Publications by authors named "Zahedi Farzaneh"

15 Publications

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General approaches to ethical reasoning in Islamic biomedical ethics discourse.

J Med Ethics Hist Med 2018 9;11:11. Epub 2018 Sep 9.

Professor, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran .

Islamic and non-religious ethics discourses have similarities and differences at the levels of meta-, normative, and applied ethics (e.g. biomedical ethics). Mainstream biomedical ethics (MBME) uses the language of contemporary, non-religious, Western ethics. Significant effort has been dedicated to comparing Islamic biomedical ethics (IBME) and MBME in terms of meta- and normative ethical positions, and final decisions on practical ethical issues have been reached. However, less attention has been given to comparing the general approaches of the two aforementioned discourses to ethical reasoning. Furthermore, IBME uses different languages to approach ethical reasoning, but identification and conceptualization of these approaches are among the important gaps in the literature. The aim of this study was to conceptualize general approaches to ethical reasoning in IBME. Through review and content analysis of the existing literature and the comparison between the languages employed by IBME and MBME, an inductive distinction have been made. The languages used in conceptualized approaches include the followings: () a language in common with the one employed by MBME; () MBME language adjusted to the basic, common beliefs of Muslims; () a language based on ; and () a language based on IBME principles. In the authors' opinion, major challenges of the above-mentioned four approaches include, respectively: identifying the lack of religious sensitivity or Islamic considerations regarding an issue; acknowledging specific beliefs as the basic, common beliefs of Muslims; diverse and relations between juridical soundness and ethical soundness; and agreement on the same principles and rules as well as who should apply them.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642444PMC
September 2018

Consanguineous marriages in the genetic counseling centers of Isfahan and the ethical issues of clinical consultations.

J Med Ethics Hist Med 2017 10;10:12. Epub 2017 Dec 10.

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

Consanguineous marriage, which is common in many regions in the world, has absorbed much attention as a causative factor in raising the incidence of genetic diseases. The adverse effects may be attributed to the expression of the genes received from common ancestors and mortality and morbidity of the offspring. Iran has a high rate of consanguineous marriages. In recent years genetic counseling has come to be considered in health care services. This cross-sectional study was conducted in order to determine the prevalence and types of consanguineous marriages in the genetic clinics in Isfahan. We aimed to define the different types of marriages, specific categories of genetic disorders associated with consanguineous marriages, and mode of inheritance in the family tree. We also narratively reviewed the ethical aspects of the issue. The data were collected using a simple questionnaire. A total number of 1535 couples from urban and rural areas formed the study population. The marriages were classified according to the degree of the relationship between couples, including: double cousin, first cousin, first cousin once removed, second cousin and beyond second cousin. The SPSS software version 16 was used for data analysis. Data obtained through genetic counseling offered during a 5-year period revealed that 74.3% had consanguineous relationships, 62.3% were first cousins, 1% were double cousins and 7.8% were second cousins. In addition, 76% of the couples had at least one genetic disease in their family tree. Related ethical issues were also considered in this study, including autonomy and informed decision making, benefit and harm assessment, confidentiality, ethics in research, justice in access to counseling services, financial problems ethics, and the intellectual property of scientific success.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797678PMC
December 2017

Global Bioethics and Scientific Sanction.

Am J Bioeth 2017 10;17(10):24-26

a Tehran University of Medical Sciences.

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http://dx.doi.org/10.1080/15265161.2017.1365190DOI Listing
October 2017

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

Paid living kidney transplantation in iran: rethinking the challenges.

Am J Bioeth 2014 ;14(10):40-2

a Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of the Medical Sciences.

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http://dx.doi.org/10.1080/15265161.2014.947443DOI Listing
October 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

Patient centred care in diabetology: an Islamic perspective from Iran.

J Diabetes Metab Disord 2013 May 10;12(1):18. Epub 2013 May 10.

Endocrinology and Metabolism Research Centre, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Patient-centred system of care is essential in managing many disorders such as diabetes mellitus. The cultural and religious context can influence the involvement of patients and their families in such a care. We intend to discuss patient-centred care in diabetology in view of Islam. For more clarification, we will take into consideration a few illustrative lines of argument in detail about situation in Iran. In conclusion, dynamic spirit of Islamic jurisprudence is reflected in its adaptability to change in medical practice. In recent decades, Iranian religious scholars have provided scientists in new fields of science and research with appropriate directions and guidelines. Decree issued by Iranian religious leaders permitting research on stem cells for therapeutic purposes in many disorders including diabetes mellitus is one example. Understanding of the nature of Islam is importance for communication with patients in Islamic countries.
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http://dx.doi.org/10.1186/2251-6581-12-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655888PMC
May 2013

Ethical issues in the end of life care for cancer patients in iran.

