advertised tobacco using various strategies, some of which have been subject to debate in terms of "rights" and at times, "ethics". Therefore, recognizing the advertising strategies in this field is of great importance. The purpose of conducting this research is to investigate whether some methods of tobacco advertising, in different eras, have resulted in "the violation of rights", or tobacco advertising is only an ethical issue.

The present research is a narrative review. The data has been collected through library and internet sources, besides referring to legal documents, books and articles. Ethical Considerations: Throughout all the stages of writing this research, authenticity, honesty and integrity have been observed.

The analysis of tobacco companies' advertising strategies indicates that, with the aim of making more profit, these companies have managed to accumulate a significant portion of capital through quite known advertising strategies: targeting women and children; inducing the sense of freedom, power and independence and some other misleading methods.

Prohibiting and restricting tobacco advertising is a crucial issue in protecting public health. Therefore, managing public affairs in the domain of health implies considering restrictions or prohibitions where necessary. Since advertising is a means of conveying specific messages and persuading the audience to achieve certain goals, it is essential to recognize the advertising mechanisms used by major tobacco companies. This knowledge can be used in future public actions such as determining precise prohibitions or reconsidering advertising restrictions.

Nurses’ clinical competence, as the basic component of nursing care, is a very important and vital issue. Nursing competence has always been a challenging issue. In order to maintain the standards of nursing care, it is necessary to know the methods of developing and promoting clinical competence. The present study aims to examine and review the challenges and the approaches to obtaining clinical competence in Iran, so that the obtained results can help nursing managers and lecturers with promoting nursing competence, whose ultimate goal is to provide quality care to the patient.

The present research is a review study. The articles written in Farsi or English were included in the study. They were extracted using Farsi databases including SID and Magiran and Latin databases including ProQuest, Science Direct, Google Scholar, Ovid, PubMed. The search was conducted with no time limit until March 2020 and using the keywords nursing competence, nursing clinical competence and competence. After the careful examination of the title, the abstract and the full text of each article, a large number of articles were excluded due to the languages in which they had been written, different titles and purposes and inappropriate abstracts or contents. In the next step, 71 articles (44 Farsi and 27 English) were studied and, finally, 23 articles were included in the study.

Ethical Considerations: 

In order to organize this research, while observing the authenticity of the texts, honesty and fidelity have been observed.

The educational and clinical challenges were investigated, along with the relevant approaches. Unmotivated students and inexperienced nurses’ low level of competence are among the mentioned challenges. Taking both educational and clinical measures, as an effective approach to improving clinical competence, will help reduce the gap between education and clinical practice.

Through recognizing the aforementioned challenges and approaches to improving clinical competence in nurses, it will be possible to ensure quality care provision, which is an important step in developing the health system. The recommended approaches include modifying the curriculum, increasing critical thinking skills in students and professors, increasing professors’ clinical and communicational skills, professors’ using different teaching methods and holding workshops and in-service training courses for nursing personnel and instructors.

Due to the nature of the nursing profession, confronting conflicting situations regarding values and facing moral dilemmas is inevitable. It can, in turn, interfere with cognitive function. Therefore, the current research was conducted with the purpose of determining the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing moral distress and enhancing cognitive fusion in the nurses working at Imam Khomeini Hospital, Ilam.

The present study is a quasi-experimental research with a pre-test and post-test design and a comparison group. The statistical sample consisted of 40 nurses working at Imam Khomeini Hospital, Ilam in 2022, who were randomly assigned into intervention and comparison groups. Data collection was performed using the Moral Distress Scale Corley & et al (2001) and the Cognitive Fusion Questionnaire Gillanders & et al (2010). Eight 90-minute acceptance and commitment therapy training sessions were held weekly; however, the comparison group did not receive any intervention. The data were analyzed by SPSS 27 software using descriptive (frequency, percentage mean, standard deviation) and inferential (Chisquare, Independent T-test, Analysis of covariance) statistical tests. Ethical Considerations: The principles of research ethics were observed: explaining the research objectives to the participants, obtaining informed consent, maintaining privacy, data confidentiality, and providing the participants with the right to withdraw from the study at any stage of implementation.

The findings of MANCOVA indicated that Acceptance and Commitment Treatment has a significant effect on reducing moral distress and enhancing cognitive fusion in the nurses belonging to the intervention group compared to the comparison group in the post-test phase. (P<0.05).

