The extent of government intervention in the public health system and individual freedoms during the Covid-19 pandemic: a theoretical analysis

The concept of individual freedom has complex and multifaceted dimensions that significantly affect the limits of permissible government interventions aimed at restricting such freedoms and maintaining public health. Therefore, the boundary between individual freedom and the social obligations of the government must be carefully clarified.  During the Covid-19 pandemic, the need for such clarifications clearly increased. This study intended to investigate the concept of freedom according to major theories and to observe their application in analyzing the relations between individuals and the government in the health system, particularly during public health emergencies.The findings revealed that “justice-based”, “development-based” and “accountability-based” conceptions of freedom provide a more appropriate rationale for implementation of public health restrictive measures by health authorities during infectious disease outbreaks including pandemics such as COVID-19. Even in minimal governments that are built upon a free-market system and unrestricted conception of individuals’ freedom, such public health interventions are justifiable in the light of the ‘Catastrophic Moral Horror’ where there is an extreme risk to the health of citizens

Ethical considerations in the biomedical research: analysis of national biomedical research ethics guidelines in Iran

The national guidelines for biomedical research ethics are approved by the "National Committee for Ethics in Biomedical Research" at the Iranian Ministry of Health and Medical Education as the regulatory body for biomedical research in the country. The focus of these guidelines should be on the ethical issues related to different stages of the research process, which would lead to increased research integrity and better supervision of research activities. The present study analyzed the contents of these national guidelines to clarify the ethical considerations connected to the five stages of a research process including 1) proposing, 2) approval, 3) operation, 4) documentation and 5) publishing. The findings showed that the assessed guidelines laid more emphasis on the ethical considerations related to the research operation stage rather than the proposal stage. In other words, activities such as identification of the research problem, formulation of hypotheses and questions, financial evaluation, data analysis and data interpretation did not receive adequate attention in these guidelines. Most of the guidelines presented subject categories such as the rights of participants and supervisory considerations in the "research operation stage", ethical considerations in the "evaluation and approval procedure stage", and editorial responsibilities in the "research review and publication stage". In general, despite noticeable content for guiding researchers for ethical conduction of research the national guidelines are not adequately developed to cover comprehensive and sufficient ethical considerations regarding all the activities of research

Ethical Considerations in Conducting Clinical Trials

Background: Clinical trials are the golden key in medical science research with human participants. They have always been considered interesting topics by researchers and scientists working in this field. However, the samples are “human participants,” so the research should be carefully conducted.Methods: In the present study, the published articles on the ethical challenges of conducting clinical trials were evaluated between 2010 and 2019 in Google Scholar, PubMed, and Scopus. The English search keywords were “clinical trial,” with at least one of the phrases of “ethical consideration” or “standard”.Results: In this article, we examined the ethical requirements and considerations in these research studies in four stages: research design and question, proposal review and approval, supervision and implementation, and publication of the results. We have examined them using relevant articles published between 2010 and 2019 and identified important and prominent issues or neglected ones. Conclusion: During this study, it was found that the “research design and question” stage was the most discussed and challenging stage, and the authors’ sensitivity about it has been more than the other three stages. On the other hand, the “results publishing” stage has been considered less sensitive with the least number of references in articles

Islamic Bioethics and Secular Bioethics and Interaction between them: Interaction between Islamic Bioethics and Secular Bioethics

