A Study on the Ethical and Behavioral Role of Physician in Following the Medical Treatment Plan by the Patient during the Treatment
Author(s)Khademolhosseini, Zeinab; دانشجوی پزشکی سال چهارم و عضو کمیته تحقیقات گروه اخلاق پزشکی دانشگاه علوم پزشکی شیراز.
Khademolhosseini, Mitra; دانشجوی پزشکی سال ششم و عضو کمیته تحقیقات گروه اخلاق پزشکی دانشگاه علوم پزشکی شیراز.
Mahmodian, Farzad; عضو هیأت علمی و دبیر کمیته تحقیقات گروه اخلاق پزشکی دانشگاه علوم پزشکی شیراز.
medical ethics principles
the principle of autonomy
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AbstractThrough taking a medical oath (Hippocratic Oath), physician swears to save the patient’s life and wait for a bright future in the seat of a doctor with full satisfaction from all the times he has passed. Medicine is a profession which is responsible for “treatment of the patient”. Through this job, the physicians are faced with different people from different sexual, social and age groups during a routine day. Though these people are not all the same person, a physician calls them all as a common title of “patient”. The patient also knows that he can indeed trust the physician and explain every problem of himself to the physician. Upon this trust, the patient can convince himself to let the physician decide about his health. A real diagnosis and treatment is possible just in case the physician is fully instructed about the necessary skills related to the patients, people and society, and is completely familiar with his society, its social behavior, rites, traditions and culture as well. The relationship between a physician and his patient must be in a way that the patient is optimistically encouraged to continue the treatment process. A correct doctor-patient relationship and an appropriate emotional atmosphere in this regard can play the role of an effective motive for the patient to follow the medical treatment process and to change his behavior in order to achieve the best result. The benefits of the patient consent from his doctor-patient relationship have been described well within the studies. The relationship between a physician and a patient should be in a way that the quadruplet essential principles of medical ethics concerning the patient rights is not ignored; it means that upon these principles, the right of the patient to make decision about the efficacy or inefficacy of the role of the selected physician in his treatment and administration of justice are achieved throughout all related fields.All attributes of a physician can be categorized into one of these four groups and so every feature of a physician can contribute towards following every one of these principles.The main objective of this research is to study the degree of the behavioral and ethical role of a physician in following the medical treatment plan by the patient during a treatment. The research is a cross-sectional study which has been done in Shiraz University of Medical Sciences in 1387. With regard to the four essential principles of medical ethics concerning the patients’ rights that is, justice, beneficence Non-malfeasance and autonomy, every attribute of a physician is classified under one of these four principles.With regard to these principles, the four questionnaire principles prepared and distributed among medical students of the clinical section and the patients and the result were analyzed using statistical tests and showed that, administration of justice by the physician is considered as the most important factor in decreasing the disobedience of the patient from doctors’ orders in the opinion of both physicians and patients. The physicians’ belief in the patients’ autonomy 37% and the patients’ belief in beneficence of the doctor’s treatment plan 43.5% are the other major factors respectively among all criterions related to justice; to chose the best and the most affordable treatment plan and liability of the physician dedicated the highest statistical number to themselves consecutively by physician and patients. In this research, no relationship is found between the four mentioned principles of medical ethics and population attributes of the examinees like age and education but a significant relationship were found between gender and the belief in the role of justice in decreasing the disobedience of the patient.
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Ethics in Medical EducationKiani, Mehrzad; دانشیار مرکز تحقیقات اخلاق و حقوق پزشکی، متخصص پزشکی قانونی و فلوشیپ اخلاق زیست پزشکی و معاون گروه اخلاق پزشکی دانشکده طب سنتی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران; Abassi, Mahmood; دانشیار و رییس مرکز تحقیقات اخلاق و حقوق پزشکی دانشگاه علوم پزشکی شهید بهشتی، مدیر گروه اخلاق پزشکی و فلوشیپ اخلاق زیست پزشکی، تهران، ایران; Sheikhazadi, Ardeshir; متخصص پزشکی قانونی، استاد گروه پزشکی قانونی دانشگاه علوم پزشکی تهران، تهران، ایران; Safar Cherati, Anousheh; روانپزشک، پژوهشگر مرکز تحقیقات ایدز دانشگاه علوم پزشکی تهران، تهران، ایران; Bazmi, Shabnam; استادیار مرکز تحقیقات اخلاق و حقوق پزشکی، متخصص پزشکی قانونی و فلوشیپ اخلاق زیست پزشکی، استادیار گروه اخلاق پزشکی دانشکده طب سنتی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران. (نویسنده مسؤول) ( Medical Ethics and Law Research Center, 2016-12-01)There is no definite code of ethics in field of medical education in Iran and we cannot even see any accent in this regard in medical education references.We can define 3 major fields in medical education ethics such as:- Student – Patient relationship- Teacher- Student relationship- Relationship with other colleagues and hospital staff In this article our concern about medical students’ envelopes all medical students in different educational levels (Interns, residents, fellowships ...).Respecting ethical values in field of education, not only help us to produce morally committed physicians, but also help medical community to respect patient rights.
