akhlāq-i pizishkī i.e., Medical Ethics

Stem cell research holds outstanding promise for both understanding fundamental mechanisms of human development and differentiation, and for developing new therapies for diseases such as diabetes, spinal cord injury, Parkinson's disease, and myocardial infarction. Stem cell research continues to be seen as a potential alternative to conventional medications. The rapid advancements in biotechnology have brought to light numerous pressing ethical and policy concerns related to stem cell research. The most significant ethical considerations surrounding stem cell and stem cell-derived product therapies are similar to those arising in other emerging biotechnologies. Given the scientific promise and ethical dilemmas of stem cell research, it is crucial to carefully consider the ethical controversies as this rapidly expanding field progresses. This essay provides an overview of the most important issues that the stem cell research community needs to address

The United Nations has launched the Decade of Healthy Ageing 2021-30, a global collaborative movement and project led by the World Health Organization (WHO) that brings together governments, civil society, international agencies, professionals, academia, the media and the private sector to improve the lives of older people, their families and the communities in which they live. Adopting healthy lifestyles and the concept of healthy ageing is an appropriate solution to reduce the problems of older people and a significant goal for older people, health professionals and society.

Background and Aim: Considering that university professors are one of the main groups of researchers and as students tend to be novices in this regard, it is of particular importance to examine their perspective and compliance with ethics in research. Therefore, this study was conducted with the aim of investigating the perspectives of the students and the faculty members of Gonabad University of Medical Sciences towards the inhibitors and the facilitators of ethical compliance in research in 2019.

Methods: In this cross-sectional descriptive study, 66 faculty members and 144 students of Gonabad University of Medical Sciences were selected through census and stratified random sampling, respectively. The research tools included a demographic information form as well as the questionnaire of ethical codes and inhibitors and facilitators of ethical compliance in research. The data were analyzed through SPSS version 18, using descriptive and analytical statistics. The Kolmogorov-Smirnov test was used to investigate the compliance of the data with the normal distribution. The chi-square test was used in data analysis, with a P-value<0/05.

Ethical Considerations: In all the stages of writing the present research, while respecting the originality of the texts, honesty and trustworthiness has been observed.

Results: Sixty-six participants (31.5%) were faculty members and 144 of them (68.5%) were students.  The most important inhibitor of ethical compliance in research from the students' point of view (84%), in the stage of choosing the topic, was the researcher’s insufficient awareness of ethics in research. From the faculty members' point of view (50%), the most important inhibitor of ethical compliance in research in the stage of reviewing the existing documents was the lack of skill in reviewing the existing documents including search skills. The most important facilitator of ethical compliance in research was placing more emphasis on the issue of ethics in research while presenting the course of research methods, from the faculty members' point of view (68%) and holding educational workshops on professional and research ethics, from students' point of view (37.5%). The results regarding the agreement to use ethical codes in research from the perspectives of the students and the professors in the three stages of choosing the research topic and stating the problem, reviewing the available documents and analyzing and reporting and publishing the results of statistical differences, showed the significance levels of P<0.001, P=0.007 and P=0.01, respectively.

Conclusion: Despite the good state of ethical compliance and the appropriate performance of the ethics committee in research, there are still obstacles on the way to reaching better ethical compliance. The need to hold periodic training workshops, monitor research projects closely and provide the necessary infrastructure is felt.

Background and Aim: Research ethics effectively influences the quality of research. Since a significant portion of research is conducted by faculty members and students, it is essential that academic institutions uphold scientific and ethical research standards. This study aimed to assess the extent to which research ethics is adhered to by medical faculty members and students.

Methods: This descriptive-analytical study was carried out during the 2022-23 academic year on 130 medical students and 98 faculty members at Abadan University of Medical Sciences. Students were selected through simple random sampling, while faculty members were included through the census method. Data were collected using demographic and research ethics questionnaires and then analyzed using SPSS 18. Statistical tests, including the independent t-test, one-way ANOVA and Pearson correlation, were applied at a significance level of Lees than P<0.05.

Ethical Considerations: The study was conducted and published in full compliance with ethical principles.

Results: The overall research ethics score and all of its dimensions, except for the justice dimension, were higher among faculty members (148) compared to students (101). There was a significant and direct correlation between the research ethics scores of faculty members and students, observed across all evaluated dimensions (P<0.001). Additionally, significant correlations were found between faculty members and students in the dimensions of professional competence (r=0.762, P<0.001), commitment to truth-seeking (r=0.767, P<0.001), benefit (r=0.786, P<0.001), respect for respondents (r=0.769, P<0.004), research activities (r=0.803, P<0.001), justice (r=0.730, P<0.001) and the overall research ethics score (r=0.804, P<0.001).

Conclusion: The adherence to research ethics was higher among faculty members compared to students; however, the score among faculty members was still average. Hence, it is recommended that greater emphasis be placed on adhering to research ethics principles as a vital and essential component of research, with the aim of enhancing the quality of knowledge production and dissemination.

Methods: The present study was a Quasi-experimental study with single-group before-after design conducted in 2019 on 35 operating room personnel who were selected by convenience sampling. Demographic information and standard anger control questionnaires were used to collect data. Data analysis was performed using SPSS version 16, with descriptive statistics such as percentage, mean, and frequency, and inferential tests including Independent T-Test, ANOVA and Pearson correlation test at a significance level less than 0.05.

