medical ethics

Medical ethics and professionalism are fundamental pillars of medical education, playing a crucial role in shaping the professional identity and ethical behavior of medical students. This study aimed to identify the organizing components of the medical ethics and professionalism course.

Relevant articles and theses were extracted from databases such as Scopus, PubMed, Magiran, and Irandoc using keywords including "Medical ethics", "Professionalism", "Medicine", and "Medical student." After applying inclusion and exclusion criteria, 33 articles and 2 theses closely aligned with the study's objectives were selected. A qualitative content analysis was conducted to identify the organizing components and elements of the medical ethics and professionalism course.

The findings revealed that the medical ethics and professionalism course should be designed based on 10 core components: curriculum objectives, teaching methods, teaching strategies, assessment methods, educational content, the year and duration of course delivery, supplementary educational materials, instructors, and challenges in teaching ethics and professional commitment. Curriculum objectives should be comprehensive and aligned with societal needs, while teaching methods should employ active approaches such as problem-based learning (PBL) and role-playing. Teaching strategies should emphasize critical thinking and reflection. Educational content should cover key concepts such as confidentiality, informed consent, and social justice, and be aligned with the cultural and societal values. Assessment should be multidimensional and include methods such as portfolios and 360-degree evaluations. The course should be delivered longitudinally throughout all years of medical education. Additionally, faculty training and addressing challenges such as the complexity of ethical concepts and the lack of clinical role models are key factors in the success of the program.

Ultimately, this study suggests that medical ethics and professionalism course should be designed and implemented in an integrated manner, based on societal needs, to train physicians with a high level of professionalism.
Key words: Professionalism, Medical Ethics, Curriculum
Funding: This research was conducted with financial support from the National Agency for Strategic Research in Medical Education (NASR). Conflict of interest: The authors of this article declare that there is no conflict of interest. .
Ethical considerations: This research was conducted with the ethical code IR.NASRME.REC.1400.004, obtained from the Ethics Committee of the National Agency for Strategic Research in Medical Education (NASR).
  Authors’ contributions:- Conceptualization: Mahboobeh Khabaz Mafinejad, Mahdieh Azin, Foad Iranmanesh
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Mostafa Hadavinejad, Mahdi Abdolkarimi, Mahdieh Azin
- Data collection: Foad Iranmanesh, Mahdi Abdolkarimi, Mahdieh Azin, Pouya Abedi, Mohammad Javad Ranjbar Karimi
- Formal analysis: Mostafa Hadavinejad, Mahboobeh Khabaz Mafinejad
- Supervision: Mahboobeh Khabaz Mafinejad
- Project administration: Foad Iranmanesh, Mahdieh Azin
- Writing - original draft: Mostafa Hadavinejad, Mahdieh Azin
- Writing - review & editing: All Authors

Findings from ancient Persian literary texts indicate that the issue of professional medical ethics and the correct and logical relationship between a doctor and a patient has not been hidden from the eyes of writers and poets. In addition to the ethical advice of famous physicians, such as Ismail Jorjani, Ibn Sina, Razi, and other ancient Persian literary works have similarly addressed this issue and provided valuable ethical advice to physicians. The society of literature, using their creative and poetic nature, have recounted the relationship between a physician and a patient, sometimes in the form of stories and sometimes in explicit language. Although the field of medical knowledge and technology has made significant progress in recent decades and modern medical ethics has replaced traditional ethics, it seems that some acts and rights related to patients in the contemporary era are the moral heritage contained in ancient works, and in order to develop and complete ethical principles, we can return to this valuable heritage and support. Therefore, the aim of the present study was to determine and examine the components of medical ethics in ancient Persian literary texts and to compare them with modern medical ethics.

The present qualitative study was conducted in a descriptive-analytical manner with the aim of identifying, classifying, extracting and analyzing the components of professional medical ethics reflected in some ancient Persian literature texts up to the end of the eighth century AH and its conformity with the principles of modern medical ethics. The data collection tool in the present research was through library research and the research data was collected through the examination of primary and secondary sources, articles related to medical ethics, searching in databases and search engines. The works studied include the poetic works: Shahnameh by Ferdowsi, Nezami Ganjavi's works, Hadigheha al-Haqeha by Hakim Sana'i, Rumi's Masnavi, Saadi's Garden, Hafez's Divan and prose works including: Qabus Nameh, Chaharmakaleh, Kalileh va Demneh and Saadi's Golestan.