Analysis of Kohlberg’s Theory on Moral Development from Quran Point of ViewJavidan, Fatemeh; دانشجوی دکترای تخصصی آموزش پزشکی، مرکز مطالعات و توسعه آموزش علوم پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران. کارشناس معاونت آموزشی، وزارت بهداشت، درمان و آموزش پزشکی، تهران، ایران (نویسنده مسئول); Dehghan, Mohammad Sadegh; دانشجوی دکترای تخصصی آموزش پزشکی، مرکز مطالعات و توسعه آموزش علوم پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران. کارشناس معاونت آموزشی، وزارت بهداشت، درمان و آموزش پزشکی، تهران، ایران; Shamsi Gooshki, Ehsan; دانشجوی دکترای تخصصی اخلاق پزشکی، گروه اخلاق پزشکی، مرکز تحقیقات اخلاق و حقوق پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران; Abbasi, Mahmoud; رییس مرکز تحقیقات اخلاق و حقوق پزشکی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران و عضو گروه اخلاق زیستی فرهنگستان علوم پزشکی ( Medical Ethics and Law Research Center, 2016-10-01)Moral development has been a noticeable social issue. The holy Quran as the most complete guiding book for humankind endorses deep teachings regarding morality. On the other hand because of importance of ethical issues, many theorists and philosophers have been trying to develop ethical and moral theories, according to their ideological and cultural back grounds. But most of them could not go beyond institutional life of human beings and failed to consider spiritual and motivational underpinnings of morality, which are deeply rooted in God creation and human nature. Although studying moral development in Quran view required a wide and deep reflection in various dimensions, this paper tries to open the discussion as an introduction for future works by analyzing the Kohlberg’s theory of moral development from Quran point of view.Method: This is a review article, which is done using library and web-based sources and deriving relevant references.Results: According to Quran, human beings pass through some stages during their lives. A similar step wised approach to moral development has been discussed in theories such as Kohlberg and Pageant’s. According to Kohlberg, steps and levels of moral development are fixed and unchangeable. In addition he mentioned that moral arguments and judgments are related to cognitive properties. But from Islamic and Quran viewpoint, moral regulations and principles are factual and abstract (Not-relative). Therefore in some dimensions views of western Theorists is completely different and even contradictory with Islamic tradition. One of These major differences is lack of a holistic approach to human moral development and lack of enough attention to spiritual and supererogatory moral ideals.Conclusion: The most important critique against Kohlberg’s theory is its relative weakness in explaining multi-dimensional nature of moral development because of its theoretical and experimental limitations. Using such western theories and instruments for evaluating moral development is not completely compatible with our religious and national culture. Although there are a number of works that try to explain moral development from Islamic (Shi’a) point of view, but very few works have used a comparative approach toward this issue. We recommend more detailed future studies about this issue.
Investigating subjects and quantity of articles related with medical ethics in Islamic countries, Eastern Mediterranean Region of World Health Organization, indexed on PubMedDehghan, Mahmmad sadegh; کارشناس معاونت آموزشی، وزارت بهداشت، درمان و آموزش پزشکی؛ دانشجوی دکترای تخصصی آموزش پزشکی، مرکز مطالعات و توسعه آموزش علوم پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران. (نویسنده مسؤول); Javidan, Fatemeh; کارشناس معاونت آموزشی، وزارت بهداشت، درمان و آموزش پزشکی؛ دانشجوی دکترای تخصصی آموزش پزشکی، مرکز مطالعات و توسعه آموزش علوم پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.; Shamsi gooshki, Ehsan; دانشجوی دکترای اخلاق پزشکی، گروه اخلاق پزشکی، مرکز تحقیقات اخلاق و حقوق پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.; Abbasi, Mahmoud; رییس مرکز تحقیقات اخلاق و حقوق پزشکی، دانشگاه علوم پزشکی شهید بهشتی. تهران، ایران. (Medical Ethics and Law Research Center, 2015-10-06)AbstractIntroduction: Among different branches of professional ethics, medical ethics has a specific position due to the high and special level of professional ethics. Medical ethics is also considered especially in Islamic teachings. Due to novelty advancements in medical science in recent years, new and deep discussions have proposed on medical ethics field that considered issues on medical ethics can be specified via investigating articles as well as the domains searching on these issues and also one can infer the priorities considered by the authors of above articles and domains regarding medical ethics that have not been nor studied or investigated up to now will be determined in that investigators can have participation on these fields based on their national and regional priorities.Methodology: This article is the review study that by referring to PubMed data base, the articles were investigated based on 19 titles includes 15 titles of 24 titles related to the introduced bioethics by health information section of Medline Plus as well as 4 titles related to war, research, education and medical ethics principles, indexed in PubMed that published by investigators in Islamic countries in Eastern Mediterranean region (EMRO) of WHO.Findings: The articles were categorized and compared based on the year of publication, country and the study title. The minimum number of articles based on the country in Time Zone from 1971 to 2012 with one article related to countries such as Djibouti and Palestine and the maximum amount that were 71 were related to country of Iran. Also, the minimum number of article based on year was one article in years of 1971, 1978, 1979 and 1984 the maximum ones were 39 in 2012. The minimum number based on title was an article on clinical trials and fraud in health and the maximum number were 64 on the principles of medical ethics. Conclusion: This survey is only to investigate the articles related to index medical ethics on PubMed in Islamic countries of Eastern Mediterranean region of WHO. Although additional studies are necessary to complete the information on this field but this article is considered as the first one with categorizing medical ethics articles with the approach of variability of issue and since the origin of their publication is in Islamic countries, is exclusive can be the basis of wider studies and investigating different dimensions in the future. The studies containing medical ethics in our country should be based on goal as well as national and regional priorities to meet the needs of Islamic Iranian nation.