Based on the findings of the present research, eight weeks’ acceptance and commitment group therapy turned out to be effective in reducing moral distress and enhancing cognitive fusion in nurses.

Observing professional ethics is one of the most basic concepts of medical ethics. Investigating the status of observing professional ethics among nursing students, as the future staff of healthcare systems, is of great importance. The purpose of this study is to investigate the observance of professional ethics among the nursing students at Ardabil University of Medical Sciences in the Iranian academic year, i.e. from September 2019 to August 2020.

The present research is a descriptive cross-sectional study. The study population consisted of 210 nursing students, from the third to the eighth semester, of Ardabil School of Nursing and Midwifery, the Health Educational Institution of Meshginshahr and Germi Nursing School. To obtain the level of observing professional ethics among the students, the questionnaire of evaluating nurses' observance of nursing professional ethics, designed by Esmail Pourzanjani et al, was used. The data were analyzed using SPSS 20 software and statistical tests such as one-way analysis of variance, independent t and linear regression. Ethical Considerations: In all the stages of this study, ethical principles and data confidentiality were observed and the questionnaires were completed after obtaining informed consents and explaining the research objectives to the participants.

The results of the study indicate that the mean score of observing professional ethics among the samples was 4.20±0.96. The mean score of observing professional ethics was 4.29±1 in the domain of nursing and community, 4.25±0.9 in the domain of nursing and professional commitment, 4.27±0.94 in the domain of nursing and providing clinical services, 3.885±1.25 in the domain of nursing and the cooperation of the medical services team and 4.29±1.06 in the domain of nursing, education and research. In general, the mean score of observing professional ethics was satisfactory in all domains. In addition, the variables of the place of study, interest in nursing discipline, educational status and service department have significant relationships with the observance of professional ethics (P<0.05).

The results indicate the observance of professional ethics in the study population. Ethical responsibilities do not belong to a specific group, but to all the members of a profession. However, the development of nursing ethics will be more achievable when it is institutionalized, as ethical decision-making in real situations will only be possible through having the knowledge of ethical concepts and values.

In today’s world, where social environments are changing exponentially, social skills play an essential role in the mediating process between emotional intelligence factors and individuals’ performance. The present study aims to investigate the mediating role of moral reasoning in the relationship between emotional intelligence and behavior in bystanders to bullying.

This correlational research is of structural equation model type. The target population consisted of male and female secondary school students in Khorram Abad, Lorestan in the academic year of 2022-23. The study population consisted of 310 students, who were selected through cluster sampling. Data collection tools included the Defining Issues Test (The DIT, Rest et al.), Bar-On Emotional Quotient Inventory (EQ-i) and the Participant Role Questionnaire (PRS, Salmivalli et al.). Data analysis was done using structural equation model and Smart PLS 3.

Ethical Considerations: 

Ethical standards were observed, including explaining the purpose of the research, anonymity, data confidentiality, voluntary participation and obtaining informed consents from the participants.

The results of the current research indicated that all significance coefficients (t-value) were greater than 1.96, R2 values for the endogenous components of the research belonged to the range of 0.53 to 0.93 and the results of Q2 values for all model structures belonged to the range of 27. 0 to 0.61, which shows the significance of all the relationships between components at the confidence level of 95%. Based on the results, emotional intelligence has a positive and significant effect on moral reasoning and behavior in bystanders to bullying. Furthermore, the results indicated that the significance number and the indirect coefficient are equal to 8.26 and 0.45, respectively, which means that moral reasoning plays a mediating role in the relationship between emotional intelligence and behavior in bystanders to bullying (P<0.05).

The research findings showed that there is a significant relationship between emotional intelligence and behavior in bystanders to bullying. The results of the equation model indicated that students' moral reasoning can play a significant mediating role in the relationship between emotional intelligence variables and behavior in bystanders and lead to an increase in the level of effectiveness.

Using non-scientific, vague and wrong words to describe the reproductive cycle of women is a common thing in Iranian culture and this can lead to negative taboos, followed by an adverse effect on the quality of life and health of half of the population. Using a word that is phonetically, structurally and conceptually worthy of describing this natural part of women's life with dignity is considered one of their rights.

This research is descriptive-analytical (theoretical analysis) in which the words used in research, medical and daily literature for women's bleeding cycles and the effect of these words on the formation of taboos or false beliefs in this field.

Ethical Considerations: 

Throughout all the stages of writing this research, authenticity, honesty and integrity have been observed.

