Publications by authors named "Kiarash Aramesh"

30 Publications

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Priority setting for research in the field of medical ethics in the Islamic Republic of Iran: a Delphi study.

East Mediterr Health J 2020 May 21;26(5):531-538. Epub 2020 May 21.

Medical Ethics and History of Medicine Research Center.

Background: Priority-setting is one way to develop research in a particular field.

Aims: We aimed to identify and prioritize the most important medical ethics issues for research in the Islamic Republic of Iran.

Methods: A 3-round Delphi survey was conducted using a questionnaire covering 77 medical ethics topics in 10 categories and subcategories (extracted from literature review); this was emailed to 40 experts in medical ethics. The participants rated categories and subcategories for importance on a 5-point Likert scale and ranked the topics based on their research priorities. The highest Likert score showed the most important issue and the lowest priority score indicated the first priority.

Results: After consensus, the panel identified 6 categories as the highest priority and most important areas: professionalism [priority score = 2.66, standard deviation (SD) 2.63, importance score = 4.45, SD 0.72], education (priority score=3.12, SD 1.89, importance score = 4.25, SD 0.84), end of life (priority score = 3.79, SD 1.91, importance score = 4.47, SD 0.66), beginning of life (priority = 4.62, SD 1.68, importance score= 4.26, SD 0.61), public health (priority score = 5.20, SD 2.39, importance score = 4.29, SD 0.75), and ethics in research (priority score = 5.33, SD 1.97, importance score = 4.34, SD 0.64).

Conclusion: The rankings for priority and importance was not the same. Our results highlight a lack of applicable knowledge in the areas of professionalism and end of life. This study could be used as a foundation for developing further investigations by ensuring the most appropriate use of limited resources.
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http://dx.doi.org/10.26719/emhj.19.085DOI Listing
May 2020

Perspectives of Hinduism and Zoroastrianism on abortion: a comparative study between two pro-life ancient sisters.

Authors:
Kiarash Aramesh

J Med Ethics Hist Med 2019 5;12. Epub 2019 Aug 5.

Assistant Professor, The James F. Drane Bioethics Institute, Edinboro University of Pennsylvania, Edinboro, Pennsylvania, USA; Department of Biology and Health Sciences, College of Science and Health Professions, Edinboro University of Pennsylvania, Edinboro, Pennsylvania, USA.

Hinduism and Zoroastrianism have strong historical bonds and share similar value-systems. As an instance, both of these religions are pro-life. Abortion has been explicitly mentioned in Zoroastrian Holy Scriptures including , and . According to Zoroastrian moral teachings, abortion is evil for two reasons: killing an innocent and intrinsically good person, and the contamination caused by the dead body (). In Hinduism, the key concepts involving moral deliberations on abortion are , and reincarnation. Accordingly, abortion deliberately disrupts the process of reincarnation, and killing an innocent human being is not only in contrast with the concept of Ahimsa, but also places a serious karmic burden on its agent. The most noteworthy similarity between Zoroastrianism and Hinduism is their pro-life approach. The concept of in Zoroastrianism is like the concept of in Hinduism, referring to a superior law of the universe and the bright path of life for the believers. In terms of differences, Zoroastrianism is a religion boasting a God, a prophet, and a Holy book, while Hinduism lacks all these features. Instead of reincarnation and rebirth, Zoroastrianism, like Abrahamic religions, believes in the afterlife. Also, in contrast with the concept of in Zoroastrianism, can either punish or forgive sins.
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http://dx.doi.org/10.18502/jmehm.v12i9.1340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166242PMC
August 2019

Science and Pseudoscience in Traditional Iranian Medicine.

Authors:
Kiarash Aramesh

Arch Iran Med 2018 07 1;21(7):315-323. Epub 2018 Jul 1.

Director, James F. Drane Bioethics Institute, Edinboro University of Pennsylvania, Edinboro, PA, USA.

