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Original Article

Copyright © 2021 Tehran University of Medical Sciences. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license https://creativecommons.org/licenses/by-nc/4.0/).

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The second strategic plan of medical ethics: a national report

*Corresponding Author

Bagher Larijani

Address: No. 10, Next to Shariati Hospital, Jalal

Al-Ahmad St., Chamran Hwy., Tehran, Iran.

Postal Code: 1411713136

Tel: (+98) 21 88 63 12 95 -7

Email: [email protected]

Received: 10 Jul 2021

Accepted: 25 Nov 2021

Published: 2 Dec 2021

Citation to this article:

Parsapour A, Shamsi Gooshki E, Malekafzali H,

Zahedi F, Larijani B. The second strategic plan

of medical ethics: a national report. J Med

Ethics Hist Med. 2021; 14: 17.

Alireza Parsapour1, Ehsan Shamsi Gooshki1, Hossein Malekafzali2, Farzaneh Zahedi3, Bagher Larijani4* 1.Assistant Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2.Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 3.Researcher, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute ,Tehran University of Medical Sciences, Tehran, Iran. 4.Professor, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute ,Tehran University of Medical Sciences, Tehran, Iran.

Abstract

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.

Keywords: Strategic plan; Medical ethics; Health policy; Islamic ethics; Iran.

The second strategic plan of medical ethics: a national report

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Introduction

Along with other advancements in

healthcare during the recent decades in Iran

(1, 2), there have been great efforts to

strengthen medical and healthcare ethics to

build up the country’s ethics capacity (3, 4).

Accordingly, some progress has been made

in various fields of research, education, and

clinical ethics in Iran in the past years (5, 6).

Medical knowledge and related technologies

are rapidly evolving in all disciplines. This

requires the close attention of policymakers,

healthcare professionals, and bioethicists to

provide proper ethical responsiveness and

support. Moreover, establishing and

sustaining an ethical infrastructure at the

national level is necessary to solve the

controversial and complex issues that have

emerged in the field of bioethics in the past

decades.

Strategic planning of the ethics activities to

address the key priorities is one of the

elements on which the success of integrative

ethics initiatives relies (7). Medical ethics

strategic planning paves the way for the

integration of ethics in the healthcare

environment and strengthening ethics in

various fields.

There are several advantages to strategic

planning in the field of medical ethics. These

include assessment of the current situation,

evaluation of strengths and weaknesses,

ability to set goals at the national level, and

empowerment of ethical infrastructure to

ensure ethical standards in healthcare

practice, education, and research.

Activities toward integration, sustainability,

and accountability in clinical bioethics have

been carried out through strategic planning

in several countries. For instance, the

Clinical Ethics Group at the Joint Centre for

Bioethics at the University of Toronto has

formulated its strategy to “foster an ethical

climate and strengthen ethics capacity

broadly throughout healthcare settings as

well as create models in clinical bioethics

that are excellent and effective” (8).

To address the demands in Iran, the first

strategic plan in the field of medical ethics

was introduced and implemented by the

Ministry of Health and Medical Education

(MOHME) in 2002 (4). The vision, mission,

specific goals, and main activities of the plan

were reviewed in a paper published in the

Developing World Bioethics journal in 2006

(4).

To review the progress and discuss the

achievements and challenges, several

workshops and expert panels were held. The

Academy of Medical Sciences of the Islamic

Republic of Iran1 (AMS), in collaboration

with the Medical Ethics and History of

Medicine Research Center (MEHMRC) of

the Tehran University of Medical Sciences

(TUMS), Medical Council2 of the Islamic

Republic of Iran, and Supreme Council of

Medical Ethics of MOHME made

substantial efforts to compile the second

version of the country’s National Strategic

Plan for Medical Ethics (2015-2017). The

Supreme Council of Medical Ethics, known

as the highest-level medical ethics

1 . http://www.ams.ac.ir 2 . http://irimc.org/?LANG=EN

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authoritative body inside MOHME, has been

involved in developing this strategic plan.

This was done through active and organized

participation of the council secretariat and

some key members of the council. All the

documents and information required for the

development of the strategic plan have been

provided by this secretariat for the project

team.