The words that are used to describe "mahingi" in Persian culture and language mainly mean repetition and emphasis on being a rule or custom, which on the contrary does not emphasize the reproductive health needs of women in this era. Some words are reminiscent of cultural or social prohibitions or even have a negative literal meaning. The word "mahinegi" has unified the description of the life cycle of women in research, medical and social literature. In terms of phonetics and structure, it is suitable for contemporary culture, in terms of lexical meaning; it is normative and dignity-oriented for women's reproductive health rights.

In this article, the philosophy of replacing the word "mahinegi", which is derived from its connection with the moon, is discussed. Using the word "mahinegi" with a metaphor of the moon as a celestial body that has many structural similarities in its evolution cycle with egg development and also using the moon as a symbol of reproductive can be a dignified description of women's Menstruation. In addition to these cases, the use of this beautiful and magnificent symbolization can facilitate the start of families' conversations with their children in this field.

Empathy is a combination of emotional and cognitive care which has the most positive effect on health outcomes and consistency in patients. This study aims to investigate the effect of empathy training on employee motivation, moral sensitivity and alexithymia in the nurses working at Bahonar hospital, Kerman.

This quasi-experimental study was conducted on 80 nurses working at Shahid Bahonar Hospital, Kerman in 2020, who were selected through census method. They were then divided into the two groups of intervention and control. The empathy training program was held through eight 90- minute sessions for the intervention group, focusing on four-factor psychotherapy, developed by Vaziri & et al (2011). The control group received no training. Data collection was done using 3 tools, including Employee Motivation Survey, the Moral Sensitivity Questionnaire (MSQ) and the Toronto Alexithymia Scale (TAS). The data was then analyzed with SPSS 23.

Ethical Considerations: 

In order to organize this research, while observing the authenticity of the texts, honesty and fidelity have been observed.

The results showed that empathy training has impacts on employee motivation, moral sensitivity and alexithymia (P<0.001) in the nurses working at Shahid Bahonar Hospital, Kerman.

The obtained results showed that empathy training has impacts on employee motivation, moral sensitivity and alexithymia in nurses; therefore, it can be used to empower nurses.

Moral sensitivity enables nurses to interpret their care recipients’ needs and respond to them according to ethical principles. Moral distress is a known phenomenon in the nursing profession, which can cause a lot of physical and mental stress for nurses, leading to their dissatisfaction, as well as reductions in their efficiency and the quality of care. Therefore, nurses’ having high moral sensitivity can play an important role in preventing the situations which cause moral distress. Thus, the present study was conducted with the aim of determining moral sensitivity and moral distress in the nurses caring for the patients with Covid-19 in the training medical centers affiliated to Hamedan University of Medical Sciences.

The current research is a descriptive-cross-sectional study, which was conducted on 113 nurses of Hamadan University of Medical Sciences from March to June 2021 using stratified random sampling method. The data collection tools included a three-part demographic information questionnaire, Moral Sensitivity Questionnaire (MMSQ) and Corelli's moral distress questionnaire. The data were analyzed using SPSS 22 statistical software, independent t-test, Mann-Whitney, ANOVA, Spearman's correlation coefficient and Chi-squared test.

Ethical Considerations: 

After obtaining informed consents from the participants, the researcher also ensured data confidentiality.

Investigating the relationship between moral sensitivity and the frequency of moral distress, a significant relationship was found between moral distress frequency and moral sensitivity (r=0.202, p=0.032) and the subgroups of experiencing problems (r=0.287, p=0.002), interpersonal communication (r=0.213, p=0.024) and promoting the care recipient’s level of independence (r=0.246, p=0.009). With the increase in these subgroups, the frequency of job distress increases significantly, too. The mean score of the nurses’ moral sensitivity was reported to be at the medium level, 57.78±13.53. The mean frequency of moral distress was 17.99±37.01 and the intensity of moral distress was 52.83±23.51. The frequency of moral distress was at the medium level and the intensity of moral distress was high.

Considering the nurses’ medium level of ethical sensitivity, efforts should be made to promote ethical issues in nursing. Various factors affect nurses’ levels of moral sensitivity and moral distress while caring for patients. This research was done in a situation when nurses were confronting the peak of the Covid-19 pandemic, under high organizational and mental pressures.

