akhlāq-i pizishkī i.e., Medical Ethics

Background and Aim: Workplace violence is one of the major occupational hazards in the health system, which can have considerable physical, psychological, and professional consequences for healthcare workers. Numerous studies have been conducted on the prevalence of workplace violence and its associated factors in different countries. A systematic review of these studies to estimate the prevalence of this phenomenon and identify its associated factors can provide valuable information for policymakers and clarify existing knowledge gaps. Therefore, the present study aims to describe the methodology and stages of conducting such a systematic review.

Methods: This study is designed as a systematic review and meta-analysis protocol. Studies published in English from January 2015 to January 2025 will be searched in PubMed, Scopus, and Web of Science databases. Original observational studies, including cross-sectional, cohort, and case-control studies that report the prevalence, risk factors, or consequences of workplace violence against healthcare workers, will be included. Study screening, data extraction, and quality assessment using the JBI checklists will be performed independently by two researchers. Data will be analyzed using STATA 17 through meta-analysis of proportions and a random-effects model. Heterogeneity will be assessed using the I² statistic and Cochran’s Q test. Subgroup analysis and, where feasible, meta-regression will also be performed. Publication bias will be evaluated using funnel plots and Egger’s test.

Ethical Considerations: This study is derived from a research project registered with the Research Ethics Committee of Shahid Beheshti University of Medical Sciences. Throughout all stages of manuscript preparation, originality, academic integrity, honesty, and proper attribution were strictly observed.

Conclusion: The proposed systematic review can provide a comprehensive overview of various dimensions of workplace violence against healthcare workers. The findings of this study may assist policymakers, healthcare system managers, and researchers in designing prevention programs, developing educational and managerial interventions, and identifying existing research gaps.

Background and Aim: Academic dishonesty refers to any deliberate act intended to deceive in the presentation of academic assignments. The purpose of this research was to examine the relationship between the dark triad of personality traits and moral intelligence with academic dishonesty among students of Lorestan University.

Methods: The research method is a descriptive-correlational survey method. The statistical population comprised all undergraduate students enrolled at Lorestan University during the 2024-25 academic year, of which 250 were selected as the research sample using proportional stratified sampling. Data were collected using questionnaires including dark triad personality traits (Jonason and Webster, 2010), moral intelligence (Lennick and Kiel, 2011) and academic dishonesty (McCabe and Trevino, 1997). Data were analyzed using Pearson's correlation coefficient and multiple stepwise regression analysis in IBM SPSS Statistics 26.

Ethical Considerations: In the present study, ethical considerations such as voluntary participation, informed consent, confidentiality of information and participants' right to withdraw from the study without consequences were observed. The participants were free to respond to the questionnaires.

Results: The findings showed a positive, significant but weak relationship between the dark triad of personality traits and academic dishonesty (r=0.22, P<0/001) and a significant negative relationship between moral intelligence and dishonesty (r=-0.44, p<0.05). The results of regression analysis showed that the dark triad of personality traits and moral intelligence explained 41 percent of the variance in academic dishonesty.

Conclusion: Based on the findings of the present study, it can be concluded that dark triad personality traits and moral intelligence are associated with students' academic dishonesty. It is recommended that university counseling and mental health centers offer workshops to inform students about the role of the dark triad of personality traits and moral intelligence in academic dishonesty.

Background and Aim: Loss of chance in medical treatment is one of the most challenging issues at the intersection of medical ethics and professional liability, particularly in acute neurological diseases where time plays a decisive role in treatment outcomes. In such cases, medical negligence does not necessarily lead to death or permanent disability, but rather to a significant reduction in the chance of recovery or prevention of irreversible damage. This situation makes it difficult to establish a definitive causal relationship and leads to the denial of compensation in many legal systems. Therefore, examining how different legal systems address this issue may help explain the ethical and legal foundations of compensation for such damage. The aim of this study is to comparatively examine the ethical and legal dimensions of compensation for damage following loss of chance in treatment in acute neurological diseases in the legal systems of Iran, England, and the United States.

Methods: This research is a review study. Keywords, including "Loss of chance", "Medical malpractice", "Causation" and "Medical liability" were searched in PubMed, Scopus, Google Scholar, SID, Magiran and Noormags databases. Relevant legal texts and selected case law were studied and analyzed.

Ethical Considerations: Throughout all stages of the present research, the authenticity of sources and the principles of honesty and academic integrity were observed.

Results: The findings indicate that English law, with a conservative approach, generally refuses to recognize loss of chance as an independent compensable damage.  In contrast, many U.S. jurisdictions,  by adopting a proportional loss of recovery, have provided a more ethically responsive compensation framework for the damage suffered by patients. Despite having significant ethical and jurisprudential foundations, Iranian law faces a gap between time-sensitive medical realities and legal remedies due to the lack of explicit recognition of this doctrine.

