Background and Aim : Marital infidelity is a shocking issue for couples and families and a common phenomenon for counselors and therapists. Extra-marital relationships create a lot of havoc for couples. Most people have come to expect monogamy and abstinence from extra-marital relationships. Due to the complex nature of infidelity and its catastrophic effects on the spouses’ relationships, it is necessary that some effective interventions be carried out to help the couples facing this problem. Recent studies indicate that forgiveness is a psychological construct and a therapeutic approach to deal with communication problems and conflicts between the married couples. Couples who forgive each other’s mistakes will experience higher satisfaction and commitment. In addition, forgiving our own and other’s mistakes will reduce stress, blame-casting, hostile behavior, and aggression in interpersonal relations. Hence, people will experience more compatibility and healthier relationships. Emphasizing it as a trait for the believers, Islamic literature refers to forgiveness as a therapy as well. Forgiveness therapy is one of the approaches used in the field of controlling and treating the responses to marital infidelity. In the Holy Quran, forgiveness is considered among the characteristics of the righteous believers, and it is pointed out that those who forgive other people’s mistakes are more pious. Inviting the believers to forgive each other, Allah in Surah Al-Imran (verse 134) warns them against revenge, malice, and enmity towards each other, stating “They contain their anger and forgive the people; Allah Almighty loves the benevolent and righteous people”. In some other verses, by patterning that Allah forgives His servants, the believers are called to go after this method. That is, the Muslims are asked to, just like their Creator, forgive the offenders and their sins. Allah in Surah An-Nur (verse 22) states: “Forgive and overlook, do you not love Allah to forgive you; Allah is Forgiving and Merciful.” Considering the need for observance of ethical principles in the Islamic society, particularly about the relationship with other people, which is also emphasized in the Quran, the importance of forgiveness in personal and social life is made clear. Therefore, the present study aimed to evaluate the effectiveness of forgiveness-oriented group counseling based on Islamic perspective to restore the marriage relationship after marital infidelity in married women who referred to counseling centers in Tehran. Materials and Methods : This study is a randomized clinical trial. The statistical population of the study consisted of the women who referred to counseling centers of Tehran in 2015 due to their husbands’ infidelity. Thirty women were randomly assigned (randomly assigned through groups matching based on the originally obtained data) into one intervention group and one control group. Having conducted the pre-test using the forgiveness questionnaires, the intervention group took part in nine weekly sessions of forgiveness therapy based on the Islamic perspective. Then, the post-test was carried out using the same questionnaire for both groups. To collect the data, the forgiveness (amnesty) questionnaire was used. Rye et al. (2001) devised a 15-item forgiveness scale. Higher scores on this scale indicate forgiving the people regarding the annoying issue. The answers were designed on a Likert scale of 5 degrees from “strongly” (1) to “not at all” (5). Rye et al. (2001) compared this scale with Enright forgiveness index. A relatively high correlation was obtained using the matching method. Its Cronbach's alpha was calculated as 0.96 in Zandipour and Yadegari’s research (2009). The reliability of this instrument was calculated in the present study as 0.81 and 0.78 using Cronbach's alpha and split-half methods, respectively. The data were analyzed in SPSS 18 software using such descriptive statistics as mean and standard deviation as well as inferential statistics such as analysis of covariance. Ethical Considerations : After presenting the research objectives, emphasizing the confidentiality of the information and obtaining patients' verbal consent to participate in the study, the questionnaires were distributed among the participants to be completed. Findings : The mean ages of the participants in the intervention and control groups were 33.41 and 35.32, respectively and the mean durations of their marriages were 9.11 and 10.33 years, respectively. The t-test did not show any significant difference in demographic characteristics between the two groups (P>0.05). The pre-test and post-test mean scores for forgiveness in the intervention group were 18.33 and 34.33, respectively. Investigating the assumption of normality of the scores indicated that this assumption was not rejected, and parametric tests can be used (P>0.05). The Levene test for equality of variances was run for forgiveness and it was calculated as 0.76 for the pre-test (P = 0.17>0.05). Given the equality of variances, analysis of covariance showed that forgiveness-oriented group consulting based on Islamic perspective has a significant effect on increasing women's willingness to forgive (P<0.01). Conclusion : The results of the present study revealed that forgiveness-oriented group consulting based on Islamic perspective (Quran and Hadiths) was able to improve the amount of forgiveness in women affected by unfaithful husbands. The findings of the study signified using forgiveness-oriented group counseling based on the Islamic perspective in planning therapeutic interventions. Since the children of families affected by infidelity witness many conflicts and lots of turmoil and suffer from many problematic effects of infidelity, it is recommended that some psychotherapy sessions be held for their children as a priority and the results of the sessions be discussed. It is also recommended that the number of psychotherapy sessions for the affected couples be increased. As a result, a more comprehensive training is offered and repetition and practice will improve the skills and the durability of the changes. Please cite this article as: Kargar Khoram Abadi H, Khodabakhsh MR, Kiani F. Effectiveness of Forgiveness- oriented Group Counseling based on Islamic Perspective to Restore the Marriage Relationship after Marital Infidelity. Med Ethics J 2017; 10(38): 29-36.
Background and Aim: One of the challenges for women's reproductive health is unsafe abortions resulting from unwanted pregnancies. The losses due to abortion complications are sometimes irreparable and their imposed costs to the health system is high. The aim of this study was to explore various aspects of abortion and related health policies in the world. Materials and Methods: In this review, observational studies published in Persian and English were searched in Google Scholar, PubMed, Iranmedex, SID databases and WHO website using the keywords and or politic, in the time limit of 2010-2015. After the initial assessment, abstracts of articles were studied, and duplicates and irrelevant articles were removed. Finally, the full text of 21 articles in Persian and 38 articles in English were enrolled and analyzed. Ethical Considerations: Honesty in the literature and citation analysis and reporting were considered. Findings: Abortion pattern has long been the same around the world and women accept the risks of abortion when they face with unwanted pregnancy, despite the legal bans. According to reports, 22 million unsafe abortions occur around the world annually among which 98% occur in developing countries. Abortion has been prohibited in various religions except in special cases. But social changes and socio-economic participation of women lead to their incompatibility in the theoretical and practical aspects and women apply to induced abortion without regard to the rules. Legal aspects of abortion has been included threatening the mother ’ s life, rape, and fetal abnormalities, but obstacles such as lack of information, third party permissions, elimination of insurance coverage, lack of access to providers or their beliefs has limited access to the safe abortion. Despite restrictive policies, developments occurring around the world have been caused increasing requests for unsafe abortion and therefore associated maternal mortality and morbidity rates in the different continents and countries. Conclusion: Developments of abortion laws from 1996 to 2013 represents an increase in licensing of therapeutic abortion in almost all legal areas that approximately two third of the countries in the cases of physical and mental endangerment of the mother health, half of the cases of pregnancy resulting from rape and anomalies, and only one third of the countries for socio-economic causes or due to the requests of the women are allowed to implement abortion. During this period, 56 countries have increased legal bases of abortion. While 8 countries have reduced the legal fields in a way that policy constraints in developing countries than in developed countries, has been 4 times higher. Studying the abortion laws and the situation in different continent and countries show that most European countries except Malta permits abortion in all fields of law. Abortion rate is between 1.4 and 25.5 per thousand women of childbearing age in Europe and lowest in Austria and highest were observed in Estonia. However, in European countries achieving legal permission for abortion needs certain circumstances, for example, in France less than 12 weeks of pregnancy, 10 weeks in Portugal, 90 days in Italy, 18 weeks in Sweden, 22 weeks in the Netherlands, and less than 24 weeks in Finland after fertilization is deadline for abortion licensing. Among different countries in the America region, the Dominican Republic, El Salvador, Nicaragua and Chile, abortion is not permitted in any area. On the contrary, in Cuba, Mexico, Canada and America in all fields abortion is licensed. The lowest abortion rate has been reported in Mexico as 0.05 and the highest rate as 28.9 per thousand women in Cuba have been recorded. In Africa, the annual rate of induced abortions has been between 2003 and 2008, from 5.6 to 6.4 million, much of it in East Africa and lowest in southern Africa have been happened. The situation in Asia indicate that although most residents are Muslims, and in Islam viewpoint abortion without