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Background: Ethical considerations are important in pandemic preparedness and response, however, there is a noticeable scarcity of ethical codes that are tailored to disease outbreaks and health emergencies. Aim: To document the development of guidelines for ethical management of infectious disease outbreaks in Islamic Republic of Iran, as a model for low- and middle-income countries. Methods: We conducted a non-systematic scoping review on PubMed and Google Scholar for drafting the guidelines for ethical management of infectious disease outbreaks in Islamic Republic of Iran. The draft was discussed and revised following consultations with different groups of experts and the Medical Ethics Council of the Iranian Academy of Medical Sciences. Results: The joint assembly of the National Clinical Ethics Committee and the Supreme Council of Medical Ethics endorsed and introduced the revised document as official guidelines for ethical response to infectious disease outbreaks in Islamic Republic of Iran. The guidelines were based on a set of core values and principles: human dignity, liberty, maximizing benefits and minimizing risks, and justice and transparency. In 3 distinct sections, the document provides ethical guidance for healthcare system management and leadership; provision of health services; and for education, research and use of technology during health emergencies. Conclusion: The guidelines have been very useful in responding ethically to the COVID-19 pandemic, there may be a need to adapt some of the recommendations for optimum benefits in specific contexts. It is necessary to create awareness of the existence of the document and educate healthcare professionals about its importance so they can apply the recommendations in their practice. [ABSTRACT FROM AUTHOR]

The article calls for actions to bridge bioethics imperatives in the Eastern Mediterranean Region and globally. It discusses the importance of ethics preparedness as an aspect of responding to public health emergencies and infectious disease outbreaks, as well as the significance of bioethics governance to improving management of health systems via accountability and transparency. Initiatives and interventions to improve bioethics governance are suggested.

Background and Aims: COVID‐19 pandemic led to a need to rapidly vaccinate as many people as possible. Children are an important part of the population with different characteristics which vaccinating them is a matter of great importance as it should be decided considering all aspects and ethics. Here, we present different aspects of COVID vaccination in children including the potential challenges. Methods: We searched on PubMed, Google Scholar and Scopus in this regard, and all of the relevant papers published until June 28, 2021 were included if we could access their full‐texts. Results: We found various expert opinions in this regard and tried to summarized them. Saving lives has similar ethical value as preventing evitable adverse event. Accordingly, mandating the children to receive the SARS‐CoV‐2 vaccine, needs risk‐benefit weighing with special consideration of ethical challenges. Conclusion: Considering the vast range of benefits resulted from pediatric vaccination both for the children and the community, implementing the program in a scientific manner and also with the least financial expenses for the families seems to be reasonable and makes it both ethical and moral. [ABSTRACT FROM AUTHOR]

This study aims at increasing our understanding of the research activities of Iranian researchers and institutions in the field of biomedical ethics from 1995 to 2015. A combination of bibliometrics and social network analysis was used to examine the bibliographic data of 580 documents published on Iranian biomedical ethics in Web of Science and Scopus databases to investigate the publication trend, scientific impact, subject keywords network, and social network analysis indicators for international and cross‐institutional co‐authorship networks. The results showed that the publication of documents has had a consistent and increasing growth and that the citation trend has grown along with it. The analysis of thematic clusters by keyword co‐occurrence network shows that Iranian biomedical ethics research has dealt with various topics and that has introduced different research directions. Researchers from 28 countries were identified in the international collaboration network. The main partners of Iranian researchers were from the US (17.8%) and the UK (9.2%). However, there is a tendency to develop and complete cooperation with researchers from different countries. The cross‐institutional collaboration network comprises of 63 institutes, of which Tehran University of Medical Sciences (38%), Shahid Beheshti University of Medical Sciences (11%) and Shiraz University of Medical Sciences (7%) have the largest share in publishing documents. The superiority of the first two universities based on centralization indicators in the cross‐institutional collaboration network has caused the exchange of cross‐network knowledge between and via these players. The network density indicator shows that almost half of the co‐authorship links within the international collaboration network and 8% of the co‐authorship links within the cross‐institutional collaboration network have been implemented and that these networks are not very coherent. [ABSTRACT FROM AUTHOR]

Discharge against medical advice (DAMA) is a common problem in the health-care system. It imposes risks to both patients and medical staff and could be the subject of ethical deliberation. This cross-sectional study was conducted in 2017 on 400 patients who were discharged against medical advice from the emergency ward of Shariati Hospital, Tehran, Iran. Patients’ information was collected using clinical records and telephone calls. The collected data were analyzed using STATA software. DAMA rate was 12% in the emergency department of Shariati Hospital. Male gender was found to be a risk factor for DAMA (OR: 1.90; CI (95%): 1.44 - 2.52; P < 0.0001). In addition, younger patients were more likely to leave hospital against medical advice (p-value: 0.04). The more common reasons for DAMA were feeling better, long delay in diagnostic and therapeutic procedures and the hectic ambience of the emergency ward. Patients’ self-discharge is a multi-dimensional phenomenon that is affected by patients’ characteristics, medical conditions and hospital circumstances. It raises some ethical concerns, mainly due to a conflict between patients’ autonomy and beneficence. It is helpful for the medical staff to create an effective relationship with patients who are at higher risk of DAMA, in order to increase their compliance and prevent the consequences of leaving hospital against medical advice. [ABSTRACT FROM AUTHOR]