An Iranian Study or a Kashanian One?

In the absence of published well-designed studies about the various ethical aspects of doctor–patient relationships in Iran, the article by Sheikhtaheri and Farzandipour is a valuable source of information about one of the most important aspects of this relationship, namely, the informed consent process (Sheikhtaheri and Farzandipour 2010). A major concern, however, may arise in the minds of readers: “To what extent does Kashan represent Iran?” Located in the central part of Iran, Kashan is a relatively small town in the middle of the desert. By population, Kashan is ranked as the 26th largest city in Iran. The population of the city itself is about 270,000, which is a small number in comparison to larger cities like Tehran with a population of about 7,700,000 and Mashhad with a population of about 2,400,000. Bearing in mind the population of Iran, which is more than 70,000,000, it is obvious that Kashan represents a very small part of the Iranian population. People in the centrally located, small cities of Iran are known for their traditional culture and conservative lifestyle, as well as lower socioeconomic status and educational level in comparison with the larger cities like Tehran, Isfahan, or Shiraz. Consequently, one of the more prominent features of medical practice and doctor–patient relationships in such communities is their paternalistic nature. The situation, of course, is rather different in the more developed urban areas of the country. Therefore, to obtain a more complete picture of the situation in Iran, one should take into account a wide variety of patient populations, ranging from small health care centers located in rural areas, to modern and expensive private hospitals located in the northern parts of Tehran, serving people who belong to the highest socioeconomic classes. There are at least three other published Iranian studies exploring some components of informed consent in Iran. In one of them, performed in 2006 in a large hospital complex in Tehran, 299 patients admitted to general internal medicine or surgery wards were interviewed. The results showed that Iranian patients were highly interested in receiving information about their condition and participating in clinical decision making. The mean (SD) scores representing patients’ desire for receiving information and participat-