Iran J Public Health 2013 1;42(2):188-96. Epub 2013 Feb 1.

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

Background: In the recent years, advances in medical technologies for end stage cancer patients' care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists' viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process.

Methods: In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data.

Results: DURING THE PROCESS OF ANALYSIS, THREE MAIN THEMES EMERGED ABOUT ETHICAL DILEMMAS IN END OF LIFE CARE FOR ADVANCED CANCER PATIENTS: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system.

Conclusion: Health care and insurance system in Iran face to end of life care challenges; therefore, health care providers and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians' communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. The findings of this study can help us to provide ethical policies for decision-making in end-of-life care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595644PMC
March 2013

The challenge of truth telling across cultures: a case study.

Authors:
Farzaneh Zahedi

J Med Ethics Hist Med 2011 27;4:11. Epub 2011 Dec 27.

MD, Endocrinology and Metabolism Research Centre, Medical Ethics and History of Medicine Research Centre, Tehran University of Medical Sciences, 5th floor, Shariati Hospital, North Kargar Avenue, Tehran 14114-13137, Iran, Tel: (+98 21) 88220037-8, , Email:

Accompanied with various opinions across cultures, truth telling is a major debate in bioethics. Many studies have focused on attitudes toward truth disclosure. We intend to review several relevant research studies, and discuss the issue through a clinical case consultation. It seems that while "the right to know" is emphasized in bioethics, in some cultural contexts, health professionals fear communicating bad news. The patients may not receive information directly, because it is believed that the truth may make the patient feel hopeless and unable to cope with the problem. Nevertheless, some believe that sharing information may strengthen a trusting relationship between patients and medical professionals. Extensive efforts are in process in some societies to make patient rights to know the truth as a natural part of medical practice. However, in some cases, the principles of respect for patient autonomy require us to accept patient's refusal to know the truth, with the provision that he assigns someone to receive information and make medical decisions on his behalf. In conclusion, it is suggested that healthcare professionals should not act on a unique presumption in all cases and they should explore what the real interest of patient is, in order to respect individual autonomy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713926PMC
August 2013

Common principles and multiculturalism.

J Med Ethics Hist Med 2009 31;2. Epub 2009 May 31.

Medical Ethics and History of Medicine Research Centre, Endocrinology and Metabolism Research Centre, Medical Sciences/University of Tehran.

Judgment on rightness and wrongness of beliefs and behaviors is a main issue in bioethics. Over centuries, big philosophers and ethicists have been discussing the suitable tools to determine which act is morally sound and which one is not. Emerging the contemporary bioethics in the West has resulted in a misconception that absolute westernized principles would be appropriate tools for ethical decision making in different cultures. We will discuss this issue by introducing a clinical case. Considering various cultural beliefs around the world, though it is not logical to consider all of them ethically acceptable, we can gather on some general fundamental principles instead of going to the extremes of relativism and absolutism. Islamic teachings, according to the presented evidence in this paper, fall in with this idea.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713936PMC
August 2013

Contemporary medical ethics: an overview from Iran.

Dev World Bioeth 2008 Dec;8(3):192-6

Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

The growing potential of biomedical technologies has increasingly been associated with discussions surrounding the ethical aspects of the new technologies in different societies. Advances in genetics, stem cell research and organ transplantation are some of the medical issues that have raised important ethical and social issues. Special attention has been paid towards moral ethics in Islam and medical and religious professions in Iran have voiced the requirement for an emphasis on ethics. In the last decade, great strides have been made in biomedical ethics, especially in the field of education, research and legislation. In this article, contemporary medical ethics in Iran, and the related moral philosophy, have been reviewed in brief and we have discussed some of the activities in the field of medical ethics that have been carried out in our country within recent years. These activities have included the establishment of the National and Regional Committees for Medical Research Ethics and the production of national codes of ethics in biomedical research in the 1990 s and the introduction of a comprehensive strategic plan for medical ethics at the national level in 2002. This paper will discuss these issues, along with the production, in 2005, of the Specific National Ethical Guidelines for Biomedical Research.
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http://dx.doi.org/10.1111/j.1471-8847.2006.00180.xDOI Listing
December 2008

National bioethical legislation and guidelines for biomedical research in the Islamic Republic of Iran.

