Ethical issues in the end of life care for cancer patients in Iran

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. 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. 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. 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

[Production of knowledge and medicine of Islamic ERA]

During the Islamic empire [7th-13th centuries], medicine was promoted surprisingly and the most brilliant contributions were made by Muslim physicians. These advancements were the source of inspiration of medicine in the West after Renaissance. Currently, we are heirs of the unique knowledge of our ancestors. However, some intellectuals believe that the time of that kind of medicine is passed. Conversely, some consider it as an experimental medicine which could be used as a productive source of knowledge. This article draws on a literature review to examine the role of Islamic medicine in the emerging current of knowledge production. It begins with a brief review of the history of medicine during the Islamic era and is followed by debate on the nature of Islamic medicine.We conclude that the traditional medicine along with the recommendations of the Prophet [PBUH] and his successors, named Islamic medicine, is absolutely an experimental science and should be considered as a research subject in academic settings in accompany with modern medicine

[ religious outlook on end of life ethical issues]

The ethical issues of end of life decisions making are widespread. Nowadays, physicians constantly involve patients whose lives could be prolonged by new medical treatments and advanced technologies. There are debates on medical futility, quality of life, and justice in such cases. Sometimes the health could not be restored and physicians only can provide for patients a comfortable natural death through palliative care. End of life decisions in the case of brain death, Persistent Vegetative State, and Minimally Conscious State would be very different and challenging. The issue of "Death with Dignity" and defining a good death is also a main matter. On occasion that the life is full of pain and suffering, allowing a person to die, Do-not-resuscitate order, withholding and withdrawing medical treatments [such as Mechanical ventilation], and even euthanasia and physicianassisted suicide are suggested as justified decisions by some practitioners. In some countries, legal approaches like "advance directives" facilitate the process of decision making. However, ethical issues and the related decisions are shaped by many factors. Among these factors, religious values are considered as one of the most influential factor. This article will discuss the ethics of end of life, focusing on religious viewpoints about end of life dilemmas, and the way religious beliefs have affected medical practice at the end of life. The teachings of Hinduism, Buddhism, Judaism, Christianity and Islam about death and dying process are reviewed in brief

[ Islam-based analysis of end of life ethical issues: case studies]

Ending of life is a critical decision which must be made with accountability and through a process of consultation with patient and some experts. The main challenge facing the ethics of end-of-life care is to avoid decisions contrary to patient's religious belief. The rights of individuals, near death, should be safeguarded and their interests at terminal stages of life should be respected. It is noteworthy that the religion is the most important factor we have in coping with dilemmas near the end of life. More than one forth of the world population are Muslims; therefore understanding their attitudes about this critical issue is imperative. We aim to state the main concepts of Islamic teachings about the death and end of life debates. The dilemmas will be discussed through some clinical cases

[Iranian model of kidney transplantation and approaches to ethical reinforcement]

Along waiting lists in many countries either developed or less developed. In current decade, substantial efforts have been made to find medically and ethically justified models of organ transplantation. In Iran, a controlled living unrelated donor [LURD] program for kidney transplantation was adopted in 1988 out of necessity as an approach for saving many lives. The current program, named "Iranian model of Kidney Transplantation" by some critics, has advantages and disadvantages. In this article, we aim to state some details about the Iranian model of kidney transplantation; its main results and some challenges. Moreover, we discuss the issue of organ transplantation from the ethical viewpoint and suggest some approaches for strengthening the current system

[ necessity of compiling the organ transplantation ethical guideline in Iran: along with a brief report of Asian task force on organ trafficking]

In recent years, policy makers and health authorities have taken various steps to address organ demand in Iran. As a result of extensive efforts, including the adaptation of the controlled living unrelated donation program for kidney transplantation, the kidney transplant waiting list has been eliminated since 1999. Currently, the Iranian model of kidney transplantation is a culturally-adapted organ procurement system. However, we need to re-examine the current system and to strengthen it from the aspect of ethics. For this reason, it is necessary to compile an ethical guideline for organ transplantation. In this paper, the importance of the issue will be emphasized and some suggestions will be pointed out. We will also state a brief report of the first and the second Asian Task force on Organ Trafficking which was held in Taipei, in July, 2007 and January, 2008. Undoubtedly, a comprehensive practical ethical guideline consisting of a special attention to the prevention of kidney diseases, enhancing cadaveric donation, motivating altruistic donation, reinforcing ethical evaluation and supervision, and supporting donors' and recipients' rights would be very helpful for supporting the current system

Insulinoma in Iran: a 20-year review

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. The medical records of 68 cases with biochemical or histological evidences of insulinoma were reviewed. 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% 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%]. 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

[Cardiovascular screening of children and parents in high-risk families]

Background: cardiovascular disease is one of the major leading cause of death in Iran. There is a strong association between parental history of cardiovascular disease clustering of risk factors in the offspring. Detection and treatment of cardiovascular risk factors since childhood is essential to reduce the incidence of disease in adulthood. This study was performed to identify major cardiovascular risk factors in middle school-aged children and their parents in high risk compared to control families

Methods: the middle schools of the 6th of Tehran were divided randomly into two groups. A total of 169 high-risk children with their families were recruited from the first group while 105 control children with their families were recruited from the second group of schools. Coronary risk factor survey was performed in the participants

Results: prevalence of increased total- and LDL-cholesterol and high FBS were higher in high-risk parents and children. Prevalence of increased BMI was higher in fathers and children of high-risk families. More fathers in high-risk families were smoker. The means of waist circumference and WHR were significantly higher in high-risk fathers. The means of total- and LDL- cholesterol were significantly higher both in parents and children of high-risk group. The means of FBS were significantly higher in fathers and offspring of high-risk families

Conclusion: cardiovascular risk factors are more prevalent and clustered in high-risk families. Screening of these families is essential to prevent progression of cardiovascular disease since childhood and reduce its burden in adulthood