Ch2 Professional Ethics & Legal Issues in Imaging Technology

The Healthcare Team

The radiographer interacts daily with peers and other members of the healthcare team.

Healthcare Team Members

Physicians: Doctors of medicine or osteopathy specializing in specific areas, prescribing, and supervising medical care.
Registered Nurses: Provide 24-hour patient care, home healthcare, case management, education, patient advocacy, and administer prescribed medications and treatments.
Vocational Nurses: Work under RN supervision.
Occupational and Physical Therapists: Work in rehabilitative healthcare.
Pharmacists: Prepare and dispense medications and oversee drug therapy.
Respiratory Therapists: Maintain or improve respiratory status.
Laboratory Technologists: Analyze specimens for pathological conditions.
Social Workers: Counsel patients and refer them to appropriate agencies.
Unlicensed Assistive Personnel: Nursing assistants, ward clerks, pharmacy technicians, and ECG technicians.

Professional Ethics

Ethics is a set of moral principles governing actions.
Moral principles set standards for right and good.
Personal ethics evolve based on cultural and environmental background, assigning values to behaviors and objects.
Ethics combines honesty, integrity, fairness, caring, respect, fidelity, citizenship, competence, and accountability.
"Ethics," "principles," and "values" are closely linked.

Bioethics

Bioethics addresses ethical issues in human life, healthcare, and death.
Coined in 1971, it now deals with prolonging life, do-not-resuscitate orders, and stem cell research.
Exposure to these ideas may influence personal beliefs and ethics.
All professionals have a set of ethical principles or a code of ethics governing professional behavior.

Standards of Ethics

The Standard of Ethics includes the Code of Ethics and the Rules of Ethics.
The Code of Ethics, revised and adopted by ASRT and ARRT in 2017, guides ethical conduct in radiologic sciences.
The Rules of Ethics, enforced by ARRT, promote patient protection, safety, and comfort.

ARRT Standards of Ethics

Preamble:

Applies to ARRT certificate holders and candidates.
Consistent with ARRT's mission statement.

Code of Ethics:

Guides professional conduct related to patients, healthcare consumers, employers, colleagues, and other healthcare team members.
Aims to maintain high ethical standards and protect patients.
Radiologic technologists act professionally, respond to patient needs, and support colleagues in providing quality patient care.
Radiologic technologists advance the principal objective of the profession to provide services to humanity with respect for the dignity of mankind.
Radiologic technologists deliver patient care without discrimination.
Radiologic technologists practice technology founded upon theoretical knowledge, use appropriate equipment, and employ proper procedures.
Radiologic technologists assess situations, exercise care and judgment, assume responsibility for professional decisions, and act in the best interest of the patient.
Radiologic technologists act as agents to obtain pertinent information for physicians, recognizing that interpretation and diagnosis are outside their scope of practice.
Radiologic technologists use equipment and techniques following standards of practice and minimize radiation exposure.
Radiologic technologists protect patient rights to quality radiologic technology care.
Radiologic technologists respect confidences and privacy, revealing data only when required by law or to protect welfare.
Radiologic technologists improve knowledge and skills through CE and professional activities.

Rules of Ethics:

Are mandatory standards of minimally acceptable professional conduct.
Certification and Registration assure the medical community and the public of an individual's qualifications.
Promote protection, safety, and comfort of patients.
Enforceable.
R.T.s must notify ARRT of ethics violations, licensing issues, and criminal charges/convictions within 30 days or during annual renewal.
Applicants must report violations within 30 days.