This paper explores the significance of moral virtues in the conduct of healthcare providers towards patients. The key moral virtues of the medical professions if accompanied by apologetics, healthcare professionals can mitigate the likelihood of patient complaints resulting from medical or nursing errors. The concept of apology, comprising three steps - regret, cause and remedy - serves as a means to foster improved relations between healthcare providers and patients. In situations where mistakes occur, offering an apology is deemed the most appropriate course of action.

Ethics is the core of care activities. In recent years, virtue ethics has been one of captivating approaches in the nursing profession .This article aims to explain the concept of virtue in the nursing profession and the role of ethical virtues in various nursing domains.

This research is a review study. The keywords care ethics, ethical theories and nursing and virtue ethics were searched without time limit in reliable Farsi and English databases including SID, Iran Medex, Google books, PubMed, Google Scholar and ProQuest. The relevant articles were selected, reviewed and analyzed based on the objectives of the study.

Ethical Considerations: 

In all the stages of the present study, ethical considerations including trustworthiness in citing documents and non-bias have been observed.

The results were categorized under a general image of virtue, virtue ethics, virtue and care, transferring virtue from ethics to practice, the role of ethical virtues in the nursing profession, the strategies of virtue ethics theory in education, the role of virtue in nursing theories and the challenges of virtue theory. Virtue is a prerequisite for ethical care. In the clinical sense, care ethics is enriched by a theoretical model of virtue. The virtue-oriented ethical approach in nursing education is learner-oriented and is considered as an essential part of nursing ethics education programs. Incorporating a discourse on virtues into the nursing theory may focus on ethical competence while meeting discipline-specific knowledge and technical skills. To solve the challenges of the virtue-based approach, ethical theories such as the consequentialism can be used besides this theory.

Ethical virtues are considered as an acceptable operations guide for clinical care practice in nursing. The virtue theory is widely used owing to the closer communication between nurses and patients and the nursing profession can make the most of this theory.

Organizational effectiveness depends on variables such as organizational development and justice. Paying attention to the concept of work conscience in health organizations, like other organizations, is in fact an ethical and humane view of the concept of work, which itself is affected by various factors. The present study was conducted with the aim of investigating how organizational development and justice relate to the work conscience of health centers’ staff.

This research is a descriptive correlational study conducted on 197 health network staff members in Shahrekord, were selected and studied through convenience sampling method. Data collection was done using three standard questionnaires: The Organizational maturity (Spiders, 2007), the organizational justice scale (Niehoff and Moorman, 1993) and the work Conscientiousness scale (Costa & McCrae, 1992). Data analysis was done using descriptive and analytical statistics (Pearson Correlation Coefficient and regression testing) and SPSS 16.

Ethical Considerations: 

This study has been approved by the Ethics Committee. Ethical considerations such as filling out the informed consent form, voluntary participation, explaining the research objectives and ensuring data confidentiality were observed.

The findings indicate that the mean score of organizational development and justice is significantly related to work conscience (P<0.001). There is a significant positive relationship between the mean score of organizational development and the staff’s work conscience (r=0.711, p>0.001). There is also a significant positive relationship between the mean score of organizational justice and the staff’s work conscience (r=0.701, p>0.001).

Reinforcing organizational justice, through applying laws and guidelines, leads to the enhancement of justice and the observance of fairness among the staff. Furthermore, improving organizational development will provide a stronger basis for the health staff’s bringing their conscience to work.

In case of failure to obtain informed consents in pediatric surgery, the four principles of medical ethics have not been observed; as a result, patients’ rights will be violated, and the physician will be held responsible both in terms of medical ethics and legally. The reason is that in the absence of the patient or his/her parents informed consents, a crime has been committed. However, if a consent is obtained, in case the patient dies or is maimed and there is no proof of fault, only civil liability will be realized. Therefore, given the importance of obtaining informed consents, this study assessed the status of obtaining informed consents in pediatric surgery through considering the relationship between the individual giving consent and the patient's age, gender, and type of surgery in terms of being emergency or non-emergency.

In this analytical descriptive cross-sectional study, the data regarding consent forms in pediatric surgery at 17 Shahrivar Hospital, Rasht was collected from April 2018 to September 2019, according to a prepared checklist including the patient’s gender and age, the type of operation, and the relationship between the individual giving consent and the patient. To analyze the research data, ANOVA test was used for quantitative variables and Fisher's exact test was used for qualitative variables. The collected data was entered into SPSS version 21 and the significance level of p<0.05 was considered.