Ethical Considerations: Written informed consent was obtained from the participants. They were also assured of data confidentiality and their right to withdraw during the research.

Results: Based on the results the mean age of the participants was 30.77±8.17 years. Results showed a significant difference between the mean score of anger control after the intervention (49.54±7.97) and before the intervention stage (104.43±21.37, p <0.001). No significant relationship was reported between anger control and the variables of age (P=0.62), service history (P=0.92) and number of working hours (P=0.74). Also, the mean of anger control was not significantly different according to gender (P=0.12).

Conclusion: The research findings showed that virtual training on professional ethics can enhance anger control. It is recommended that managers and authorities provide virtual courses on professional ethics so that operating room staff can improve interpersonal relations and anger control by increasing their awareness of professional ethics principles.

Background and Aim: Awareness of patient rights and respecting them are both an important and a fundamental duty of healthcare staff. This study aimed to assess nurses' awareness of the patient bill of rights and their adherence to it from the perspective of hospitalized patients.

Methods: This cross-sectional descriptive study was conducted in 2022 on 168 nurses and 383 patients admitted to Qa’em Hospital, in the city of Asadabad, Hamadan. The participants were selected using convenience sampling. The questionnaires "The Awareness of the Patient Bill of Rights" by Ruintan et al and "The Level of Compliance with Patient Bill of Rights" by Basiri Moghadam were used in this study. Data analysis was done using SPSS 18, considering a significance level of less than 0.05.

Ethical Considerations: In all the stages of this study, ethical principles and data confidentiality were observed and the questionnaires were completed after obtaining informed consent and explaining the research objectives to the participants.

Results: A positive but non-significant correlation was observed between the nurses' awareness of the patient bill of rights and the level of compliance with it from the patients' perspective at a significance level of 0.05 (r=0.04, p=0.61). The mean and standard deviation of nurses' awareness of the patient bill of rights were 9.44±4.34, indicating an average level. The mean and standard deviation of compliance with the patient bill of rights in the hospital from patients' perspective were 32.90±7.73, which was considered optimal. The mean score of nurses' awareness of the patient bill of rights was higher in nurses aged 31-40 years, and this difference was statistically significant (p=0.01). There was a significant difference in the mean score of compliance with the patient bill of rights in the hospital from the perspective of patients across different age groups; the highest mean score was reported by patients over 40 years of age and the lowest, by patients aged 20-30 years (p=0.005).

Conclusion: The results of the study showed a correlation between nurses' awareness of the patient bill of rights and the level of compliance with it from patients' perspective. It is necessary for the healthcare planners and policymakers to consider interventions in developing and implementing in-service training programs, providing incentives to motivate employees, and establishing strict rules to improve compliance with the patient bill of rights in hospitals. To examine the impact of factors, other than awareness, on the level of compliance with the patient bill of rights in hospitals, it is recommended that interventional and qualitative studies be conducted in the future

Background and Aim: Patient safety and prevention of medical errors are matters of global importance. The present study was conducted to investigate the frequency and the factors affecting them in the files of the medical system organization of Shahriar City between 2011-2019.

Methods: In this cross-sectional analytical study, the files of the medical system organization of Shahriar City from 2011 to 2019, which had been given a final decision, were studied using the census method. The data of the study were analyzed using SPSS version 16 software.

Ethical Considerations: In this research, the principles of trustworthiness, honesty, neutrality, and originality of the work have been respected.

Results: The largest share of errors was related to the lack of proper diagnosis of the disease (53.1%) and the highest number of complaints were from dentists, followed by specialist doctors. The most common cause of medical malpractice identified, after not diagnosing the disease, was related to medical negligence (21.9%). Non-observance of scientific standards as well as the employment of unqualified people were identified in (6.2%) cases of medical malpractice in the treatment of patients. Medical technical error during surgery, non-observance of the correct principles of prescription and drug administration, and non-observance of government systems, as well as wrong prescription/how to take medicine, each accounted for (3.1%) cases of medical malpractice in the treatment of patients. Among the studied variables, a statistically significant relationship was observed between the expertise of the complainants and types of medical malpractice (P=0.021).

Conclusion: Failure to properly diagnose the disease accounted for the largest share of errors. The number of complaints against dentists, followed by specialist doctors, was higher than against other members of the treatment staff, which is partly attributed to the lack of a proper referral system in the country.

Background and Aim: Given the high prevalence of academic self-defeating behaviors among students and their destructive effects and irreparable consequences for individuals, families and society, it is essential to investigate the factors influencing these behaviors. Therefore, this study aimed to determine the role of moral intelligence and sense of belonging to school in predicting academic self-defeating behaviors.

Methods: The research method was descriptive-correlational. The study population included all male and female students of the first and second secondary schools in one district of Karaj during the academic year 2023-24. A sample of 120 students was selected using the convenience sampling method. Data collection tools included the Moral Intelligence Questionnaire by Lennick and Kiel (2005), the Sense of Belonging to School Questionnaire by Brew & Beatty (2004) and the Academic Self-Defeating Behaviors Questionnaire by Azdarbin et al (2023). Data analysis was conducted using Pearson correlation and multiple regression with the help of SPSS 18 statistical software at a significance level of less than 0.05

Ethical Considerations: Written consent was obtained from participants and they were assured of the confidentiality of their information.

