MODULE - I

&
JURISPRUDENCE
 ETHICAL ISSUES
1. Moral uncertainty/conflict

When the RT is unsure which moral principle to apply, or even what the problem is. Common with
new RTs, they‟re not sure what they are supposed to be doing

2. Moral distress

When the individual knows the right thing to do but organizational constraints keep them from
doing it

3. Moral outrage

An individual witnesses an immoral act by another but feels powerless to stop it

4. Moral/ethical dilemma

Occurs when two or more clear principles apply but they support inconsistent courses of action

5. Self-awareness

Not an ethical issue, but is absolutely vital in ethical decision making

FOUNDATION
Ethics - philosophical ideals of right and wrong behavior.

- Ethics is not religion or law

- RTs have a duty to practice ethically and morally

- Tells us how human beings should behave, not necessarily what they do.

- Not a religion, not law, but both of these can be the basis of ethical decisions that you make.

- The word duty is a legal term…

ETHICAL FRAMEWORKS
Utilitarian – most good, least harm
Most common approach, “First do no harm” is related to this. Attempts to produce the
greatest good with the least harm.

Rights based– best protects the rights and respects the moral rights of those affected
Begins with idea of human dignity and freedom of choice. The pt has the right to make the
decision.
 Duty based - duty to do or to refrain from doing something
Decisions are made because there is duty!

Common good – best for community/society

Decisions should be made on what is good for the community as a whole, not necessarily for
the individual. Where many of our nations laws are base

Virtue – actions consistent with certain ideal virtues

Decisions should be directed at maintaining virtues (honesty, courage, compassion, etc.). A
person using this approach may ask themselves, “If I carry out these actions, what kind of person will
I be?”

PRINCIPLES ETHICAL REASONING

Autonomy Beneficence

Nonmaleficence Confidentiality

Double Effect Fidelity

Justice Paternalism

Respect for Persons Sanctity of Life

Veracity Solidarity

AUTONOMY
- Definition: “autos” = self, “nomos” = rule
- Individual rights
- Privacy
- Freedom of choice
- Patient (Pt) has the right to make decisions for themselves. May see this come up with consent
for treatment issues, informed consent. Pt has right to know procedure, complications, other
options, that they can opt to not have the procedure/treatment. Framework is rights based

BENEFICENCE & NONMALEFICENCE

Duty to do good Includes: nonmaleficence

goodness, kindness, charity Centerpiece for caring

Duty: NOT TO CAUSE harm Duty: PREVENT harm

Duty: REMOVE harm More binding than beneficence

Because you’re going beyond just trying to do good to that pt, you’re trying to prevent harm
CONFIDENTIALITY
- Keep privileged information private
- Exceptions

Protecting one person’s privacy harms another or threatens social good (direct threat to
another person)

Drug abuse in employees, elder and child abuse

The case of pt is communicable (ex. Leprosy)

The court requested to divulge the information

DOUBLE EFFECT
- Some actions can be morally justified even though
- consequences may be a mixture of good and evil

Must meet 4 criteria:

1. The action itself is morally good or neutral

2. The agent intends the good effect and not the evil (the evil may be foreseen but not intended)
3. The good is not achieved by the evil
4. There is no favorable balance of good over evil

FIDELITY
- Duty to be faithful to one’s commitments
- includes implicit and explicit promises
- Make a promise, follow thru

Implicit – those promises that are implied, not verbally communicated

Like when pt comes into the hospital, they expect to be cared for

Explicit – those that we verbally communicate

Like if you tell them you’ll be back with pain meds, you’d better come back

JUSTICE
- Seeks fairness
- More specifically, distributive justice refers to distribution of benefits and burdens
- Distributive Justice Concepts

Equally disbursed according to:

Need Effort

Societal contribution Merit

Legal entitlement

PATERNALISM
- When one individual assumes the right to make decisions for another
- Limits freedom of choice

Think about parents making decisions for children

 Ex. Withholding pertinent information from a pt. Like elderly diagnosed (dx) with terminal
cancer, and family asks to not tell them that it’s terminal so they will still be motivated to fight

RESPECT FOR PERSONS

- Closely tied to autonomy
- Promotes ability of individuals to make autonomous choices and should be treated accordingly
- Autonomy is preserved thru advanced directives.

SANCTITY OF LIFE
- Life is the highest good
- All forms of life, including mere biologic existence, should take precedence over external criteria
for judging quality of life

If life is the highest good, is it ethical to keep a brain-dead person alive?