It is worth mentioning that the second

strategic plan is not merely an update of the

first one. This article reviews the second

national strategic plan for medical ethics and

discusses its advantages in comparison to the

initial version. We will also mention some

similar plans in other countries.

Methods

The draft of the strategic plan was prepared

by the “Philosophy, Ethics and Biomedical

Sciences Department” of the AMS in

collaboration with the MEHMRC of the

TUMS following several focus group

discussion sessions. The first outline of the

strategic plan was prepared by the steering

committee of the project, which consisted of

the vice president and secretary of the

Supreme Council of Medical Ethics,

Secretary of the National Committee for

Ethics in Biomedical Research, one

professor of Methodology, and the chairman

of medical ethics group of Iranian AMS.

The first draft was discussed in two

workshops on 9th and 30th January 2014.

The 55-member advisory group who

discussed and expanded that first outline

consisted of 31 medical ethics specialists

and Ph.D. Candidates, 13 specialists of

various medical sciences disciplines, six

specialists from the legal and forensic

aspects of medical practice, one religious’

scholar, and one philosopher. Following a

series of study group meetings at the AMS,

the second draft was introduced during the

annual summit of the chairmen of medical

sciences universities, and their opinions

were gathered. The third draft was assessed

and finalized by holding a workshop on 14th

October in 2015. Ultimately, the compiled

national strategic plan of medical ethics was

confirmed by the Supreme Council for

Medical Ethics of MOHME, then published

and widely disseminated as a booklet in

summer 2017.

Experts from various fields of medicine,

medical ethics, law, and jurisprudence

participated in the workshops and other

sessions. Individuals who contributed to this

review process are listed in the

acknowledgments section.

Result

The “Philosophy, Ethics, and Biomedical

Sciences Department” of the AMS decided

to reassess the national medical ethics

strategic plan in collaboration with other

stakeholders after 11 years. The creation of

the strategic plan was initiated by

contemplating the vision and the mission

(Table 1).

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Table 1- Vision and mission statement of national medical ethics strategic plan

Element Definition

Vision

To institutionalize knowledge and practice of medical ethics based on the Islamic

and humane values reflected in all individuals and all pillars of the Iranian health

system, aiming to establish a responsive system with the utmost respect for human

dignity.

Mission

To strive for achieving thorough knowledge and inclusive management (including

needs assessment, policymaking, planning, implementation, monitoring, evaluation,

and rescheduling) of medical ethics in the fields of education, research, and health

services according to the Islamic-Iranian values and by respecting for human

dignity and justice in health.

SWOTs Analysis

The analysis of strengths (S), weaknesses

(W), opportunities (O), and threats (T)

(SWOTs) was conducted as a key

component of the strategic planning process.

SWOTs’ analysis was carried out

comprehensively to identify the internal

(strengths and weaknesses) and external

(opportunities and threats) factors that

intervene with achieving the goals set for the

plan. Table 2 summarizes the output of

SWOTs analysis based on a wide spectrum

of the contributing factors.

Goals, Objectives and Activities

As the next step, the measurable goals and

objectives towards the fulfillment of the

mission were defined and the related

activities were stated. The goals were

prioritized based on the existing

infrastructure and resources.

Table 3 illustrates the defined eight main

goals.

Table 2- Medical Ethics SWOTs Analysis.

S tre

n g th

• The presence of executives' decision-makers and professionals with insights on the Islamic- Iranian model of progress.

• The stakeholders’ attention towards new issues of medical ethics. • Feeling the need to work on the new issues of medical ethics due to the raised cultural awareness

and knowledge of the health services recipients and their increasing demands as well as the

development of science and technology in medical sciences.

• Existence of departments for education, research, and services related to medical ethics. • Existence of a former version of the strategic plan, the National Comprehensive Health Plan, and

other high-level documents.

• Specified structures in the field of medical ethics in the country and the possibility of the formation of new structures based on the emerging needs.

• Educating and training the ethics professionals and promoting the presence of the graduates in medical ethics-related fields.

• Availability of scientific resources related to medical ethics. • Availability of guidelines and codes on issues related to medical ethics. • Possibility of studying in medical ethics-related fields. • Possibility of centralized policy-making in the field of medical ethics.