A number of medical laws and ethics, especially the human relations between doctors and patients in contemporary times, are consistent and in line with the moral heritage contained in ancient works, and in order to develop and complete the principles of professional ethics, we can return to this valuable heritage and support.

 The results of the present study indicated that ancient Iranian literature has a special place for medical ethics, and the ethical and cultural teachings reflected in ancient literary works are approved and recommended by medical ethics experts and are consistent with the principles of modern medical ethics.

Hope in infertile couples has increased with the introduction of assisted reproductive technologies including gamete donation to medical treatments and its significant progress. The purpose of this article was to review the ethical issues of gamete donation from the perspective of medical ethics.

This review study using the regular search of internet resources and information databases Magiran, Irandoc, SID, PubMed, Elsevier and Scholar google search engine between the years 2000 to 2023 with the keywords “Donor offspring, Embryo donation, Oocyte donation, Sperm donation, Gamete donation, Medical ethics”, have been done. A total of 42 articles were found. Including criteria were being related to the field of medical ethics and gamete and embryo donation, publication in Farsi and English and the availability of full text of articles and exclusion criteria were articles with letters to the editor and abstract articles, finally 15 articles were investigated

Issues such as confidentiality, consent of the parties, gamete buying and selling, and gender selection that arise in the process of gamete donation are important component for researchers and families. Infertile couples face the concerns of the social and cultural effects of this process on their society and family. According to the laws of each country, ethical issues are also variable in this case. In Iran, in addition to moral issues, attention is also paid to legal and jurisprudential issues.

Gamete donation is one of the big challenges of infertile couples, which requires the Medical team members to learn its ethical issues, and of course, proper training about the ethical issues related to gamete donation is also the responsibility of the medical team members. Increasing public awareness about the ethical issues and the rights of the parties in the gamete donation process can help the society to make more appropriate decisions with the support of scientific knowledge. In the decision-making process, ethical issues related to gamete donation should be carefully assessed and appropriate decisions should be considered to protect the rights and justice of all parties.

Medical ethics education is very vital to maintaining legality and maintain public trust in dentistry. Therefore, this study aimed to measure the knowledge, attitude, and practice of medical ethics of Birjand dental faculty students in 2021.

In this descriptive-analytical cross-sectional study, 117 dental students who passed or were passing the medical ethics unit participated. The data was collected using a questionnaire consisting of two sections (demographic information and questions related to the areas of knowledge, attitude and performance). The knowledge and attitude were measured through a questionnaire that was used in previous studies and its validity and reliability were confirmed. Performance was measured using a researcher-made questionnaire, the reliability of which was obtained by Cronbach's alpha method of 0.78. Data analysis was done using Independent Samples T-tests, One-way analysis of variance, Mann-Whitney and Kruskal-Wallis tests at the significance level of 0.05.

The mean score of students' knowledge, attitude, and practices was 34.11 ± 6.09, 47.07 ± 5.73, and 31.74 ± 6.02, respectively. There was a significant relationship between performance and attitude of students (r = 0.403, P < 0.05). Furthermore, there was a significant difference in the mean score of attitudes according to gender (p = 0.020), female students had a higher mean score of attitudes than males.

Based on the study's results, despite good knowledge, students' attitudes and performance are at an average level. Therefore, proper education on dental ethics among students, especially male students, seems necessary.

Treating patients whose lives are in danger or threatened by irreparable harm, is an obligatory act. However, sometimes, due to old age, the severity of the disease, or the lack of definitive treatment, the patient faces a situation where, according to the diagnosis of the medical staff, starting or continuing the treatment has no effect on patient recovery, or the effect is so insignificant that is ignored in medical practice. This study was conducted using a descriptive and analytical method based on library resources to compare “futile treatment” in medical ethics with “Israf” (extravagance) in Islamic jurisprudence so as to indicate the level of conceptual compatibility between these two concepts. Moreover, considering the illegitimacy of extravagance in jurisprudential teachings, it was attempted to explore whether it is illegitimate, according to Islamic rules, to perform futile treatment. To do so, first, futile treatment and its characteristics in medical texts were defined. Second, the ethical considerations of performing such treatment were explained based on the teachings of medical ethics. Third, extravagance was analyzed in terms of concept, topic, and sentence by referring to valid lexical, jurisprudential, narrative, and interpretative resources. Finally, based on a comparative study, the level of compatibility of futile treatment with extravagance was investigated. The findings of this study showed futile treatment is an example of extravagance as it causes the waste of personal or public property, lacks rational purpose, and does not lead to patient recovery or promotion of health status. Therefore, futile treatment is not considered an obligatory act but even an illegitimate one as it is a clear example of extravagance. In addition to punishment in the afterlife, it entails civil liability as it results in the loss of others’ property.

