PT Care: Ethics and legal considerations

Ethics and Legal Considerations in Cancer Radiation Therapy Management

Objectives

• Define terminology associated with ethics and legal considerations.

• Define informed consent.

• Discuss advance directives.

• Apply HIPAA compliance standards.

• Examine the role of risk management.

• Quote the legal doctrines applicable to patient care.

• Discuss standards of ethics and practice standards in Radiation Therapy.

Code of Ethics for Radiation Therapists

• RT (Radiation Therapy) advances the principal objective of the profession:

  • To provide services to humanity while fully respecting the dignity of mankind.

  • Delivers patient care and services without regard to personal attributes or the nature of the disease or illness.

  • Ensures nondiscriminatory treatment with respect to race, color, creed, sex, age, ability, or national origin. Source: ASRT

• RT is responsible for:

  • Assessing situations with care, discretion, and judgment.

  • Assuming responsibility for professional decisions.

  • Acting in the best interest of the patient.

  • Engaging in lifelong learning to maintain, improve, and enhance professional competence and knowledge. Source: ASRT

• The Code of Ethics serves as:

  • A guide for RTs to evaluate their professional conduct.

  • A means to maintain a high level of ethical conduct while providing patients with protection, safety, and comfort.

Definition of Ethics

• Ethics as defined in Webster’s New Collegiate:

  • The discipline dealing with what is good and bad, moral duty, and obligation.

  • A set of moral principles or values.

  • A theory or system of moral values.

  • The principles of conduct governing an individual or a group.

Individual Ethics

• Individual ethics stem from personal values defined as:

  • What each person considers to be “right” or “wrong.”

• Influences on personal values include:

  • Culture

  • Experience

  • Religion

  • Science

• Factors shaping individual values encompass:

  • Family

  • Friends

  • God

  • Society

  • Religion

  • Profession

Moral vs. Legal Ethics

• Morality relates to conscience and involves:

  • Right or wrong in relation to God(s) or logical rationalization.

• Legal Ethics defined as:

  • A sum of rules and regulations governing society.

  • Must support the good of society as a functioning unit.

Group Discussion

• Discuss differences between values, morals, and ethics by providing examples for each.

• Describe circumstances where conflicts may arise between values and morals.

Ethics in Cancer Management

• This area is categorized as Bioethics and includes:

  • Seven principles of bioethics:

  • Autonomy - Patient freedom and rights to make their own decisions.

  • Beneficence - The act of doing good and acting in the best interests of patients.

  • Confidentiality - Keeping patient information private.

  • Justice - Ensuring equality and fairness among all patients.

  • Non-maleficence - An obligation to avoid causing harm to patients.

  • Role Fidelity - Loyalty to professional roles.

  • Veracity - Obligations to truthfulness and honesty.

Principle Descriptions

• Autonomy: Respecting the patient’s right to control their own health care.

• Beneficence: Encompasses palliative care as an aspect of doing good for patients.

• Confidentiality: Secured under the Patient’s Bill of Rights and HIPAA, ensuring protection of patient private information.

• Justice: Equal treatment of patients regardless of:

  • Illness

  • Age

  • Gender

  • Sexual preference

  • Socioeconomic status

  • Religious preference

• Non-maleficence: The principle of "First, do no harm."

• Role Fidelity: Following ASRT-defined Standards of Practice.

• Veracity:

  • Defined as the habitual observance of truth, with instances where it may supersede confidentiality (e.g., child/elder abuse, public health matters).

Ethical Theories

• Teleology: Consequentialism focuses on the outcomes of actions to decide ethical dilemmas.

• Deontology: Non-consequentialism emphasizes formal ideals of right and wrong, based on Kant’s categorical imperative.

• Virtue Ethics: Involves applying practical wisdom and experience to resolve ethical issues.

Ethical Models

1. Engineering/analytical model: Caregiver emphasizes factual clinical data, neglecting personal dimensions.

2. Priestly model: Caregiver assumes godlike authority, making decisions on behalf of the patient.

3. Collegial model: Encourages cooperation, trust, and a focus on shared goals.

4. Contractual model: Defines a business-like relationship detailing expectations.

5. Covenant model: Reflects a traditional relationship built on mutual understanding and trust.

Group Discussion

• Apply examined Ethical Theories to Radiation Oncology.

• Assess effectiveness of various Ethical Models in professional practice.

Professional Autonomy

• Lack of autonomy negates responsibility; thus, ethics cannot exist without it.

• RT must establish personal ethics and choose suitable interaction models based on patient-specific values.

Informed Consent

• As per the AMA, patients should:

  • Be informed about their conditions.

  • Understand and approve their treatment plans.

  • Participate actively in their own care decisions, consistent with communication ethics and legal standards.

Elements of Informed Consent

Patients must understand:

• The nature of their procedure or disease.

• Treatment expectations and success likelihoods.

• Alternatives and probable outcomes if treatment is declined.

• Material risks entailed in the procedures.

• Consent can be written, implied, or verbal.

Competency

• Competency denotes minimal mental, cognitive, or behavioral ability for responsibility:

  • Must be above 18 years old.

  • Certain mental health conditions may render an individual incompetent.

  • Only a competent person can provide valid consent.

Legal Aspects of Cancer Management

• Potential civil actions against healthcare professionals include:

  • Assault - Defined as the threat of injurious contact.

  • Battery - Actual harmful contact without consent.

  • False Imprisonment - Unauthorized confinement.

  • Libel/Slander - Defamation, with direct implications in patient interactions.

  • Invasion of Privacy - Includes unauthorized touching or exposure and breach of confidentiality.

  • Negligence - Failure to uphold standard care leading to patient harm.

Distinctions

• Negligence: Failure to exercise care leading to harm.

  • Example of malpractice.

• Carelessness vs. Negligence:

  • Carelessness denotes neglectful behavior; unintentional harm under negligence is still serious but may not exhibit careless intent.

Risk Management (RM)

• Seen as key for loss prevention from adverse medical incidents:

  • Involves measurable outcomes applied to Quality Improvement programs to reduce patient injury.

  • Employees must document anomalies through incident reports, which are separate from patient health records.

Patient Medical Records

• Legal documents chronologically documenting patient care:

  • Personal details (ID, address, physician info).

  • Health history, lab tests, imaging procedures, surgical procedures, treatment setups.

  • Must not contain editorial comments.

Group Discussion

• Discuss a case involving Charlie, a radiation therapy student who notices an unsafe practice:

  • Analyze the therapist’s justification and Charlie's ethical response.

  • Clarify if the issue is ethical, legal, or both.

Take Away Message

• Ethical development starts from personal values, shaping perceptions of right versus wrong.

• RT ethical standards guide practice and adherence is crucial; failure attracts legal consequences.

• An ideal RT can synergize technical expertise with collaborative patient care, ensuring patient dignity and rights are respected.