Background and Aim: Nowadays, we are observing the increasing development of sciences, particularly biological sciences and medicine. In the Muslim world, the ethical requirements of such scientific developments are taken into account without paying sufficient attention to their indigenous and Islamic aspects. Even international institutions are not properly informed of the need for the religious aspects of bioethical discourse in Muslim countries. Hence, this study attempts to address the differences in the ideologies of these two ethical theories. Materials and Methods: In this review article, the keywords "bioethics", "Islam", "secularism", "philosophy of ethics", "ideology differences" and "ethical theories in secularism" were searched in PubMed, SID, and Google Scholar databases and the relevant literature was determined and analyzed. Ethical Considerations: Honesty and integrity were taken into consideration in searching, analyzing, and reporting the texts. Findings: Of the appropriate methods in analyzing the texts, one is the comparative study between the ideological and meta-ethical foundations of Islamic bioethics and secular bioethics, some of which are: the differences in the belief in the origin of existence and the Creator of existence; differences in the attitudes towards the totality of existence; differences in the views of the materialistic existence and the laws governing it. In addition, there exist anthropological differences in these two ethical theories, among which we can refer to the differences in the attitudes towards the creation of human beings, the differences in the attitudes towards the dimensions of human existence, and life after death. Finally, we can also refer to the meta-ethical differences between Islamic bioethics and secular bioethics, including the difference in moral ontology, the difference in ethical epistemology, ethical semantics, as well as several similarities between Islamic bioethics and secular bioethics that are mostly normative. Conclusion: Accepting the differences and similarities can be found as a present reality to begin a constructive bilateral dialogue and to introduce the fundamentals of Islamic bioethics. *Corresponding Author: Mahmoud Abbasi; Email: [email protected]; ORCID: https://orcid.org/0000-0002-4223-6818  Please cite this article as: Abbasi M, Shamsi Gooshki E. Islamic Bioethics and Secular Bioethics and Interaction between them. Bioeth Health Law J. 2021; 1:1-10: (e3). http://doi.org/10.22037/bhl.v1i1.3812

The social context-mining of trust in physicians and policy recommendations for improvement and promotion

