Despite the legal prohibition of alcohol in Iran, consumption of non-standard and often toxic alcoholic beverages continues to present a significant public health challenge. Methanol poisoning and associated mortality underscore the urgent need to address alcohol-related harms through ethical and population-centered strategies. This analysis employs the three core goals of contemporary public health—autonomy, well-being, and equality—integrating both duty-based and outcome-oriented ethical reasoning to evaluate current responses and guide interventions. A public health approach is necessary to address ethical issues such as disproportionate impact on young adults and socioeconomically vulnerable groups. A public health centered approach that emphasizes prevention, protection, and health promotion provides opportunities to reduce harm, improve health outcomes, and empower individuals even within restrictive legal and cultural environments. Lessons from national experiences in harm reduction and public health interventions, such as programs for substance addiction and sexually transmitted disease control, particularly HIV control, demonstrate that effective and ethically grounded strategies are achievable even when such certain behaviors such as sex work or alcohol consumption are legally sanctioned or even criminalized. These experiences highlight the moral responsibility of public health authorities to protect vulnerable populations while promoting collective well-being through inclusive, evidence-based, and context-sensitive measures.
Ethical sensitivity is vital for nursing students as it affects decision-making and care quality. This systematic review and meta-analysis assessed ethical sensitivity among Iranian nursing students. For this purpose, databases (MagIran, SID, PubMed, Scopus, EMBASE, and Web of Science) were searched up to December 30, 2024. Observational studies reporting ethical sensitivity scores were selected, and scores were standardized to a 0–100 scale. Heterogeneity was assessed using I², and analyses were performed with STATA. Sixteen studies yielded a pooled ethical sensitivity score of 67% (95% CI: 62–72), with substantial heterogeneity (I² = 87.2%). Subgroup analyses (by publication year and language) and meta-regression (age, *Corresponding Author Simin Sharafi Address: School of Nursing & Midwifery, Moalem Sq., Birjand, Iran. Postal Code: 9717853577 Tel: (+98) 56 32 38 14 28 Email: siminsharafi@bums.ac.ir Received: 18 Sep 2025 Accepted: 9 Feb 2026 Published: 20 Jun 2026 Citation to this article: Ghanei Gheshlagh R, Dehvan F, Bigdeli K, Sharafi S. From theory to practice: a systematic review and meta-analysis of ethical sensitivity in Iranian nursing students. J Med Ethics Hist Med. 2026; 19: 6. sample size) identified no significant moderators, and sensitivity analysis and trim-and-fill confirmed the stability of the estimate. Based on the findings, ethical sensitivity among Iranian nursing students is moderate, which highlights the need for targeted educational interventions and enhanced clinical experiences.
The rapid growth of medical tourism, the provision of elective healthcare across borders, has raised complex ethical challenges. In Iran, the significant expansion of this industry can be attributed to advanced expertise and relatively low costs. This qualitative study examined the critical ethical issues in medical tourism in Iran through semi-structured interviews with purposively selected ethics scholars, managers, healthcare providers, facilitators, and international patients, using maximum variation sampling. Data were transcribed, analyzed, and refined through expert consensus, yielding 215 meaning units. Analyses revealed four thematic domains: rights and ethical entitlements of stakeholders; financial responsibility and economic equity; sociocultural determinants of ethical practice; and governance and regulatory accountability, with governance and regulation-particularly legislative gaps and weak coordination-emerging as the top ethical concern. Findings demonstrate the need for coherent policies and ethical frameworks to safeguard stakeholder rights, integrate ethics into planning, and align practices with both local values and global standards.
This study investigates the history of male castration, tracing its evolution from an ancient practice used for punishment and court control in civilizations like Sumer and China to a topic of sophisticated medical and ethical debate in the Persian world. The research highlights the important work of Persian physicians such as Rhazes, Avicenna, and Jorjani, who carefully recorded and improved surgical techniques—including total removal (hence the Arabic term Khasi, meaning “castrated”), and blood vessel ligation—within a detailed medical framework. Significantly, these scholars developed a strong and systematic ethical stance opposing non-therapeutic castration, condemning it as a breach of the body's natural, divinely ordained condition. *Corresponding Author Saeed Changizi-Ashtiyani * Address: Department of Medical Physiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.. Postal Code: 14496-14535 Tel: (+98) 912 19 63 253 Email: ashtiyani@yahoo.com Received: 3 Oct 2025 Accepted: 24 Feb 2026 Published: 3 Jun 2026 Citation to this article: Shamsi M, Asadi MH, Khosravi A, Ranjbar M, Zarei A, Changizi-Ashtiyani S. The unkindest cut: castration, power, and early bioethical deliberations in ancient medicine and the Persian tradition. J Med Ethics Hist Med. 2026; 19: 2. Although earlier traditions expressed concerns about bodily integrity, their incorporation into a formal medical-ethical system marks a key milestone in medical ethics. This established the mentioned physicians as prominent advocates for bodily integrity, a concept that has often been challenging to political authorities. By combining historical and medical perspectives, the paper argues that castration should not be regarded merely as a social custom, as it unintentionally facilitated early advances in surgery and endocrinology. Ultimately, the study underscores the ongoing conflict between medical ethics and political power, offering a nuanced insight into the interplay of science, morality, and authority throughout history.