Results: The results showed that the mean and standard deviation of the research variables-moral intelligence, sense of belonging to school and academic self-defeating behaviors were 109.03±10.98, 107.34±17.16 and 69.80±10.47, respectively. The regression analysis indicated that moral intelligence accounted for 50.4% and sense of belonging to school accounted for 59.2% of the ability to predict academic self-defeating behaviors. Additionally, there was a significant inverse relationship between moral intelligence (r=-0.705, P<0.01) and sense of belonging to school (r=-0.777, P<0.01) with academic self-defeating behaviors.

Conclusion: These reducing academic self-defeating behaviors in students requires attention to moral intelligence and sense of belonging to school. Therefore, it is recommended to develop and implement intervention programs focusing on teaching moral intelligence and enhancing the sense of belonging to school.

Background and Aim: Respecting patient rights is a fundamental aspect of delivering humane and ethical healthcare. Health and medical professionals lacking knowledge of ethical principles and related topics may struggle to meet patients’ needs effectively. This study aimed to assess the knowledge of clinical medical students regarding patient rights at Birjand University of Medical Sciences.

Methods: This descriptive-analytical study involved 401 clinical medical students. A convenience sampling method was employed, utilizing an electronic questionnaire link distributed to all clinical medical students. The first section gathered demographic information, including age, gender, academic term, Grade Point Average (GPA) and living situation. The second section contained 29 multiple-choice questions addressing the five principles of the Patient Charter in Iran, which include access to services, informed consent, individual freedom, knowledge of the treatment process and confidentiality of information. The data were analyzed using SPSS 17, employing correlation coefficients and independent t-tests, with a significance threshold set at p<0.05.

Ethical Considerations: Throughout the research process, efforts were made to uphold the originality of the texts, ensuring honesty and integrity in reporting.

Results: A total of 401 clinical medical students participated in the study, with a mean age of 24.32 ±1.69 years. Of the participants, 237 (59.1%) were female and 164 (40.9%) were male. knowledge levels regarding the Patient Rights Charter revealed that 27 students (6.74%) exhibited poor knowledge, 360 students (89.77%) demonstrated moderate knowledge and 14 students (3.49%) displayed good knowledge. No significant differences were found in knowledge levels based on age (p=0.218), gender (p=0.87), academic term (p=0.11), GPA (p=0.634) or living situation (p=0.98).

Conclusion: The findings indicate that the level of knowledge among students concerning the Patient Bill of Rights is moderate. The study revealed no significant differences in knowledge based on gender, living situation, or academic term. Furthermore, no correlation was identified between age and GPA with the knowledge of patient rights among medical students. Given the critical importance of the Patient Bill of Rights and the necessity for its implementation, it is imperative to undertake educational initiatives for relevant stakeholders, particularly medical and paramedical students, to enhance cultural knowledge and understanding.

Background and Aim: With the beginning of the pandemic caused by the COVID-19 virus, the concept of social distancing received a lot of attention and was used in many public health announcements. However, this concept is vague and inexpressive and in the scientific literature, there is no consensus about what is called social distancing. Considering the multi-dimensional view and the ambiguity in different dimensions of social distancing, the need for further development and efforts to achieve a deep perception of this concept is felt. Therefore, this study was conducted with the aim of analyzing the concept of social distancing and determining its dimensions and characteristics.

Methods: The analysis of the concept of social distancing, based on Walker and Avant's approach, was done in eight steps: Choosing a concept; determining the purpose of analysis; identifying the uses of the concept; defining attributes, antecedents and consequences; identifying model, borderline and contrary cases and finally, empirical referents. The articles within the time span of 2019-22 were searched in electronic databases PubMed, ProQuest, CINAHL, Irandoc, SID and Google Scholar search engine, using the keywords social distancing and social distance.

Ethical Considerations: In the current research, the ethical aspects of the review study have been observed, including the originality of the texts, honesty and trustworthiness.

Results: The result of the search was 480 articles, which were screened according to the research criteria and finally, 23 articles that had repeatedly been used to define or describe the antecedents, characteristics and consequences of the desired concept were analyzed. After analyzing the studies, the concept of social distancing was found to have certain qualities: Preventing the transmission of infectious diseases, recommending staying at home and being quarantined, being culture-oriented and the passage of time.

Conclusion: In this study, a definition of social distancing was obtained, which is also supported by the literature. According to this definition, social distancing is a health protection and preventive measure, which prevents or reduces the transmission of contagious diseases through recommending keeping physical distance from others, staying at home and being quarantined during the outbreak of infectious diseases. Future studies can use this definition in designing preventive interventions related to the adverse consequences of this concept. Furthermore, this definition can be the basis for better teaching this phenomenon to students. Since concepts such as social distancing are always associated with issues like changing social relations and ethical challenges, the need for more reflection on the application of this concept is felt, due to the lack of respect for individuals’ independence.

Background and Aim: The most crucial element of any organization is its workforce, particularly in hospitals where job satisfaction is essential for maintaining an active and efficient staff, especially among nurses. This study aims to investigate the mediating role of organizational health in the relationship between professional ethics and job satisfaction among nurses in public hospitals in Ahvaz.