زمینه و هدف: فهم این وضعیت چالش‌انگیز مستلزم پژوهش‌های علمی است تا بتوان از نتایج آن برای سیاستگذاری اجتماعی، آموزشی و بهداشتی استفاده کرد. هدف پژوهش حاضر شناسایی مؤلفه‌های اعتماد بیمار به پزشک و فهم چگونگی بهبود «اعتماد» بیماران به پزشکان بود. مواد و روش‌‌ها: روش این پژوهش کیفی از نوع فراترکیب است. طراحی، اجرا و نتیجه‌گیری این پژوهش در بازه زمانی 1398 تا 1400 انجام شده‌ است. پایگاه‌های علمی داخلی و بین‌المللی Normagz، MagIran، SID، Scopus، Science Direct و پایگاه نشریات با دسترسی آزاد مراجع اصلی استخراج متون بود. منطبق با رویکرد هفت مرحله‌ای Sandelowski و Barroso (2007 م.) و با راهبرد جستجوی هدفمند، 110 مقاله انتخاب شدند. برای دستیابی به اطلاعات مورد نیاز در خصوص پرسش‌های مطالعه، از واژگان کلیدی اصلی از قبیل «اعتماد به پزشک»، «رابطه پزشک و بیمار»، «اعتماد بین بیمار و پزشک» و «Trust to Patient»، «Trust between Patient and Physician» و «Relationship between Patient and Physician» استفاده شد. به لحاظ معیار ورود و خروج، انتخاب مقالات بر اساس شباهت‌های روش‌شناختی و فراهم‌ساختن پوشش عمیق و جامع از ویژگی‌های مورد نظر و مؤثر بر نتایج بود. با قیاس عنوان، چکیده، روش و یافته‌های پژوهش مرحله به مرحله تعدادی مقاله از دایره مطالعاتی حذف شد و در نهایت 54 مقاله مبنای کدگذاری و تحلیل قرار گرفت. ملاحظات اخلاقی: در مراحل مختلف طراحی، گردآوری و تحلیل داده و یافته‌های پژوهش از اصول و موازین اخلاق در پژوهش از قبیل وفاداری به متن، ارجاع‌دهی به منابع و رعایت اصول نگارش علمی تبعیت شده ‌است. یافته‌ها: نتایج این پژوهش نشان داد که اعتماد بیمار به پزشک رابطه‌ای پیچیده، دوسویه و متأثر از مؤلفه‌های متنوعی است. طبق یافته‌های این پژوهش عوامل اعتمادساز رابطه بیمار و پزشک در سه سطح کلان (اجتماعی ـ فرهنگی)، سطح میانی (قانونی ـ اخلاقی)، سطح خرد (حرفه‌ای ـ تخصصی، فردی ـ روان‌شناختی) طبقه‌بندی شد. افزون برآن، زیرطبقات یا زیرمؤلفه‌های این پژوهش شامل «اعتماد اجتماعی، رضایت اجتماعی، آموزش فرهنگی، مدیریت و محیط درمان، حقوق قانونی، اصول اخلاقی، امکانات درمان و بهداشت، محرمانگی، اخلاق علمی، حقوق قانونی، اصول اخلاقی، تعهد شغلی محرمانگی، دانش بالینی ـ تخصصی، مهارت کلامی ـ ارتباطی، باورمندی، آگاهی و تجربه درمانی بیمار و متغیرهای دموگرافیک» هستند. نتیجه‌گیری: بر اساس یافته‌های این پژوهش، بهبود رابطه مبتنی بر اعتماد میان بیمار و پزشک مستلزم فراهم‌نمودن شرایط و زمینه‌های اجتماعی و حرفه‌ای متنوعی است که در این میان مدیریت درمان (افزایش برابری در فرصت‌های دسترسی و با کیفیت برای همه و ساخت و تجهیز فضای درمانی بیمارمحور)، یادگیری درمان (آموزش آگاهی‌بخش و تقویت مهارت‌های ادراکی و انسانی پزشکان و کادر درمان) و مدیریت محیط درمان (آموزش مهارت ارتباطی، همزبانی با بیماران و فاصله‌گرفتن از جایگاه اقتدارگرایانه برای کلیه کادر پزشکی و درمان بر اساس نوع ارتباط)، از ضروریات زیرساختی آن تلقی می‌شود.Background and Aim: Trust between patient and physician has been challenged by overt and covert factors such as eroding social capital and increasing the cost of medical services in the community. To understand such a challenging situation, scientific research needs to be done so that the results of which can be used for making social, education and health policies. This study aimed to identify the components of trust between patient and physician as well as understand how to strengthen "trust" in physicians. Materials and Methods: A meta-synthesis was used to evaluate systematically the results of previous research regarding trust in physicians. This study has been designed, implemented and concluded from 2019 to 2021. Domestic and international scientific databases such as Normags, MagIran, SID, Scopus, Science Direct and open-access databases were the main sources for extracting text110 articles were selected based on the seven-step approach of Sandelowski and Barroso (2007) and focused search strategy. Key terms of "trust in patient", "trust between patient and physician", "physician-patient relationship", "trust between patient and physician" was used to obtain information about questionnaires. The criteria for selecting articles were methodological similarities and comprehensive coverage of the desired features affecting the results. By comparing the title, abstract, method and findings of the research, some articles were excluded from the study and finally, 54 articles were used as final sources for coding and analyzing. Ethical Considerations: The research ethical principles such as fidelity to the text, reference to sources and observance of the principles of scientific writing have been adhered to by the researchers in different stages of the research design, data collection, analysis and conclusion. Findings: The results of this study showed that the patients trust in the physician is a complex, two-way relationship and is affected by a variety of components. Based on the results, the confidence-building factors of the patient-physician relationship were classified into three levels of macro (socio-cultural), meso (legal-moral) and micro (professional-specialized, individual-psychological). In addition, the sub-components of this study include social trust, social satisfaction, cultural education, management and treatment environment, legal rights, ethical principles, treatment and health facilities, scientific ethics, legal rights, ethical principles, job commitment, confidentiality, clinical-specialized knowledge, verbal-communication skills, credibility, patient knowledge and therapeutic experience and demographic variables. Conclusion: Based on the findings of this study, improving the trust-based relationship between the patient and physician requires the provision of various social conditions and circumstances, including treatment management (increasing equality in access to high-quality educational opportunities as well as building and equipping patient-centered treatment spaces), treatment learning (educating, informing and strengthening the perceptual and human skills of physicians and treatment staff) and treatment environment management (communication skills training, communicating with patients and distancing oneself from an authoritarian position for all medical staff and treatment based on the type of communication), considered as its infrastructural requirements.   Cite this article as: Safaei M, Farasatkhah M, Shamsi Gooshki E. The Social Context-Mining of Patients Trust in Physicians and Recommendations for Improvement and Promotion: A Meta-Synthesis Analysis. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e29