The recent efforts for revitalizing traditional Iranian medicine (TIM) have shaped two main streams: The quackery traditional iranian medicine (QTIM) and the academic traditional iranian medicine (ATIM). The QTIM encompasses a wide range of practitioners with various backgrounds who work outside the academic arena and mostly address the public. These practitioners have no solid bases or limited boundaries for their claims. Instead, they rely on making misleading references to the Holy Islamic Scriptures, inducing false hope, claiming miraculous results, appealing to the conspiracy theories, and taking advantage of the public resentment toward some groups of unprofessional healthcare providers. The theories and practices of ATIM, however, can be categorized into two major categories: First, valid and scientific TIM that is aimed to conduct well-designed clinical trials and thereby, supply the evidence-based medicine with new treatments originated in or inspired by TIM. Second, a pseudoscientific part of the current TIM that is based on some obsolete medical theories, especially the medieval humoral medicine, and erroneous accounts of human anatomy, physiology, and physiopathology, mostly adopted from the ancient and medieval medical scripts. TIM has recently established some clinical centers for practicing humoral medicine that is partly pseudoscientific and involves significant risks. This paper suggests that the public health sector has a duty to act against the promulgation of medical superstitions by QTIM and the pseudoscientific medical practices of ATIM, and at the same time, support and promote the valid and potentially beneficial research pursued by ATIM aimed to explore the rich recourses of TIM and thereby enrich the evidence-based medicine.
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July 2018

An International Legal Review of the Relationship between Brain Death and Organ Transplantation.

J Clin Ethics 2018 ;29(1):31-42

Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Avenue, Room 687, Seattle, Washington 98101 USA.

The "dead-donor rule" states that, in any case of vital organ donation, the potential donor should be determined to be dead before transplantation occurs. In many countries around the world, neurological criteria can be used to legally determine death (also referred to as brain death). Nevertheless, there is considerable controversy in the bioethics literature over whether brain death is the equivalent of biological death. This international legal review demonstrates that there is considerable variability in how different jurisdictions have evolved to justify the legal status of brain death and its relationship to the dead-donor rule. In this article, we chose to review approaches that are representative of many different jurisdictions-the United States takes an approach similar to that of many European countries; the United Kingdom's approach is followed by Canada, India, and influences many other Commonwealth countries; Islamic jurisprudence is applicable to several different national laws; the Israeli approach is similar to many Western countries, but incorporates noteworthy modifications; and Japan's relatively idiosyncratic approach has received some attention in the literature. Illuminating these different justifications may help develop respectful policies regarding organ donation within countries with diverse populations and allow for more informed debate about brain death and the dead-donor rule.
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May 2018

Compassion as the reunion of feminine and masculine virtues in medicine.

Authors:
Kiarash Aramesh

J Med Ethics Hist Med 2017 7;10. Epub 2017 Oct 7.

Associate Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Scholar in Residence, Center for Healthcare Ethics, Duquesne University, Pittsburgh, PA, USA.

The central role of the virtue of compassion in the shaping of the professional character of healthcare providers is a well-emphasized fact. On the other hand, the utmost obligation of physicians is to alleviate or eliminate human suffering. Traditionally, according to the Aristotelian understanding of virtues and virtue ethics, human virtues have been associated with masculinity. In recent decades, the founders of the ethics of care have introduced a set of virtues with feminine nature. This paper analyzes the notion of compassion as a common virtue between the traditional/masculine and care/feminine sets of virtues and shows that compassion is a reunion and merging point of both sets of human virtues. This role can be actualized through the development and promotion of compassion as an important part of the character of an ideal physician/healthcare provider. In addition, this paper argues that the notion of compassion can shed light on some important aspects of the contemporary debates on healthcare provider-patient relationship and medical futility. Despite the recent technological and scientific transformations in medicine, the interpersonal relationship between healthcare providers and patients still plays a vital role in pursuing the goals of healthcare. The virtue of compassion plays a central role in the establishment of a trust-based physician-patient relationship. This central role is discernible in the debate of medical futility in which making difficult decisions, depends largely on trust and rapport which are achievable by compassion in the physician and the recognition of this compassion by the patients and their surrogate decision makers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747837PMC
October 2017

Shiite Perspective on the Moral Status of the Early Human Embryo: A Critical Review.

Authors:
Kiarash Aramesh

J Relig Health 2018 Dec;57(6):2182-2192

Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.