Methods: This research employed a descriptive-correlational design. The statistical population consisted of all nurses from Golestan, Imam Khomeini and Amirul Momenin hospitals in Ahvaz, totaling 1,506 individuals. A sample size of 306 participants was selected using a stratified random sampling method. Data were collected using Cadozier’s Professional Ethics Questionnaire (2002), Weiss et al.'s Job Satisfaction Questionnaire (1967) and Jafari et al.'s Organizational Health Questionnaire (2023). Content validity was established through expert evaluations from the field of educational sciences and the reliability of the questionnaires was assessed using Cronbach’s alpha coefficients, yielding values of 88, 89 and 86%, respectively. Data analysis was conducted using SPSS 18 and AMOS version 18, focusing on both descriptive statistics (demographic characteristics, means, standard deviations, skewness and kurtosis) and inferential statistics (Pearson correlation, Cronbach’s alpha, composite reliability, fit indices and hypothesis testing through structural equation modeling) at a significance level of 0.05.

Ethical Considerations: The study adhered to ethical research principles, including explaining the research objectives to participants, obtaining informed consent and ensuring privacy and data confidentiality.

Results: The findings indicated that all significant coefficients (t-values) exceeded 1.96, demonstrating the significance of all relationships between variables at a 95% confidence level. There was a positive and significant relationship between professional ethics and job satisfaction, as well as between organizational health and job satisfaction. Additionally, organizational health was found to mediate the relationship between professional ethics and job satisfaction among nurses (p<0.05).

Conclusion: The study’s findings reveal a significant relationship between professional ethics and nurses’ job satisfaction. The results from the structural equation model indicate that organizational health significantly mediates the relationship between professional ethics and job satisfaction, enhancing the overall effectiveness of these factors. Organizational health enables desirable professional ethics to more effectively influence nurses’ job satisfaction.

Background and Aim: Spiritual care is a key component and the missing link in holistic care. Providing high-quality holistic care requires technical training and mastery of technological advances, but another important concept involved in quality clinical practice is ethical sensitivity to guide professional performance. The present study aimed to determine the relationship between Moral sensitivity and spiritual care competence of nurses working in educational and medical centers of Lorestan University of Medical Sciences in 2024-2025.

Methods: This descriptive correlational study was conducted on 407 nurses working in teaching hospitals affiliated with Lorestan University of Medical Sciences in 2024-2025 who were selected by stratified random sampling method. Three questionnaires were used to collect data: demographic information, Moral sensitivity of Lutzen et al. (1995), and the questionnaire of spiritual care competence of Van Leon et al. (2009). Descriptive statistics, chi-square test, Pearson correlation coefficient and one-way analysis of variance were used to analyze the data. Data analysis was performed at a significance level of P<0.05 using SPSS V 23 software.

Ethical considerations: The present study was approved by the university ethics committee with the ethics code IR.IAU.AGZ.REC.1403.004.

Findings: The mean scores of spiritual care competence and moral sensitivity of the nurses participating in the study were 95.15±18.94 and 62.15±15.65, respectively. The results of this study showed that there was a significant correlation between total moral sensitivity and total spiritual care competence and people with higher moral sensitivity had higher spiritual care competence. According to the results of the ANOVA test, a significant relationship was observed between total moral sensitivity and total spiritual care competence.

Conclusion: The level of moral sensitivity and moral care competence of the nurses participating in this study was average. With the increase in moral sensitivity in the participants, their spiritual care competence also increased. Considering the positive effects of spiritual care on treatment outcomes and patient satisfaction, as well as the effects of moral sensitivity on the adequacy of spiritual care in nurses, it seems that increasing moral sensitivity in nursing personnel can have very positive effects on treatment, satisfaction with treatment, increasing nurses' job satisfaction, reducing burnout, and also the adequacy of nurses' spiritual care.

Background and Aim: Professional ethics training, alongside criminal protection, are influential factors in addressing environmental challenges, including the waste problem. Therefore, researchers aimed to conduct a study to examine the role of ethical and criminal protection in the proper management of hospital waste in reducing the fear of disease.

Methods: This cross-sectional study was descriptive-analytical, with the statistical population comprising all physicians and nurses in healthcare centers in Fars Province. Using convenience sampling, a total of 241 questionnaires were collected. The data collection tool in this study was a researcher-made questionnaire on ethical and criminal protection for the proper management of hospital waste (based on Clause E of Article 2 of the Executive Guidelines and Methods for Medical Waste Management and Criminal Justifications in accordance with Article 50 of the Constitution and Articles 25 and 66 of the Criminal Procedure Code) and the standard disease fear questionnaire (Salkosis and Warwick, 2002). The validity of the questionnaires was assessed in terms of content and construct and their reliability was calculated at 0.78 and 0.82, respectively. The collected data were analyzed using Pearson correlation and stepwise regression methods with SPSS 20 software.

Ethical Considerations: Ethical principles and confidentiality were observed at all stages of this study and the questionnaires were completed with informed consent and an explanation of the research objectives provided to the participants.

Results: The results indicated that ethical and criminal protection in the proper management of anatomical, sharp and cutting waste did not have a significant role in reducing the fear of disease. However, the standard coefficients of ethical and criminal protection in the proper management of infectious waste (T=-6.44 and ß=-0.43), radioactive waste (T=-7.11 and ß=-0.39) and hazardous pharmaceutical and chemical waste (T=-3.62 and ß=-0.23) were significant at the 0.001 level.

Conclusion: Ethical training and criminal protection have the greatest impact on the proper management of infectious waste and the least impact on hazardous pharmaceutical and chemical waste, while they do not influence the proper management of anatomical, sharp and cutting waste.

