مجله ایرانی اخلاق و تاریخ پزشکی
سال ششم شماره 2 (خرداد 1392)

More than half a century has passed since the onset of successful life-saving and at times astonishing transplantations of organs from brain dead donors، numerous books and articles have been written on the subject، and local، regional and international meetings and conferences have been held. Nevertheless، no consensus has yet been reached among scholars of various fields such as medical sciences، religion، ethics and law on a number of generalities as well as theoretic and practical details of this issue. There have been discussions on topics such as the organ donor’s legal will، gaining consent while the donor is still alive، seeking consent from the brain dead patient’s family، nature of the required organ، observance of religious، cultural and conventional standards، individuals’ dignity and so on. The main challenge to overshadow other factors has so far been the discord among experts، physicians and religious scholars specifically، over determining the time the spirit leaves the body، and a unified definition of death. Some researchers have attempted to minimize religious، ethical and legal challenges and thus facilitate organ donation following brain death by emphasizing the urgency of organ donation and the practices related to certain specialties، and even maintain that brain death is the equivalent of death and a lifeless body. Others have focused on the time of death and the spirit leaving the body based on lexical، religious and medical evidence، regardless of equality of brain death and death، and ensuing rulings. These researchers have thus separated the solution to the problem of those in need of transplants from considering brain death to occur at the same time when the spirit leaves the body، and encourage experts to seek different solutions. Organ donation by brain dead patients is an undeniable social necessity that can be resolved without bringing about fundamental changes in lexical and jurisprudential concepts، and through other alternatives such as propounding “urgency”، declaring a patient “as good as dead” and in general “non-elucidated jurisprudential issues”. Through references to lexical، jurisprudential and medical sources and examination of previous research، the present article will review several definitions of death، spirit، and the time the spirit leaves the body، as these are concepts that are related to brain death for all practical purposes. The article also considers organ donation following brain death to be an undeniable and unavoidable fact of life in human societies، and will examine the necessity of altering lexical and jurisprudential concepts to accommodate current interests and goals.

Practically، scientific foundations illustrate that the embryo plays a main role in the related technical scenarios. Considering this fact، if technical researches orientated to human subjects، essential legal and juridical arguments will be generated. This article aims to offer a new analysis about moral and juridical nature of human embryo and the associated parental relationships. Adopting this idea that the embryo before 4th month has no human dignity، the author attempted to present a parental relationship based on ownership and material value. Although the author believes that this idea is built on the legal foundations، it primarily seems that the adopted idea will be faced to moral challenges. From the stand point of this article the concept of the material value of the embryo absolutely refers to an intrinsic value and it doesn’t necessarily relate to financial treats. On the other hand، according to the main pure content of the Islamic juridical rule of Taslit، it illustrates that the right of ownership has been limited by different restrictions.

When medical treatment is futile، the physicians must refrain from treating patients، and this can lead to serious and stressful problems. In this paper، in order to facilitate ethical decision making relevant literatures have been reviewed. This review article aimed to explaining the different clinical forms of futile treatment، and exploring theoretical and practical dimensions of futility. The first problem in this field is ambiguity in the definition of futility. The next problem is determining the practical criteria and attributing the meaning of futility to particular treatments. This ambiguity is partly due to different perspectives about the goal of treatment، and variations in physicians'' and patients’ values and also disagreements regarding the person who should have the right to make decisions ultimately. It may also be related to finances and immoral motives. The third problem is some practical conflicts the most notable are futile care، requested by the patient and the sanctity of life، especially in the concern of religious considerations. In this regard، several definitions have been proposed for the futile treatment. Studies indicate that requesting futile care is often due to emotional problems or lack of trust a case that requires the physician’s tact to resolve and rarely is resolved by rule. Another serious problem that is regarding to end of life cares، especially in the context of religious views، is the necessity of life saving، that is closely related to the inactive euthanasia. This can be solved by giving priority to more important issues such as health budget constraints.

Nurses encounter challenging ethical issues in practice that can make decision making tough for them. The purpose of this study was to determine the moral sensitivity of critical care nurses in clinical decision making and its correlation with their caring behavior in teaching hospitals of Bandar Abbas in 2012. This research is a descriptive analytic study with intensive care unit nurses as its participants. A demographic and background questionnaire، a standard questionnaire of the nurses’ moral sensitivity، and a caring behavior questionnaire were used to collect information. Data were analyzed using SPSS16 software، descriptive statistics، Mann-Whitney U test، Kruskal-Wallis، and Spearman’s correlation. The mean score of the nurses’ moral sensitivity was 70. 15 ± 6. 90 (maximum score was 96 and minimum score was 49) that was moderate in 85. 6% of the nurses. The mean score of the nurses’ caring behavior was 108. 90 ± 10. 62 (maximum score was 120 and minimum score was 69). There was no significant correlation between moral sensitivity and caring behavior scores، but both scores were significantly associated with the place where the nurses were working. The dimension of respect for patient autonomy had a significant relationship with participation in medical ethics seminars or workshops. The moral sensitivity of the nurses in this study was moderate and did not have a significant correlation with caring behavior scores. In view of the fact that nurses deal with serious situations in patient care that call for adequate ethical abilities for decision-making as well as good performance، it is necessary for them to be familiar with and sensitive to ethical issues related to their profession.