According to Shiite perspective, the relative inviolability of the human embryo starts at the time of implantation and attains complete ethical status at ensoulment. Different paradigms of embryology have been influential on the understanding of Shiite jurists of the relevant Qur'anic verses. This paper provides a critical review of the process of issuing religious decrees on issues related to the early human life and concludes that Shiite jurisprudence needs to obtain consistency in its adopted account of embryology and adopt a proactive approach toward the bioethical new-emerging issues.
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http://dx.doi.org/10.1007/s10943-017-0518-6DOI Listing
December 2018

Biopolitics, Pseudoscience, and Bioethics in the Global South.

Authors:
Kiarash Aramesh

Am J Bioeth 2017 10;17(10):26-28

a Tehran University of Medical Sciences and Duquesne University.

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http://dx.doi.org/10.1080/15265161.2017.1365187DOI Listing
October 2017

History of attitudes toward death: a comparative study between Persian and western cultures.

Authors:
Kiarash Aramesh

J Med Ethics Hist Med 2016 26;9:20. Epub 2016 Dec 26.

Associate Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Phd Candidate in Medical Ethics, Center for Healthcare Ethics, Duquesne University, Pittsburgh, PA, USA.

In his seminal book on the historical periods of Western attitudes toward death, Philippe Aries describes four consecutive periods through which these attitudes evolved and transformed. According to him, the historical attitudes of Western cultures have passed through four major parts described above: "Tamed Death," One's Own Death," "Thy Death," and "Forbidden Death." This paper, after exploring this concept through the lens of Persian Poetic Wisdom, concludes that he historical attitudes of Persian-speaking people toward death have generally passed through two major periods. The first period is an amalgamation of Aries' "Tamed Death" and "One's Own Death" periods, and the second period is an amalgamation of Aries' "Thy Death" and "Forbidden Death" periods. This paper explores the main differences and similarities of these two historical trends through a comparative review of the consecutive historical periods of attitudes toward death between the Western and Persian civilizations/cultures. Although both civilizations moved through broadly similar stages, some influential contextual factors have been very influential in shaping noteworthy differences between them. The concepts of after-death judgment and redemption/downfall dichotomy and practices like deathbed rituals and their evolution after enlightenment and modernity are almost common between the above two broad traditions. The chronology of events and some aspects of conceptual evolutions (such as the lack of the account of permanent death of nonbelievers in the Persian tradition) and ritualistic practices (such as the status of the tombs of Shiite Imams and the absolute lack of embalming and wake in the Persian/Shiite culture) are among the differences.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432944PMC
December 2016

Fee Splitting among General Practitioners: A Cross-Sectional Study in Iran.

Arch Iran Med 2016 Dec;19(12):861-865

Department of Health Information Management, Faculty of Allied Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background: Fee splitting is a process whereby a physician refers a patient to another physician or a healthcare facility and receives a portion of the charge in return. This survey was conducted to study general practitioners' (GPs) attitudes toward fee splitting as well as the prevalence, causes, and consequences of this process.

Methods: This is a cross-sectional study on 223 general practitioners in 2013. Concerning the causes and consequences of fee splitting, an unpublished qualitative study was conducted by interviewing a number of GPs and specialists and the questionnaire options were the results of the information obtained from this study.

Results: Of the total 320 GPs, 247 returned the questionnaires. The response rate was 77.18%. Of the 247 returned questionnaires, 223 fulfilled the inclusion criteria. Among the participants, 69.1% considered fee splitting completely wrong and 23.2% (frequently or rarely) practiced fee splitting. The present study showed that the prevalence of fee splitting among physicians who had positive attitudes toward fee splitting was 4.63 times higher than those who had negative attitudes. In addition, this study showed that, compared to private hospitals, fee splitting is less practiced in public hospitals. The major cause of fee splitting was found to be unrealistic/unfair tariffs and the main consequence of fee splitting was thought to be an increase in the number of unnecessary patient referrals.