Bull World Health Organ 2008 Aug;86(8):630-4

Endocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

Rapid advances in biomedical science and technology, which have revolutionized medicine and health-care services in different societies, have been associated with inevitable ethical challenges. Undoubtedly, these innovations could lead to irreversible disasters if they are not limited by appropriate regulations. Substantial attempts have been made in the Islamic Republic of Iran to establish a structured approach for identifying, analysing and resolving ethical issues in clinical practice. Given the consensus of religious and scientific scholars, some laws recently approved by the parliament include the Deceased and Brain-Dead Patients Organ Transplantation Act (2000), Embryo Donation to Infertile Spouses Act (2003) and the Therapeutic Abortion Act (2005). National guidelines for ethical assessment and supervision of research proposals have also been compiled by the authorities. This paper reviews the main endeavours made in bioethics legislation in the Islamic Republic of Iran.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649463PMC
http://dx.doi.org/10.2471/blt.08.050724DOI Listing
August 2008

Strengthening medical ethics by strategic planning in the Islamic Republic of Iran.

Dev World Bioeth 2006 May;6(2):106-10

Director and Chief Scientific Officer, Endocrinology & Metabolism Research Center, Floor 5, Shariati Hospital, North Kargar Avenue, Tehran 14114, Iran.

To bring attention to medical ethics and to enhance the quality of health care in Iran, the Ministry of Health and Medical Education has introduced a strategic plan for medical ethics at a national level. This plan was developed through the organization and running of workshops in which experts addressed important areas related to medical ethics. They analysed strengths and weaknesses, opportunities and threats, and outlined a vision, a mission and specific goals and essential activities surrounding medical ethics. The current strategic plan has six main goals that will be reviewed in this paper. Some major activities that were carried out in recent years, and some future plans, will be also reviewed.
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http://dx.doi.org/10.1111/j.1471-8847.2006.00145.xDOI Listing
May 2006

Household cardiovascular screening of high-risk families: a school-based study.

Eur J Cardiovasc Prev Rehabil 2006 Apr;13(2):229-35

Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: A parental history of cardiovascular disease has a strong relationship with risk factor clusters in the offspring. This study was performed to identify major cardiovascular risk factors in middle school-aged children and their parents in both high and low-risk families.

Design: A school-based, cross-sectional study.

Methods: The middle schools of the 6th district of Tehran were divided randomly into two groups. A total of 169 high-risk children with their families were recruited from the first group and 105 low-risk children with their families were recruited from the second group of schools. Anthropometric and metabolic measurements were performed.

Results: The means of the waist circumference and waist-to-hip ratio were significantly higher in high-risk fathers. The means of total and low-density lipoprotein (LDL) cholesterol were significantly higher in both parents and children of the high-risk group. The means of the fasting plasma glucose were significantly higher in fathers and offspring of high-risk families. More fathers in high-risk families were smokers. The prevalence of increased total cholesterol, LDL-cholesterol and hyperglycemia (> or = 100 mg/dl) were higher in high-risk parents and children. The prevalence of increased body mass index (> or = 25 kg/m for parents and 85th percentile for children) was higher in fathers and children of high-risk families.

Conclusions: Cardiovascular risk factors are more prevalent and clustered in high-risk families. The screening of high-risk families is essential to prevent the progression of atherosclerosis from childhood and reduce the burden of cardiovascular disease in adulthood.
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http://dx.doi.org/10.1097/01.hjr.0000214605.53372.62DOI Listing
April 2006

Insulinoma in Iran: a 20-year review.

Ann Saudi Med 2005 Nov-Dec;25(6):477-80

Tehran University of Medical Sciences, Endocrinology and Metabolism Research Center, Iran.

Background: The time between onset of symptoms of insulinoma to diagnosis ranges from 10 days to more than 20 years. To help physicians make an earlier diagnosis, we defined the clinical, imaging and paraclinical characteristics of insulinoma in cases from seven referral hospitals in Iran over two decades.

Methods: The medical records of 68 cases with biochemical or histological evidences of insulinoma were reviewed.

Results: More males were affected (53%). The mean age at diagnosis was 39 +/- 15.3 years. The mean duration of symptoms was 39.9 +/- 59.3 months. Eighty-four percent of patients had been initially misdiagnosed as cereberovascular accident (CVA), epilepsy, conversion disorder, and others). Neuroadrenergic symptoms were observed in 89.6% and and neuroglycopenic symptoms in 97% of patients. Mean diameter of tumours was 2.9 cm (range, 1 cm to 8.5 cm). Of 52 pathologically confirmed cases of insulinoma, 43 tumours (87.8%) were single and 49 (94.2%) were benign. Fifty-five patients had undergone surgery, with a successful outcome in 44 (80%).

Conclusion: The high incidence of neuroglycopenic symptoms suggest the clinical impression of insulinoma when patients present with a suggestive clinical syndrome. The clinical impression is essential to decrease the frequent delay in the diagnosis of insulinoma.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089739PMC
http://dx.doi.org/10.5144/0256-4947.2005.477DOI Listing
May 2006