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W e a

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e sse

• Lack of transparency in the national macro-management policies in the field of medical ethics and instability of the administratorship in the related fields.

• Lack of a coherent theoretical Islamic–Iranian framework to address medical ethics issues in practice. • Limited access to basic and applied research and updated original Iranian-Islamic literature in medical

ethics.

• Lack of communication, interdisciplinary, inter-sectoral cooperation, and interaction, particularly between the universities and the Islamic seminaries.

• Inadequate numbers of medical ethics experts and uncertainty of their position in the organizational chart of the healthcare system.

• Insufficient access to the international scientific resources and communications in the related fields. • Unavailability of the necessary resources to support medical ethics research. • Weakness of the educational content and implementation processes of medical ethics educational

curriculums.

• Ignoring the professional ethical capability in recruiting, the assessment, and promotion of the learners, faculty members, and providers of health services.

• Lack of appropriate and consistent rules, regulations, and bylaws about several issues of medical ethics. • Lack of efficient system for monitoring and surveillance of medical ethics. • Absence of an institutional mechanism for ethical appraisal of policies, rules, and regulations in the health

system.

• Absence of nationwide structures and national, provincial, and organizational ethics committees in areas other than research, e.g., the absence of national committees of clinical ethics and ethics in medical

education.

• Weaknesses in the management of medical ethics research to direct them towards solving ethical problems of the healthcare system.

O p p o rtu

n itie

• Emphasis of the Supreme leader on theorizing in the field of humanities, knowledge-producing, and discourse based on ethical-spiritual values.

• Numerous areas for research in the field of medical ethics. • Islamic-Iranian noble resources of knowledge related to medical ethics. • Growing demand for the ethical improvement of education and research among the scientific and medical

community as well as the stakeholders.

• Support of the high-level national documents, including the constitution, development plans, and national comprehensive scientific map, for ethical development.

• Researchers interested in medical ethics. • Religious beliefs, inner conscious, unconscious ethical, and common cultural, ethical, or moral beliefs

among the society.

• Active related intellectual fields such as jurisprudence, philosophy, sociology, etc. • Potential stakeholders' desire to enter this field. • Research and educational institutes in medical universities that are active in the field of medical ethics.

T h

re a

ts • The negative influence of the public ethics issues on professional medical ethics. • Reduced public trust in the medical community. • Reduced motivation of healthcare community to work effectively due to the socio-economic conditions. • Insufficient justification of the stakeholders of medical ethics discourse and lack of common language

among the clergy, doctors, lawyers, philosophers, and other stakeholders.

• Governance of technical-empirical paradigm (worldview) over the humanities worldview in the country. • Growing tendency to use the medical methods and devices for non-medical purposes • Lack of sufficient sensitivity to vulnerable groups including migrants, refugees, and slumdogs. • Lack of public awareness and misunderstanding of medical ethics debates. • Wrong and restrictive perception of laws and regulations affecting the implementation of medical ethics. • Lack of the explanation of the consistency between the Islamic and Iranian medical ethics with the

predominant secular discourse of medical ethics.

• Uncontrolled and unmannered use of the social networks by students. • Giving the power to enhance commercial, technological, and industrial aspects of medical professions.

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Table 3- The main goals of the national strategic plan for medical ethics in Iran.

Goal 1 To attain the basic Islamic-Iranian framework based on the heritage of medical

ethics regarding the related contemporary knowledge.

Goal 2 To assemble a national collection of documents stating the approved standards of

medical ethics.

Goal 3 To achieve and implement policies, structures, and specific resources in the field of

medical ethics.

Goal 4 To obtain the support and involvement of the key stakeholders of medical ethics.

Goal 5 Development of research in the field of medical ethics.

Goal 6 Development of education in medical ethics.

Goal 7 Developing effective national and international communications in the field of

medical ethics.

Goal 8 Establishment of a comprehensive system of action plans in the field of medical ethics

The first goal emphasizes shifting the

medical professionals’ attention towards the

great heritage of Islamic-Iranian knowledge.

Four objectives were defined in this regard,

as follows:

• Assembling, translating, classifying, and

publishing the Islamic texts related to

medical ethics.