Conclusion: Disregarding loss of treatment opportunity solely due to uncertainty in outcomes is inconsistent with the principles of medical ethics and therapeutic justice. Ethical-legal recognition of loss of chance, subject to scientific and legal safeguards, can be an effective step towards fair protection of patients, especially in acute neurological diseases.

Background and Aim: The global expansion of individualistic ideologies has influenced the field of medicine and has led to the development of the concept titled "autonomy of patients" in contrast to the traditional "paternalism" dominating medical practice. The development of the "Advance Directive" is one of the prominent outcomes and manifestations of these ideologies.  "Advance Directive" allows patients to reflect their current treatment preferences in predetermined forms, so that they can be utilized by physicians in the future and in situations in which they lose their decision-making capacity. This study aims to explain the concept of advance directives, analyze principal ethical considerations, and examine its status within the legal framework of Iran.

Methods: This study was a narrative review. Persian and English articles were searched in databases, including SID, Noormags, ScienceDirect, and the Google Scholar search engine. Keywords included "Advance Directives," "Advance Care Planning," and their Persian equivalents. The articles published from 2015 to 2025 were included in this study.

Ethical Considerations: Throughout all study stages, the fundamental principles of research ethics, including originality, honesty, and trustworthiness, have been observed.

Results: According to the research findings, although the "Advance Directive" was developed to promote patients’ autonomy and respect for their preferences. However, its implementation faces fundamental challenges and considerations. At the theoretical level, these challenges include self-paternalism, the prioritization of autonomy over principles of beneficence and non-maleficence, violation of human dignity, and neglect of relational autonomy. At the practical level, these challenges include uncertainty in predicting patients’ future preferences, ambiguity in interpretation, disregard for the influence of cultural and social factors, physicians’ failure for its implementation due to deeply established medical practices, and lack of access in emergency situations.

Conclusion: Studies indicate that although the "advance directive" has been introduced to respect patients’ autonomy in the course of medical treatment and has attempted to overcome certain challenges associated with medical paternalism, it faces fundamental challenges at both theoretical and practical levels. Therefore, it cannot necessarily be considered a definitive and effective solution for end-of-life care. Within the Iranian legal system, particularly under the Patient Rights Charter, the advance directive has been recognized as a therapeutic instrument; however, it lacks legally binding force.

Background and Aim: Although induced abortion is considered part of women’s right to choose in many societies, evidence indicates that this experience can be associated with significant psychological consequences. This study aimed to review the psychological consequences of induced abortion and analyze the conflict between the right to choose and the principle of non-maleficence, with an emphasis on women’s mental health.

Methods: This study was a narrative review that was conducted in two main phases. In the first phase, eligible Persian- and English-language articles were identified and reviewed in the PubMed, Scopus, and Web of Science databases and the Google Scholar search engine using English keywords, including induced abortion, psychological consequences, moral injury, non-maleficence, and no harm, along with their Persian equivalents in the SID database. In the second phase, the conflict between individual choice, or the principle of respect for the autonomy of pregnant women regarding induced abortion, and the principle of non-maleficence was explained and analyzed.

Ethical Considerations: In this study, principles of scientific integrity, accurate citation of sources, and respect for intellectual property rights were observed throughout all stages of manuscript preparation.

Results: The literature review indicated that the consequences of induced abortion can be classified into three main categories: psychological consequences, moral injury, and cultural, social, and individual factors affecting these consequences. In the psychological consequences category, depression, anxiety, post-traumatic stress disorder, complicated grief, shame, and guilt, and, in some studies, impairment in interpersonal relationships, sexual functioning, and long-term psychological adjustment were reported. Regarding the moral injury category, feelings of guilt, shame, and distress arising from conflicts between the abortion experience and personal or religious values and beliefs were reported. In the category of cultural, social, and individual factors, cultural and religious attitudes and beliefs, social stigma, economic and family pressures, social support, individual circumstances, and the alignment of decisions with personal values were among the most important factors associated with the severity and persistence of psychological consequences. An analysis of the conflict between a pregnant woman's right to choose induced abortion and the principle of non-maleficence indicates that harm prevention necessitates the provision of psychological counseling and support before decision-making, so that their choice does not subsequently lead to depression, anxiety, guilt, or moral distress. In fact, the ethical principle of respect for autonomy can be deemed to be genuinely upheld when the decision is made with full awareness of the complications and potential consequences of abortion.

Conclusion: The psychological consequences of induced abortion are not solely attributable to the abortion itself but are also associated with the circumstances surrounding the decision, cultural and social contexts, and the quality of psychological support. From a bioethical perspective, a balance should be maintained between respect for individual autonomy, prevention of psychological harm, and comprehensive support for women. Providing psychological counseling and social support before and after abortion may not only contribute to decisions to refrain from induced abortion but may also, when abortion does occur, play an effective role in reducing psychological harms.

