Journal of Medical Ethics and History of Medicine
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The controversial role of ethics in clinical education and its ability to draw the attention of a large audience is inevitable. The issues and challenges of the COVID-19 pandemic have transformed the clinical education environment. This study was conducted to explore the challenges and ethical requirements of medical sciences education during the COVID-19 pandemic in 2020. The study was qualitative research and the instrument was a semi-structured interview. The participants included faculty members of the basic and clinical Sciences at Iran University of Medical Sciences. After 16 rounds of interviews, theoretical saturation was achieved. Qualitative data were analysed using conventional content analysis, which resulted in 81 preliminary codes and 28 sub-categories. Finally, two themes of "ethical challenges" and "ethical requirements", and 10 categories were achieved. The sub-categories were consisted of "being patient-centred", "social accountability of curriculums", "ethical challenges of the clinical environment", "the poor performance of the clinical faculty members and students", "being justice-centred", "raising awareness", "observing clinical research ethics", "preservation and promotion of mental health", "patient confidentiality", and "respect for individuals". We hope the ethical challenges in medical education that were created due to the emergence of Covid-19 can be reduced and eliminated by defining a framework for ethical requirements. 

It appears that up until now, no comprehensive tool has been developed to assess medical students’ attitudes toward the different dimensions of professionalism. The present study aimed to develop a comprehensive quantitative tool to evaluate medical students’ attitudes toward professionalism. This study consisted of two phases: The first phase was item generation and questionnaire design based on literature review and a qualitative survey. The qualitative data were extracted from 49 semi-structured individual interviews and one focus group discussion. In the second phase, the questionnaire was developed and its face, content, and structure validity and reliability were evaluated. To measure the construct validity of the questionnaire, a cross-sectional study was conducted on 354 medical students at different academic levels at Isfahan University of Medical Sciences. The final questionnaire was loaded on five factors. The factors accounted for 43.5% of the total variance. Moreover, Cronbach's alpha was 0.84 for the total scale, and the interclass correlation coefficient was 0.77 for the test-retest reliability. The 17-item questionnaire measuring medical students’ professional attitude had acceptable validity and reliability and can be adopted in other studies on physicians’ and medical students’ professional attitudes.   

Protection of patients' rights is critical in improving healthcare quality, and hence this study aimed at reviewing patient rights’ practices in healthcare organizations of Iran. Using systematic search, this review was conducted based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Several keywords, including "patient rights", "patient bills of rights" and "patients rights’ charter" were searched bilingually in the databases of SID, Magiran, PubMed, Scopus, and Web of Science from 2010 to 2021, and then, following a three-tier screening using the Critical Appraisal Skills Program (CASP) checklists, 76 articles were extracted. The degree of compliance with the Patients' Rights Charter (PRC) in healthcare organizations was 60.88% on average. As to the observance of the PRC dimensions, respectively, the highest and lowest scores were related to the "right to privacy and confidentiality" (70.16%) and "right to access an efficient complaining system" (53.01 %). Respect for patients' rights in organizations was assessed at a moderate level, and some aspects of patients' rights should be attended to immediately. Therefore, discrepancies in the dimensions of patients' rights and their implementation by organizations should be on the agenda of healthcare managers and policymakers.

The article's abstract is not available.

 In this paper, the evolution of the ethics committees for health research, their history, membership, and function in China and Australia is described. Investigators in each country compared the history and governance of their ethical systems based on the published evidence rather than personal opinions. Similarly, examples of challenges were selected from the literature. In both countries, the aim was to maximize the social benefits of research and minimize the risk imposed on the participants. Common challenges include maintaining independence, funding and delivering timely ethical reviews of the research projects. These challenges can be difficult where research ethics committees rely on voluntary contributions and lack a strong resource base. They must adapt to the increasingly rapid pace of research as well as the technological sophistication.  Population health research can challenge the conventional views of consent and privacy. The principles of the sound ethical review are common in both countries; governance arrangements and operational procedures, however, can differ, reflecting the cultural values and norms of their host countries and in respect of legal environments. By studying the evolution and function of ethics committees in the two countries, we established the differences in the governance and health systems, while similar ethical objectives helped sustain collaborative research.

