Ethical and Legal Foundations

Ethical and Legal Foundations

Professional Profile

Legal and ethical issues surround me daily in my professional career as I carry out my responsibilities as a picture archiving and communication system (PACS) coordinator and radiologic technologist. As I maintain the PACS system, which requires great emphasis on computer security and information (according to standards set by Health Level Seven [HL7] and the Health Insurance Portability and Accountability Act [HIPAA]), and perform radiographic procedures, I must constantly observe a level of ethical behavior and be cognizant of my legal responsibilities toward maintenance of information, care of my patients, and protection of their rights. Legal and ethical concerns influence the way I and every other technologist perform procedures, the way we interact with patients, and even the way we dress.

When performing any radiographic procedure, I try to maintain focus on the code of ethics set forth by the American Society of Radiologic Technologists (ASRT) and the provisions of the American Registry of Radiologic Technologists (ARRT). As a registered radiologic technologist, I must carry a sense of morality and ethical traits. My choice to become a radiographer was driven by a desire to have technical involvement in the care and treatment of sick and injured people. The care I give in the radiology suite and elsewhere implies my sense of responsibility and accountability.

Professional ethics must be adhered to in the radiology department and in all other locations in health care. Allied health professionals must practice decorum both in the workplace and in the community. Radiologic technologists share a commitment to the patient and the physician to perform procedures as well as possible, whether that be securing the proper view, handing off the proper contrast pharmaceutical, or ensuring the use of the correct technique. We must be conscious of patients’ rights while maintaining a civil and caring demeanor. We should treat all persons with the utmost respect and put our personal beliefs aside to work with others as a united team.

Radiographers provide health care services while maintaining the patient’s dignity and meeting specific needs. We are patient advocates in maintaining high-quality care, which includes ensuring patients’ rights to privacy and confidentiality. We act together with other members of the health care team to make professional decisions and enhance personal accountability. Professional conduct and a conscious awareness of our and our patients’ ethical and legal rights are key to success in delivering health care in the 21st century.


Imaging and radiation science professionals face a variety of ethical challenges within medical imaging services. Because of their differing diagnostic applications, individual modalities present specific ethical dilemmas. Imaging professionals should consider these dilemmas to be challenges and opportunities for growth. When faced with such challenges, imaging professionals and radiation science practitioners must apply professional standards and exercise personal integrity to respond correctly to the situation. A firm grounding in ethics may help imaging professionals, radiation therapy specialists, and other health care professionals respond positively to the dilemmas they encounter in the workplace.

Ethics may be defined as the system or code of conduct and morals advocated by a particular individual or group. It is also the study of acceptable conduct and moral judgment.1 Ethics is a system of understanding determinations and motivations based on individual conceptions of right and wrong. It is not determined by strict rules or rigid guidelines, and although it is relatively stable, it can change over time.

The preceding description of ethics is broad and general. For the imaging professional, biomedical ethics may be defined as the branch of ethics dealing with dilemmas faced by medical professionals, patients, and their families and friends. Biomedical ethics may also be described as guidelines for proper activities and attitudes toward patients and peers. In this case, biomedical ethics suggests a standard of conduct that is expected of members of the profession. These standards are based on the seven principles of biomedical ethics. They are displayed in Box 1-1 and are discussed later in the text.

High ethical standards must be the foundation of professional practice to ensure the recognition of the imaging technologist as a competent health care professional: “The development of a code of ethics is one of the identifying steps in the sequence of the transformation of a semiprofession into a profession.”2 Professional codes of ethics help ensure a high standard of practice. A well-designed code lists the principles and rules defining ethically sound practice. It encourages those within the profession to consider the implications of their actions and educates those outside the profession about the sort of care they may expect. A good code of ethics also serves a regulatory function by specifying a standard of conduct by which all members of a profession must abide. Although many certifying bodies in the imaging and radiation sciences have developed codes of ethics (see Appendix A), unification remains a challenge. The American Society of Radiologic Technologists (ASRT) Code of Ethics considers various aspects of the imaging professional’s role in health care. These areas include conduct, respect, diversity, technical applications, decision making, aid in diagnosis, radiation protection, ethical conduct, confidentiality, and education.

No code of ethics provides the answers to the dilemmas faced by the imaging professional, nor is a code of ethics merely a set system of conduct. Ethics is also a personal study and investigation. Thus the purpose of a code of ethics is to present a framework for a systematic examination of beliefs that may lead the technologist to an understanding of personal and professional morality and responsibility.

The creation of an ethical framework requires critical thinking. Critical thinking has been defined as “purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference.”3 It is an ethical problem-solving tool that allows the imaging professional to perform the following tasks:

Critical thinking allows the professional to process personal experience and knowledge and incorporate them into daily decisions. Through critical thinking the professional internalizes and personalizes ethical concepts. Attributes of critical thinkers are listed in Box 1-2.


Values determine both personal and professional ethics; therefore ethical questions generally involve conflicts between values. A value is a quality or standard that is desirable or worthy of esteem in itself. Values are expressed in behaviors, language, and the standards of conduct the imaging professional endorses or tries to maintain.5 A person’s daily experiences influence and guide the expression of values. For example, a professional who attempts to maintain honesty with co-workers and patients has honesty as a personal value.

