Provision of Healthcare Services for Children in Iran: Common Ethical Principles and Obstacles to Successful Implementation
Ethics is an essential element in the provision of healthcare services. Fundamental ethical values determine the manner in which the professional behavior is implemented in the healthcare area. These ethical principles find meaning in time and place and in the social context of ethical values and among children as vulnerable groups. So, this study examined the ethical principles of providing health care services for children and barriers to their application in Iran from key informants’ perspective. Therefore, qualitative content analysis method was used by means of semi-structured questionnaire to theoretical saturation scale with the participation of 20 key informants. Each interview underwent the process of implementation, evaluation, coding, and analysis, and then its findings were presented in two dimensions: desirable principles and barriers for its application, including 15 classes. Desirable principles include autonomy, beneficence, non-maleficence, justice, confidentiality, accent, consent, and participation. Obstacles to their compliance also included weakness of the policy landscape, weakness of the judicial system, cultural conservatism, socio-economic inequality, services commodification with unequal distribution, resource mismanagement (limitation), weakness of the professional education system, and the emergence of complex situations. From the key informants’ point of view, codes of ethics do not differ significantly from international principles, but their application is faced with difficulties, and they are likely to be improved through evidence-based policies according to the results of scientific studies.
Thompson E I. The implications of medical ethics. Journal of Medical Ethics 1976; 2: 74-82.
Dehghani A, Mosalanejad L, Dehghan-Nayeri N. Factors affecting professional ethics in nursing practice in Iran: a qualitative study. BMC Medical Ethics 2015; 61: 1-7.
Vinson A, J. Nursing’s epistemology revisited in relation to professional education competencies. Journal of Professional Nursing 2000; 16: 39-46.
Franzblau J, M. Ethical issues in health care: facing our responsibilities in 2010. Clinics in Dermatology 2010; 28: 112-114.
Thompson, A, R. Vulnerability in research: a developmental perspective on research risk. Child Development 1990; 61: 1-16.
Morrow V, Richards M. The ethics of social research with children: an overview. Children & Society 1996; 10: 90-105.
Thurman L, S. Ethical considerations in longitudinal studies of human infant. Infant Behavior & Development 2015; 38: 116-125.
Kabir M, Az-Zubair, B. Who is a parent? Parenthood in Islamic ethics. J Med Ethics 2007; 33: 605-609.
Ross F, L. Health care decision making by children: is it in their best interest? Hasting Center Report 1997; 27: 41-45.
Hein I, Troost P, Broersma A, Vries M, Daams J, Lindauer, J. Why is it hard to make progress in assessing childrens decision making competence? BMS Medical Ethics 2015; 16: 1-7.
Virkiki M, Tolonen T, Koskimaa T, Paavilanien E. Children as decision makers in health care – an integrative review. Clinical Nursing Studies 2015; 3: 47-54.
Banazadeh M, Foroozy M, Iranmanesh S. Assessment of barriers in providing end of life care to terminally ill pediatric patients from the perspective of nursing staff. Iranian Journal of Pediatric Nursing, 2015; 2: 73-85 [in Persian].
Furingsten L, Sjorgren R, Forsner M. Ethical challenges when caring for dying children. J Nursing Ethics 2015; 22(2): 176-187.
Leeuwenburgh-pronk WG, Miller-smith L, Forman V, Lantos JD, Tibboel D, Buysee C. Are we allowed to discontinue medical treatment in this child? J Pediatrics 2015; 155(3): 545-549.
Beckstrand RL, Rawle NR, Callister L, Madleco BL. Pediatric nurses’ perception of obstacles and supportive behaviors in end-of-life care. American Journal of Critical Care 2010; 19(6): 543-552.
Scheuneman LP, White DB. The ethics and reality of rationing in medicine. J Chest 2011; 140(6): 1625-1632.
Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and structure of medical education. Academic Medicine 1994; 69(11): 861-871.
Sofaed S. Qualitative methods: what are they and why use them. Health Services Research 1999; 34(5): 1101-1118.
Mayer J. Qualitative research in health care: using qualitative method in health related action research. BMJ 2000; 15: 178-181.
