Professionalism and Ethics

3 fundamental principles of medical professionalism

1. Primacy of patient welfare - i.e., the patient comes first (altruism of the medical practitioner).

2. Patient autonomy - i.e., the medical practitioner helps the patient make an informed decision, and does not make the decision for them.

3. Social justice - i.e., medical resources should be provided fairly without discrimination.

   1. Resource access is often skewed toward the higher end of the socioeconomic ladder.

   2. Unnecessary services are contrary to cost-effective care.

conflict of interest

a situation wherein pre-existing biases or personal interests may influence someone’s actions.

1. This is exemplified by private interests (such as financial gain) interfering or otherwise motivating public service (such as patient care).

Authorship criteria

1. Substantial contributions to concept or design of the work; or the acquisition, analysis or interpretation of data. (AND)

2. Drafting the work or revising it critically for important intellectual content. (AND)

3. Final approval of the version to be published; (AND)

4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

honorary authorship

when an author’s attribution is given when the individual did not fulfill the authorship criteria.

gift authorship

when an author’s attribution is given in exchange for favors or recompense or even simply out of respect.

guest authorship

when an author's attribution is given to a senior or well known figure to lend a greater sense of importance to the work.

coercive authorship

when an individual of authority coerces a junior figure to grant authorship (including gift and/or guest authorships).

ghost authorship

someone who contributes to the work and meets the eligibility of authorship is omitted.  This may occur due to a perceived conflict of interest.

duplicate submission

1. when the same work is contributed to multiple publishers.  This redundancy should always be avoided due to the needs of redundant resources consumed in the process and all publishers in these cases could claim rights to the same manuscript.

   1. This is not just limited to the manuscript as a whole but may include just portions recycled in different submissions.

   2. This does not include submitting a manuscript to a different publisher after the peer review process of a prior publisher has rejected the work.

conferences and meetings rules for vendors

1. Grants may be provided by a company provided that the meeting is an objective educational activity and the institution or conference sponsor selects the attendees.

2. Meal and refreshments may be provided as long as they are equitably distributed (such as to all attendees) and focus on the goals of the meeting during the meal.

3. Faculty expenses may be covered by grants to the conference sponsor for travel, lodging, and modest meals.

4. Advertisements may be purchased such as booth space at the conference.

Things not allowed as gifts by vendors

• Gifts of more than $100 are prohibited unless they are educational such as a textbook or anatomical phantom.

• No entertainment or recreation activities

• Charitable donations are permitted but should not go directly to the healthcare provider but, instead, to a charitable organization.

principles governing human research

1. Respect for individuals - treat them with courtesy and respect their autonomy.

2. Beneficence - being mindful to maximize the benefit to the participants and/or society while minimizing risk.

3. Justice - ensuring that procedures aren’t exploitative of the participants.

4. Non-maleficence - ensuring that potential for harm is minimized

A patient has a recurrent tumor in their brain that is impinging on their optic chiasm following prior radiation therapy the year before.  The patient is not a candidate for other treatment options.  The previous treatment pushed the chiasm to its dose limit.  The physician discusses this with the patient but the patient is adamant that they be given additional radiotherapy.  The physician determines, in light of this, that an SRS treatment course is most appropriate but will exceed the chiasm tolerance likely causing blindness.  The patient is informed and signs the consent for treatment.  It is acceptable to proceed with this course of treatment.

True

A pregnant patient is referred to your radiotherapy department following a diagnosis of rectal carcinoma.  She is past the point in her pregnancy where an abortion could legally be given.  Her successful treatment requires the use of radiation therapy but this carries extreme risks to the unborn fetus.  Her social situation is quite challenging with the father being unaware of the current situation.  She signs the consent for treatment.  It is acceptable to proceed with treatment.

False

During a radiotherapy procedure, a patient has a seizure but does not want their family told about this.  Further questioning reveals that the patient drove themselves in for treatment and intends to drive themselves home.  It is appropriate and ethically necessary for you to notify the family of this matter.

True

On reviewing a radiation therapy plan, you discover that the patient was supposed to get 200 cGy in 10 fractions for prophylactic cranial irradiation but actually received 300 cGy in 10 fractions.  This particular patient has a severe anxiety disorder.  Which of the following choices would be the best course of action?

notify state, patient, PCP

During monthly QA of a high dose rate (HDR) afterloader in a clinic that has a large HDR eligible patient population, you find that the source was positioning itself 3 mm short of where it was supposed to be.  Further review yields the likelihood that significant dose deviations would have resulted from this.  During the last monthly QA, the source positioning was accurate.  An internal review yields that the moving warm-up was not being completed properly and the deviation went undetected.  Every patient treated in the last month should be called and the potential error reported to them.

True