Seminar 𝐈 Proficiency Exam

What health trend should be strongly encouraged?

move toward greater emphasis on prevention and early detection

As new technology is born, so are ___

the ethical and legal complications

Laws are generally written for ___

new technologies when those technologies are being developed

Decisions for laws on new technologies are concerning:

• wellness

• research

• early detection

• archiving

• monitoring of disease processes

• prediction of future health problems

• lulling consumers into a false sense of security

Explain biomedical research

• research on humans

• can be expensive

• the expense involved should produce good proportionate to the evils risked

What are some ethical dilemmas to be faced (in the near future)?

• obligation to research

• ethics of interpretation of imaging procedures

• ethical dilemmas of transplants

• new reproductive methods

• human genome project

The radiographer may become involved in ethical dilemmas concerned with ___, ___, and ___

biomedical research, reproduction methods, and quality improvement

Explain legal issues in radiography

• reproductive law: uniform parentage act

• legal issues with the human genome project

  • the human genome project includes the goal of transferring related technologies to a private sector

• new technology and the law for imaging professionals

Diversity is rooted in:

• culture

• age

• experience

• health status

• gender

• sexual orientation

• racial/ethnic identity

• mental abilities

• other aspects of sociocultural description and socioeconomic status

What is multiculturalism?

respect for the diversity of the many ways of knowing beyond the Western model (brought about by a broadening of learning and and an opening of the mind to new ways of thought)

Imaging professionals should be able to recognize the ___ commonly encountered when issues of diversity are discussed

interaction pattern

The interaction patterns encountered when issues of diversity are discussed are called ___

-isms

-isms are ___

prejudgments

(entailing a tendency to judge others according to a standard considered ideal or “normal”)

-isms are grounded in ___

bias, prejudice, and discrimination

An -ism is centered on ___, regardless of evidence

personal judgment

What are some -ism examples?

ableism, adultism, ageism, elitism, egocentrism, ethnocentrism, heterosexism, racism, sexism, sizeism, sociocentrism, etc.

What is cultural competence?

set of congruent behaviors, attitudes, and policies coming together in a system or agency or among professionals that enables effective interactions in a cross-cultural framework

What is linguistic competence?

providing readily available, culturally appropriate oral and written language services to patients with limited English proficiency

(bilingual staff or interpreters)

What are professional mandates?

the ASRT supports nondiscrimination in the practice of radiography (diversity is part of the accepted ASRT curriculum)

What are federal mandates?

• federal government created the Office of Minority Health in 1994

• health care language barriers were addressed and an executive order was issued to state federal agencies (must have better access to assist with language needs)

• this is in compliance with the Civil Rights Act of 1964

How many states have adopted English as their official language?

27

What states have selected non-English languages as their official language?

Louisiana - French

Hawaii - Hawaiian

New Mexico - Spanish

Civil Rights Act of 1964

prohibits discrimination because of race, color, gender, religion, or national origin

Equal Pay Act of 1964

prohibits discrimination based on gender

Age Discrimination in Employment of 1967

prohibits discrimination based on age

Americans with Disabilities Act of 1990

prohibits discrimination based on a disability

Family and Medical Leave Act of 1993

prohibits employers from discriminating against employees who use such leave

Explain Prima Facie Case

• must be proved by a complainant making a claim of employment discrimination

• requires complainants to prove:

  • they belong to a protected class

  • were qualified for the position

  • were not hired or were discharged

  • after their discharge, the employer continued to look for an individual with the complainant’s qualifications (or less) to fill the position

What is the most common employment discrimination claim?

sexual harassment

Sexual harassment includes:

• unwelcome sexual advances

• requests for sexual favors

• verbal and physical conduct of a sexual nature that the employee is required to submit to as a term or condition of employment

What are the 2 types of sexual harassment claims that have been recognized by the courts?

• quid pro quo: claims that initial or continued employment or advancement depends on sexual conduct

• hostile work environment: the harassment unreasonably interferes with the employee’s work performance or creates an intimidating, hostile, or offensive work environment

Emergency Medical Treatment and Labor Act (EMTALA)

requires treating everyone, regardless

Rehabilitation Act of 1974 and ADA

prohibits discrimination against persons who are disabled

Violations of antidiscrimination laws can cause institutions to ___

not be able to receive federal funds such as Medicare

What is the correct balance of ethical issues?

provide high-quality educational programs, high-quality employment opportunities, and high-quality imaging services

What are the 3 ethical theories?

