Unit 1 (Standard of Ethics)

• A. Moral Beliefs
• B. Ethical Codes
• C. Professional Ethics
• D. Code of Ethics
• E. Rules of Ethics

• To protect the public
• defines what it means to be qualified via the education, ethics, and examination requirements for ARRT certification (as part of the equation for excellence)

Promote high standards of patient care by recognizing qualified individuals in medical imaging, interventional procedures, and radiation therapy.

• A. the code of ethics
• B. the rules of ethics
• C. administrative procedures

The Code of Ethics

The Rules of Ethics

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Administrative Procedures

• 1. professional conduct
• 2. providing services with full respect
• 3. delivering patient care free from discrimination
• 4. practicing technology appropriately
• 5. acting in the best interest of the patient
• 6. acting as the physician's agent
• 7. minimizing radiation exposure
• 8. conducting oneself ethically
• 9. respecting privacy
• 10. continually improving knowledge and skills

• indicating on a resume that one is certified or registered with ARRT when one is not
• using the initials R.T. behind your name when not registered.

• cheating on the test
• discussing or providing answers to the test to other students, former students, or educators

• no speeding, parking or other traffic violations (unless they also include drugs/alcohol, like a DUI)
• no juvenile records

Ex. If a nurse with a revoked license tried to enter radiography without disclosing revoked nurse's license

failing to properly shield an elderly patient because you think that doing so wouldn't really make a difference.

accessing a patient's records for personal use

performing a procedure you're not qualified to do.

• prescription or non-prescription drug use 
• duh. this one's very obvious.

this has to be determined by a court of law, not you or your family

• Indicating that you did the QC check on a monitor or processor when you haven't.
• diverting drugs from a facility
• not following facility protocols (leaving pt. unattended, injection of contrast, etc)

telling a patient you think he/she is sexy.

discussing a patient's results with a third party (except when otherwise required or permitted by law)

• Medicare/Medicaid fraud
• intentially billing for services that were never performed

• altering patient records to cover up a mistake
• not keeping enough records; not documenting

• allowing someone who doesn't have a valid state license or ARRT certification if required by that state and/or facility
• allowing a parent to make the exposure while you hold their child for an xray

• violations of HIPAA, state, and/or federal drug and alcohol laws
• taking narcotics from a facility

if a patient falls off an x-ray table while in your care and you deny it.

but duh, do your CEUs yourself, don't help others do theirs. don't cheat. yadayadayada.

ignoring a letter from the Ethics Department in the hopes that it will go away

• submitting CEUs you didn't earn
• falsifying clinical experience documentation
• submitting an invalid ARRT card or state license
• indicating that you are registered/certified when you are not
• indicating that you are certified in a modality that you are not
• using the R.T. credential string when you are not registered

not reporting to your supervisor that your co-worker took x-rays of a family member without an order from a licensed provider

• not reporting if a wrong dosage is injected
• not reporting if an incorrect area was imaged

• Have you ever been convicted of a misdemeanor, felony, or a similar offense in a military court-martial?
• Have you had any license, registration, or certification denied, revoked, suspended, placed on probation, or subjected to discipline by a regulatory authority or certification board (other thant ARRT)?
• Have you ever been suspended, dismissed, or expelled from an education program that you attended in order to meet ARRT certification requirements?

the Family Educational Rights and Privacy Act, 20 U.S.C. Section 1232g

FERPA is the act under which the student can release his school information/records to ARRT.

moral beliefs (ethical viewpoints of society)

• religion
• culture
• ** moral beliefs can change

• Lawrence Kohlberg (Kohlberg's Theory, the 70s)
• preconventional: ages 2-7
• conventional: ages 7-12
• postconventional: ages 12 and over

• ages 2-7
• child has no real understanding of values, accepts authority of others
• the focus is on personal satisfaction (self-centered)
• learn from experience, obedience, punishment

• ages 7-12
• conformity with expectations of family, group, nation to win approval of authority figures
• focus fixed on rules, social order, respect for authority
• idea of rules can be very rigid, ex. tattling

• ages 12 and up
• focus is the development of the social construct and autonomous decisions apart from authorities
• child establishes a social-contract
• abstract concepts like justice and respect for others become important
• one's conscious becomes the final arbiter in ethical dilemmas 

• the system or code of conduct and morals advocated by a particular individual or group
• a systematic reflection on morality
• study of acceptable conduct and moral judgement
• a system of understanding determinations and motivation based on individual conception of right and wrong.

group ethical behavior

• moral principles give us a sense of right and wrong and the desire to do the right thing; they influence our professional ethics
• professional ethics define correct moral behavior in the context of performing professional duties; more structured and defined.