Ethical Considerations: 

This study has been approved by the Ethics Committee. Ethical considerations such as filling out the informed consent form; voluntary participation, explaining the research objectives and ensuring data confidentiality were observed.

Based on the results obtained from 187 cases, 61.3% had emergency surgeries and the rest had non-emergency surgeries. Among the individuals giving consents, 202 were legal custodians (66.2%) and the rest included the mothers without custody of their children (31.8%), the individuals with child custody letters (0.7%) and the individuals without a legal status (other than mothers) (1.3%). According to the results of the present study, among the legal custodians, 199 (98.5%) individuals giving consents were fathers and 3 (1.5%) were both parents. In the case of the individuals without a legal status, 97 (96%) were mothers, 2 (2%) were nurses, 1 (1 percent) was a foster mother and 1 (1 percent) was a grandmother. There was 1 individual with a child custody letter (50%) and 1 grandmother (50%). Based on the obtained results, it was found that gender (p=0.894) and age (p=0.336) had no significant relationship with the individuals giving consents; however, the type of surgery had a significant relationship with the individuals giving consents (p<0.001). Most of the individuals giving consents in emergency surgeries were the patients’ legal custodians.

In many investigated cases, ethical and legal standards were observed in obtaining informed consents from the children’s legal custodians. However, in none of these procedures, there was recorded proof of obtaining consents from children, which needs attention in the health system.

Social stigmatization is one of the major consequences of the Covid-19 pandemic. With the onset of the Covid-19 pandemic, the crimes caused by stigma and hate increased all over the world, which targeted the identity and the personality of the infected people and East Asian communities and intensified insecurity in societies. This article explains the factors and analyzes the impact of the Covid-19 pandemic on the increase in hate crimes with a criminological approach.

The present study is a review and narrative research with a descriptive-analytical approach, which has been conducted using the relevant authentic resources and articles as well as some criminological theories in order to analyze the issue.

Ethical Considerations: 

In this research, ethical study aspects including the authenticity of texts, honesty and trustworthiness have been observed.

Hate crimes are the unlawful acts committed with the motive of hating the identity characteristics of the victim, such as ethnicity, race, nationality, religion and gender. Moreover, being violent, being committed in public places and causing extensive damage to victims are among the features of these crimes. Factors such as stigmatization, moral panics, pre-judgment and hateful attitudes played important roles in the increase of hate crimes during the Covid-19 pandemic around the world. Furthermore, the process of social stigmatization of the people infected with coronavirus and some Asians is also rooted in these prejudgments, ultimately leading to hate crimes.

Besides intensifying the punishment for such crimes, if necessary; removing hatred through strengthening cohesion among different groups and communities; raising awareness and modifying dominant discourses, with the help of the media and the Internet, can be effective in reducing the hate crimes caused by the Covid-19 pandemic.

In recent years, tremendous progress has been made in organ transplantation; as a result, the legal issues associated with it have become more visible, too. Furthermore, transplant patients need more exact knowledge and observing patient rights is more crucial to them, considering their special condition. Therefore, the present study was conducted with the aim of investigating the level of observing Patient Rights Charter in Montaserieh Hospital, Mashhad in 2017 from the perspective of the transplant patients.

The current research is a descriptive cross-sectional study conducted on 99 liver and kidney transplant patients during the first 3 months of 2017 at Montaserieh Hospital, Mashhad. In order to investigate the level of observing Patient Rights Charter from the perspective of transplant patients, the researcher made a questionnaire consisting of 28 questions, based on the 5 dimensions of Patient Rights Charter in Iran. The data was analyzed using descriptive statistics in SPSS software version 16.

Ethical Considerations: 

Sufficient explanations regarding the objectives of the research were given to the subjects and data confidentiality was ensured.

The mean score of observing Patient Rights Charter was 100.05±20.24. From the perspective of the transplant patients, the second dimension (the right to receive sufficient information in a desirable manner), with the mean of 36.53±7.88 and the fifth dimension (the right to access an efficient complaint-handling system), with the mean of 5±3.70 were, respectively, the rights observed the most and the least.

Surveying the patients, it was found that the dimensions of patients’ right to have freedom of choice and making decisions around receiving healthcare services and the right to have access to an effective complaint-handling system have been observed less frequently than others. Therefore, it is recommended that healthcare centers provide patients with sufficient explanations regarding the treatment plan so that they can participate in choosing their treatment methods. In addition, certain guidelines should be developed to ensure access to an efficient complaint-handling system.