indications for treatment is religiously forbidden, but since in the two countries of India and China, abortion in all areas of law is legal and most of the women live with free abortion laws, most abortions are observed in south Central and east Asia, and the annual number of abortions in Asia has increased between 2003 and 2008, from 25.9 million to 27.3 million. In Iran there are no accurate statistics of the unsafe abortion. There is a wide range of behavior among the people because of its functions, and dysfunctions of the related structures. The findings suggest that severe restrictions on access to services related to the abortion has not only failed to prevent it, but also increased unsafe abortions by unskilled people and even cause women to migrate to other countries for this action. There is no accurate statistics regarding the rate of abortion, even in countries with free policies. Hence, more research is needed to learn about various aspects of the abortion completely. Also, preventive policies in this area are helpful. So that using primary measures such as increasing health literacy in communities, the establishment of programs to protect the poor and vulnerable groups, increased counseling facilities appropriate to increase women's awareness about spacing between births, sexual education of young people and couples, facilitates the process of marriage, educational programs about the complications of abortion, increased monitoring of offices and private training health care providers about the areas of abortion law and the conditions of safe abortion and access to services, and postoperative care miscarriage, abortion and its adverse consequences can be prevented. Regarding social changes, policies must be based on understanding the social determinants of health. Facilitating consultation and lawful grounds for abortion, and access vulnerable groups to reproductive health services is recommended. Please cite this article as: Fathnezhad Kazemi A, Sharifi N, Khazaeian S, Ramazankhani A. Various aspects of abortion and related policies in the world. Med Ethics J 2017; 11(39): 75-89.
Background and Aim : Human capital is the most critical strategic element and most basic way to improve the performance and efficiency of the organization. Human resources committed and loyal to the goals and values of the organization is not only considered as a factor positively affecting the organizational excellence, but also a sustainable competitive advantage for many organizations. Considering the importance of human resources, it is obvious that human resources, in addition to having skills and expertise, should have high sense of belonging and commitment so that health system goals are achieved. Organizational commitment is among constructs that affects the behavior of employees in organizations. It also affects many organizational variables such as employee relocation intention, clinical practice, organizational behavior, absenteeism rate as well as job conflict and stress. Components such as attaching importance to organizational goals and values, a sense of belonging and loyalty to the organization, replication and identification with the organization and the desire to stay in the organization are the core of the organizational commitment construct. According to the desirable results of employees' organizational commitment, organizational commitment has special place in many studies and attitudes and its different aspects have been taken into consideration. This study aimed to determine the organizational commitment of nurses working in hospitals of Arak city in 2016. Materials and methods : In this descriptive-analytical study, 176 nurses were enrolled in the study using simple random sampling. The main inclusion criterion was having a university degree in nursing. To collect data, Allen and Meyer's Organizational Commitment Questionnaire was used. The questions included 24 questions in three dimensions (affective, intellectual and normative commitment). Each dimension consisted of 8 questions that measure the organizational commitment based on 5-point Likert scale ranging from “Strongly Disagree on one end to Strongly Agree on the other. The scores obtained from this questionnaire ranged from 0 to 100, and the best score of this instrument is 100. A demographic questionnaire relates to the characteristics of the subjects, which consists of questions related to gender, age, marital status, education, employment history and employment status. The reliability of the Organizational Commitment Questionnaire (OCQ) in three subscales of affective, continuance, normative commitment was confirmed by Abbaszadeh in his PhD thesis in 2011 with Cronbach's alpha of 85%, 79% and 77%, respectively. The reliability of questions was evaluated and confirmed in a sample size of 20 and Cronbach's alpha equal to 86%. To ensure the validity of the questionnaire, which were used by various researchers (including Bahrami, 2011, Abbaszadeh, 2012), the researcher used the opinion of 10 professors of the field. The process collecting data from all hospitals lasted for 15 days. Data were analyzed using descriptive and inferential statistical tests in using SPSS