Discussion: Fee splitting is an unethical act, contradicts the goals of the medical profession, and undermines patient's best interest. In Iran, there is no code of ethics on fee splitting, but in this study, it was found that the majority of GPs considered it unethical. However, among those who had negative attitudes toward fee splitting, there were physicians who did practice fee splitting. The results of the study showed that physicians who had a positive attitude toward fee splitting practiced it more than others. Therefore, if physicians consider fee splitting unethical, its rate will certainly decrease. The study claims that to decrease such practice, the healthcare system has to revise the tariffs.
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http://dx.doi.org/0161912/AIM.008DOI Listing
December 2016

The doctor-patient relationship: toward a conceptual re-examination.

J Med Ethics Hist Med 2016 28;9:10. Epub 2016 Aug 28.

Professor, Medical Ethics and History of Medicine Research Center, and Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

The nature of the doctor-patient relationship as a keystone of care necessitates philosophical, psychological and sociological considerations. The present study investigates concepts related to these three critical views considered especially important. From the philosophical viewpoint, the three concepts of "the demands of ethics "," ethical phenomenology and "the philosophy of the relationship" are of particular importance. From a psychological point of view, the five concepts of "communication behavior patterns" (including submissiveness, dominance, aggression, and assertiveness), "psychic distance", "emotional quotient", "conflict between pain relief and truth-telling", and "body language" have received specific emphasis. Lastly, from the sociological perspective, the three notions of "instrumental action", "communicative action", and "reaching agreement in the light of communicative action" are the most significant concepts to reconsider in the doctor-patient relationship. It should be added, however, that from the sociological point of view, the doctor-patient relationship goes beyond a two-person interaction, as the moral principles of doctors and patients depend on medical and patient ethics respectively. The theoretical foundations of the doctor-patient relationship will finally help establish the different dimensions of medical interactions. This can contribute to the development of principles and multidisciplinary bases for establishing practical ethical codes and will eventually result in a more effective doctor-patient relationship.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5149463PMC
August 2016

Informal Payments for Health Care in Iran: Results of a Qualitative Study.

Iran J Public Health 2015 Jan;44(1):79-88

5. Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences , Tehran, Iran.

Background: Informal payments to health care providers have been reported in many African, Asian and European countries. This study aimed to investigate different aspects of these payments that are also known as under-the-table payments in Iran.

Methods: This is an in-depth interview-based qualitative study conducted on 12 purposively chosen clinical specialists. The interviewees answered 9 questions including the ones about, definitions of informal payments, the specialties and hospitals mostly involved with the problem, how they are paid, factors involved, motivation of patients for the payments, impact of the payments on the health care system and physician-patient relationship and the ways to face up with the problem. The findings of the study were analyzed using qualitative content analysis method.

Results: Six topics were extracted from the interviews including definitions, commonness, varieties, motivations, outcomes and preventive measures. It was revealed that under-the-table payments are the money taken (either in private or public portions) from patients in addition to what formally is determined. This problem is mostly seen in surgical services and the most important reason for it is unrealistic tariffs.

Conclusion: Regarding the soaring commonness of informal payments rooted in underpayments of health expenditures in some specialties, which deeply affect the poor, the government has to boost the capitation and to invest on health sectors through supporting the health insurance companies and actualizing the health care costs in accord with the real price of the health care delivered.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450017PMC
January 2015

A comparison between conflict of interest in Western and Islamic literatures in the realm of medicine.

J Med Ethics Hist Med 2014 17;7. Epub 2014 Mar 17.

Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.

In Western literatures, "conflict" is a general term that refers to discord between two or more entities. In Islamic jurisprudence, however, in addition to the term "conflict" (Taāruz), there is another term which is called tazāhum. The two terms, however, have different definitions. Conflict between two concepts, for instance, indicates that one is right and the other is wrong, while tazāhum does not necessarily have to be between right and wrong, and may appear between two equally right concepts. Moreover, conflict exists on a legislative level, while tazāhum is a matter of obedience and adherence, meaning that in practice, both sides cannot continue to coexist. Conflict of interest is a known term in Western literatures, and according to D.F. Thompson, it refers to a situation where professional judgment regarding a primary interest is improperly and unjustifiably influenced by a secondary interest. Taking into account Thompson's definition and the distinction between "conflict" (Taāruz) and "tazāhum", the English term "conflict of interest" translates to "tazāhum of interest" in Islamic jurisprudence as it refers to a person's action without reflecting right or wrong, and simply concerns priority of one interest over another. The resolution to tazāhum in Islamic jurisprudence lies in two principles: the principle of significance and the principle of choice. For instance, in case of conflict (the Western term) or tazāhum (the Islamic term) between the interests of patient and physician, the patient's interest should be the main concern based on the principle of significance. Although Western literatures propose methods such as disclosure or prohibition in order to resolve conflict of interest, the foundation for these solutions seems to have been the principle of significance.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263381PMC
December 2014

End-of-life care ethical decision-making: Shiite scholars' views.