Background and Aim: Awareness of the therapist's interventions includes informing the patient of the nature of the medical decision, treatment methods, the risks and benefits of the proposed treatment and the possible side effects of each treatment method. Failure to understand these elements distorts the consent and acquittal obtained from the patient; it is considered a violation of medical ethics and causes civil and criminal liability for the therapist. In medical emergencies, it is either impossible or difficult and time-consuming to inform the patient or his/her legal representative of the complications and risks of treatment, necessitating the modification of the legal standards of emergency medical interventions in Iranian health law, especially in the case of patients with mental disorders.

Methods: The present study is a narrative review with a Critical Legal Studies (CLS) approach. To this purpose, relevant books and articles were extracted using Farsi databases such as SID and Magiran and international databases including Science Direct, PubMed, and Google Scholar motor engine. The search was conducted without the limitation of   until June 2024, using the keywords criminal law, EMS, mental disorders, patient rights, victimization. The present study is conducted after reviewing 25 references out of a total of 61 Farsi and English books and articles, focusing on presenting a critical legal analysis and not limited to reviewing the mentioned studies.

Ethical Considerations: Throughout all the stages of conducting this research, authenticity of sources, honesty and integrity have been observed.

Results: The "Executive Regulations on the Maintenance and Treatment of Individuals with Mental Health Conditions" (approved in 2019) and the "Bill for the Protection of the Rights of Individuals with Mental Disorders" (drafted in 2020) have not addressed issues related to healthcare providers’ consent and acquittal of the patients, as outlined in the Islamic Penal Code and the Criminal Procedure Code. The challenge of criminality/victimization of patients with mental disorders during the transfer to the emergency department is still not adequately regulated.

Conclusion: The regulations governing the practice of medical professions and related occupations do not adhere to a coordinated and consistent criminal policy, especially regarding the conditions, scope, legal enforcement guarantees for medical acquittal and consent. Between article 492 of the Islamic Penal Code (approved in 2013) and Note 1 of Article 496 of the same Code contain contradictions regarding the nature of medical consent and acquittal, the related legal burden of proof and the concurrence of causation and agency in cases of medical malpractice (involving the physician and other members of the medical staff). Furthermore, it is necessary to amend the Bill of Rights of Individuals with Mental Disorders, before it is approved by the Islamic Consultative Assembly (Iranian Parliament), especially regarding the need to clarify the provisions of this bill concerning hospitalization orders for patients with psychological disorders. It is also essential to determine the duration and manner of its implementation, since it has been overlooked by the legislator thus far.

Background and Aim: TRIPS-plus agreements establish various terms governing the relationships between originators and recipients of pharmaceutical technology, particularly in the realm of intellectual property rights and pharmaceutical patents. This study aims to introduce and describe these terms, followed by an analysis of their effects on the transfer of pharmaceutical technology.

Methods: This research employs a review methodology, gathering information through a library-based approach utilizing credible English and Persian resources. Articles from the Heinonline, SouthCentre and Noormags databases were consulted, along with agreements related to intellectual property rights and pharmaceutical patents available on the official website of the Office of the United States Trade Representative (USTR). Additionally, relevant regulations from the United States Food and Drug Administration (FDA) were referenced.

Ethical Considerations: Throughout the research and writing process, ethical principles were upheld, ensuring the originality of the text and the reliability of the sources used.

Results: This study analyzes the terms that restrict the transfer of pharmaceutical technology in TRIPS-plus agreements. Given the extensive nature of these regulations, they are categorized into two groups: common terms (data exclusivity, patent term extension, restrictions on parallel imports, protection of new uses of known drugs and limitations on compulsory licensing) and new terms (patent linkage, protection of biologics and grace periods).

Conclusion: TRIPS-plus agreements and their associated regulations for intellectual property rights and pharmaceutical patents create significant barriers to the transfer of pharmaceutical technology to developing countries and restrict access to generic drugs. This situation poses risks to human rights and medical rights, particularly the public’s right to access medicine and ensure public health. Despite these challenges, the acceptance of such agreements remains high, with newer and stricter protective regulations being developed. Developing countries often enter into these agreements due to various economic, commercial and political pressures.

Background and Aim: Depending on the nurse’s perception, conscience can be a significant factor in providing quality nursing care. In fact, paying attention to the concept of conscience means paying attention to ethics and ethics leads to commitment in doing one’s work. The aim of this article is to clarify the concept of conscience from nurses' perspective.

Methods: This study was conducted through a review method. The data was searched in the databases such as Magiran, Iran Medex, the electronic database of university Jihad (SID), as well as the international databases such as Medline, Google Scholar and Science Direct, using the keywords conscience, nursing and perception, from 2008 to 2024. The selected articles were analyzed based on objectives.

Ethical Considerations: Throughout the research stages, the originality of texts and trustworthiness in quoting was observed.

Results: The concepts related to nurses' perspective towards conscience include the entity of conscience, promoting conscience, exercising conscience, establishing conscience and its subclasses. These concepts make individuals sensitive to their duties in the best possible way, in the absence of external control; as a result, they take steps towards achieving the goals of the health system. Additionally, paying attention to multiple factors in creating and strengthening conscience during work can be a guiding light for nurses in this path, considering their professional sensitivity and the necessity of precision in providing care. It can, in turn, lead to a better perception of conscience in the clinical setting through further research, establishing specific frameworks and even providing specialty content.