A part of the important missions of the higher medical education system is formed in the official curricula and an important part of it is formed through the hidden curriculum. Therefore, in order to fulfill its missions, the higher medical education system cannot ignore the part of the hidden medical curriculum. This study was conducted with the aim of predicting medical ethics through hidden medical curriculum components among students of medical sciences universities in Tabriz.

 In this cross-sectional study, the statistical population included all students of medical sciences universities in Tabriz. The statistical sample of this study was made up of 400 students from the fourth year and above of medical schools of the national and Azad universities of Tabriz based on Morgan's table. Due to the equality of the statistical population from each of the universities of medical sciences (only the faculty of medicine), 200 samples were selected by multi-stage (quota) sampling method. The tool of data collection was the hidden medical curriculum and medical ethics questionnaire. Pearson's correlation test and multiple regression were used to analyze the data.

The correlation between the medical ethics variable and the hidden medical curriculum components shows that the relationship between medical ethics and the curriculum (0.104), clinical/specialist education (0.144), educational content (0.133), physical space Social (0.195), incentive and punishment system (0.146), organizational structure (0.126), respect for rights (0.100), ethical behavior (0.104) and sense of responsibility (0.122) are positive and statistically significant. The relationship between medical ethics and personal/environmental background (-0.189) and perspective and career/financial pattern (-0.321) is negative and statistically significant. No significant relationship was found between medical ethics and evaluation and attitude and participation.

The components of the hidden medical curriculum have a positive relationship with the medical ethics of students, and some of the components of the hidden curriculum in line with the development of medical ethics should be given serious attention in medical sciences universities of Tabriz.

Physician self-referral is the referral of a patient to a medical facility in which the referring physician has a financial interest. This can take two forms: internal referrals within the same office and external referrals, often involving joint ventures. Many claims, positive or negative, have been made regarding self-referral. Proponents claim that self referral causes, reduction of costs by fostering a competitive environment, encourage investment in health facilities particularly in underserved areas, financial benefits for both the doctor and the patient via cost reduction, and inhance the quality and accessibility of health services. Conversly, opponents, citing multiple studies, argue that self- referral may result in excessive and unnecessary utilization of healthcare services, leading to increased healthcare costs, low quality of services provided, and jeopardise patient safety. In certain countries, such as the United States and the Islamic Republic of Iran, ethical codes address self-referral. These guidelines either deem it unethical or require disclosure, accompnied by regulations to govern this practice.

Scientists now believe that precision medicine, which employs complicated technology and information derived from omics, can treat complex diseases and provide justice in health. Implementation of precision medicine will face new ethical challenges, considering the principles of medical ethics. With respect to philosophical principles, this study addressed the issue of justice and some ethical challenges of precision medicine. Because, in order to gain the benefits of precision medicine, a proper ethical framework must be developed while considering the challenges. The manner in which precision medicine information is shared and accessed can have an impact on people’s future careers, marriage choices, and type of health insurance. Furthermore, preserving people’s privacy and autonomy are important ethical concerns in precision medicine since there will be no perfect guarantee about data security and access. Although in the short and medium term, due to the design of studies and expensive and complex technologies, precision medicine will be limited to certain groups and will intensify the inequality in justice, in the long run, with the easy access and inexpensive cost of precision medicine technologies, the accumulation of medical expenses will decrease throughout life, and justice will be established between and within countries.

Ancient medical science is as old as human history and the history of science. Authentic documentation before Avesta is insignificant and there are few prominent scientific and civilizational institutions in the field of medicine before Jundishapur. This study endeavors to analyze the evolution of medicine and specifically Traditional Persian Medicine from the most prominent pre-Islamic civilizational institutions, namely Jundishapor, to the modern era, with an analytical approach, and to decipher the secrets of stagnation and transformation, and with the future research, to suggest the necessary and worthy developments of the present time and the next half century. Analytical historiography was used as the method to conduct this study.