سلامت معنوی در برنامه آموزش علوم پزشکی

مقدمه: امروزه گرایش به معنویت به عنوان گرایشی نو، در عرصه‌های آموزشی، تربیتی و فرهنگی بیش از عرصه‌های دیگر به چشم می‌خورد. حوزه‌ی تعلیم وتربیت بهترین موقعیت و فرصت را برای تبلور معنویت در انسان فراهم می‌کند و موضوع معنویت ذاتاً موضوعی تربیتی است. توجه به سلامت معنوی در آموزش نیازمند برنامه‌ریزی آموزشی مناسب است. لذا در این پژوهش به بررسی سلامت معنوي در برنامه آموزش پزشکی و پرستاری ایران پرداخته‌ایم. روش: این مطالعه، با روش توصیفی و نظری اجرا شده است. داده‌ها با روش اسنادی و جستجو در پایگاه‌ها و منابع اطلاعات علمی اینترنتی گردآوری شده است. یافته ها: ورود سلامت معنوی در برنامه‌های آموزشی بسیاری از کشورهای دنیا صورت گرفته است و برنامه‌های آموزشی و درسی بر آن اساس و در بستری از مفاهیم معنوی ساخته و پرداخته می‌شوند. در برنامه آموزشي دوره دكتراي پزشكي و دوره کارشناسی پرستاری در ایران نیز حرکت‌هایی صورت گرفته است. اما محتواي درسی باید در مورد معنويت و سلامت معنوي در برنامه آموزش پرستاري و پزشکی گنجانده شود. بحث و نتیجه‌گیری: آموزش سلامت معنوی در دانشگاه‌ها مکرراً توصيه شده است. لازم است که در این راستا محتوا و محيط آموزشي مناسب نیز فراهم گردد. در کنار مهارت‌هايي که در زمينه مراقبت پرستاری و پزشکی برای دانشجویان لازم است به دست آوردن مهارت در زمینه سلامت معنوی نیز لازم و ضروری به نظر می‌رسد.Introduction: today, the tendency toward the spirituality is observed as a new trend in the educational, training and cultural arenas more than other arenas. The area of teaching and training provides the best situation for the crystallization of the spirituality in man. Noticing the spiritual health in education needs a proper educational planning. Therefore, in this research we have dealt with the study of the spiritual health in the program of medical and nursing education of Iran.  Method: this study has been performed by a descriptive and theoretical method. Data have been collected by a documental method and searching in scientific information and data bases in internet. Findings: the spiritual health has entered into the educational programs of many countries throughout the world and the educational programs and curriculums are made and developed based on it in a bed of spirituals concepts. Some measures have been taken also in the curriculums of doctoral course in medicine and the bachelor course in nursing in Iran. But, the educational content on the spirituality and the spiritual health must be included in the nursing and medical curriculums. Conclusion: the education of the spiritual health has been recommended in different universities. It is necessary that proper educational content and setting to be provided also in this respect. Beside necessary skills for the students in respect of nursing and medical care, gaining skill in respect of the spiritual health seems necessary too.مقدمه: امروزه گرایش به معنویت به عنوان گرایشی نو، در عرصه‌های آموزشی، تربیتی و فرهنگی بیش از عرصه‌های دیگر به چشم می‌خورد. حوزه‌ی تعلیم وتربیت بهترین موقعیت و فرصت را برای تبلور معنویت در انسان فراهم می‌کند و موضوع معنویت ذاتاً موضوعی تربیتی است. توجه به سلامت معنوی در آموزش نیازمند برنامه‌ریزی آموزشی مناسب است. لذا در این پژوهش به بررسی سلامت معنوي در برنامه آموزش پزشکی و پرستاری ایران پرداخته‌ایم. روش: این مطالعه، با روش توصیفی و نظری اجرا شده است. داده‌ها با روش اسنادی و جستجو در پایگاه‌ها و منابع اطلاعات علمی اینترنتی گردآوری شده است. یافته ها: ورود سلامت معنوی در برنامه‌های آموزشی بسیاری از کشورهای دنیا صورت گرفته است و برنامه‌های آموزشی و درسی بر آن اساس و در بستری از مفاهیم معنوی ساخته و پرداخته می‌شوند. در برنامه آموزشي دوره دكتراي پزشكي و دوره کارشناسی پرستاری در ایران نیز حرکت‌هایی صورت گرفته است. اما محتواي درسی باید در مورد معنويت و سلامت معنوي در برنامه آموزش پرستاري و پزشکی گنجانده شود. بحث و نتیجه‌گیری: آموزش سلامت معنوی در دانشگاه‌ها مکرراً توصيه شده است. لازم است که در این راستا محتوا و محيط آموزشي مناسب نیز فراهم گردد. در کنار مهارت‌هايي که در زمينه مراقبت پرستاری و پزشکی برای دانشجویان لازم است به دست آوردن مهارت در زمینه سلامت معنوی نیز لازم و ضروری به نظر می‌رسد