Al-busaidi ZQ. Qualitative research and its uses in health care. Sultan Qaboos University Medical Journal 2008; 8(1): 11-19.
Huston P, Rowan M. Qualitative studies: their role in medical research. Can Fam Physician 1988; 44: 2453-2458.
The world medical association. The WMA international code of medical ethics. Pilanesberg: the WMA Genral Assembly, 2006.
Gillon R. Medical ethics: four principles plus attention to scope. BMJ 1994; 309: 184-188.
Turner L. Bioethics in a multicultural world: medicine and morality in pluralistic settings. Health Care Analysis 2003; 11(2): 99-117.
Gillon R. Justice and medical ethics. British Medical Journal 1985; 91: 201-202.
Koelch M, Fgert JM. Ethics in child and adolescent psychiatric care: an international perspective. International Review of Psychiatry 2010; 22(3): 258-266. dx.doi.org/10.3109/09540261.2010.485979
Milanfar A, Larijani B, Paykarzade P, Ashtari G, Akhondi MM. Breaching confidentiality: medical mandatory reporting laws in Iran. J Med Ethics Hist Med 2014; 7(13): [Preceding 13]
Afshar L, Joolaee S, Vaskouei K, Bagheri A. Nursing ethics priorities from nurses aspects: a national study. Medical Ethics and History of Medicine 2013; 6(3): 54-63. [in Persian]
Borhani F, Alhani F, Mohammadi E, Abbaszadeh A. Professional ethical competence in nursing: the role of nursing instructors. J Med Ethics Hist Med 2010; 3(1): 3.
Alijany-Ranany H, Tamaddoni A, Haghighy-zadeh MH, Pourhosein S. The effect on using partnership care model on the quality of life in the school-age children with β-thalassemia. J Sharekord Univ Med Sci 2012; 14(1): 41-49. [in Persian]
Ministry of Health and Medical Education. [Rahnamay payaesh bimarestanhay dustdar kudak]. Tehran: Ministry of Health and Medical Education, 2014.
Borhani F, Abbaszadeh A, Hoseinabadi-Farahani MJ. Moral sensivityand its dimensions in Iranian nursing students. J Med Ethics Hist Med 2016; 9(1): 21.
Sanjari M, Zahedi F, Larijani B. Ethical codes of nursing and the practical necessity in Iran. Iranian Publ Health 2008; 37(1): 22-27.
Kadivar M, Mardani-Hamoleh M, Shatestefar S. Evaluation of pediatric residents attitudes toward ethical conflict: a cross sectional study in Tehran, Iran. 2017; 10(1). 2.
Mokhtari NL, Nafar M, Ghabari AK, Khazemnezhad EL. Nursing students’ views on code of ethics, commitment to the ethic of, academic dishonesty and neutralization behaviors. Journal of Holistic Nursing and Midwifery 2013; 24(73): 64-71. [in Persian]
Sadati AK, Tabei SZ, Ebrahimzade N, Zohri M, Argasi H, Lankarani KB. The paradigm model of distorted doctor-patient relationship in southern Iran: a grounded theory study. J Med Ethics Hist Med 2016; 9(1): 2.
Kadivar M, Mosayebi Z, Asghari F, Zarrini P. Ethical challenges in the neonatal intensive care units: perceptions of physicians and nurse; an Iranian experience. J Med Ethics Hist Med 2015; 8(1): 1.
Dehghani A, Dastpak M, Gharib A. Barriers to respect professional ethics standards in clinical care; viewpoints of nurses. Iranian Journal of Medical Education 2013; 13(5): 421-430.
Panahi H, Aleemran SA. The relationship between mortality of Infant under one year and poverty, urbanization and GDP per capita in Iran. Payesh 2015; 4: 399-410.
Kalantari M, Kamali M, Joolaee S, Rassafiani M, Shafarodi N. Perception of professional ethics by Iranian occupational therapists working with children. J Med Ethics Hist Med; 2015: 8(1): 8.
|Issue||Vol 56, No 7 (2018)|
|Medical ethics Professional ethics Ethics of health care Applied ethics Child healthcare Children|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|