Moral distress is one of the common issues in nursing that has been receiving a lot of attention in research related to this profession. Moral distress is a phenomenon that can impact nurses، patients and health systems greatly. One significant impact of moral distress on nurses is its role on their desire to continue to work in their profession، and the present cross-sectional، descriptive and analytical study was conducted in order to determine this impact. Study samples were nurses in Birjand teaching hospitals who were selected through polls and according to entrance criteria. A 22-item questionnaire was developed by combining demographic information، Corley’s moral distress scale and the nurses’ desire to stay in the profession. The questionnaire was translated from English by the researcher and its validity and reliability were assessed. The results indicated that there is no significant relationship between moral distress and the desire to stay in the nursing profession (P>0/05). Moreover، levels of moral distress in the nurses in this study were moderate 2. 25±0. 6 (mean±SD) Given the level of moral distress in nurses and its possible consequences، strategies and solutions should be devised to familiarize nurses with moral distress and its underlying factors in order to reduce the undesirable outcomes of this phenomenon more effectively.

Considering the importance of medicine and the ever-increasing developments in medical research، the implementation of such research according to the ethical principles and criteria of creditable national and international declarations is of great significance. According to these declarations، the researcher has the highest responsibility to observe the rights and safety of participants. The present study intends to survey the rate of observance of research ethics in proposals approved at Urmia University of Medical Sciences between the years 2003 and 2008. Three hundred and twenty four research proposals that had been approved between 2003 and 2008 were evaluated retrospectively. Related checklists (self- constructed ones and World Health Organization checklists) were completed for each project، a statistical analysis of the results was done by SPSS software، and descriptive statistics were subsequently extracted. A summary of the most important results is as follows: In 85. 5% of the proposals، the ethical considerations part was completed. In 68. 4% of the cases the participants were aware of participating in the study and in 67. 9% of the cases the informed consent of participants was obtained، 50. 9% of which was in written form. Among clinical trials، in 80% of the proposals informed consent was obtained، 85% of which was written. Out of 60 clinical trials، 37 projects (62%) were confirmed by the ethics committee. Considering the results obtained in this study، principles of research ethics were applied more closely in this study compared to similar studies in Iran. It seems this is due to the establishment and launch of regional ethics committees in 2003 and afterwards. However، in order to bring these measures closer to current standards، holding educational workshops for honorable members of scientific boards and students is recommended. Moreover، more accurate supervision of ethics committees، especially in clinical trials and animal experimentations، seems to be beneficial.

The study of work ethics has gained great significance in recent years following the failures of major corporations and the West’s crisis. The main objective of this study is to examine the relationship between Islamic work ethics (IWE) and organizational commitment and its three dimensions including affective، continuance and normative commitments. This is a descriptive study that has been conducted in 2010. One hundred and fifty nine employees participated in this study who selected from hygiene، nursing & midwifery، pharmacy & medicinal sciences، dentistry، rehabilitation sciences، and management & information faculties through stratified random sampling. Data were collected via the 17-item Islamic Work Ethics Questionnaire، constructed by Ali (2000)، and the 24-item Organizational Commitment and its dimensions questionnaire، constructed by Meyer & Allen (1991). The collected data were analyzed through correlation and regression using SPSS17. The result of factor analysis confirmed the multidimensional nature of organizational commitment. The result of correlation and regression analysis also showed that there is a positive and direct relationship between IWE and total organizational commitment and its three dimensions. The demographical variables did not impact on IWE and organizational commitment. According to the results، the employees of Isfahan University of Medical Sciences are committed to the organization either because of an emotional bond to the organization or in the absence of better job opportunities outside the organization. It may be beneficial to convey these results to managers in order to make them aware of the fact that the employees are not reluctant to leave the organization for a better job with better conditions. In view of the relationship between Islamic work ethics and organizational commitment، it is recommended that university directors and presidents attempt to increase organizational commitment by providing ethical codes and promoting Islamic work ethics principles.

Nurses and administrators can identify and implement mechanisms to manage، change، and improve the ethical climate in their workplace through an understanding and awareness of this concept as well as how it is perceived by everyone involved. This study aimed to compare the nurses’ perception of the actual and ideal organizational ethical climate in hospitals of Ahwaz Juondishapour University of Medical Sciences. This was a cross-sectional descriptive study conducted on 558 nurses working at 9 medical centers of Ahwaz Jondishapour University of Medical Sciences selected by systematic sampling. Data instrument consisted of 2 parts: 1) demographic characteristics، and 2) actual & ideal climate questionnaire based on the Farsi version of Olson’s ethical climate questionnaire، used to assess nurses’ perception of the hospital ethical climate in 5 categories (managers، colleagues، physicians، patients، and hospitals). Descriptive and inferential statistical tests، independent T-test and One-Way ANOVA were used to analyze the data. Results demonstrated a positive hospital ethical climate (mean = 3. 66)، while the nurses’ perception of the ideal ethical climate was positive as well. A significant difference was found between the mean scores of the nurses’ perceptions of actual & ideal ethical climates (P<0. 05). Results demonstrated a significant relationship between nurses’ work experience & organizational level، and their perceptions of the hospital ethical climate. A positive ethical climate exists in hospitals، although it is far from the ideal ethical climate، and therefore managers must maintain the actual ethical climate and at the same time implement strategies to improve their hospitals’ ethical climate.