Priority-setting for early access to COVID-19 vaccines in Islamic Republic of Iran.

Background: Priority-setting for early access to vaccines during a pandemic optimizes the impact of vaccine rollout, however, low- and middle-income countries (LMICs) have little experience in policymaking on this. In the Islamic Republic of Iran, the national clinical ethics committee developed a policy for early access to COVID-19 vaccines with support from the national committee on COVID-19 vaccine. Aims: This paper reports the process and results of a national COVID-19 vaccine priority-setting in the Islamic Republic of Iran and discusses its ethical and cultural aspects. Methods: A multidisciplinary team of experts planned and developed a national guideline following an extensive literature review and face-to-face consultations. Results: We present the list of priority groups and subgroups, tiered through a 4-phase process, as well as the ethical values and sociocultural issues underpinning COVID-19 vaccine prioritization in the Islamic Republic of Iran. Conclusions: Our experience shows that a transparent and well-reasoned policymaking process can inform fair prioritysetting for pandemic vaccines, especially in LMICs.

Access to health care for Afghan immigrants and refugees: an ethico-legal analysis based on the Iranian health law system.

The right to health is an internationally recognized and established human right with a long history of appreciation, indicating that governments should guarantee the highest possible level of access to health and provide health-care serivces with no discrimination based on nationality, race, gender, language or religion. The present study explored this topic using an analytic-descriptive approach. We reviewed related laws, policies and other available documents with the aim to investigate the ethico-legal aspects of Afghan refugees' and immigrants' access to health care and the challenges in in this regard within the Iranian health law system. According to the results of this study, the Iranian health law could be interpreted to include all Afghan immigrants in the country's public health system as a legal commitment. In addition, while basic and primary health coverage is available for all Afghan immigrants in Iran, provision of other medical and rehabilitative health services to documented and undocumented immigrants follow different methods. In order to alleviate the current situation, we recommend strategies such as supporting policy changes intended to register undocumented immigrants, which naturally results in an increase in their access to health care.

Priority Setting of Ventilators in the COVID-19 Pandemic from the Public's Perspective.

Background: Ventilator allocation plan for a public health crisis should be developed through recognizing the values of society and engaging the general public. This study was conducted to assess the Iranian citizens' attitude about some principles and criteria for allocation of ventilators in the current COVID-19 epidemic.Materials and Methods: An electronic self-administered questionnaire was publicly distributed through social networks of Telegram and WhatsApp to perform this cross-sectional study. The questionnaire consisted of 11 statements about the selection and prioritization of patients for the use of a ventilator.Results: 1262 persons, including 767 citizens and 495 health care providers participated in this study. More than 95% of participants agreed upon the necessity to avoid discrimination and avoid prioritization according to patients' gender, economic and political status. While 40.9% of citizens and 49.6% of healthcare workers believed that a ventilator can be disconnected from a patient with a poor prognosis to help another patient who has a better prognosis (P-value = 0.13), 34.3% of people and 29.6% of healthcare workers believed that the earlier admitted patients have the right to receive the device even if the likeliness of his/her survival is less than the next patient (P-value = 0.009).Conclusions: Maximizing health benefits as a measure of ventilator allocation in the pandemic of COVID-19 is an accepted criterion. Meanwhile, periodic evaluation of patients and disconnecting the device from a patient that no longer benefits from ICU services requires its scientific and ethical basis to be brought in public discourse.

The second strategic plan of medical ethics: a national report.

Medical ethics faces several challenges in different aspects of education, research, and treatment in medicine and healthcare practice. Design and implementation of a national strategic plan can pave the way for the development of a roadmap in various countries to strengthen ethics and address these challenges. To create a comprehensive plan compatible with the Iranian healthcare system, a multidisciplinary team of main stakeholders compiled a national strategic plan of medical ethics following several focus group discussion sessions and two workshops (2014-2017). Ultimately, the plan was confirmed by the Supreme Council for the Medical Ethics of the Ministry of Health and Medical Education. The current paper is a national report of the process and the medical ethics strategic plan in Iran. We have also tracked signs of progress and achievements in the country. In conclusion, this valuable effort has led to significant success in the implementation of medical ethics in clinical medicine, medical research, and education by using all the resources in our country. The participation of all the stakeholders, especially healthcare professionals in this way is required.

Iranian Society of Asthma and Allergy Codes of Professional Ethics.

The advances in science and technology in recent decades, especially in medical sciences, have raised new ethical challenges. Hence, professional organizations in the field of medical science are trying to develop regulations in the field of medical ethics to help medical science professionals in making the best decisions in different circumstances and moral dilemmas. The organizations also try to monitor their performance using those regulations. On the other hand, due to the specialization of medical science as well as the complexity of communication between these disciplines, there is a growing need for regulations to answer questions and resolve the challenges of each discipline. Certainly, scientific societies, due to benefit from relevant specialists, are the best reference for the development of specialized guidelines, one of which is the Iranian Society of Asthma and Allergy (ISAA). The aim of the current study was to develop codes of ethics for ISAA members, using a qualitative study. Generally, the ISAA codes of professional ethics consists of general and specific sections. In order to compile the general section, the upstream medical documents, including the patients' rights charter in Iran, the research ethics guidelines approved by the Ministry of Health and Medical Education (MOHME), ethical codes from the international societies of asthma and allergy, the general codes of professional ethics of the Iran Medical Council and the Islamic jurisprudential rules and the statute law of the country were used. To develop specific sections, we interviewed the experts in the field of Asthma and Allergy about the ethical challenges they had ever faced with. The ISAA codes of professional ethics developed in five chapters, entitled "Ethical Guidelines for the Mangers and Director of the Society, General Guidelines, Specific Guidelines, Ethical Guidelines for Research and Education, and Procedure for Supervision on the Professional Behavior of the ISAA Members", and approved by the board of directors of ISAA.