Conduct or activities violating the Rules of Ethics:

Employing fraud or deceit.
Engaging in false, fraudulent, deceptive, or misleading communications.
Knowingly engaging in abusive or fraudulent billing practices.
Subverting ARRT's examination/CQR process.
Subverting ARRT's CE/CQR requirements.
Subverting ARRT's certification/registration processes.
Engaging in unprofessional conduct.
Engaging in sexual conduct with a patient.
Engaging in unethical conduct.
Performing procedures without competence.
Assisting unqualified persons in practicing radiologic technology.
Delegating functions creating danger to patients.
Inability to practice with reasonable skill due to illness or substance use.
Adjudication as mentally incompetent.
Improper management of patient records.
Revealing privileged communications.
Knowingly providing false or misleading information related to patient care.
Violating narcotics or controlled substance laws.
Violating state/federal regulatory rules.
Convictions, criminal proceedings, or courts-martial (excluding minor traffic violations).
Knowing of and failing to report violations of the Rules of Ethics.
Failing to report errors connected with patient imaging or care.

These documents represent the application of moral principles and are the minimum acceptable standards of conduct, focusing on duties and responsibilities toward self, patients, peers and associates.

Ethical Philosophies

Three basic ethical philosophies are utilitarianism, deontology, and virtue.

Utilitarianism

Also called consequentialism, advocating actions are morally right when the largest number of persons benefits from the decision made.
The important element is the result of the action.
Based on the principle known as teleological theory (end or completion).
It is based on consequences with the highest good with the greatest happiness for the largest number of people.

Deontology

Upholds the philosophy that rules are to be followed at all times by all individuals.
Requires judging an action by deciding if it is an obligation.
Decisions generally do not consider consequences.

Virtue

Focuses on using wisdom rather than emotional and intellectual problem solving.
Incorporates principles of both utilitarianism and deontology to provide a broader view of issues.
Analysis, review of consequences, and societal rules are essential to forming decisions using virtue.

Ethical Principles

A set of principles to resolve ethical dilemmas:

Autonomy

Refers to the right of all persons to make rational decisions free from external pressures.
Patients have the right to make decisions concerning their lives, and all healthcare workers must respect those decisions.

Beneficence

All acts must be meant to attain a good result or to be beneficial.
The radiographer must always plan patient care to ensure safe outcomes and avoid harmful consequences.
Beneficence requires action that either prevents harm or does the greatest good for the patient.

Confidentiality

Refers to the concept of privacy.
Patients have the right to have information concerning their state of health; personal information should be kept in confidence without disclosing it to others

Double Effect

Some actions may produce both good and bad effects.
Four criteria must be fulfilled before this type of action is ethically permissible:

The act is good or morally neutral
The intent is good, not evil, although a bad result may be foreseen
The good effect is not achieved by means of evil effects
The good effect must be more important than the evil effect, or at least there is favorable balance between good and bad

Fidelity

Refers to the duty to fulfill one’s commitments and applies to keeping promises both stated and implied.
The radiographer must not promise patients results that cannot be achieved.

Justice

Refers to all persons being treated equally or receiving equal benefits according to need.
One patient must not be favored over another or treated differently from another, regardless of personal feelings.

Nonmaleficence

Refers to the duty to abstain from inflicting harm and also the duty to prevent harm.
The radiographer is obligated to practice in a safe manner at all times.

Paternalism

Refers to the attitude that sometimes prompts health care workers to make decisions regarding a person’s care without consulting the person affected.

Sanctity of Life

Refers to the belief that life is the highest good and nobody has the right to judge that another person’s quality of life is so poor that life is not of value and should be terminated.

Veracity

Refers to honesty in all aspects of one’s professional life.
One must be honest with patients, coworkers, and oneself.

Respect for Property

Refers to keeping the patients’ belongings safe and taking care not to intentionally damage or waste equipment or supplies with which one works.

Ethical Issues in Radiography

Radiographers must conduct themselves professionally, being reliable, punctual, competent, sensitive, and efficient.
Expected to be cooperative members of the healthcare team, using articulate speech.
Patients are to be treated with dignity and worth in a non-discriminatory manner.
Student radiographers may observe ethically questionable patient care, such as protecting colleagues violating ethics codes or unequal medical resource allocation.
Observed issues violating the ethical code should be discussed with supervisors and/or instructors in private conference.

