Investigating the Moral Sensitivity of Medical Students in the Preclinical and Late Clinical Courses.

Background: Paying attention to moral issues is one of the essential requirements of medical practice, and moral aspects must be considered in making decisions to achieve the desired results and ensure the patient's satisfaction. Moral sensitivity is one of the components that enable physicians to act ethically in their decisions. Since medical students must acquire the necessary skills to deal with patients properly in clinical courses, the current paper examines the moral sensitivity of medical students in both preclinical and late clinical courses. Methods: This is a cross-sectional study performed on 180 medical students in the preclinical and late clinical course. The study tool is an adapted version of the Kim-Lutzen ethical sensitivity questionnaire with 25 items and Likert scoring 0-4. The obtained score can be between 0-100. Data was analyzed using SPSS25. Statistical t-test or its non-parametric equivalent (Mann-Whitney) was used for quantitative variables and Chi-square or Fisher exact tests were used for qualitative variables. Pearson's correlation coefficient was used to measure the correlation of the variables. Results: The mean age of stagers and interns was 22.7 + 0.85, and 26.5 + 1.11. 41 (51.2%) of stagers and 51 (63.7%) of interns had a history of participating in workshops related to medical ethics, and 4 (5%) of the former and 3 (3.8%) of the latter had previously conducted research in the field of medical ethics. there was a significant relationship between the stagers' history of conducting research in the field of ethics and their moral sensitivity. Concerning moral sensitivity components, the highest scores belonged to "altruism and trustworthiness", "the use of moral concepts in moral decisions", and "respect for the patient's autonomy" in both groups., 95% of stagers and 98.8% of interns had medium level (51-75) of moral sensitivity. Conclusion: Medical students' moral sensitivity did not increase significantly during the clinical course. It is necessary to review and reconsider medical ethics educational methods, the time allocated to relevant courses, and the practical need for clinical education in addition to theory. Directing research projects and student dissertations toward topics related to medical ethics can also contribute significantly to enhancing moral sensitivity.

To use or not to use? an ethical analysis of access to data and samples of a deceased patient for genetic diagnostic and research purposes.

Using genetic tests on deceased patients' samples for diagnostic purposes affects the family members' health and lives but raises some ethical issues in today's practice of medicine and research. In this paper, we address a common ethical dilemma of clinicians regarding whether to perform genetic tests on a deceased patient's sample upon a request from first-degree relatives against the patient's wishes in the last days of life. In this paper, a real case scenario is presented that echoes the above-mentioned ethical challenge. Reviewing the genetic basis of the case, the ethical arguments for and against the reuse of genetic material in a clinical context are discussed. An ethico-legal analysis of the case is proposed based on Islamic medical ethics resources. As reusing stored samples of expired patients without their consent also challenges the researchers in the field of genetics, a debate is included on the post-mortem use of genetic data and samples for research. Finally, defining the special features of the presented case and positive benefit-risk ratio, it is concluded that reusing the patient's sample may be justified if the first-degree family members insist on genetic testing and are comprehensively informed about the benefits and harms.

Error Disclosure Algorithms: How to Disclose Colleague's Medical Error at Individual and Organizational Levels.

Background: Medical error is one of the most important causes of mortality and morbidity in the health care system. Considering the significance of medical error management in the healthcare system, error disclosure is an imperative moral responsibility of medical and healthcare professionals from medical ethics experts' perspective. In literature, no or inadequate protocols were suggested for disclosing colleague's medical error; and hence, this study was conducted to provide two algorithms for colleague's medical error disclosure at individual and organizational levels. Methods: This study conducted a narrative review on several valid Internet databases, including PubMed, Science Direct, and Scopus. First, the literature on the colleague's error was reviewed using articles of the last 20 years focusing on medical errors and error disclosure keywords. Next, two algorithms were developed for the colleague's error disclosure for individuals and with the assistance of organizations, respectively. Results: If we personally notice a colleague's error at an individual level, we should plan for a conversation to encourage the colleague to inform the patient or the related organization about the error. If we notice a medical error from a colleague relating to an organization, we should decide based on circumstances considering the organization's responsible parties for handling error disclosure. Conclusion: This study proposes a simple protocol for detecting peer error at the individual level and at the organizational level, using the existing literature. However, the improvement of these types of methods requires analysis of the specific conditions of each health system.

Ethical considerations and interdisciplinary approach to research on COVID-19 pandemic: The response of Iran University of Medical Sciences.

Background: Research ethics committees are comprised of policymakers, supervisors, and decision-makers and aim at increasing adherence to professional ethics standards in conducting health-related research. The existential philosophy of these committees is to preserve the patients' health, maintain and promote public trust in health care providers, protect the rights of both patients and health care providers, and promote organizational ethics. However, this task can be complex and challenging during a public health emergency. Research ethics committees set the standard of research in the emergency situations through defining which research has the potential to promote the quality of response to a public health emergency. Methods: This study aims at collecting and classifying the valuable experiences of the research ethics committee members and reviewers during the early days of the COVID-19 epidemic in Iran University of Medical Sciences, one of the major universities in Tehran. It provides a basic understanding of the key concepts and challenges in reviewing and approving research by research ethics committees and the recommendations to overcome these challenging issues. Results: To accelerate the review process of COVID-19 research proposals, the scientific, methodological and ethical review panel was integrated as a large committee called 'IUMS Corona Research Team'. The first meeting was held on March 7, two weeks after the official announcement of the first case of the disease and is continued once a week. A total of 130 projects have been discussed and evaluated in this committee, among which 83 proposals were approved after modification. Conclusion: An interdisciplinary approach supports a flexible and effective scientific and ethical review of research leading to more protection of research subjects as well as promotion in the treatment and management of the pandemic ahead.

Confidentiality challenges surrounding plasma therapy during the COVID-19 pandemic: a case discussion in Iran.

Maintaining confidentiality, both in national and international codes of ethics, is considered an important principle in healthcare and the medical profession for both patients and physicians. This case-report article focused on a real case. Based on the request of the Iranian Blood Transfusion Organization (IBTO) for plasma donation from recovered COVID-19 patients, we asked the names and personal information of those patients from hospitals affiliated with Iran University of Medical Sciences (IUMS) and arranged for the subjects to be referred to the Medical Ethics Department of IUMS for consultation during the COVID-19 pandemic. Various ethical and legal aspects of this case were discussed in a special meeting, and practical solutions were then provided considering the limits of confidentiality and conditions for ethical access to patients' information during a pandemic. Since plasma therapy is not a definitive cure for COVID-19 and considering the ethical and legal points presented in this article, it is not recommended to announce the names of patients in the early stages. Given the potential impacts of the procedure and the possibility of patients being cured, however, their consent should be obtained in different situations and, if necessary, providing information to patients or educating them should be considered.