During the last two decades, there has been a great deal of interest in addressing issues related to medical and nursing ethics. As these issues are addressed internationally, it is important to consider how ethical principles are interpreted in a national context. This column describes how Iranian cultural beliefs need to be considered while developing ethical guidelines for nurses in Iran.
Iran is an ancient country with more than 2,500 years of civilization. Over 90% of the approximately 72 million people in Iran are Muslim. Since respect for human beings is important in the Iranian Islamic culture, it is surprising that the concept of patients' rights and ethical codes have not been considered until recently. To bring attention to healthcare ethics and to enhance the quality of healthcare in Iran, the Ministry of Health and Medical Education has introduced a strategic plan to advance the study of medical ethics at the national level (La rija ni, Malek-Afzalí. Zahedí. & Motevaseli. 2QQ6Ì. The Ministry (20_0_2) also published a Patients' Bill of Rights. However, the Bill is an amalgamation of western versions of such bills and is not based primarily on the Iranian sociocultural context. It is not yet clear how this Bill relates to the provision of services offered by the Iranian healthcare system Üoolaee. NasrabadL Parsa-Yekta. Tschudin, & Mansouri. 2006).
In over 19 years of nursing practice in Iran, the authors have witnessed incidents in which patients' rights to practice their religion or cultural beliefs have been ignored and cases in which patients were not even fully aware of their rights. In some situations patients with gastritis were forbidden to fast while they were in the hospital, regardless of their religious obligations. In other situations patients were asked to provide preoperative informed consent themselves (as stated in the international nursing codes); yet this practice contradicts the Islamic rule that one ask the husband to consent to perform a reproductive-system operation on his wife.
Although many aspects of current international codes are practical in Iran, there remains a need to establish ethical guidelines that are compatible with the unique cultural and religious characteristics of the Iranian people in order to provide more effective nursing and medical services to them. During the last two decades, the rapid advances in science and concurrent development of bioethics have prompted important questions which call out for practical answers and appropriate actions in policy-making, organizing, and teaching ethics. Because of the special Iranian cultural beliefs, development of a code of ethics for nurses in Iran is still in the early stages. More research is needed to complete this code. To advance the development of ethical codes in Iran the Medical Ethics Center of Tehran University of Medical Sciences focused their second Medical Ethics Conference on topics of professional commitment, research ethics, the beginning and end of life, teaching ethics to students, resource allocation, and equity in health and medical services (The 2nd International Congress, 2008). The remainder of this column will focus on two important issues that evolved from this ethics conference, namely patients' rights and nursing ethics.
An important tenet of nursing is respecting the human rights and dignity of all patients. The priority of healthcare organizations must be protection of patients' rights. After the Iranian revolution of 1979, the Iranian government began to focus on specific rights in healthcare and the accessibility of healthcare services for its population. Since that time great strides have been made in the study of biomédical ethics fHamidian, 2007: LarijanL Zahedi, & Malek-AfzalL 2005). It has been said that one's rights define the other's responsibilities; therefore a patient's rights define the healthcare professional's responsibilities fHasanian. …