Concepts of health and disease occupy a foundational position within medicine, shaping clinical decision-making, research agendas, public health policies, and ethical evaluation. Despite their differences, both naturalistic and normativist approaches to health and disease share an organism-centered orientation. While these frameworks have offered important insights, their underlying assumptions have become increasingly difficult to sustain in contemporary medical practice. Advances in medical technology have produced forms of embodiment in which implantable devices, long-term pharmacological regulation, neurotechnological interventions, and algorithmic decision systems play a constitutive role in regulating bodily functions and clinical judgment. In such contexts, technology can no longer be understood as merely external to a selfcontained organism. Drawing on the concept of the cyborg condition, this paper analyzes the growing interdependence between biological and technological elements in medicine. Against this background, the paper critically examines naturalistic and normativist theories, focusing on their reliance on biological norms and species-typical functioning. As technological interventions become pervasive, distinctions between natural and artificial, internal and external, and therapy and enhancement grow increasingly unstable. Rather than proposing a complete alternative theory, the paper highlights the limits of existing frameworks and argues for a more relational and systemic view in which health and disease are understood as features of human-technology systems.
Bullying behaviors may undermine ethical standards in clinical education. This study aimed to assess the prevalence of bullying behaviors in university-affiliated hospitals and to identify the characteristics of victims and perpetrators.This cross-sectional study was conducted among undergraduate medical students during the autumn of 2022. Data were collected using a validated and reliable researcher-designed questionnaire that assessed demographic characteristics, experiences with different types of bullying, perceived perpetrators, inquiries about seeking support, and awareness of preventive policies.Among the 297 participants (response rate: 72.4%; mean age: 24.50 ± 1.36 years; females: 65.3%; interns: 46.8%), 90.6% reported experiencing at least one form of bullying during clinical training. The most frequently reported types of bullying were psychological (81.1%), behavioral (80.5%), and verbal (61.3%). Internship and a self-declared history of psychological problems were associated with higher reports of bullying (P-value < 0.05). Residents (93.7%) and clinical faculty members (91.4%) were most commonly identified as perpetrators. These findings indicate that bullying in clinical education is a significant ethical issue that may undermine professional development and respectful clinical practice.The results underscore the need for ethically grounded institutional interventions to prevent mistreatment and support the students at risk.
This cross-sectional correlational study was conducted with 479 nurses working at educational and medical centers affiliated with Tabriz University of Medical Sciences in 2022-2023 to examine the relationships among social intelligence, moral courage, and resilience. Participants were selected using a multistage sampling method. Data were collected using validated Persian versions of the TSIS Social Intelligence Scale, Sekerka's Moral Courage Scale, and the CD-RISC Resilience Scale, with Cronbach's alpha coefficients of 0.75, 0.85, and 0.94, respectively. Data were analyzed using SPSS version 19. The findings showed that nurses had moderate social intelligence scores (94.98 +/- 14.55) and relatively high moral courage (78.99 +/- 17.98), while their resilience level was moderate to high (65.77 +/- 15.56). A positive and statistically significant relationship was found between resilience and both social intelligence and moral courage (P < 0.001). Given the importance of resilience in stressful nursing environments and the positive influence of social intelligence and moral courage on resilience, educational interventions focusing on these characteristics may help improve nurses' resilience.
Ethics is the systematic study of moral principles that guides conduct in complex social and professional contexts. In medical education, faculty members' professional ethics and communication skills are critical, since they influence student development and institutional success. This study examines the relationship between professional ethics and communication skills to inform faculty development programs. This was a descriptive-analytical, cross-sectional study conducted in 2023-2024 at Alborz University of Medical Sciences. It investigated the relationship between professional ethics and communication skills among 178 faculty members using validated Cadozier & Brown and Queendom questionnaires. Pearson's correlation, t-tests, and ANOVA revealed significant associations (P < 0.05) between ethics, communication, and demographic variables. Most participants were female (53.4%) and mid-career (35-45 years, 43.8%). The majority were assistant professors (78.7%) with medical specializations (60.1%) or PhDs (36.0%). Self-reported ethics (M = 65, SD = 5.7) and communication skills (M = 116, SD = 7.7) were high, with 85.4% and 96.6% rated "Good." A moderate positive correlation (r = 0.33, P < 0.01) was observed between the constructs, and listening skills were strongly associated with ethical dimensions such as honesty and empathy. Gender, age, experience, employment status, and rank influenced sub-dimensions, showing patterns. The findings revealed a significant positive correlation between faculty professional ethics and communication skills, shaped by academic rank, teaching experience, and employment type. Integrated training and supportive policies are recommended to enhance faculty communication skills and ethics.