v.16. Ethical considerations : Participants' oral consent to participate in the research was obtained and they were assured about the anonymity of the questionnaires about the confidentiality of their information. Findings : The average age of participants and their age range was 28 years and 20-50 years, respectively. Female and male participants accounted for 88.3% and 11.7% of the subjects, respectively. The average overall organizational commitment score was estimated 77.77%. Among organizational commitment dimensions, affective commitment has higher average (6.30±26.77) and continuance commitment (with an average of 2.79 ±25.80) and normative commitment (with an average of 4.51± 25.19) were at a moderate level. Of the total subjects of study, 2.3%, 25.6%, 68.1% and 4% of the participants obtained too low, low, high and very high commitment score, respectively. Fisher's exact test showed that there was a significant positive correlation between organizational commitment and type of employment and work experience (p 0/05). Discussion and Conclusion: Considering average-to-above organizational commitment of nurses and their higher affective commitment than the other dimensions of organizational commitment, the findings provide valuable guidance to researchers and managers to effectively increase the organizational commitment of nursing staffs and ultimately increase their organizational attachment and to improve the quality of services provided to patients. Affective commitment represents employees' affective bond, their identification with the values and goals of the organization and the extent of their involvement with the organization. Therefore, employees who have strong affective commitment maintain their membership in the organization and continue to work in the organization. On the other hand, the normative commitment implies a sense of faith and commitment to stay in the organization and individuals who have this kind of commitment, believe that they should continue working in the organization. They also feel obliged to stay in the organization. Therefore, strengthening the normative dimension can prevent the turnover of nurses in the workplace. Continuance commitment also reflects the costs of leaving the organization compared to the interests of staying in it and the individual who has continuance commitment will likely leave the organization and join new organization by comparing investments and income obtained from new business. Holding in-service training sessions, division of labor based on merit and competency, continuous performance assessment and focusing on the abilities and talents of nurses usually have a role in enhancing the normative commitment. So, given the above-to-average organizational commitment of nurses, it is essential to identify the factors hindering the improvement of organizational commitment of nurses to an excellent level and senior managers adopt mechanisms to strengthen and improve their organizational commitment. Please cite this article as: Khosravani M, Khosravani M, Rafiei F, Mohsenpour M. Organizational commitment and its dimensions in nurses working in Arak’s hospitals. Med Ethics J 2017; 11(39): 37-44.
Background and Aim: Researchers tend to understand children’ response to disease, hospitalization and their health and disease experiences for various reasons. The importance of information has increased the demand for qualitative research on children in order to gain sufficient and deep knowledge and understanding of their insights in this age group about health and disease so that we can plan for better physical, mental care and finally improve their quality of life by acquiring of necessary knowledge and information. Although ethical considerations in qualitative research are similar in different groups, ethical considerations are critical in this group considering the complex process of qualitative research and children’s vulnerable nature. This study was designed to determine the ethical considerations in qualitative research with children’s participation. Materials and Methods: In this review, Persian and English articles published in Scopus, PubMed, SID, Irandoc, Magiran and Google Scholar databases were searched with no time limit using main keywords of "Ethical Considerations and Qualitative Research "or" Qualitative Research and Children ". The title and abstract of all articles were studied, duplicate and non-related articles were deleted, and contents of related articles were later analyzed. Ethical Considerations: This study has been approved by the Vice Chancellor for Research and Technology, and Ethics Committee of Shahid Beheshti University of Medical Sciences with the identification code: IR.SBMU.RESEARCH.REC1395.514. Publication of the results is carried out without bias, honestly and by citing the original reliable resources and references. Findings: Review of extract studies revealed general principles and ethical considerations in qualitative research with children’ participation are similar to other qualitative research and include attention to children’s participation, obtaining informed consent, ability to establish friendly and honest relationships, confidentiality