• Collecting, translating, and critical

evaluation of the contemporary knowledge

of medical ethics.

• Strengthening the conceptualization and

interdisciplinary dialogue in the field of

medical ethics.

• Compiling the textbooks related to medical

ethics.

To pursue the goal and its related objectives,

the 19 defined activities included compiling

comprehensive textbooks for the students of

different fields of study (general medicine,

nursing, dentistry, pharmacy, etc.) and at

various education levels. Development of

the “Islamic Medical Ethics Encyclopedia”

and other reference books are also among

these activities.

The second goal aims to provide necessary

national documents, codes, guidelines, and

regulations related to medical ethics as

indicated in table 3. This is to be fulfilled

through the following objectives:

• Development of an appropriate mechanism

for the required assessment of ethical

standards (laws, regulations, and guidelines

related to medical ethics).

• Supporting the development of ethical

standards (laws, regulations, and guidelines

related to medical ethics).

• Design and implementation of appropriate

mechanisms for the approval and

legitimization of ethical standards (laws,

regulations, and guidelines related to

medical ethics).

To achieve these objectives, 35 activities

were designed in a detailed and complete

way. These activities included the

“Establishment of a committee to identify

the gaps in legislation and required ethical

guidelines in healthcare and drafting the

suggested regulations and ethical

guidelines”. Compiling ethical codes and

guidelines for the dentistry, pharmacy,

reproductive health, assisted technologies,

organ transplantation, end of life care,

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emergency medicine, the care of vulnerable

groups, the care of patients with mental

illness, healthcare in disasters, the use of

biobanks, collected health data, the

transmission of biologic samples to foreign

countries, etc.

Goal 3 focuses on achieving and

implementing policies, organizational

structures, and resources in the field of

medical ethics through the following five

objectives:

• Creating the necessary organizational and

administrative structures for healthcare

institutions.

• Providing required financial and human

resources for the healthcare institutions.

• Considering ethical enclosures in all

policies, laws, and regulations related to

healthcare.

• Ethical surveillance and monitoring of all

the healthcare-related policies and

regulations.

• Revising the health system regulations and

laws based on ethical approaches and

concepts.

The establishment of the national committee

for clinical ethics and related secretariat

office in the MOHME are among 18

activities set to achieve this goal and its

associated objectives. Forming the

departments of medical ethics in the major

organizations such as the “Iranian Medical

Council” and the “Nursing Organization of

the Islamic Republic of Iran” and providing

the checklists and regulations for ethical

appraisal of the pharmacies, the drug

companies, medical professionals, faculties,

fellows, residents, and students in the field

of healthcare are among these activities.

Likewise, the allocation of specific funds to

support the educational, research, and

executive affairs of medical ethics by the

MOHME is one of the activities related to

the third goal.

Involvement of the main stakeholders in the

field of medical ethics and attracting their

support and contribution have been

following through the objectives of the

fourth goal as outlined below:

• Developing appropriate strategies for

disseminating information to the key

stakeholders including the general public

and patients.

• Creating appropriate mechanisms for

surveillance and obtaining feedback from

key stakeholders including the public and

patients.

• Providing a supportive environment for the

stakeholders’ engagement and their support.

• To support founding non-governmental

organizations (NGOs) in the field of medical

ethics and encourage the existing health-

related NGOs to focus on the issues of

medical ethics and patient rights.

Activities defined for materializing the goal

include teaching general concepts of

bioethics, patients’ rights in high schools

and compiling age-appropriate books for the

children and adolescents to familiarize them

with the ethics-related issues.

Six objectives are defined for the fifth goal

that targets expanding research in the field

of medical ethics. The objectives include:

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• Development of necessary strategies for

the needs assessment and priority-setting for

research in the field of medical ethics.

• Supporting research in the field of medical

ethics in all related healthcare sciences.

• Backing the production of evidence-based

science in the field of medical ethics.

• Supporting the publication of the scientific

literature and improving the quality of the

existing journals.

• Provision of the infrastructure needed by

medical ethics researchers to access

international resources.

• Providing required funds for essential

research projects and national initiatives in

the field of medical ethics.