Medicine in medieval Islam was not simply a technical trade but a crucial societal institution guided by moral values and collective obligations. At the heart of this institution lies the concept of trust. This study aims to conceptualize the formation and dynamics of trust in medieval Islamic medicine, using a qualitative, historical-analytical approach. For this purpose, we analyzed manifestations of trust throughout society in accordance with theoretical frameworks of trust across three interconnected levels of relationships: trust within the community of physicians, trust between people and physicians, and generalized or public trust in physicians. The study results show that the framework of trust in the community of physicians is widespread and is created through professional knowledge, ethical standards, medical ethics, collaboration, and medical practices within the community of physicians; trust between physicians and people is also typical and is a product of socioeconomic factors and reputation; and finally, public trust is pervasive and is formed through societal and cultural measures.
This study examined the barriers to complying with nursing ethics principles in adult intensive care units at teaching hospitals affiliated with Tabriz University of Medical Sciences and their relationship with caring behaviors in 2024. Using a descriptive-analytical design, 300 ICU nurses were surveyed through proportional random sampling. Data were collected via demographic forms, an ethical barriers questionnaire, and the Caring Behaviors Inventory (CBI-42). Results showed that the "individual and caring" domain had the highest ethical barrier score (52.36 ± 9.43), while the "workspace" domain had the lowest (20.56 ± 3.44). Most nurses (75.3%) perceived ethical barriers to be serious. Among the caregiving behaviors, "respect for others" had the highest score (56.93 ± 10.69), and "attention to others' experiences" had the lowest (20.02 ± 3.68). No significant correlation was found between ethical barriers and caregiving behaviors (P = 0.072, r = 0.104).Despite serious ethical challenges, the nurses in this study maintained acceptable standards of care. It is recommended to conduct further research into the specific ethical barriers subscales to better understand their influence on care quality and to develop strategies to improve nurses’ working conditions.
In the past decades, AIDS has represented one of the most significant global health challenges to mankind. Upholding ethics and respecting patients' rights play a critical role in enhancing treatment among individuals living with HIV/AIDS. This study aimed to evaluate the adequacy of ethical considerations in the HIV/AIDS care system guidelines in Iran. For this purpose, we critically reviewed the existing policies and the Anti-Stigma and Discrimination Bylaw. We extracted articles on ethical considerations and patients' rights and classified them according to the principles of bioethics and the professional responsibilities associated with medical practice.We found that the present guidelines address informed consent (except those related to childcare), confidentiality, and privacy. However, ethical issues such as capacity assessment, substitute decision-making, treatment refusal, and disclosure of diagnosis have been overlooked. Furthermore, a review of the Anti-Stigma and Discrimination Bylaw revealed a lack of guidance on non-discriminatory and equitable care for people of specific populations, such as drug users, female sex workers (SW), men who have sex with men (MSM), and healthcare workers exposed to HIV-positive patients.These findings highlight gaps and deficiencies within the guidelines in addressing the rights of healthcare recipients and emphasize the need for developing dedicated ethical guidelines for the care and support of individuals living with HIV/AIDS.
This study examines the collaboration between art and science in the history of modern anatomy education in Iran, particularly in the era following the establishment of Dār al-Funūn (1851). Using a historical-analytical approach and citation network analysis of primary sources, we trace the evolution of anatomical illustration from imitation of European texts to original creation. Our findings highlight the pivotal role of European physicians, such as Jakob Eduard Polak, in introducing modern anatomy and visual aids at Dār al-Funūn. We identify the publication of Kālbod-Shenāsi-ye Towṣifi (Descriptive Anatomy, 1944–1950 CE) as a key milestone, marking the first major physician-artist collaboration to produce original anatomical illustrations in Iran. However, the subsequent increase in reliance on foreign resources led to a decline in indigenous production, thereby representing a missed opportunity to preserve a unique scientific-artistic heritage in medical illustration in Iran. Ultimately, this trajectory reveals that, unlike the European Renaissance, where the mutual interest of physicians and artists in understanding human anatomy drove innovation, medical illustration in Iran was primarily propelled by physicians to meet educational needs.