and researcher’s sensitivity regarding publication of information and the imbalance of power. Conclusion: The findings suggest that the ability to establish a friendly relationship and win the child's trust play a very important role in the child's active participation in the research process as well as reducing the imbalance of power between the researcher and the child. So, it is essential to directly obtain information from the child. Obviously, the participation of children in research play a very important role in empowering and valuation to view of this vulnerable group. Thus, children' research must be carried out in a valuable, supportive and safe environment using appropriate methods to support their social and mental abilities, so that children easily express their opinions. Obtaining informed consent is an ongoing process that requires researcher’s patience and the guarantee that the child has understood the necessary information. In fact, obtaining children’ consent and encouraging them to make a decision strengthen the right to participate in or withdraw from the study, even if the parents are not willing to participate in the study. Therefore, the researcher must ask children in the process of research regarding their consent and participation in the study and must pay attention to their body language and gestures. The ethical principle of confidentiality of information is the challenging part because most children are not independent of their parents; therefore, interviewing with children alone is associated with some problems. Sometimes a child may also disclose information and researchers in support for vulnerable children, are forced to disclose certain informationin some cases. Two other very important concepts in the process of qualitative research with children’s participation include freedom, power, and thus an imbalance of power between researcher and participant. Establishing a friendly false relationship is immoral, so the way in which the researcher introduces him/herself, the language and clothes used and body language and manner of interacting with children have an impact on their relationship. The difference in children’s perception and experience of the world’s, compared with adults, and their different ways of communication, make it different and challenging to implement and observe ethical principles. Long tradition of the research on children mainly focused on getting information from families and caregivers instead direct research on children. Today, researchers should know that the concept of children research is defined as study ‘’with’’ child instead of "on" child. This fact highlights the importance of Children's participation and consent in the process of research. Even if researchers attend to active participation of children in the process, the concept of vulnerability is still dominant in them that require more caution for children's participation in the research. Children’s research must be conducted in a supportive and safe environment using appropriate methods, but different from adults, in order to support their social and mental abilities, so that, children easily express their opinions. The researcher must frequently review the thoughts and process through self-reflection and ask questions regarding whatever is doing in this process. Also, the researcher must clearly explain his/her motivation regarding the involvement of children. He must win trust and honesty of adults responsible for children and to do so, all forms of applied ethics should be completed in research and child-centered approach must be used in their study. Also, in qualitative research with children’s participation, in addition to the fact that methodology and ethical considerations should be assessed by knowledgeable individuals, the Research Ethics Review Committee should carefully examine the capacity and strength of children in a proposed research project. Please cite this article as: Moosavi S, Hasani P. Ethical considerations in qualitative research with children's participation. Med Ethics J 2017; 11(39): 63-73.
Background and Aim: Human rights issues are based on human dignity. In this regard, Rights of the Child are considered by most of world's organizations and the scientific communities. Different types of child punishment are prohibited according to international conventions as well as national legislation. Historically, the first legal action to protect the rights of children was taken in 1924. Then rights of the child were briefly referred to in the Universal Declaration of Human Rights approved in 1948. Afterwards, United Nations General Assembly adopted, in a resolution, the draft prepared by the Human Rights Commission under the Declaration of the Rights of the Child in 1959. Iran is also among the states that signed and approved this declaration in 1993. However, child abuse has become a global problem and violence against children is one of the major challenges for health care providers that has endangered their physical and mental health and creates serious problems for them in the future. According to Islamic-Iranian culture, children counts as trust and the family is responsible to take care of them