Today, abortion treatment is performed legally for reasons such as preserving the health and life of the mother and fetus with disabilities. The aim of this study was to investigate the basic information and determine the main reasons for legal abortions in medical abortions referred from forensic medicine in Babol as a basis for designing and conducting studies in the future regarding the improvement of reproductive health among women of reproductive age.

This cross-sectional study was conducted via census sampling method among 104 cases of medical abortion referred from the forensic medicine of Babol to affiliated hospitals of Babol University of Medical Sciences in 2017-2020. Information related to individual and social factors and maternal and fetal causes leading to abortion was collected by a researcher-made checklist. Then, the data were reviewed and compared in terms of gestational age, termination of pregnancy, and maternal and fetal causes leading to abortion.

The mean gestational age at termination of pregnancy with fetal causes was 16.21±2.35 weeks and for maternal causes was 10.33±3.96 weeks. There was a statistically significant relationship between the history of underlying disease, gender at the time of abortion, gestational age, and the causes of termination of pregnancy (p<0.05). In maternal causes of abortion, the highest frequency (50%) was related to maternal cardiovascular causes, and in fetal causes of abortion, the highest frequency (51.08%) was related to genetic causes of the fetus. Misoprostol was used to terminate the pregnancy of 23.1% of mothers.

The results of the study showed that a large number of cases of medical abortions are related to the fetal cause.

Medical ethics is a field focused on studying the code of conduct and principles that healthcare practitioners are required to adhere to. The progress of medical knowledge and new methods of biological research have created various ethical conflicts, which necessitate the need to pay attention to medical ethics. Medical ethics in Iran and Islamic civilization have a long history. In the era of Islamic civilization, Rhazes and Qutb al-Din Shirazi, two of the greatest scientists of the Islamic world, pointed out important issues about medical ethics. The purpose of this research is to examine the basics of Rhazes and Qutb al-Din Shirazi's medical ethics.

This study was conducted based on a descriptive-analytical approach using library research to collect information from historical sources and texts.

In general, Rhazes was known for being a rationalist and Qutb al-Din Shirazi for being a Shariatist and having a God-oriented manner. The results show that Rhazes has paid attention to the topics of physician-patient communication, physician's scientific and practical competence, physician's confidentiality, and patient's beliefs. Qutb al-Din Shirazi has stated the moral requirements of a physician in ten principles.

In general, the examination of the views of Rhazes and Qutb al-Din Shirazi in the field of medical ethics from the perspective of traditional Iranian medicine shows that both Rhazes and Qutb al-Din Shirazi, similar to many doctors bound by ethical principles in the relationship between doctor and patient, consider compliance with ethical principles as a professional requirement.  They have paid attention to the issue of medical ethics in various areas, such as behavioral qualifications and specialized treatment issues.

Today, artificial intelligencetechnologies can provide incredible benefits to the health system. While artificial intelligence has a significant capacity to improve the performance of the health system, it is accompanied by challenges that sometimes lead to damages the health system. Therefore, the aim of the current research is to review the ethical and legal challenges associated with the use of artificial intelligence in the health system.

This research is a review study. To collect data, evidence wassearched in Web of Science, PubMed, Scopus and Google Scholar databases using the keywords artificial intelligence, medical ethics, health rights, health care and human dignity.

In all the stages of writing the present research, while respecting the originality of the texts, honesty and trustworthiness have been observed.

Based on the findings of the present research, several items can be mentioned regarding ethical challenges: trust in artificial intelligence, violation of human dignity in artificial intelligence, observing the principle of individual independence and its rules, artificial intelligence in diagnosing the completion of treatment, and artificial intelligence and emotional functioning. The legal challenges include the standardizationof artificial intelligence in medicine, artificial intelligence and civil liability, artificial intelligence and the physician’s warranty, artificial intelligence and the breach of data confidentiality, and artificial intelligence and cyber security.

While using artificial intelligence technologies to provide healthcare and medical services, decisions should be made based on respect for human dignity and observing ethical and legal principles, rules and regulations. Any AI-based technology which is considered for use in healthcare and the health system must be efficient, safe, standardized and regulated. Such technologies can only be efficient if they are implemented in healthcare and medical services along with monitoring and evaluation.