Moreover, the foundation of the medical

ethics research centers in the leading

universities of the country, integrating

medical ethics departments within the

structure of specialized medical research

centers, creating and supporting related

journals, holding medical ethics conferences,

post-doctorate, sabbatical courses, and

providing comprehensive databases of

medical ethics studies and researchers are

among 11 activities defined for fulfilling the

fifth goal.

Goal 6 focuses on education emphasizing

the following objectives:

• Qualitative and quantitative improvement

in the relevant academic courses on medical

ethics as well as expanding the

interdisciplinary postgraduate programs.

• Forging regional, and international,

scientific, and educational collaborations

with prominent universities by supporting

the student and faculty exchange programs.

• Improving the quality of medical ethics

education provided to the learners in

different disciplines at various levels.

• Integration of medical ethics education into

the curriculum of all medical and health-

related disciplines.

• Providing and offering medical ethics and

professional ethics education in the form of

in-service programs and continuing medical

education (CME) courses for the healthcare

system personnel.

The change of the pedagogical methods in

medical ethics from the traditional lectures

to the interactive methods such as small

group discussion, workshops, case reports,

launching dual degree doctorates

(MD/Ph.D.), MD/MPH programs,

fellowships, and short-term courses in

clinical ethics and research ethics are among

13 activities listed under the sixth goal.

The seventh goal aims to promote

collaborative activities in the country or

around the globe and consists of four

objectives, as follows:

• to establish a national medical ethics

network with the participation of all main

stakeholders.

• To support organizing national, regional,

and international conferences on medical

ethics.

• To provide Iranian researchers with the

opportunity to participate in regional and

international conferences.

• To develop international collaborations and

partnerships with the universities and

institutions scientifically active in the field

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of medical ethics.

To achieve these objectives, twelve activities

including the establishment of a regional

medical ethics forum in the Eastern

Mediterranean Region, founding the Islamic

Medical Ethics Forum within the Islamic

countries, facilitating membership in

regional and international organizations

related to medical ethics, and signing

agreements for scientific cooperation with

national and international universities have

been considered.

Four objectives shed more light on the

operational planning of medical ethics as the

8th goal:

• Establishing future studies and a

surveillance system for medical ethics in the

fields of education, research, and service

delivery.

• Establishing a system for monitoring,

evaluation, and providing feedback for

medical ethics in the fields of education,

research, and service delivery.

• Integrating the descriptive and analytical

data and findings in the field of medical

ethics.

• Establishing a rating, accreditation system,

and encouraging ethical features in the

healthcare system.

The main related activities are consisted of

developing a framework for the national

reports in the field of medical ethics,

compiling annual reports of “medical ethics

strategic planning program”, “ethics in

medical sciences research”, “monitoring of

medical ethics education”, “observing

patients’ rights and the status of the medical

professionals' rights”, “evaluating justice in

health care”, “analysis of complaints

received by the MOHME, the Iranian Legal

Medicine Organization (LMO), and the

Medical Council of the Islamic Republic of

Iran”

Discussion

The historical documents confirm the

Iranian physicians’ interests in ethical

conduct in their practice for centuries (9,

10), under the influence of the rich culture

and the religious principles of

Zoroastrianism and Islam (11). Despite

facing various difficulties in the recent

decades (12), substantial scientific progress

has been made in the field of medical ethics

in the country (13).

After the compilation of the first national

strategic plan of medical ethics in 2002 (4),

policymakers, related organizations,

faculties, and researchers were responsible

for its implementation. Key stakeholders

approved the vision and mission of the plan

and were committed to achieving its goals. It

is worth mentioning that in the current

strategic plan, the specified stakeholders

consisted of seven groups as follows:

1. International stakeholders (such as UN

agencies, regional scientific organizations,

associations, universities, and research

centers, especially in the Islamic world).

2. Decision-making and policy-making

bodies including the Parliament, High

Council of the Cultural Revolution, the

Guardian Council, and the MOHME.

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3. Governing and executive bodies including

the MOHME, several related ministries,

Iranian Legal Medicine Organization, Red

Crescent Society, regulatory authorities, and

medical universities.