J Med Ethics Hist Med 2014 14;7. Epub 2014 Jan 14.

Professor, Medical Ethics and History of Medicine Research Center, and Endocrinology and Metabolism Research Centre,Tehran University of Medical Sciences, Tehran, Iran.

Recent advances in life-sustaining treatments and technologies, have given rise to newly-emerged, critical and sometimes, controversial questions regarding different aspects of end-of-life decision-making and care. Since religious values are among the most influential factors in these decisions, the present study aimed to examine the Islamic scholars' views on end-of-life care. A structured interview based on six main questions on ethical decision-making in end-of-life care was conducted with eight Shiite experts in Islamic studies, and was analyzed through deductive content analysis. Analysis revealed certain points in Islamic views on the definition of death and the persons making decisions about end-of-life care. According to the participants, in addition to conventional criteria ('urf) such as absence of heartbeat and respiration, the irreversible cessation of human voluntary acts (as a sign that the soul has control over the body and the faculty of thinking) are considered to be the criteria in establishing death. The participants also recognized physicians as the main authorities in verifying signs of death. Furthermore, it was emphasized that life preservation and continuation of care must be sensible, and the patient can request not to have death-prolonging procedures started or continued. In the view of participants, patient's autonomy cannot be the sole basis for all measures, but Islamic ethical and jurisprudential principles should be relied upon to make correct and sensible decisions whether to continue or stop terminal patients' care. Final decisions should be made by a team of experts, and physicians must be at the center of such a team. Finally, we suggest that a guideline in keeping with Islamic norms on human life and death, purpose of life, God's will, boundaries of man's authority, and the physician's ethical duties and obligations should be developed.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263386PMC
December 2014

Ethical Considerations of Community-based Participatory Research: Contextual Underpinnings for Developing Countries.

Int J Prev Med 2014 Oct;5(10):1328-36

Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.

Background: The nature of community-based participatory research (CBPR) poses distinctive ethical challenges. In the absence of organized guidelines, a remarkable amount of researchers' time and energy will be spent tackling these ethical challenges. The study aimed to explore ethical issues and principles potentially arising when conducting CBPR.

Methods: This qualitative study conducted in CBPR Center of Tehran University of Medical Sciences. Required data were gathered through systematic literature review and semi-structured interviews. Representatives of community, academia, and nongovernmental organizations (NGOs) participated in our study. Ten interviews with representatives of partner organizations, four group interviews with academic staff, and four with representatives of community were conducted. Repeated thematic analysis was used to elicit ethics-related overarching themes from transcribed interviews. As recommendations, these themes were then organized into a set of CBPR-related ethical issues and principles.

Results: Four CBPR ethical guidelines (including 173 articles) were selected from a systematic review. Overarching themes relating to ethical principles which emerged from interviews were as follows: Trust, transparency and accountability, equity and inclusion, power imbalance, tolerance and conflict management, and attention to cultural sensitivity. Practical principles that emerged included: Consensus rather than informed consent, ownership of data and research achievements, and sustainability and maintenance of relationships. According to findings and in comparison to international guidelines, the present study put more emphasis on cultural sensitivity and sustainability as CBPR ethical tangles.

Conclusions: Community-based participatory research ethical challenges are of the same kind in most parts of the world. However, some discrepancies exist that calls for local scrutiny. Future use and critic of current explored ethical issues and principles are highly encouraged.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223954PMC
October 2014

A closer look at the Iranian model of kidney transplantation.

Authors:
Kiarash Aramesh

Am J Bioeth 2014 ;14(10):35-7

a Tehran University of Medical Sciences.