Design and Development of Dentistry Ethical Codes: Proposed for National Implementation in Iran.

OBJECTIVES: The dental profession has a special place of trust in the society, and dental clinicians must adhere to ethical standards in all dental procedures. Ethical conduct is one of the main expectations of individuals from this profession. The aim of this study was to design and develop dental ethical codes for national implementation in Iran. MATERIALS AND METHODS: This qualitative study was performed using directed content analysis method and purposive sampling. Data were collected until saturation through 15 semi-structured face-to-face individual interviews and two expert panels with academic staffs from dental faculties in Tehran, Iran. RESULTS: Data were classified into five principles and 90 codes. The principles included consideration of patients' interest as a priority, respect for human dignity and patient autonomy, confidentiality of patient information, the excellence of knowledge and skills, and building trust. CONCLUSION: The ethical codes for Iranian dentists were drafted considering Islamic teachings and the prevailing culture. Some codes were exclusively developed for the cultural atmosphere of Iran especially on topics such as interaction with patients previously treated by other dentists. Some codes addressed the principles of consultation and continuing the therapeutic communication with such patients. Some items have not been considered in codes released by other associations, such as religious considerations in Islamic cover and alcohol consumption that were taken into consideration in this draft. These codes can serve as a guide for professional practice of dentists. It seems that these sets can help us reach the standardized code.

Physicians' attitude toward their ethical responsibility regarding air pollution: a qualitative research.

Air pollution is among the environmental problems that adversely affect people's health. There is a close relationship between medicine and environment, and as a consequence, there are ethical considerations surrounding the problem of air pollution. The present research aimed to determine physicians' attitude toward their ethical responsibility regarding air pollution, and their role in reducing it. This was a qualitative research using content analysis, conducted in Tehran University of Medical Sciences. The focus group included 21 physicians with specialties and subspecialties in pediatrics, infectious diseases, pulmonology, gynecology, and midwifery selected through predetermined sampling along with 13 personal in-depth interviews. A number of questions were asked regarding physicians' ethical responsibility to decrease environmental crises, particularly air pollution. As a result, 4 themes and 20 subthemes were extracted by assessing the focus group and interviews. These four general themes included the role of a physician as 1) an ordinary person, 2) a special citizen and a role model, 3) a professional person with special personal and social commitments, and 4) an administrator of the healthcare system. In the present research, physicians acquired a special attitude toward air pollution. The research population mentioned physicians' impact as role models for the society, as well as their educational, supervisory, informative, promotional, and administrative roles among their most important obligations regarding air pollution. It is recommended to conduct further studies on physicians' knowledge, attitude and practice regarding their responsibility toward environmental issues in order to investigate this important matter further.

A survey of the complaints entering the medical council organization of tehran in three time periods: the years ending on 20 march 1992, 20 march 1997 and 20 march 2002.

One of the most important occupational tensions a physician encounters in his/her practice is the complaints lodged against him/her by the patients. The purpose of this study is examining the complaints against physicians and dentists entering the Medical Council Organization of Tehran in the years ending on 20 March 1992, 20 March 1997 and 20 March 2002 from the viewpoint of number, dispersion and inducing factors. The present study was performed as a descriptive and retrospective one with the aid of a questionnaire containing concerned data. Filling in the questionnaire or studying the file was accomplished by a trustee expert of the Medical Council Organization and the data obtained were analyzed after classification. During a 3-year period, 832 complaints were lodged against physicians and dentists. The complaints against physicians in the years ending on 20 March 1997 and 20 March 2002 were 70% more than that in the year ending on 20 March 1992. 83.1% of the physicians and dentists of Tehran that were sued had not been convicted until the date of the performance of the study, on the basis of the contents of the files, and had no malpractice from the vantage point of the Medical Council Organization. The most common causes of complaints from the viewpoint of complainers were therapeutic errors (38%), neglect (30.2%), financial affairs (25.4%) and the physicians' lack of skill (17.7%). On the basis of this study, with the increase of the doctor's practice track record and experience more than 15-20 years, the number of the complaints decreases and most of the complaints are against the middle-aged doctors/dentists with 10-20 years of experience. Most physicians and dentists of Tehran having been sued have not committed any wrong from the vantage point of the Medical Council Organization experts and a large part of the complaints are a consequence of doctor-patient inconvenient interactions. A behavior based on professional commitment of the physician/dentist vis-à-vis the patient can hinder a major part of complaints.