As the scope of practice grows, so do ethical responsibilities.

If professional code of ethics cannot resolve ethical dilemmas, the problem should be presented to the institution's ethics committee.

Legal Issues in Imaging Technology

Law refers to rules of conduct, prescribed by an authority or group of legislators.
Authority includes ARRT and ASRT.
Rules of conduct refer to Practice Standards.
Standards define the practice and determine compliance.

The four sections of the standards are:

Scope of Practice.
Clinical Performance Standards.
Quality Performance Standards.
Professional Performance Standards.

Patient Rights:

The radiographer has a legal responsibility to relate to colleagues, other members of the health care team, and the patient in a manner that is respectful of each person with whom interaction occurs and to adhere to the Patient’s Bill of Rights and The Patient Care Partnership.

Areas of Practice Where Healthcare Workers May Infringe Upon Patient’s Rights and Be Held Legally Liable

Acting as a diagnostician and providing results, impressions, or diagnoses.
Failing to obtain appropriate consent from women of childbearing age.
Failing to obtain a complete history before administering contrast.
Failing to correctly identify a patient.
Failing to explain a procedure.
Failing to document technical factors.
Failing to maintain privacy.
Failing to maintain high-quality images with the lowest possible radiation dose.

Radiographers must never assume the role of other medical personnel in the department.

If a patient is injured, the radiographer must not dismiss the patient until the patient has been examined by a physician and deemed safe for discharge.

Patient Responsibilities

Provide an accurate and complete health history.
Keep appointments and notify the practitioner/hospital when unable to do so.
Responsible for all actions when refusing treatment or not following instructions.
Fulfill financial obligations as promptly as possible.
Follow hospital rules and regulations affecting patient care and conduct.
Be considerate of the rights and property of others.

Legal Concerns

Statutory law and common law are significant.

Statutory Laws

Derived from legislative enactments.

Common Law

Results from judicial decisions.

The two major classifications of law are:

Criminal Law
Civil Law

An offense is regarded as criminal behavior in the realm of criminal law if it is an offense against society or a member of society.

Felony

Is a crime of a serious nature punishable by a fine higher than $1,000.00$ and a prison sentence of more than 1 year or, in extreme cases, by death.

Misdemeanor

Is a crime of a less serious nature punishable by a fine or imprisonment for less than 1 year.

Civil Law

Has been broken if another person’s private legal rights have been violated.
A tort involves personal injury or damage, resulting in civil action or litigation to obtain reparation for damages incurred.

Forms of a Torts

Torts can be committed intentionally or unintentionally.

Immobilizing patients against their will (false imprisonment).
Falsely stating that a patient has a socially unacceptable disease (defamation of character).
Causing extreme emotional distress resulting in illness through outrageous or shocking conduct.

Unintentional Torts

May be committed when a radiographer is negligent in the performance of patient care and the patient is injured as a result.

Examples of Unintentional Torts

Improperly marking radiographic images.
Omitting to apply gonadal shielding on a pregnant patient.
Improperly positioning a trauma patient.
Handing the radiologist the incorrect syringe.
Leaving an unconscious patient unattended.
Improperly positioning a footboard on an x-ray table.
Not providing parents of pediatric patients with the proper protective attire.

Respondeat Superior

Is a Latin term meaning “Let the master answer”.

It holds the employer liable for the negligent actions of an employee.
States the employer is responsible for the employee’s actions.
Requires proof of an employer-employee relationship.

Res Ipsa Loquitur

Means “the thing speaks for itself”.
Occurs when negligence is obvious.
Requires no proof. The patient does not contribute to negligence.
Example: A patient is burned during a procedure.

The Patient Care Partnership

Also known as the Patient’s Bill of Rights.
States what a patient can expect during a hospital stay.
Informs patients about their rights, including:

Excellent medical care.
A safe environment.
Participation in care decisions.
Privacy protection.
Assistance when leaving the hospital.