• consequentialism

• deontology

• virtue ethics

What is the purpose of the ethical theories?

serve as guidelines for ethical problem solving for both educational programs and students and for employees and employers

Explain consequentialism

• evaluates an activity according to whether it can provide the greatest good for the greatest number

• student - GPA

• imaging professional - selection for advancement

Explain deontology

• uses formal rules of right and wrong for reasoning and problem solving, and judges an action on its merits alone

• student - disciplinary process

• imaging professional - employee handbook

Explain virtue ethics

• holistic approach to problem solving using practical wisdom

• student - rights and responsibilities

• imaging professional - problem solving

What is the contractual model?

• students enter into a businesslike arrangement

• rights and responsibilities may be defined within this agreement

What is the covenantal model?

based on trust and shared experiences within the educational program and the department

Each student and employee has a right to ___

be respected and treated with dignity and consideration

Programs that respect student autonomy provide ___

realistic and current opportunities for graduates

What are the 4 basic components of a positive learning environment?

1. truthfulness

2. maintenance of student and employee confidentiality

3. justice

4. fairness

Explain truthfulness (as a basic component of a positive learning environment)

students and employees have the right to the truth (they must believe that when they ask even ethically difficult questions, they can expect the truth)

Explain confidentiality (as a basic component of a positive learning environment)

students and employees have the right to expect confidentiality during their educational process or their employment

Explain justice (as a basic component of a positive learning environment)

encourage justice, fairness, and appropriate application of ethical theories and models

Explain fairness (as a basic component of a positive learning environment)

students and imaging professionals expect to be treated fairly (sometimes difficult to define)

What are values?

worthwhile or desirable standards or qualities

Students, educational programs, employers, and employees must have aligned ___

values

Explain contract law

• student enters into a contract with the program

• parties can agree to almost any transaction as long as both parties know to what they are agreeing

Due process outlines ___

specific procedures that must be followed when disciplinary action is taken against a student

What are the 2 elements of due processes?

1. substantive element - defines and regulates the rights of citizens and defines the circumstances under which those rights may be restricted

2. procedural element - provides an opportunity for citizens to refute attempts by government to deprive them of their right

What 2 organizations provide standards for students that must be followed?

JRCERT and ARRT

Explain substantive due process

• rights of citizens and the circumstances under which those rights may be restricted must be clearly defined and regulated

• requires a school to show denial of any student’s rights to life, liberty, or property is a valid, objective, and reasonable means of accomplishing a legitimate objective

Explain procedural due process

• in the context of denying students’ rights in an educational program, authorities must provide:

  • written statement regarding reasons for action

  • formal notice of a hearing where the student may answer the charges

  • hearing at which both sides may present their case and any rebuttal evidence

• administration of discipline should guarantee procedural fairness to the accused student

• educational institution has an obligation to clarify standards of behaviors it considered essential to its mission

Do schools (legally) have to provide an appeals process?

NO; but JRCERT says it should be available

What is JRCERT Objective 2.4?

program must have due process standards that are readily accessible, fair, and equitably applied

Explain whistleblowing

reporting concerns about unsafe conditions or poor quality of care

Legal protections for whistleblowers vary depending on ___

the subject matter of the whistleblowing and the state in which it arises

How soon do whistleblowing complaints need to be handed in (in order to be protected)?

30 days

Explain the Whistleblower Protection Act of 1989

strengthened the protection for whistleblowers; most states have enacted statutes

Explain malpractice insurance

• imaging professional’s employer carries liability insurance that will defend the radiographer in the event of a negative outcome

• a radiographer can elect to carry their own insurance as well

What does Respondeat Superior mean?

“let the master answer”

common law doctrine that makes an employer liable for the actions of an employee when the actions take place within the scope of employment

Explain the employment at will policy

• allows employers and employees to terminate their relationship for no cause

• subject to the restrictions of antidiscrimination and other statutes

The ethics of health care distribution affects both ___ and ___

imaging professionals and patients

What nation spends the most on health care?

the US

What happened in the 1940s (biomedical ethical challenge)?

patients’ needs come first regardless of cost

What happened in the 1980s (biomedical ethical challenge)?