This article traces the historical evolution of medical negligence from ancient outcome-based penalties to modern tort law. Employing a historical-analytical method, it examines primary legal texts—from the Code of Hammurabi to landmark cases like Bolam and Bolitho—and secondary sources to analyze this transformation. The findings reveal a shift from ancient codes that penalized results, through medieval guild regulation, to the common law's establishment of a duty of care and a professionally defined standard subject to judicial scrutiny. Modern developments, such as the rise of informed consent and defensive medicine, illustrate tort law's ongoing adaptation to the complexities of healthcare. The conclusion underscores that this journey reflects evolving societal expectations for reasonable medical care, balancing patient rights with clinical realities. Understanding this history is vital for contemporary debates on patient safety and professional accountability, pointing to future research into non-Western traditions as well as to challenges such as artificial intelligence.
Missed nursing care is a significant issue in healthcare systems that can compromise patient safety. The present study aimed to investigate the relationship between moral sensitivity and missed nursing care among nurses. This descriptive-correlational study was conducted in 2024. A sample of 120 nurses from the internal and surgical wards of educational hospitals in Urmia was selected using quota sampling. Data collection tools included a demographic information form, Lutzen’s Moral Sensitivity Questionnaire, and Kalisch’s Missed Nursing Care Questionnaire. Statistical analysis was performed using Pearson’s correlation coefficient, multiple regression, independent t-test, and one-way ANOVA in SPSS version 26. The mean score for moral sensitivity was 76.45 ± 4.7, and for missed nursing care, it was 46.45 ± 5.5. A significant inverse correlation was observed between moral sensitivity and missed nursing care (r = -0.25, P < 0.05). Additionally, education level and work shift were significantly associated with missed nursing care (P < 0.05). The findings indicate that higher moral sensitivity among nurses is associated with a lower incidence of missed nursing care. Therefore, it is recommended that managers develop programs to enhance nurses’ moral sensitivity to reduce missed nursing care and improve the quality of nursing care.
Defensive medicine, driven by fear of litigation, increases healthcare costs and physician stress, particularly in high-risk specialties such as surgery. This study investigates the attitudes and practices of faculty members and residents in surgical discipline regarding defensive medicine. In this cross-sectional study, 147 surgeons (faculty, residents, and fellows) from IUMS teaching hospitals completed a validated questionnaire assessing attitudes toward the ethicality of defensive medicine and the prevalence of defensive practices. Data were analyzed using SPSS version 24, applying chi-square tests, independent t-tests, and Mann-Whitney U tests.Nearly half of the participants (48.9%) considered defensive practices ethical. Common defensive behaviors included consultation referrals (47.6%), unnecessary laboratory tests (36.7%), and avoidance of high-risk procedures (44.3%). Key concerns driving defensive practices were non-expert judicial rulings (35.4%), stress related to high-risk patients (34.7%), and litigation costs (35.2%). Factors such as intervention type (32%) and lack of awareness of ethical standards (27.2%) were associated with increased defensive behaviors. General surgery (29.8%) and orthopedics (17%) reported the highest conviction rates. The results showed that defensive medicine is prevalent among surgeons at IUMS due to legal fears and low self-confidence.Enhancing targeted education and establishing clear ethical guidelines may reduce defensive practices and improve surgical care delivery.
Professionalism impacts professional identity, staff efficiency, and patient care quality. The purpose of this study was to evaluate the professional behavior and climate in a teaching hospital in Iran. A cross-sectional study was performed among faculty members, nursing staff, and specialized residents. The study used the validated 30-item "Medical Professionalism Climate in Clinical Settings" questionnaire developed by Asghari et al., containing two domains: adherence to professional behavior, and perceptions of the professional climate. Data were analyzed using SPSS version 26. The study population consisted of 271 individuals working at a teaching hospital, 44.3% male and 55.7% female, averaging 34.79 years in age.The results showed there was a relationship between the total mean score, the professional behavior score, the professional climate score, and the participants' professional titles (P-value < 0.001), as well as the duration of their work experience in the department (P-value: 0.005, P-value: 0.039, P-value: 0.001, respectively). The faculty members achieved the best scores, followed by the residents, nurses, and nursing assistants. Analysis of the professional behavior scores revealed strengths and weaknesses among the medical staff. More training is recommended to enhance skills and promote positive behavior to boost hospital staff's job satisfaction and sense of belonging.
Reexamining science journalism through the constructivist lens of Science and Technology Studies (STS), the present paper argues that this perspective promotes a more responsible approach to reporting scientific discoveries in medicine. The dominant anti-constructivist, realist approach often results in what we term "dramatic modalization," which attributes greater facticity and universality to scientific findings than they actually possess at the time of publication, leading to significant moral consequences.To illustrate this, we will first explore the STS perspective as a framework for understanding the construction of facts in practice. Next, through a discourse analysis of two historical cases in medical journalism—the MMR-autism link and the depression-serotonin connection—we will demonstrate that the realist media coverage of these cases engaged in dramatic modalization, resulting in tangible moral repercussions. We hereby propose an alternative STS model for science journalism in medicine, arguing that it offers a more morally responsible approach.