Conclusion: Conscience can serve as a guide for nurses in providing clinical care. Understanding and perceiving conscience in nursing is very useful and nursing can benefit from it the most.

Methods: This analytical study reviewed 41 relevant articles (from an initial pool of 50 identified using Web of Science, Scopus, ScienceDirect, Noormags and Civilica databases) published between 2015 and 2023. Keywords included: "Metaverse", "Children's Rights", "Bioethics", "Right to Health", "Artificial Intelligence" and their Persian equivalents. The ethical challenges regarding the protection of children’s rights in the Metaverse were extracted and analyzed, followed by the proposal of legal solutions.

Ethical Considerations: The principles of honesty and integrity were observed in reporting the literature, citing sources and avoiding bias.

Results: Bioethics encompasses a wide range of ethical, social and political issues significantly influencing life sciences and the quality of life, particularly for children. The reviewed articles yielded four main themes: 1. Legal implications and challenges within the Metaverse ecosystem; 2. Frameworks and tools required to support children's right to health in the Metaverse; 3. The creation of complex data networks through blockchain technology; 4. The use of artificial intelligence in areas related to privacy.

Conclusion: While the Metaverse offers potentially immersive and beneficial experiences for children, enhancing their understanding of the world, the risks they face are significant and require proactive solutions. Fundamental children's rights-including the right to education, safety, play, privacy and access to social support are particularly vulnerable to violation in the Metaverse, especially regarding security and privacy. This underscores the need for legislators to develop specific legal frameworks to protect children in virtual environments, particularly within the Metaverse.

Background and Aim: The term "ageism" has been recognized for centuries across various countries, contexts and cultures, yet it remains relatively new and is not universally defined in many languages. Ageism encompasses three key components: Stereotyping (how we think), prejudice (how we feel) and discrimination (how we act). Given that ageism is a relatively recent concept that has only recently gained attention, the aim of this study is to establish a common and consistent understanding of ageism as presented in scientific literature.

Methods: This review aims to examine the concept of ageism in relation to older adults. A comprehensive search was conducted in the databases PubMed, Scopus, Web of Science and Embase using the keywords "ageism" and "older adult". Articles published between 2014 and 2024 were included. Initially, 18,945 abstracts of English-language papers were retrieved. Two researchers reviewed the papers in two stages. In the first stage, titles and abstracts were screened, resulting in the selection of 77 relevant papers. In the second stage, after a full-text review, 34 English papers were identified, of which 17 were ultimately approved based on quality evaluation.

Ethical Considerations: Throughout all the stages of conducting this research, authenticity of sources, honesty and integrity have been observed.

Results: The findings highlight various aspects of ageism, including its definitions, types, effects, determining factors and strategies recommended by the World Health Organization to mitigate ageism.

Conclusion: Age discrimination significantly diminishes the quality of life for older adults, contributing to increased social isolation and loneliness. The consequences of ageism are profound, affecting health, well-being and human rights. For older individuals, ageism is linked to shorter life expectancy, poorer physical and mental health, slower recovery from disabilities and cognitive decline. Based on the findings of this study, it is recommended to implement policies and laws, educational interventions from elementary school through university and both formal and informal education. Additionally, investing in intergenerational contact initiatives can help reduce age discrimination.

Background and Aim: Health promotion is most effective when it addresses the diverse needs and unique challenges of various communities. Equity-focused health promotion emphasizes fair access to resources, healthcare and support, particularly for marginalized and underserved populations. By reducing health disparities, this approach empowers individuals and communities to take control of their health and well-being. Prioritizing equity not only enhances health outcomes but also fosters empowerment, resilience and community cohesion, laying the groundwork for sustainable health improvements across all segments of society. This study examines the critical role of health promotion in empowering individuals and communities, highlighting the importance of a justice-based approach.

Methods: This article presents a systematic review of the key principles and strategies underlying effective health promotion initiatives, drawing on relevant literature and examples of community-based programs. A comprehensive search of Persian databases (SID and Magiran) and English databases (PubMed, Embase and CINAHL) identified articles, reports and texts related to justice-focused health promotion and its effects on empowerment, with no time limit until August 2024. Articles were assessed for relevance to the research topic, leading to the exclusion of unrelated content. Ultimately, 75 articles (41 in Persian and 34 in English) were reviewed, with 22 articles selected for detailed analysis.

Ethical Considerations: In this research, the principles of trustworthiness, honesty, neutrality and originality of the work have been respected.

Results: The findings indicate that the effectiveness of health promotion is contingent upon five key factors: Core Focus Areas (preventive care, early intervention and health education), Community-Based Approaches (culturally relevant and accessible programs tailored to local needs), Consideration of Social Determinants of Health (socioeconomic status, education, environmental factors), Stakeholder Collaboration (multi-stakeholder cooperation, comprehensive strategy development) and Focus on Marginalized and Vulnerable Populations (prioritizing marginalized groups for justice-based, equitable health outcomes). These elements collectively aim to empower individuals and foster inclusive health improvements across communities.