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http://dx.doi.org/10.1080/15265161.2014.947044DOI Listing
October 2015

A Brief History of Biomedical Research Ethics in Iran: Conflict of Paradigms.

Authors:
Kiarash Aramesh

Dev World Bioeth 2015 Aug 11;15(2):107-12. Epub 2014 Apr 11.

During the past two decades, Iran has experienced a noteworthy growth in its biomedical research sector. At the same time, ethical concerns and debates resulting from this burgeoning enterprise has led to increasing attention paid to biomedical ethics. In Iran, Biomedical research ethics and research oversight passed through major periods during the past decades, separated by a paradigm shift. Period 1, starting from the early 1970s, is characterized by research paternalism and complete reliance on researchers as virtuous and caring physicians. This approach was in concordance with the paternalistic clinical practice of physicians outside of research settings during the same period. Period 2, starting from the late 1990s, was partly due to revealing of ethical flaws that occurred in biomedical research in Iran. The regulatory and funding bodies concluded that it was not sufficient to rely solely on the personal and professional virtues of researchers to safeguard human subjects' rights and welfare. The necessity for independent oversight, emphasized by international declarations, became obvious and undeniable. This paradigm shift led to the establishment of research ethics committees throughout the country, the establishment of academic research centers focusing on medical ethics (MEHR) and the compilation of the first set of national ethical guidelines on biomedical research-one of the first and most important projects conducted by and in the MEHR. Although not yet arrived, 'period 3' is on its way. It is predictable from the obvious trends toward performance of high-quality clinical research and the appearance of a highly educated new generation, especially among women.
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http://dx.doi.org/10.1111/dewb.12053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194183PMC
August 2015

Brief report: The Third Annual Medical Ethics Congress in Iran.

J Med Ethics Hist Med 2013 2;6. Epub 2013 May 2.

Assistant Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran;

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740194PMC
August 2013

Attitude toward plagiarism among Iranian medical faculty members.

Acta Med Iran 2012 ;50(11):778-81

Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.

The goal of this study was to assess attitude towards plagiarism in faculty members of Medical School at Tehran University of Medical Sciences. One hundred and twenty medical faculty members of Tehran University of Medical Sciences were enrolled in this cross-sectional study. They were asked to answer to valid and reliable Persian version of attitude towards plagiarism questionnaire. Attitude toward plagiarism, positive attitude toward self-plagiarism and plagiarism acceptance were assessed. Eighty seven filled-up questionnaires were collected. Mean total number of correct answers was 11.6±3.1. Mean number of correct answers to questions evaluating self-plagiarism was 1.7±0.4 and mean number of correct answers to questions evaluating plagiarism acceptance was 1.4±0.2. There was no significant correlation between plagiarism acceptance and self-plagiarism (r=0.17, P=0.1). It is essential to provide materials (such as workshops, leaflets and mandatory courses) to make Iranian medical faculty members familiar with medical research ethics issues such as plagiarism.
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July 2013

Attitude towards plagiarism among Iranian medical students.

J Med Ethics 2013 Apr 13;39(4):249. Epub 2012 Apr 13.

Brain and Spinal Injury Repair Research Center, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1136/medethics-2012-100560DOI Listing
April 2013

Healthcare utilization in patients with esophageal cancer in a high risk area in northeast of Iran.

Asian Pac J Cancer Prev 2011 ;12(9):2437-42

Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.

Introduction: Golestan, a province located north of Persian Gulf in northeastern part of Iran is a well known area for high risk of esophageal cancer (EC) in the world. There is no information about healthcare utilization in populations residing in the area. This study was conducted to assess utilization of healthcare and its associated factors among esophageal cancer patients in this region as well as to address ethical implication of this utilization.

Methods: All new cases of EC in Golestan province during year of 2007 were recruited. Seven diagnostic and five therapeutic services were used to assess diagnostic utilization index (DUI), and therapeutic utilization index (TUI), respectively. Multivariate regression analysis was used to assess the relationship between variables and DUI or TUI. P-value of less than 0.05 was considered as statistically significant.