4. Clients (Patients, their relatives, and the

whole community).

5. Unions and Professional Organizations

(the Medical Council and the Nursing

Council of the Islamic Republic of Iran).

6. Service providers (including Hospitals,

clinics, health care providers, insurance

companies, and pharmaceutical or medical

equipment companies).

7. Professional stakeholders (educational

departments and instructors in the field of

medical ethics at the universities and the

religious seminaries, research centers related

to the field of medical ethics, postgraduate

students, and faculties).

The process of design and development of

the current strategic plan was led by the

AMS, a high-level independent scientific

authority in the country. This is considered

as an advantage and opportunity to generate

the plan through the consensus of several

stakeholders and reinforce their

responsibilities for achieving future goals. It

is so important that the AMS set timelines

and monitor the progress of the plan towards

the goals. Moreover, reviewing the plan

would be carried out regularly.

All the key stakeholders are expected to be

fully engaged in the implementation of the

plan, commit time and efforts to venture out

and accomplish the objectives. Despite the

consensus on the defined goals and

activities, there may be controversies on the

priority rankings of the action plan and

surveillance strategies.

The World Medical Association (WMA)

adopted a 5-year (2020-2025) strategic plan3

in 2019, the main purpose of which was to

promote international standards in medical

ethics. “Medical Ethics”, “Universal Health

Coverage”, “Human Rights and Health”,

and “Organizational Capacity” are four

main strategic priorities. Promoting the

international code of medical ethics along

with global discussion to provide a new

revision of the international code of ethics in

2022, governance development, member

integration, and staff development are

among the priorities and deliverables.

The Emory Center for Ethics (Atlanta,

Georgia, US) has been a leader in several

fields of ethics since 1990, creating the first

5-year strategic plan in 2011. The “Vision”

of the second strategic plan (2016-2021) is

“to inspire and advance scholarship and

education in ethics, to ignite the moral

imagination of leaders in all walks of life,

and to foster lives of moral meaning and

ethical engagement”.4 Key strategic priority

areas of the Center consist of:

- Ethical engagement through scholarship

- Ethical engagement in health and science

- Ethical engagement through corporate

partnerships

- Ethical engagement through citizenship and

the public good

- Ethical engagement in education

3. www.wma.net/wp-content/uploads/2020/02/2020-

2025-Strategic-plan-1.pdf

4.http://ethics.emory.edu/about_the_center/CFE%20Strat

egic%20Plan%202016%202021%20FINAL.pdf

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- Ethical engagement in Arts

- Ethical engagement through financial

stability

For each strategic priority, some initiatives

and their metrics are determined. For

example, academic books and peer-reviewed

journal articles are two initiatives of “Ethical

Engagement through Scholarship”. As for

“Ethical Engagement in Education”, some

initiatives such as developing ethics

curriculum and courses (undergraduate,

graduate, doctoral) and non-degree

educational offerings are defined. Defining

metrics for each initiative plays an

encouraging role in engaging the faculties

and the members in related studies.

Kirigia et al have reviewed and discussed

the current status as the way forward to the

establishment of the national health research

systems in 47 countries of the World Health

Organization (WHO) African Region (14).

Although “Research for Health” was the

subject of their study, their strategies and

recommendations are used in other fields as

well as for strengthening medical ethics

discourse. Several key contributing factors

emphasized by Kirigia et al include (14):

- An official national health policy and

strategic plan

- Related legislation components

- Appropriate coordination mechanisms

- Regulation mechanisms for scientific and

ethical review committees at national and

institutional levels and in hospitals and

clinics

- Developed collaborative agreements

- Creating and sustaining resources

- Financing and health budgetary planning

- Securing funding by the private sector and

local and international NGOs

- Promotion and implementation of research

- Facilitating the production of human

resources and strengthening their

competencies through design and

implementation of master and Ph.D. courses,

bursaries, and training grants

- Building or reinforcing necessary

infrastructures, such as well-equipped

offices and laboratories

All identified factors that enable national

health research systems are critical for the

establishment and reinforcement of the

national medical ethics plans. Fortunately, it

seems that the eight goals of our strategic

plan cover all emphasized factors stated by

Kirigia et al (14).