• in prehistoric times, when people recognized that the individual's behavior affected the rest of the group/society
• began as customs, then laws were developed as established customs were deviated from.
• ethics, while usually stable, can change
• **you are not competent as a technologist if you have no ethical principles

biomedical ethics

• the natural law ethics of Saint Thomas Aquinas:
• people could discover moral principles, which may be described as objective truths, simply by exploring the nature of things and applying reason. "The ability to reason is a unique God-given trait."

• microethics (microallocation)
• ex. who will receive scarce resources such as intensive care beds, dialysis services, solving problems like abortions, ventilators, feeding tubes

• macroethics (macroallocation)
• decisions made by congress, state legislators, insurance companies, private foundations, and healthcare organization

• autonomy: respect for the pt as a person able to make his own decisions
• beneficence: performance of good acts
• confidentiality: duty to protect the privacy of the patient
• justice: moral rightness
• nonmaleficence: avoidance of evil
• role fidelity: faithfulness and loyalty
• veracity: obligation to tell the truth and not to lie

To present a frame work for a systematic examination of beliefs that may lead the technologist to an understanding of personal   and professional morality and responsibility.

it is one of the identifying steps in the sequence of the transformation of a semi-profession into a profession.

• Lists the principles and rules defining ethically sound practice.
• Encourages professionals to consider the implications of their actions.
• Educates outsiders about the sort of care they may expect.
• Serves a regulatory function by specifying a standard of conduct by which all members of a profession must abide
• ** Many certifying bodies in imaging have their own code of ethics

developed and jointly adopted by ASRT and ARRT

• just for fun:
• 

critical thinking

• adequately interpret and analyze ethical theories and models
• evaluate the application of those theories and models to a given situation
• plan an appropriate course of action

• the beginning of physicians' practices and medications
• with the Babylonians, Egyptians, Persians

• early moral philosophy
• first developed by Pythagoras, who also influenced the Hippocratic Oath
• Hippocrates is given credit for the Hippocratic Oath.

the Hippocratic Oath, which focuses on "First, do no harm..."

Plato provided the theory of morality and the influence it has on human behavior: we act according to our moral beliefs

Saint Thomas Aquinas provided the world an ethical theory based on religion, put for in the "Natural Law Theory" of the Roman Catholic Church.

• physicians began to examine their own educational needs
• the plagues of the time made them recognize their moral duties to their patients
• this increased awareness lead to the formation of professional associations which eventually developed specific qualifications and educational requirements for their fields.

• 16th-19th centuries
• Sir Francis Bacon
• Immanual Kant, Jeremy Bentham, and John Stuart Mills
• Rodericus Castro
• David Hume

• established three main goals of healthcare:
• the preservation of health
• the cure of disease
• the prolongation of life

• developing one of the two most common traditional ethical theories:
• Deontology

• developing one of the two most common traditional ethical theories:
• Utilitarianism

recognizing the responsibilities of the physician to the public

development of community organizations; public health; national goals

Deontology

utilitarianism (the ends justifies the means)

• "the birth of bioethics"
• W.D. Ross (Oxford)
• John Rawls (Harvard)
• Lawrence Kohlberg

• developed a set of rules geared toward governing professional behavior
• (Oxford)

• principle of justice - used the strengths and weaknesses of common ethical theories to derive a set of principles providing equal liberty for all while addressing the needs of the less fortunate
• (Harvard)

value

• developed Values Clarification:
• allows us to develop alternatives
• enables us to discover, analyze, prioritize

• choosing or making the decision
• prioritize after decision is made
• acting

values

• personal
• cultural
• professional

personal values

cultural values

professional values

Professionalism

• Utilitarianism (Consequentialism or Teleology)
• Deontology (Nonconsequentialism)
• Virtue Ethics

Utilitarianism (Consequentialism or Teleology)

Utilitarianism (Consequentialism or Teleology)

• Ex. They may not put the most critical patient first if there is a disaster with a large number of patients. Instead, they would take care of the majority first and the most critical last.
• Ex. If reducing staffing in a department, they might let the employee go who made the most money in order to save
• more people from losing their job.

• the ends justifies the means
• the greatest good for the greatest amount of people

Deontology (Nonconsequentialism)

• Deontology (Nonconsequentialism)
• (they strictly go by what is right and what is fair and not the consequences)

Ex. When reducing staff they would probably let the last one hired go because they are going to feel a sense of loyalty to the person who has been there the longest. Ex. They would put the most critical patient first if there is a disaster with a large number of patients, not prioritizing the majority over the ones in most need of help.