Results: Tow hundred twenty three, patients were enrolled with mean (Standard Deviation) age of 64.3 (12.5) years with 57.8% male. We observed that occupation (P<0.01), ethnicity (P<0.01) and sex (P=0.03) were strongly associated with DUI. Insurance coverage (P<0.01), place of residency (P<0.01), and occupation (P=0.01) were associated with TUI.

Conclusion: We concluded that several factors contribute to disparity in healthcare utilization in the studied population.
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September 2012

A closer look at the abortion debate in Iran.

Authors:
Kiarash Aramesh

Am J Bioeth 2009 Aug;9(8):57-8

Medical Ethics and History of Medicine Research Centre, Medical Sciences/University of Tehran, 16 Azar Street, Tehran, Iran.

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http://dx.doi.org/10.1080/15265160902939966DOI Listing
August 2009

Measuring professionalism in residency training programs in Iran.

Med Teach 2009 Aug;31(8):e356-61

Tehran University of Medical Sciences, Iran.

Background And Aim: To assess the Farsi (Persian) translated and modified version of the questionnaire of the American Board of Internal Medicine (ABIM) for measuring professionalism, and also, measuring the professional attitudes and behaviors associated with the medical residency training environment in Iran.

Methods: After a pilot study, a 17-item questionnaire was distributed to 282 medical residents of two major universities of Iran, from December 2006 through February 2007.

Results: Of the 282 distributed questionnaires, 259 (95.2%) were used in the analysis. Based on the analyses, two items were omitted and 15 items were retained for further analysis. The mean score was 106 (Standard Deviation (SD), 22.4) out of maximum 150, whereas the item mean was 6.12 (SD, 0.37) out of maximum 10. Corrected item-to-total correlations ranged from low to moderate. The internal reliability of the scale, based on Cronbach's alpha, meets Nunnally's minimal requirement. A factor analysis was performed, based on principal components and varimax rotation. The solution identified three factors (subscales) including excellence, honor/integrity and altruism/respect. Together these factors represented 58.8% of the common variance.

Conclusion: This study showed the content validity and internal reliability of the Farsi version of the ABIM questionnaire. Therefore, it can be considered as an encouraging step toward developing a short, reliable and valid instrument for measuring professionalism in medical environments.
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http://dx.doi.org/10.1080/01421590802638022DOI Listing
August 2009

The compatibility between Shiite and Kantian approach to passive voluntary euthanasia.

J Med Ethics Hist Med 2009 24;2:21. Epub 2009 Dec 24.

Assistant Professor, Iranian Institute of Philosophy;

Euthanasia is one of the controversial topics in current medical ethics. Among the six well-known types of euthanasia, passive voluntary euthanasia (PVE) seems to be more plausible in comparison with other types, from the moral point of view. According to the Kantian framework, ethical features come from 'reason'. Maxims are formulated as categorical imperative which has three different versions. Moreover, the second version of categorical imperative which is dubbed 'principle of ends' is associated with human dignity. It follows from this that human dignity has an indisputable role in the Kantian story. ON THE OTHER HAND, THERE ARE TWO MAIN THEOLOGICAL SCHOOLS IN ISLAMIC TRADITION WHICH ARE CALLED: Ash'arite and Mu'tazilite. Moreover, there are two main Islamic branches: Shiite and Sunni. From the theological point of view, Shiite's theoretical framework is similar to the Mu'tazilite one. According to Shiite and Mu'tazilite perspectives, moral goodness and badness can be discovered by reason, on its own. Accordingly, bioethical judgments can be made based on the very concept of human dignity rather than merely resorting to the Holy Scripture or religious jurisprudential deliberations. As far as PVE is concerned, the majority of Shiite scholars do not recognize a person's right to die voluntarily. Similarly, on the basis of Kantian ethical themes, PVE is immoral, categorically speaking. According to Shiite framework, however, PVE could be moral in some ethical contexts. In other words, in such contexts, the way in which Shiite scholars deal with PVE is more similar to Rossian ethics rather than the Kantian one.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713908PMC
August 2013

The ownership of human body: an islamic perspective.

Authors:
Kiarash Aramesh

J Med Ethics Hist Med 2009 30;2. Epub 2009 May 30.

Assistant Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences.

