Policy considerations to achieve practical ethics: closing the gap between ethical theory and practic.

Social and professional behaviors are driven by extrinsic as well as intrinsic factors including executive rules and regulations enacted by extrinsic agents through coercion, police force and penalties. Despite their effectiveness, these mechanisms undermine the fact that ethics is an intrinsic human quality. The present study seeks strategies to apply extrinsic coercion as an incentive to direct ethics as an intrinsic value. Ethical behaviors driven by intrinsic motivations are more permanent and less costly. Legal force can either strengthen or weaken intrinsic requirements. Extrinsic conditions such as considering the interests, attitudes and preferences of others, involving people in the regulation and execution of law, justification of law, avoiding excessive punishment or rewards, and indirect support of ethics by establishing the appropriate social context can help boost intrinsic requirements in individuals. Ethics will not be practically established unless we harness individuals' 'willingness to act' as an essential determinant for ethical behavior. This requires adoption of a more psychological approach to ethics. If this aspect of ethical behavior is considered in regulations and executive processes, extrinsic forces can strengthen intrinsic requirements and spread ethics.

Bridging the Gap Between Ethical Theory and Practice in Medicine: A Constructivist Grounded Theory Study.

Physicians try hard to alleviate mental and physical ailments of their patients. Thus, they are heavily burdened by observing ethics and staying well-informed while improving health of their patients. A major ethical concern or dilemma in medication is that some physicians know their behavior is unethical, yet act against their moral compass. This study develops models of theory-practice gap, offering optimal solutions for the gap. These solutions would enhance self-motivation or remove external obstacles to stimulate ethical practices in medicine. The Constructivist Grounded Theory Methodology is applied here where the participants and the main researcher mutually interacted with each other. Data collection was performed through qualitative methods including observation and semi-structured interviews with 21 physicians and medical students. Initial and focused coding was done, from which principal concepts were later extracted. MAXQDA software was used for analyzing data. Analysis of twelve major concepts in the study resulted in two factors and solution groups, from which four general notions influencing the ethical theory and practice gap in medicine were extracted: (1) providing effective education to change attitude and behavior; (2) considering motivational and emotional factors; (3) reconstructing regulations and processes to facilitate ethical practice; (4) conducting comprehensive and systematic studies. The existing medical educational system needs to be reconsidered to add to individual internal motivation, including optimizing persuasion strategies, maximizing participation of students, adhering to virtuous ethical theories, and fostering emotions. Additionally, regulations and processes can be reconstructed to remove practical obstacles and promote ethical practice with insignificant damages to individual self-motivation.

To Tell, or Not to Tell; Confidentiality in an Iranian HIV Positive Patient: A Viewpoint.

Confidentiality is a basic concept in medical ethics and protecting confidentiality is considered as physicians' duty. In some occasions, this protection is in conflict with the right of the patient's sexual partner, who should be informed about the possibility of being infected. The sexual partner being pregnant, the situation is going to be more complicated. In this paper, we present a case discussion with special ethical, legal, social, cultural, and religious aspects. According to this informing sexual partner with the patient's assent, opt-out Human immunodeficiency virus (HIV) screening in pregnant women and enhancing psychosocial and family support are highly recommended. Strategic changes in health system policies and regulations seem to be necessary as well.