The national strategic plan working group

has approved 60 activities including

compiling books and educational resources,

ethical guidelines, related codes, and

regulations. It has also endorsed 60

recommendations to MOHME to provide the

required infrastructure and empower the

healthcare professionals. Table 4

summarizes the key activities carried out in

recent years, before and after compiling the

second strategic plan.

The second strategic plan of medical ethics: a national report

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Table 4- Summary of some key activities in recent years

Title/type Timeline In accordance

with

Responsible

Organization(s)

General guideline for Professional

Codes of Ethics 2017 Goal 2

The Medical Council of

Islamic Republic of Iran

Revising National Guidelines for

Publication Ethics 2017 Goal 2,4,5 MOHME

Compiling a textbook as an

educational resource for medical

residents

2015-2020 /

in press Goals 1,6

MEHRC, the Medical Ethics

Group of EMRI of TUMS

Evolution and Innovations packages in

Medical Education: 6th package:

Promotion of Professional Ethics

2015-2016 Goal 6 MOHME

Herbal Medicine Research Protocol 2015 Goal 2 MOHME

Hidden curriculums as longitudinal

themes for “medical ethics and law”

and “professionalism”

ongoing Goal 6 TUMS, and a few other

designated universities

The Charter of Rights for clients in

Medical diagnostics Laboratories 2012 Goal 2

High Council of Medical

Ethics of MOHME

The code of Ethics for National

Pharmaceutical System 2012 Goal 2

MEHRC, High Council of

Medical Ethics of MOHME

The National Code of Ethics for

Nurses 2009-2011 Goal 2

The Medical Ethics Group

of EMRI of TUMS, MEHRC,

MOHME

Enhancing specific publications such

as journals in the field of medical

ethics; including the Journal of

Medical Ethics and History of

Medicine

ongoing Goal 1

MOHME, Ethics research

centers and universities of

medical sciences

Annual Medical ethics Congress/

And Training workshops and courses

2013- up to

now /

ongoing

Goals 3,4,6,7

MOHME, MEHRC, AMS,

TUMS and other

Universities of Medical

Sciences, etc.

Defining an educational package to

promote medical ethics and

professionalism

2016-

now/ongoing Goal 6 MOHME

Evaluating teaching medical ethics in

all medical universities 2018-2019 Goal 6 MOHME

To plan and execute the proposed activities

to achieve the goals, several tasks are in

progress. As an example, the development of

the Iranian Code of Medical Ethics (ICOM)

to determine the ethical codes of mutual

behaviors in the provision of medical

services are being pursued by the MEHRC

at the Tehran University of Medical Sciences

in collaboration with the AMS. The ICOM

has been on the agenda with approximately

150 headings; 24 topics of which have

already been completed in the public

consultation phase. After summarizing and

incorporating the feedback from the

workshop participants, the codes were

published in Farsi (Persian Language) to

Parsapour A., et al.

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seek the input of the healthcare academics

and practitioners. The final results are

reported in a recent report of AMS.5

Moreover, the promotion of ethical

standards and the development of related

guidelines have been high on the agenda

during recent years. For example, specific

national guidelines for palliative care in

terminal patients have been compiled by the

medical ethics department of the

“Endocrinology and Metabolism Research

Center of Endocrinology and Metabolism

Institute (EMRI)” of Tehran University of

Medical Sciences (TUMS) in 2017 due to

the ever-increasing attention to palliative

care in the country. This was supported by a

grant from the WHO office in the MOHME.

The results of the project6 were submitted to

the High Council of Medical Ethics of

MOHME and after approval (February

2019) was conveyed to the medical sciences

universities for being implemented in

clinical practice.

Education is an integral part of the current

strategic plan and has been the focus of

accrediting bodies. Although working in the

field of medical ethics requires lifelong

learning, the educational mission of ethics is

never accomplished. This is based on the

Henk ten Have stating (15) that the

empowerment of medical ethics education

has always been one of the main initiatives

around the globe. Accordingly, more than

5.http://www.ams.ac.ir/sites/default/files/book%20Akhl agh%201400--02-18-021.pdf 6. Available (in Farsi) at:

http://nursing.fums.ac.ir/images/Palliative_Care_guidelin

es-Final_compressed.pdf

twenty projects including the development

of textbooks for different graduate and

undergraduate programs, ethical guidelines

for medical education, and ethical checklists

for health professionals have been proposed.