and strive for their excellence. This study aimed to analyze a case of child abuse in 2016 with an ethical approach. Materials and Methods: In this case study, a real case was referred to Tehran Children Medical Center in a monthly session of medical ethics, and the ethical analysis was later carried out based on ethical considerations raised by the medical staff and specialists in various fields. The case is a 5-year-old boy who was physically abused and was brought to the emergency department at Children's Medical Center in the morning due to the multiple fractures in different parts of the hands as well as cigarette burn caused by his parents in his hands and feet. According to his mother, she first noticed the swelling of the child's hands and referred to the physician. After exact examination and radiography of the child's body, physicians noticed old and new fractures in the arm, the elbow and wrist. The mother claimed that the child's fractures were caused by falling off the swings and slides. The physicians also saw scars of old wounds on the child's head, as the mother claimed, they were caused as a result of fractures associated with falls. The child's physical examination showed that part of the back and posterior side of the thigh of one of his legs was burned and traces of cigarette burns were seen on one of the child’s hands. Thus, physicians requested help from forensic experts. After examining the child's condition and examining him thoroughly, they, while acknowledging the child physical abuse, found that the victim underwent sexual harassment by some of the family boys. Ethical considerations : While observing honesty in the case report, attempts were made to respect the confidentiality of personal information of the case and his family. Findings : The mother has rejected the occurrence of physical child abuse in the form of for multiple fractures in areas of the hands and feet as well as multiple burn cases on the child's body and tried to mislead the medical staff. Investigations suggest that the child's father was responsible for the physical abuse, but the mother denied it. On the other hand, the mother tried to hide the child molestation by male relatives, and following this sexual abuse, the father also resorted to unethical manner and has punished the child rather than appeasing and supporting the child as well as denouncing the actions of those who commit this immoral act. Employees participating in the study, said that it is essential to examine all surfaces of the child's body in cases of child abuse. It is essential to monitor vital signs of the abused child, particularly his temperature because high temperature could be the reason for this accident and the fact that child abuse is committed through exposing him to high temperature. Physical examination must also include any examination of external genitalia and anal area. Considering that the sexual abuse is a hidden conduct, if there is suspicion of rape, the assessment is necessary. The child's privacy must be respected during a physical examination, and explanations should be provided regarding measures that are going to be taken. Considering the foregoing, obtaining thorough medical and social history, thorough examination of the naked body, lack of secrecy about sexual assault on children, respect for human dignity, honesty, privacy, confidentiality and privacy of information, respectful conduct, respect for the child's independence, neutrality and social protection are considered as the most important ethical considerations referred to in this analysis . Also, helping families adapt in order to prevent further incidents of child abuse is another finding of the present analysis. Conclusion: In this study, it was found that the families of abused children deny and distort the facts about the children instead of supporting them for some reasons. However, medical staffs are usually the first individuals who are informed about the child abuse, so it is logical to consider their views in order to find appropriate solutions to help these children. In this case, one can provide better education and adequate facilities to properly deal with this vulnerable group. The relevant authorities are also recommended to design a written programs based on the ethical considerations raised and submitted it to the medical centers of the country. Also, a group consisted of pediatrics and medical ethics, social workers, psychiatric nurse and psychiatrist should assess needs of abused children and their families and plan to solve their problems. The importance of this lies in the right to social protection and care of abused children and their families to improve their quality of life. Effective measures can be taken in this regard through awareness raising at different levels of society, training for child rearing free from any violence, amending the Child Protection Act, identifying vulnerable families and providing rehabilitation services for victims of child abuse and finally take steps to prevent this phenomenon. Please cite this article as: KadivarM, Mardani-Hamooleh M, MadaniM. Analysis of a case of child abuse with ethical approach. Med Ethics J 2017; 11(39): 27-35.