Background and Aim: Spiritual care is an integral component of holistic nursing care; however, many nurses are not adequately prepared to provide it. This study aimed to analytically review and synthesize the available evidence on the effectiveness of spiritual care education programs and their outcomes for nurses and nursing students over the past decade, from January 2016 to August 2026.

Methods: This study was a narrative review. A comprehensive search was conducted in PubMed, Scopus, Web of Science, and CINAHL databases using the keywords, including “spiritual care education,” “spiritual competence,” “nurses,” and “nursing students,” along with their Persian equivalents in SID and Magiran databases. Articles published in Persian and English between January 2016 and August 2026 were reviewed. After removing duplicate and irrelevant records, 13 out of 180 retrieved articles were included in the final analysis. The studies were critically appraised based on methodological quality, study design, sample adequacy, clarity of the intervention, measurement instruments, and the generalizability of findings. Data were categorized and interpreted using thematic analysis.

Ethical Considerations: In this study, principles of scientific integrity, accurate citation of sources, and respect for intellectual property rights were observed throughout all stages of manuscript preparation.

Results: A total of 13 eligible studies were included in the study from the retrieved records. Of these, 5 studies (38.5%) focused on face-to-face workshops, 3 studies (23.1%) on e-learning, 2 studies (15.4%) on clinical simulation, and 3 studies (23.1%) on structured model-based educational programs. The findings were organized into two main categories and three core themes. The first category, educational outcomes, included the themes of enhanced spiritual competence, improved attitudes, and increased knowledge among nurses and nursing students. The second category, professional and clinical outcomes, included increased clinical resilience, improved empathy, and reduced job burnout.

Conclusion: Spiritual care education, as an essential component of holistic care, has considerable potential to enhance nurses’ professional competence and improve the quality of patient care. The findings highlight the need to integrate structured, evidence-based, and culturally and ethically appropriate spiritual care education into nursing curricula and continuing professional education programs.

Background and Aim: Ethical issues in medical sciences have become increasingly complex and diverse with the expansion of emerging technologies. In this context, classifying these issues can contribute to better comprehension, more structured education, and more precise analysis of ethical challenges. This study was conducted to review the classification of ethical issues in medical sciences and to explain the necessity of adopting a comprehensive and multidimensional framework.

Methods: This study was a narrative review. To identify relevant published articles, searches were done in PubMed, Scopus, Web of Science, SID, and Magiran databases and the Google Scholar search engine from 2000 to 2025 using keywords including medical ethics, bioethics, classification, and conceptual frameworks. Included articles were then reviewed and analyzed in terms of classification type, area of focus, and conceptual limitations.

Ethical Considerations: In this research, the ethical aspects of library-based research, including the authenticity of texts, honesty, and academic integrity, were observed.

Results: The literature review showed that ethical issues in medical sciences can be examined through several major approaches, including stakeholder-based, temporal-stage-based, conceptual and principle-based, and context-based approaches. While each of these classifications has certain advantages, they also face limitations in addressing the increasing complexity of medical sciences, emerging technologies, and broader challenges in healthcare systems. The literature also indicated that a considerable proportion of ethical issues in medical sciences arise in areas such as the beginning of life, clinical care, end-of-life care, biomedical research, public health, emerging technologies, and medical education and organization.

Conclusion: Given the diversity, overlap, and dynamic nature of ethical issues in medical sciences, existing classifications alone do not appear sufficient to encompass all dimensions of this field. Therefore, considering the development of a comprehensive and multidimensional framework in this area is essential.

Providing end-of-life care to critically ill patients in intensive care units (ICUs) is consistently associated with numerous ethical challenges for nurses. These challenges typically arise from disagreements regarding the continuation or withdrawal of life-sustaining treatments, conflicts between patients’ and families’ preferences, legal constraints, communication difficulties with unconscious patients, and significant professional responsibilities. Given the pivotal role of nurses in these units, enhancing their ethical reasoning abilities could serve as an effective strategy in dealing with such situations. This letter to the editor aims to emphasize the necessity of training nurses in ethical reasoning skills to deal with ethical decision-making challenges in providing end-of-life care for critically ill patients admitted to ICUs. It appears that training ethical reasoning skills can be considered a strategic necessity for nurses in ICUs. Such training can assist them in analyzing difficult clinical encounters and making ethical decisions in complex circumstances, while also leading to the enrichment of professional identity and quality of care offered for patients and their families. Given the existing evidence indicating the unsatisfactory level of ethical reasoning proficiency among Iranian nurses, particularly in ICUs, implementing targeted and systematic training programs can be essential. These interventions can play a key role in managing ethical conflicts and enhancing care standards; therefore, it is expected that health policymakers prioritize the development and integration of such training programs into continuing education and professional development for nurses.