• Immanuel Kant
• based on Thomas Aquinas's natural law ethics
• (nothing is good in and of itself except a "good will")

• rationality/reason
• Universal truths apply to all people, for all times, in all situations.

• a maxim
• Kant (Deontology): "We must always treat others as ends and not as means only"

Virtue Ethics

• Engineering - provider views the patient as condition or procedure
• Paternal/Priestly - Provider thinks he or she knows what is best for patients
• Collegial- Mutual cooperation between provider and patient.
• Contractual -Business relationship where provider and patient both have obligations, rights, and responsibilities
• Covenantal Agreement between provider and patient grounded on traditional values

The Patient Care Partnership

ethical dilemma

ethical dilemma of justice

ethical distress

Locus of Authority Issue

• Assessment of the problem
• Isolation of the issues
• Analysis of the data
• Development of a plan of action
• Institution of the plan
• Analysis of the outcome

law

• Common Law from England, but it has been molded by statutes and judicial decisions since the birth of the U.S.
• exception: Louisiana (Roman Law and Napoleonic Code)

legislation

tort

the wrong doer could be held liable in a criminal action suit as well as a civil action.

civil law

found in the liability of those who profess to be competent in certain "public" callings (duty of care).

can be found under current law only if a duty is owed, that duty is breached, and demonstrable harm has resulted from the breach.

statutory law (can be formed, set by a precedent)

physician-based standard

reasonable patient standard

current law

• Administrative Law
• Criminal Law
• Civil Law

Administrative Law

Criminal Law

Civil Law

negligence

malpractice

• Ordinary negligence: failure to do what a prudent person would or would not do, under the circumstances of the act or omission in question
• Gross Negligence: intentional or wanton omission of care that would be proper to provide or the doing of that which would be improper to do so. (something really bad; basically a complete disregard for human life)

• assault (threaten)
• battery (touching without consent)
• false imprisonment
• defamation (false statements that damage a reputation)
• negligence
• lack of informed consent
• breach of patient confidentiality

• Pleading Phase:
• complaint filed by plaintiff (court is petitioned)
• defendent is "served" with notice of the filing of the law suit
• defendent must file a written answer within a set amount of time

• Discovery Phase:
• Facts are sought in written (interrogatories) or oral (depositions) form, under oath.
• A trial decision is made.
• (most cases settle out of court)

• attorneys for the plaintiff, defendent, and defendent's insurance company (and the parties themselves)
• sometimes negotiators/mediators

• Statute of Limitations
• (restrictions are placed on attorneys to file such lawsuits only after a reasonable inquiry has been made with regard to the facts of the claim)

• Document, obtain informed consents, maintain patient confidentiality, practice radiation   protection, and maintain a safe environment for patients and employees.
• Set in place a risk management team. The system for identifying, analyzing, and evaluating risks and selecting the most advantageous method for treating them.

To maintain quality patient care and conserve the facility’s financial resources.

• Elimination of the causes of loss experienced by the hospital and its patients, employees, and visitors
• Lessening of the operational and financial effects of unavoidable losses
• Covering of inevitable losses at the lowest cost

Quality Assurance

Considers a wide range of concerns and uses hospital committees to oversee the quality of various hospital functions.

Ranges from overseeing the quality and necessity of surgery to the determination of which doctors may practice in the hospital and what procedures they may perform.

• The focus of Quality Assurance is on the quality of the medical care and how it can be improved. 
• Risk management relates more to the physicalfacility and the risks involved with accidents; it is more accident prevention.

the Patient Safety and Quality Improvement Act of 2005

• Science
• Culture
• Religion
• Experience

• Accountability
• Caring
• Fairness
• Honesty
• Integrity
• Loyalty
• Promise keeping
• Pursuit of excellence
• Respect for others
• Responsible citizenship

• "Distributive justice"
• "Compensatory"
• "Corrective"
• "Retributive"

• Center for Disease Control and Prevention (CDC) 
• National Institutes of Health(NIH)
• Office of Technology assessment(OTA)
• United States Supreme Court

whistleblowing

• Internal – informing higher management about problems by going over the boss’s head
• External – informing an outside body, such as a regulatory agency or newspaper reporter

• 1.  How serious is the unethical or illegal behavior?
• 2.  What is the strength of the evidence?
• 3.  What are the normal channels for resolving the issue?