To achieve the educational goal of the new

strategic plan, we designed a national

descriptive survey to evaluate the medical

ethics education in medical sciences, which

is an ongoing project. Providing higher

academic education in the field of medical

ethics is also considered an educational

achievement in our country (5). The

bioethics graduates are now helping to

empower medical ethics discourse in the

research centers, clinics, and hospitals, to

provide specific education, ethics

consultations, and to lead ethics ground

rounds, and even to contribute to health

policymaking.

Conclusion

Academic knowledge and practice of

medical and research ethics have developed

enormously in recent decades. Compared

with the first strategic plan (4), we have

made great progress in strengthening and

flourishing medical ethics throughout the

country. However, considering the ethical

challenges ahead, it is evident that there is

no room for complacency.

The development of the medical ethics

strategic plan was an attempt to improve the

capacity of the health system to be more

proactive in client advocacy. Today, the

main challenges facing our healthcare

system include increasing moral sensitivity,

enhancing adherence to ethical principles

The second strategic plan of medical ethics: a national report

14 J Med Ethics Hist Med. 2021(December); 14:17.

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amongst medical professionals and

promoting a positive ethical climate in the

system. It is also known that an acceptable

level of accountability of health

professionals is necessary to provide decent

standards of care in an ethical atmosphere.

We hope that achieving the goals and

objectives of the recent strategic plan would

play an essential role in the promotion of

professionalism among healthcare

practitioners in Iran. The strategic plan

presented in this article can also be adapted

for other contexts and environments, taking

into account the national priorities,

challenges, and shortcomings.

Acknowledgements

We would like to convey our sincere thanks

to workshop participants (in alphabetical

order): Dr. Forozan Akrami, Dr. Khalil

Alizadeh, Dr. Masoud Asadi, Dr. Omid

Asemani, Dr. Amin Asgharian, Dr. Morteza

Ashrafi, Dr. Hamidreza Ayatolahi, Dr. Sajad

Azmand, Dr. FattanehSadat Bathaie, Dr.

Shabnam Bazmi, Dr. Hasan Behboodi, Dr.

Saeed Beiroodian, Dr. Kourosh Delpasand,

Dr. Zeynnab Derakhshan, Dr. Sedighe

Ebrahimi, Dr. SeyedAli Enjoo, Dr. Mohsen

Fadavi, Prof. Dariyoosh Farhhod, Dr. Mina

Foroozandeh, Dr. Nazafarin Ghasemzadeh,

Dr. Sadat Hosseini, Dr. Nikzad Isazadeh, Dr

Maliheh Kadivar, Dr. Ali Khaji, Dr.

Mehrzad Kiani, Dr. Mansoureh Madani, Dr.

Alireza Milanifar, Dr Mina Mobasher, Dr.

SeyedHasan Moghadamnia, Dr. Maryam

Montazeri, Dr. FatemehSadat Nayeri, Dr.

Nasrin Nejadsarvari, Dr. Davood Nezam-

Eslami, Dr. Mahshad Nouroozi, Prof.

Mohammad Pajoohi, Dr. Mojtaba Parsa, Dr.

Roya Rashidpouraie, Dr. MohamadReza

Razaghi, Dr. Mohsen Rezaie-Adriani, Dr.

Mahbobeh Saber, Dr. Mehran Seyf, Dr.

Behzad Shams, Dr. MohammadNader

Sharifi, Prof. SeyedMahmood Tabatabaie,

Dr. Ladannaz Zahedi.. The special thanks go

to Dr. Pooneh Salari, Dr. Amir

Keshavarzian, and Dr. Leila Afshar for their

valuable input and contribution in compiling

this national plan. The authors also would

like to thank Dr. Reza Baradar Jalili and Dr.

Ali Tooti for the English editing of the

paper’s first draft. We have furthermore to

thank Ms. Firoozeh Hajipour for her sincere

cooperation.

Parsapour A., et al.

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