VERACITY
- The obligation to tell the truth and not to lie or deceive others

SOLIDARITY
- highlights in a particular way the intrinsic social nature of the human person, the equality of all
in dignity and rights and the common path of individuals and peoples towards an ever more
committed unity.
- solidarity is simply that no man is an island entire of himself. We are all a continent, a part of the
main. We are our brother’s keeper. We are responsible for everyone else–not just ourselves. The
second principle avoids the big government solution.

ETHICS AND PROFESSIONAL PRACTICE

 Code of Ethics for Radiologic Technologist

 4 Fundamental Responsibility of a Health Care Worker

 Informed Consent

 Durable power of attorney for healthcare guardian

 Euthanasia

 Assisted suicide

 Death

 Disasters
 Board of Radiologic Technology
Code of Professional Ethics for Radiologic Technologists
and X-Ray Technologists

Article I

RELATION WITH THE STATE AND SOCIETY

Section 1. Radiologic technologists and X-ray technologists should be aware of the supreme authority of the state
and should adhere to the Constitution, R.A. No. 7431 and other laws, the rules and regulations
promulgated pursuant to such laws.

Section 2. They should, above all, consider the welfare and well-being of the public and the interest of the state.

Section 3. They are encouraged to involve themselves in civic affairs and cooperate with other organizations to
promote the growth and welfare of the community.
Article II
RELATION WITH PATIENTS/CLIENTS

Section 1. Patients/clients are the focus in the practice of Radiologic Technology and X-Ray Technology. Hence,
Radiologic Technologists and X-Ray Technologists must at all times act with dignity and sincerity and
must express genuine concern in the discharge of their work.

Section 2. They should keep in confidence any data or findings obtained in the performance of their duty.
Disclosure, if warranted, should be done by the Radiologists concerned.

Section 3. They should not discriminate against anybody and should attend to all patients/clients regardless of
creed, race, belief, or political affiliation.

Section 4. They should provide the highest level of technical Know-how in the performance of their work,
employing courtesy, empathy, compassion, and privacy to the patient/ client and his family. They
should try to perform the examination within reasonable time to avoid the risk of repetition to minimize
the radiation exposure to the patient.

Article III
RELATION WITH OTHER ALLIED PROFESSION

Section 1. Radiologic Technologists and X-Ray Technologists should bear in mind that their profession is a public
trust, and that they at all times maintain and uphold the dignity and integrity of their profession and
protect it from misinterpretation.

Section 2. They should not directly or indirectly assist in any unauthorized practices of the profession. They
should report any violations of R.A. 7431, the rules and regulations and this Code of Ethics for
registered Radiologic Technologists and X-Ray Technologists to the Board of Radiologic Technology.

Section 3. They should share information and experiences with their fellow paramedical professionals,
participate, and be active members of the accredited association of Radiologic Technologists and X-
Ray Technologists. Schools and Colleges with courses on Radiologic Technology and X-Ray
Technology should be encouraged to conduct research to enhance the growth and advancement of
the profession.

Section 4. They should observe punctuality and keep appointments, particularly in the discharge of their duties
with patients/clients.

Section 5. They should avoid instances where their personal interest and financial gains will be in conflict with
those of their patients/clients, colleagues or employers.

Section 6. They should at all times perform their tasks with honor and dignity and should be fair and impartial to
all.
 Section 7. They should at all times keep their reputation above reproach and conduct themselves with proper
decorum to gain public esteem and respect for the profession.

Section 8. They should at all times strive to enhance professional growth through continuing education and
subscriptions for professional journals.

Section 9. They should not degrade the reputation, competence, and capability of a colleague to aggrandize
themselves.

Section 10. They should encourage and provide opportunities for professional development and advancement of
their colleague.

Section 11. They should adhere to the principles of due process and equality of opportunity in peer relationship
and personnel actions.

Section 12. They should align personal philosophies and attitudes with those of the institutions they serve.

Section 13. They should help to create and maintain conditions under which scholarship can exist, like freedom of
inquiry, thoughts and expressions.

Section 14. They should be receptive to new ideas, knowledge, and innovations that contribute to the
development and growth of the profession.

Article IV
RELATION TO AGENCY

Section 1. Radiologic Technologists and X-Ray Technologists should assist in the improvement of
governmental
Agencies’ functions and the lightening of their patient’s work load.

Section 2. They should be vigilant in the protection of equipment and materials needed to perform their duties.

Section 3. They should perform the tasks assigned them by their governmental agency employer in good faith
and to the best of their abilities utilizing their technical skills and diligence, particularly in instances
where the patients safety maybe jeopardized by their neglect.

Section 4. They should help promote, support, assist, and establish goodwill and camaraderie towards their
peer employees in the paramedical professions.

Article V
RELATIONSHIP WITH ONESELF

Section 1. Radiologic Technologists and X-Ray Technologists should always be honest, dependable,
levelheaded, and morally upright.