Medical ethics committees play an important role in examining and resolving ethical problems in hospitals by developing ethical guidelines and making ethical decisions. This study aimed at investigating the challenges that these committees typically face. This qualitative phenomenological study was conducted in 2020. Data was collected through semi-structured interviews with purposive sampling and participation of 19 ethics committees’ members in Tehran hospitals. Then, data were analyzed by the content analysis method using MAXQDA-10 software. Challenges of hospital ethics committees were classified into three main themes including external factors, intra-organizational factors, and ethics committee structure, in addition to six sub-themes including inadequate supervision, lack of instructions, organizational culture, human resources, nature of the committee, and ineffectiveness of committees’ decisions. Since many challenges are faced by ethics committees, plans should be developed and implemented to fulfill the following purposes: (i) strengthen the position of these committees in hospitals, (ii) continuous supervision over the formation and holding of the committees, (iii) their operation process, (iv) their decision-making process, and (v) process of sharing committees’ decisions with all hospital stakeholders and staff.

Medical ethics faces several challenges in different aspects of education, research, and treatment in medicine and healthcare practice. Design and implementation of a national strategic plan can pave the way for the development of a roadmap in various countries to strengthen ethics and address these challenges.  To create a comprehensive plan compatible with the Iranian healthcare system, a multidisciplinary team of main stakeholders compiled a national strategic plan of medical ethics following several focus group discussion sessions and two workshops (2014-2017). Ultimately, the plan was confirmed by the Supreme Council for the Medical Ethics of the Ministry of Health and Medical Education. The current paper is a national report of the process and the medical ethics strategic plan in Iran. We have also tracked signs of progress and achievements in the country. In conclusion, this valuable effort has led to significant success in the implementation of medical ethics in clinical medicine, medical research, and education by using all the resources in our country. The participation of all the stakeholders, especially healthcare professionals in this way is required.  

Telemedicine can improve access to healthcare services; however, it has raised ethical concerns demanding special considerations. This study aimed at developing the codes of ethics for telemedicine, and hence several approved national and international ethical guidelines related to telemedicine practice were reviewed, and 48 semi-structured interviews were conducted with medical ethics and medical informatics experts as well as with physicians and patients who had telemedicine experiences. Content analysis was then performed on the interviews’ transcripts and a draft on code of ethics was prepared, which was further reviewed by the experts in the focus group meetings to reach a consensus on the final document. The final document consisted of a preface, five considerations, and 25 ethical statements. Considering the growing trend of adopting telemedicine worldwide, this document provides an ethical framework for those who use telemedicine in their medical practice.  

Compassion is a basic approach to medical practice and is the core component of health care. The purpose of the present study was to explore nurses' perceptions of compassion-based care (CBC) for COVID-19 patients. In this qualitative study, the participants were selected using purposeful sampling. Individual and semi-structured interviews were conducted with 25 nurses, and conventional content analysis was used to categorize the data. In the care of COVID-19 patients, CBC consisted of three categories including pro-social behaviors, paying attention to the beliefs and values ​​of patients, and concern for family members. The first category had three subcategories including empathy, altruism, and helping in critical situations. The second category included the subcategories of the spiritual approach to care and respect for cultural aspects. The third category, concern for family members, had one subcategory: the need to consider the patient's family. Our findings may help to develop a comprehensive model in COVID-19 care according to which, in addition to routine patient care, nurses will consider concepts such as empathy, altruism, helping in critical situations, spirituality, cultural values, ​​and the family’s needs at the end of the patient's life.  

Narrative medicine (NM) is an educational tool that can be used to promote the professional competencies of medical students. This study aimed to investigate Iranian medical students’ perceptions of the first NM program offered in 2019. The study was conducted on 69 medical interns who participated in the weekly NM program that was part of the professional ethics course for two months. We used a questionnaire to determine medical interns' perceptions and personal attitudes toward NM. Three experts confirmed the validity of the questionnaire in Persian, and its reliability was verified by internal consistency (α = 0.879). The independent t-test was used to compare the differences in the total scores of students' perceptions. Data analysis was conducted using SPSS 23 software (P < 0.05). The response rate to the questionnaire was 95.65%. The results showed overall students' perceptions of the program were found to be positive. Furthermore, the scores showed a significant difference in terms of gender (P = 0.014), but none in terms of marital status (P = 0.936). According to the results, NM was effective in improving students’ reflections and their empathy with patients. Therefore, it is recommended to include NM in professional ethics education.