Ethical issues in Iranian pediatrics: a qualitative study

Children are recognized as one of the most vulnerable groups in society, and their integration into healthcare systems involves not only medical care but also significant emotional investment and time to achieve optimal outcomes. This process is complicated by various ethical challenges that healthcare teams face daily, influenced by social, cultural, economic, and religious factors. This study aims to identify the ethical challenges and the factors influencing their emergence in pediatric care in Iran. While developed countries have established ethical guidelines to address these challenges, Iran lacks similar frameworks tailored to its cultural and social context. Developing such ethical guidelines is crucial for fostering critical thinking, building trust among stakeholders, and ultimately facilitating ethical decision-making in pediatric healthcare. Given the absence of prior research on this topic in Iran, this study seeks to fill this gap by exploring the specific ethical dilemmas faced in pediatric settings.

The present qualitative study was conducted based on a grounded theory. The participants were 39 practitioners who were interviewed after giving consent and being briefed about the study. All interviews were recorded, transcribed, and then analyzed in this study. The data were then analyzed using Strauss-Corbin (1998) method in three phases of open, axial, and selective coding.

During analysis, 1410 initial (open) codes, 22 categories, and 6 axial codes were obtained to explain the ethical challenges. These challenges included "Insufficient collaboration of physicians with parents and children"," Lack of support and respect for the service recipient by the physician", "Lack of trust and mutual understanding between physician and parents", "Lack of responsiveness and proper education to parents by the physician". Several factors contributed to the development of ethical challenges. This presented model, the most central of them was the distorted professional identity of the treatment team.

The factors that cause ethical challenges in the pediatric clinic include: Inadequate moral education, Weak management, Lack of moral and legal rule, Individual Capabilities and Personality Traits, popular culture, distorted professional identity, the central code of which was distorted professional identity. The process of professional identity formation is a long-term and continuous process that is influenced by several factors. This conceptual model of professional identity creates the above ethical challenges in pediatrics medicine.