Prospective Payment System (PPS) expedited a more equitable system

What happened in the 1960s (biomedical ethical challenge)?

cost became a greater concern and Diagnostic Related Groups (DRG) were developed

What happened in the 1990s (biomedical ethical challenge)?

the call for health care reform was made

What happened in the 21st century (biomedical ethical challenge)?

the ethical dilemma of equitable health care distribution remains

Patients may feel entitled to ___

the benefits of new technologies

Define right

a claim or an entitlement

Define health care

a practice, a commodity, an approach, or a collective responsibility to ensure wellness of a population

Explain health care scarcity

health care is increasingly expensive and in higher demand

Distribution allocation is divided into 3 groups:

1. macro-allocation

2. meso-allocation

3. micro-allocation

Explain macro-allocation

• how big the health care budget will be

  • who will pay for it?

  • to what end?

  • is there a right to this care?

  • what standards will be used?

• government agencies, private insurance companies

Explain meso-allocation

• how the health care budget will be divided

  • what health care needs will be addressed?

  • how will they be prioritized?

  • who delivers the services?

• division of budget

Explain micro-allocation

• who gets what share of the health care budget

  • distribution is equitable

  • determine rationing of services

  • what factors should eb used

• scarce resources, such as organs for transplant

What is triage?

system of prioritizing

• treatment to those with the greatest opportunity for a positive outcome

• practical method to bring justice and fairness to distribution

What are the 4 basic distribution theories?

1. egalitarian

2. entitlement

3. fairness

4. utilitarian

Explain egalitarian theory

demands equal distribution of equal opportunities and resources

Pros: all persons have equal access to imaging services

Cons: patients’ needs are different

Explain entitlement theory

system of contracts in which a patient has to pay for the contract

Pros: all persons have needs

Cons: patients must be involved in a contract to pay for services (more concerned with cost value of treatment rather than the intrinsic value of the service to the patient)

Explain fairness theory

adjusts the equality of individuals with the inequality of their needs and resources

Pros: balances dignity and equality of all persons with the inequality of their needs and circumstances

Cons: identifying the differences (inequality of needs) can lead to subordinating the dignity of the individual to the convenience of the society

Explain utilitarian theory

the greatest good for the greatest number of people

Pros: providing the greatest good for the greatest number of people

Cons: identifying patients as a group rather than individuals

What is the rights theory of justice?

• individuals have a right to health care because of their human dignity and because society has an obligation to serve their needs

• questions the rights and autonomy and the ways in which they are implemented

You must use practical wisdom to assess:

• individual needs

• ability to pay

• scarce resources

• resource distribution

What are the 6 criteria that aid the health care professional in ethical problem solving (when a fair distribution of scarce resources is required)?

1. need

2. equity

3. contribution

4. ability to pay

5. patient effort

6. merit

Explain need (as a criteria of ethical problem solving)

seems to be an obvious and useful criterion, but is complicated

looks at the level of necessity of each patient

Explain equity (as a criteria of ethical problem solving)

expectation that each patient will have an equal type and number of examinations (rarely used)

Explain contribution (as a criteria of ethical problem solving)

determination of what an individual might be expected to give to society at a future date

Explain ability to pay (as a criteria of ethical problem solving)

limited benefit based on the individual situation (may be considered a criterion for elective treatment)

third party payers may determine the allocation of resources

Explain patient effort (as a criteria of ethical problem solving)

patients who fail to heed medical advice or don’t make an effort to improve themselves

Explain merit (as a criteria of ethical problem solving)

the potential to benefit from the additional investment of limited health care resources (decisions based on data or evidence)

the best criteria that decisions for ethical dilemmas can be made on

Explain traditional care

• allows patients to choose their own physicians and facilities for health care services

• everyone must have traditional insurance or be able to pay for the services

• the more choices allowed = greater the cost of the insurance

• provides high quality health care

  • people unable to pay may not get high quality services

• managed care movement

  • inequity of service

  • escalating health care costs

  • demands of society

What are the primary objectives of patient focused care?

• move hospital care services closer to the patient’s bedside

• decentralize hospital services - including radiology

Explain patient-focused care

• implement teams of multi-skilled, cross-trained health care professionals to provide patient care

• (critics believe that cross-training and decentralization will lead to the loss of professional identity)

  • may lose your expertise in a certain area

New methods of health care distribution provide ethical challenges for imaging professionals:

• maintaining quality

• providing access to more individuals

• cutting costs