Patient data is protected by law.

Patient Confidentiality

HIPAA (Health Insurance Portability and Accountability Act of 1996)

Requires healthcare providers to protect patients’ rights. Includes:

Privacy
Confidentiality
Security of health information.

Signed into law to protect patient information.
All healthcare workers must adhere to HIPAA.
Violation of HIPAA could result in termination and/or a considerable fine.
Penalties increase with malicious intent.
Patients must be informed about HIPAA at the time of service.
Healthcare workers must keep patient information confidential; discussing a patient’s case with friends/family is unethical and illegal.
Medical records are legal documents and cannot be altered.
Healthcare facilities are legally required to institute and maintain policies and procedures to protect the integrity of patient information.
All radiology reports, images, and requests are confidential.

Informed Consent

States a patient must be fully informed about their treatment before signing a consent form.
Consent form confirms the patient understands the procedure and consents to the risks.
Consent requirements:

The patient must be of legal age and mentally competent.
The patient must offer consent voluntarily.
The patient must be adequately informed about the medical care being recommended.

Required before an invasive procedure.
Required before contrast administration.
Contrast materials are considered drugs and must be administered under proper medical supervision by licensed or certified personnel.
Radiographers must ensure the patient has no allergies or previous reactions and should follow all steps required for medication administration.
Refusal should be documented and reported

Patient Identification

One of the first steps in imaging is proper patient identification.
Failure to properly identify a patient can cause great patient harm.
Ask the patient their full name and date of birth.
Compare the information to the request form.
Check the patient’s wristband.

Immobilization

May be used to obtain diagnostic images.
When patient safety is in jeopardy, immobilization may be necessary. (Ex. Trauma patient)..
An immobilization device restricts patient movement.
If using immobilization, explain necessity to the patient for consent and cooperation.
Do not use immobilization if a patient can cooperate.
Pigg-o-stat is a common immobilization device for pediatric chest imaging.
Papoose board secures the child for short periods of time.
Octagonal contour bands are used for skull radiography.
Sandbags, tape, and sponges are inexpensive positioning aids.
Liability may be incurred if a patient is unlawfully confined or restrained.

Documentation

Accurate documentation is essential in healthcare.

Documentation Must Include:

Date
Time
Examination
Radiographer performing procedure

When Documenting Medication Administration:

Record the name
Strength
Dosage
Route of administration
Lot number
Expiration date
Patient reaction

For Patient Safety Always

Keep accurate and complete records
Follow legal, ethical, and institutional guidelines

Manipulation of Electronic Data

Radiographers can manipulate images and should be manipulated for diagnostic purposes only.

Unethical practices include:

Cropping or masking anatomy
Hiding artifacts or errors

Professional Malpractice Insurance

Protects radiographers from financial loss and provides legal defense.
Malpractice, or professional negligence, may cause patients to take legal action.
Health professionals should consider carrying their own malpractice insurance.

Current Methods of Healthcare Delivery in the United States

Traditional Fee-for-Service
Health Maintenance Organization (HMO)
- Requires a primary care physician (PCP) referral to see specialists.
- Often has lower out-of-pocket costs but less flexibility in choosing providers.
- Focuses on preventative care.
Preferred Provider Organization (PPO)
- Allows patients to see specialists without a referral.
- Typically has higher premiums and out-of-pocket costs than HMOs.
- Offers more flexibility in choosing providers.
Medicaid
- A joint federal and state program that provides health coverage to millions of Americans, including children, pregnant women, seniors, and people with disabilities.
- Eligibility generally depends on income and household size.
- Offers comprehensive benefits, including doctor visits, hospital care, and long-term care.
Medicare
- A federal health insurance program for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD).
- Divided into four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug insurance).
- Has premiums, deductibles, and co-pays that vary depending on the coverage.