Section 2. It is incumbent for them to provide for their professional growth through continuing education,
attendance in seminars or subscriptions for professional journals and research materials.

Section 3. They should be entitled to a just and fair compensation for services rendered.

Section 4. They should not allow their names to be advertised by any person or organization, unless they are
employed therein.

4 Fundamental Responsibility of a Health Care Worker

 Promote health
 Prevent illness
 Restore health
 Alleviate suffering
INFORMED CONSENT
- Core underlying value is patient autonomy
- Physician / practitioner obtains consent
- Rts role: witness / monitor
- Emergency consent is presumed when patient unable to provide Informed consent is a
process that people go thru, not just a paper.
- Rts role is to make sure pt understands everything and that the person that signs is the
person who needs to be signing! The Rt can’t go in and explain the procedure again, if
you contradict what the doc told the pt, you’re in big trouble! Don’t do it!
CAPACITY TO FORM CONSENT
Decision-making capacity (not competency) determined by:

 Appreciation of right to make the choice

 Understanding of risks/benefits of procedure
 Understanding of risks/benefits of opting out of procedure
 Ability to communicate decision:
- Communication may not always be verbal, can be written or whatever
- Needs to have interpreter available! Can’t just use the family or whatever
- Use layman jargon. Normal words… Don’t say layman jargon.
ADVANCE DIRECTIVES
Includes:

 Directive to Physician and Family or Surrogate

Most common. Allows pt to document wishes for treatment (tx) or withdrawal, also
commonly known as “Living Will”

 Medical Power of Attorney

Allows the pt to designate another person as their decision maker

 Out of Hospital Do-Not-Resuscitate Order

Allows competent adults to refuse life sustaining procedures when out of the
hospital setting. Can include not wanting to be taken to ER, let me sit here and
die…
 Declaration of Mental Health Treatment
Allows a court to determine incapacity and allows the pt to refuse electro
convulsive therapy (ECT) and psychoactive drugs
 Sometime generically called “Living Will”
 Not same as DNR (do not resuscitate)
These are written during hospitalization after the doc and the pt (or pt
surrogate) decide to withdrawal life sustaining treatments.
 Advanced Directives are documents that state in writing the pts wishes for
healthcare interventions if they should become incapacitated.
 Directives unavailable / never done
  Autonomy versus “best interest” of clients
 Substituted judgment  Legal standard that presumes the surrogate is capable of making decisions
for that pt

 Dementia clients  Dementia diagnosis doesn‟t necessarily mean the pt is incapable of making their
own decisions. Esp in the first few stages of dementia. Pt is very alert and very aware and very much
can make that decision for themselves.

WITHHOLDING/WITHDRAWING CARE
 Can withhold “inhumane” treatment if it is “virtually futile” in extending life – usually DNR
 Allowing to die vs making die

EUTHANASIA
Definition – intentional termination of life (at the request of that person who wishes to die)
Active vs. Passive
- Generally illegal
- May be legal under certain circumstances
Active – involves purposefully causing the persons death (doc or nurse). Dr. Kevorkian. Usually involved
with law problems
Passive – involves hastening of death by altering some form of support, taking a pt off a vent, generally
accepted by medical community
Terminal sedation
- Doctrine of Double Effect (the whole intent of the act, thing)
- Do a thing with one intent, but causes something else to happen – morphine OD
Procedure used in dying pts to relieve suffering. Pts who are in extreme pain may chose terminal sedation

ASSISTED SUICIDE
- Patient actively seeks physician/nurse to “help” them commit suicide
- Criminal offense in all states but Oregon, Washington, and Montana
- Usually, pt is given prescriptions in amts that are legal and the pt decides if they want to use it.

DEFINING DEATH
- Uniform Determination of Death Act – patient is dead if any one of the following conditions are met:
 Cardiopulmonary death
 Neurological death
 Whole brain death – Flat EEG
  Not PVS – (persistent vegetative state)

“ETHICAL DILEMMAS”
 the action or situation involves actual or potential harm to someone or some thing
 a possibility of a violation of what we generally consider right or good
 is this issue about more than what is legal or what is most efficient?

HOW TO PROCESS AN ETHICAL DILEMMA

1. Determine whether or not a dilemma exists
2. Gather all relevant information
3. Reflect on your values on the issues
4. Verbalize problem
5. Consider all possible courses of action –including referral to ethics committee
6. Negotiate outcome
7. Evaluate action, not the outcome.

CONCLUSION
 Know yourself and your values
 Protect your patient by intervening if you identify an ethical question
 Know your facility policy for access to the ethics committee
 Know your responsibilities with regard to informed consent
 Respect the patient’s advance directives