Conclusion: The Ottawa Charter provides a comprehensive framework for global health promotion, emphasizing principles such as individual empowerment, community participation and the development of healthy public policies. A review of various studies underscores the critical role of education and skill development, especially for vulnerable groups, in facilitating informed decision-making and promoting behavioral changes. Community involvement in the design and implementation of health programs, coupled with the use of digital technologies, serves as a powerful means to enhance the effectiveness of health interventions. Emphasizing social justice and addressing health inequities are essential for achieving sustainable improvements in quality of life. The coordinated implementation of these principles, supported by inter-organizational collaboration and active community engagement, is vital for attaining social welfare and sustainable health outcomes at all levels.

Background and Aim: he nature of the fetus as either a child or an independent entity, particularly regarding its legal and ethical implications, has long been a subject of debate among scholars in philosophy, jurisprudence, ethics, and law. In contemporary times, this controversy has not only persisted but has also taken on new dimensions due to advancements in biomedical science. In this context, the landmark ruling of the Alabama Supreme Court in February 2024 recognized embryos stored in the process of in vitro fertilization (IVF) as “persons” under the Wrongful Death of a Minor Act. This ruling, for the first time, categorizes extrauterine embryos as children, leading to significant consequences in reproductive rights, medical ethics, and legal frameworks. This study aims to critically examine and propose a new perspective on the perception of the fetus as a child by analyzing this ruling, its legal and ethical foundations, and its implications for the legal system.

Method: In this analytical study, academic sources from 2010 to 2023 were retrieved from Web of Science, Scopus, Science Direct, Noormags, and Civilica based on the study’s key terms: Fetus, Child, Verdict, Alabama Court, Reproductive Rights, Frozen Embryo, Child Rights, and In Vitro Fertilization. Of the 45 articles identified, 40 relevant articles were reviewed. After extracting and analyzing the ethical challenges surrounding the recognition of frozen embryos as children, legal solutions were proposed accordingly.

Ethical Considerations: In all stages of writing the present research, the ethical aspects of library-based study Including the originality of the texts, honesty and trustworthiness have been observed.

Findings: The conceptualization of the fetus as a child can be traced in ethical, philosophical, and jurisprudential doctrines. The Alabama Supreme Court ruling similarly defines the fetus as an unborn child, granting it legal rights and protections equivalent to those of a born child. Consequently, it allows parents to file legal claims for damages in cases of harm or loss of stored embryos in fertility clinics. The Chief Justice, emphasizing the sanctity of life and drawing upon ethical and religious principles, asserted that the fetus deserves respect and inherent human dignity. This ruling has broad implications for parental rights, the liability of fertility clinics, and the IVF process. However, it also raises conflicts with constitutional principles, particularly the separation of church and state. Moreover, the ruling overlaps conceptually with reproductive rights and abortion-related issues, giving rise to further legal and ethical challenges.Conclusion: By recognizing the fetus as a child, the Alabama Supreme Court ruling delineates a new intersection between ethical and legal principles. Beyond generating theoretical debates and practical challenges in medicine and reproductive law, this ruling presents an opportunity for re-evaluating concepts such as human dignity and children’s rights. However, the absence of comprehensive legal frameworks and potential conflicts with constitutional law and medical and judicial standards pose significant obstacles to the broader application of this ruling. This highlights the necessity for legal reforms and judicial harmonization in tandem with the increasing influence of the “fetus as a child” discourse within various societal and policymaking spheres.

Background and Aim: In health systems, upholding the dignity and human rights of individuals particularly mothers is of critical importance. However, in many cases, the dignity and rights of mothers are neglected during caregiving processes. Such oversight can negatively affect maternal experiences throughout pregnancy, childbirth and neonatal care, ultimately impacting public health. This review study aims to identify and analyze the key components of maternal dignity.

Methods: This review study, based on Roberts’ six-stage model, examined articles published on maternal dignity from 2017 to 2024. The study population consisted of 174 articles extracted from reputable national databases (Magiran, SID, IranPaper, Megapaper) and international databases (PubMed, Web of Science, Google Scholar, Connect Paper). Based on predefined inclusion criteria and theoretical saturation, 15 articles were purposively selected for detailed analysis. Data collection and analysis were carried out in accordance with the PRISMA protocol.

Ethical Considerations: All ethical standards were upheld throughout the review process, including adherence to authenticity, honesty and academic integrity.

Results: The analysis identified six main dimensions and thirteen sub-dimensions as the key components of maternal dignity. The valuation dimension includes respect for the mother’s individuality, fostering a sense of safety and calm and personalized attention. The participation and autonomy dimension encompasses involvement in care planning, information sharing, empowerment in managing pregnancy, the right to choose, preserving independence in care decisions and respecting maternal preferences. The interaction and communication dimension involves effective communication, clarification of medical procedures, empathy and emotional and psychological support. The support for pregnant mothers dimension covers both physical and medical support aimed at promoting maternal well-being. The support for the fetus/newborn dimension encompasses safeguarding newborn health, nurturing the emotional bond between mother and child and creating a safe and supportive environment. The education and empowerment dimension involves educating mothers, equipping them to manage challenges and offering continuous support and education postpartum.

Conclusion: The findings highlight that respect for individuality and the creation of a secure and peaceful environment (the valuation dimension) are essential to maternal satisfaction and positive caregiving experiences. Active maternal participation in care planning and access to comprehensive information are equally important. Within the interaction and communication dimension, empathy, emotional support and procedural clarity significantly strengthen the relationship between mothers and healthcare providers. Physical and medical support, particularly during pregnancy, is crucial to both physical and mental health outcomes. Furthermore, supporting the fetus and newborn through ensuring neonatal health and creating a safe, supportive environment can enhance the overall maternal experience and contribute to favorable neonatal outcomes. Overall, these key components emphasize the necessity of integrating maternal dignity and rights into caregiving systems to improve the experience of pregnancy and childbirth, promote maternal and newborn health and ultimately enhance public health.