Ethical considerations in sexual health research: A narrative review

Background: There is an assumption that sexual health research has great influence on the quality of human life through elevating sexual health standards, and their results will eliminate the burden of sexual health challenges on family relationships. The aim of this study was to review ethical considerations in sexual health research. Materials and Methods: This narrative review was conducted between January 1990 and December 2017 based on the five-step approach of York University. The keywords used to search for the studies included ethical issues, research, sexual health, reproductive health, and sensitive topics. The language of the literatures was English and the search process was performed on PubMed, Elsevier, Ovid, Springer, Google Scholar, ResearchGate, SAGE Publishing, ProQuest, WHO website, Kinsey Confidential, and Worldsexology. Results: After assessing the quality and eligibility of 94 articles, 13 were selected. The results of the present study showed that the most important ethical considerations were protecting the confidentiality and privacy of participants, obtaining informed consent, and paying attention to vulnerable people. Conclusions: The review of literature exhibited several considerations that sexual health researchers are faced with. In order to manage these considerations, the researcher should have sufficient understanding of them. The important matter is that strategies to manage these challenges should be completely rational and practical according to each context. These strategies can also be applied in other societies with great similarities in their context

بررسی اخلاقی شاخص‏های تخصیص کبد پیوندی به بیماران نیازمند در مرکز پیوند اعضای بیمارستان نمازی شیراز

One of the most effective methods for many end stage liver patients is organ transplantation. The main source of transplantable liver is cadaveric organ. Since, the demand for such organs is more than procured livers, selecting is inevitable and usually debatable. In Shiraz organ transplantation center, the candidates are ranked based on MELD score. According to this ranking method, the patient who holds the highest score will be at the top of the transplantation list and priority for receiving organs. Although using MELD score decreases the mortality rate of people on the waiting list, but it cannot predict mortality rate after transplantation. So, in this regard, we are going to discuss the ethical issues about priority setting of end stage liver patients for liver transplantation in Shiraz Organ Transplantation Center.یکی از مؤثرترین راه‏های درمان بسیاری از بیماران پیشرفته کبدی، پیوند کبد است. منبع عمده پیوند کبد در مرکز پیوند اعضای شیراز، از مرگ مغزی بوده و به دلیل کمبود ارگان پیوندی و از سوی دیگر تقاضای روزافزون برای پیوند، بین عرضه و تقاضای کبد تعادل برقرار نیست. به همین دلیل انتخاب کاندیدای مناسب پیوند بسیار بحث‌انگیز است. در حال حاضر در مرکز پیوند اعضای شیراز، کاندیداهای پیوند کبد بر اساس نمره مِلد رتبه‏بندی می‏شوند و بیماری که بیشترین نمره را کسب کند، برای پیوند انتخاب می‏شود، اگرچه با بکاربستن نمره مِلد در رتبه‌بندی بیماران نیازمند، مرگ و میر در لیست انتظار کاهش یافته است، اما این سیستم نمی‏تواند به خوبی مرگ و میر پس از پیوند را پیش‏بینی کند. بنابراین در این مقاله هدف بر آن است تا نکات اخلاقی مرتبط با پیوند کبد و نحوه رتبه‏ بندی بیماران مورد بحث و بررسی قرار گیرد

COVID‐19 vaccination in children as a global dilemma through an ethical lens: A retrospective review

Abstract Background and Aims COVID‐19 pandemic led to a need to rapidly vaccinate as many people as possible. Children are an important part of the population with different characteristics which vaccinating them is a matter of great importance as it should be decided considering all aspects and ethics. Here, we present different aspects of COVID vaccination in children including the potential challenges. Methods We searched on PubMed, Google Scholar and Scopus in this regard, and all of the relevant papers published until June 28, 2021 were included if we could access their full‐texts. Results We found various expert opinions in this regard and tried to summarized them. Saving lives has similar ethical value as preventing evitable adverse event. Accordingly, mandating the children to receive the SARS‐CoV‐2 vaccine, needs risk‐benefit weighing with special consideration of ethical challenges. Conclusion Considering the vast range of benefits resulted from pediatric vaccination both for the children and the community, implementing the program in a scientific manner and also with the least financial expenses for the families seems to be reasonable and makes it both ethical and moral