Using human dead body for medical purposes is a common practice in medical schools and hospitals throughout the world. Iran, as an Islamic country is not an exception. According to the Islamic view, the body, like the soul, is a "gift" from God; therefore, human being does not possess absolute ownership on his or her body. But, the ownership of human beings on their bodies can be described as a kind of "stewardship". Accordingly, any kind of dissection or mutilation of the corpse is forbidden, even with the informed consent of the dead or his/her relatives. The exception of this principle is when such procedures are necessary for saving lives of other persons. In this article using the human dead body for medical education, research and treatment is discussed and the perspective of Iranian Shiite religious scholars in this regard is explained.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713940PMC
August 2013

Justice as a principle of Islamic bioethics.

Authors:
Kiarash Aramesh

Am J Bioeth 2008 Oct;8(10):26-7

Medical Ethics and History of Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1080/15265160802485052DOI Listing
October 2008

The influences of bioethics and Islamic jurisprudence on policy-making in Iran.

Authors:
Kiarash Aramesh

Am J Bioeth 2007 Oct;7(10):42-4

Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran 14155-6447, Iran.

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http://dx.doi.org/10.1080/15265160701588196DOI Listing
October 2007

An Islamic perspective on euthanasia.

Am J Bioeth 2007 Apr;7(4):65-6; discussion W4-6

Tehran University of Medical Sciences.

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http://dx.doi.org/10.1080/15265160701220907DOI Listing
April 2007

An Islamic view to stem cell research and cloning: Iran's experience.

Am J Bioeth 2007 Feb;7(2):62-3

Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1080/15265160601109697DOI Listing
February 2007

Knowledge, attitude, and practice toward contact isolation precautions among medical students in Shiraz, Iran.

Am J Infect Control 2006 Nov;34(9):593-6

Community Medicine Department, Shiraz Medical School, Shiraz, Iran.

Background: Proper behavior regarding infection control may be learned during clinical training for medical students.

Methods: Different groups of medical students at the Shiraz Medical School were asked to complete a questionnaire. The survey had 2 components: demographic inquiries and questions designed to assess the knowledge, attitude, and practices regarding contact isolation precautions used in Iranian hospitals.

Results: A total of 468 (of 622) useable surveys were analyzed. Responses to knowledge and attitude questions concerning isolation precautions in general were acceptable as being in accordance with the CDC guidelines (Mean scores approximate 66.3% and 63.4% of the total possible scores, respectively). However, self-reporting behaviors indicated an overall lack of compliance with expected practices (approximately 19.1% of a total possible perfect score).

Conclusion: This study suggests that knowledge of transmission routes and a positive attitude toward infection control measures alone are not sufficient to induce acceptable compliance (behavior) with current recommendations.
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http://dx.doi.org/10.1016/j.ajic.2006.03.005DOI Listing
November 2006

Knowledge, attitude, and practices regarding contact precautions among Iranian physicians.

Infect Control Hosp Epidemiol 2006 Aug 20;27(8):868-72. Epub 2006 Jul 20.

Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: To assess the knowledge, attitudes, and practices of Iranian physicians regarding contact isolation precautions.

Design: Data were collected between May and November 2002 using a cross-sectional survey design.

Setting: Teaching hospitals in Shiraz, Iran.

Participants: A total of 155 physicians: 78 attending clinicians and 77 resident physician surgeons or internists.

Results: The mean scores for knowledge and attitude were acceptable, with 71% of physicians scoring the maximum for knowledge and 65% achieving the maximum scores for attitude, whereas the mean score for practice was low, with only 26% achieving the maximum score. A good level of knowledge be associated with a good attitude (odds ratio [OR], 68.4 [95% confidence interval {CI}, 20.0-285.6]; P<.001), good practices were associated with good knowledge (OR, 22.5 [95% CI, 7.1-91.3]; P<.001), and a good attitude was associated with good practice (OR, 20.0 [95% CI, 5.7-105.2]; P<.001).

Conclusion: Although strong associations were found among knowledge, attitude, and practice, the level of compliance with precautions was not nearly as high as it should be.
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http://dx.doi.org/10.1086/506411DOI Listing
August 2006