Background and Aim: Spirituality, as the foundation of human existence and its impact on healing and recovery, has garnered increasing attention in recent years. Education in spirituality and spiritual care is considered a fundamental component of delivering high-quality nursing services, as emphasized by the World Health Organization and the International Council of Nurses. Training knowledgeable and competent nurses to address patients’ spiritual needs is a crucial step toward improving the quality of nursing care. This study aims to enhance nurses’ awareness and competencies in the field of spiritual care in order to promote the quality of nursing services and meet the spiritual needs of patients within the framework of care delivery.

Methods: This review study was conducted by searching Persian and international databases including IranMedex, SID, Magiran, PubMed and Scopus, using Persian keywords as well as English keywords "Nursing Care", "Spiritual Care" and "Iran". The search covered publications from 2000 to 2024. From an initial pool of 2,000 articles, 73 articles were selected for analysis based on inclusion criteria: The articles had to be written in Persian or English, be relevant to the study objective and have full-text availability.

Ethical Considerations: Throughout the research and the writing of this article, ethical principles, textual integrity and academic honesty were duly observed.

Results: The results, categorized based on the types of studies reviewed, were organized into four main domains: 1- The effects of spiritual care; 2- Policymaking in this area; 3- Concepts associated with spiritual care; 4- Attitudes toward such care. These findings underscore the significance and distinct position of spiritual care as an influential approach. Accordingly, there is a clear and pressing need for more extensive research and the development of comprehensive, standardized and clearly defined frameworks in this field.

Conclusion: Spiritual care is an indispensable part of healthcare services that necessitates interdisciplinary and collaborative engagement among all healthcare personnel in hospitals. However, gaps in information dissemination, comprehensive staff training, access to spiritual care services and the precise definition of therapeutic roles have hindered the effective implementation of such care. Additionally, more in-depth research and the documentation of patients’ experiences can assist in the design of comprehensive and efficient programs.

Background and Aim: The main objective of this article is to investigate the role of rationality, intelligence and emotions as mental-physical components in the moral-legal agency of artificial intelligence, based on the findings and achievements of contemporary cognitive science. Moral-legal agency of AI refers to the ability of AI systems to make independent decisions and to be held accountable for the consequences of their decisions.

Methods: This is a review study. The necessary resources and data were collected through library research and by accessing reputable domestic databases such as Civilica and Magiran and international databases such as Scopus, using books and articles from 2009-2024. A total of 72 articles and books (67 English and 5 Persian sources) were selected as the main sources for the final review.  Of these 72 documents, 22 sources are directly related to the research findings, which are mentioned in the findings section.

Ethical Considerations: This research was conducted in full compliance with all ethical considerations regarding honesty and originality of texts.

Results: Currently, according to the prevailing view of cognitive scientists, due to the algorithmic and non-biological structure of AI systems and the lack of inherent rationality (lack of self, self-awareness, a perspective containing its own beliefs and preferences), the lack of high-level fluid intelligence and the lack of the biological and anatomical structure of the human nervous and brain system for emotional perception, it is not possible to speak of independent moral-legal agency for AI. Conversely, some researchers believe in minimal or participatory agency of AI. However, with the advancement of AI in the areas of human-like phenomenal and mental components (such as emotional perception, fluid intelligence, self and self-awareness), it may be possible in the future to attribute independent moral and legal agency to them.

Conclusion: Although AI currently lacks the mental capabilities necessary for independent agency, with the development and advancement of this technology in the future, if AI is equipped with human-like mental abilities (inherent rationality, fluid intelligence and emotional perception), achieving independent moral-legal agency will not be out of reach.

Background and Objective: Medical diagnostic laboratories are one of the important and essential branches in disease diagnosis and healthcare providers responsible for the health of patients and communities. The role of the laboratory in medical science is highly significant as it assesses individual health and examines the likelihood of disease occurrence. However, despite advancements in society and the internet, ethical issues related to diagnostic laboratories have not been thoroughly analyzed. This study aims to enhance the knowledge of laboratory personnel in the field of medical ethics to provide better services to patients referred to the laboratory.

Methods: This review article involved a search for key terms in Persian and English, including professional ethics, medical diagnostic laboratories, patient rights, and medical laboratory personnel in national and international databases without any time restrictions. Ultimately, the objectives of this article were compiled from 44 studies that were found.

Findings: Today, diagnostic laboratories operate by conducting various tests in a short time with high accuracy and minimal error for diagnosing and treating diseases, based on the interpretation of the obtained test results. Besides providing the most accurate test results, laboratory personnel must also address ethical issues; therefore, the most crucial aspect of laboratories is their staff. Knowledge of professional ethics is highly important, and the World Health Organization has issued guidelines over the years based on professional ethics in various medical fields, including codes of medical ethics available online. These guidelines include protecting patient rights, maintaining confidentiality and trust, sampling procedures, testing processes, reporting methods, quality control, and data record-keeping.

Conclusion: Laboratories must continuously update their practices and utilize new data to implement necessary protocols in their workflow and adhere to the latest rules and standards of professional ethics in the laboratory field.