Values clarification developed by Louis Rath enables the individual to discover, analyze, and prioritize what he or she has.6 Rath explains that an individual should make choices only after careful consideration of the alternatives. The person should take pride in these choices and be willing to defend them. An example of this might be an imaging professional who has, after careful consideration of personal values, made the choice to become a radiation therapy professional. The individual takes great pride in this decision and is willing to discuss and defend this choice. The imaging professional has based this decision on a desire to enhance the quality of life for patients who may be dealing with life-threatening illnesses.

Values clarification enables the imaging professional to organize values into a personally meaningful system. The individual’s set of beliefs about truth and reality is defined by this system. Thus the imaging professional who values honesty may believe that others are honest with him or her because of this personal value.

Imaging professionals prioritize their values, creating a hierarchy. For example, an imaging professional who values honesty may also value privacy to a greater or lesser degree. Depending on the way each of these values ranks within the personal hierarchy, the professional may take several different courses of action when faced with a dilemma in which both privacy and honesty are involved. This hierarchy may change over time as a result of life experiences and individual reassessment.7

Values guide and motivate the decisions and choices of imaging professionals, often without their realizing it.8 Because the motivations and actions of others may be based on different hierarchies and different value systems, awareness of individual values improves communication.

Imaging professionals should use self-analysis to determine their own values before they begin ethical problem solving, which is discussed later in this chapter. Understanding the values of others and recognizing their importance are important steps in ethical decision making. Imaging professionals must recognize that others’ values are as valid as their own.9 The three basic groups of values are personal values, cultural values, and professional values.

Personal Values

Personal values are the beliefs and attitudes held by an individual that provide a foundation for behavior and the way the individual experiences life.9 For example, an imaging professional may personally value timeliness and organization. These values influence the way the imaging professional makes decisions and judgments. Religious convictions, family, political beliefs, education, life experiences, and culture influence the imaging professional’s personal values. Each person’s values differ.10

Cultural Values

Values specific to a people or culture are known as cultural values. They may also guide the imaging professional’s decision making because they influence opinions about health care. The value of individual choice may be important to an imaging professional from the United States. An imaging professional from an Asian culture may place more emphasis on the value of elderly people than would some professionals from other cultures.9 Multiculturalism and diversity integrated into the imaging curriculum facilitate discussions of cultural values and their importance to high-quality imaging services (see also Chapter 9). The imaging professional must acknowledge the impact of culture on decision-making processes. Figure 1-2 presents continua of cultural values.


The director of radiology services receives a memo from the institution’s chief executive officer (CEO) concerning a patient complaint. He begins the investigation by listening to all the parties involved and remains objective while visualizing the overall situation. With this approach, he realizes that the complaint has arisen from a difference in cultural values. These cultural differences caused confusion and emotional discomfort to the patient and involved issues of being touched, privacy, and communication.

The female patient, who speaks little English, was scheduled for a mammogram, which a male technologist was to perform. Because English is not her primary language and she was uncomfortable being undressed with a man touching her, the patient became upset and left without her examination. On questioning, the mammographer reports that he tried his best to explain the procedure to the patient and that he was pleasant and considerate. Each person involved in the situation sees the problem from a different perspective.

The significance of this situation for the patient is the emotional trauma involved and the lack of completion of the examination. The mammographer failed to complete the procedure. The director of radiology services has been advised by the CEO that mammography is heavily marketed and that these types of situations should not happen and are not to happen in the future. How best can the situation be resolved while including recognition of all the parties’ values?

The director first interviews persons from varying cultural backgrounds to make himself more knowledgeable. He then provides a brainstorming session for radiology personnel and asks them to compile a list of possible solutions. One solution is to initiate focus groups that include community members from a variety of cultural backgrounds. The patient is invited and participates in a focus group to work out solutions to situations such as the one she experienced. After the many solutions and alternatives are evaluated, several are implemented at different levels, including educational activities within the department and the development of a department procedure and policy to promote recognition of all patients’ cultural values in future situations.

Professional Values

Professional values are the general attributes prized by a professional group.9 Imaging technologists may learn about their profession’s values, standards, and motivations through codes of ethics, formal instruction, and role modeling.

Values in Practice

Values may conflict with one another, with the imaging professional’s duties, and with patients’ rights. Personal, professional, and cultural values may provide conflicting guidelines.8 The computed tomography (CT) specialist’s value of providing good care for the patient during the examination may conflict with the value of honoring the patient’s right to choose, especially if the patient is hesitant to have the examination. The radiation therapy technologist’s value of carefully giving safe therapeutic doses of radiation may conflict with the patient’s value of relief from suffering. In each of these situations, imaging professionals must identify the values involved in the decision-making process and determine the most important ones.


The imaging professional works in a challenging and changing environment. To respond appropriately to the many biomedical ethical dilemmas they will face, imaging professionals must be able to apply the basic concepts of professionalism—an awareness of the conduct, aims, and qualities defining a given profession (Figure 1-3).11 Familiarity with professional codes of ethics and understanding of ethical schools of thought, patient-professional interaction models, and patients’ rights prepares imaging professionals to address future ethical dilemmas. When difficult situations arise, they have already thought through the various courses of action and can respond in keeping with their personal standards of ethics.


Ethics may be divided into three broad schools of thought:

Consequentialism, deontology, and virtue ethics are ways of establishing a value hierarchy in ethical decisions. Each school of thought offers different guidelines for ethical problem solving. No one school is better than the others; imaging professionals must choose the one that best serves individual, professional, and institutional goals.


Consequentialism, or teleology, bases decisions on the consequences or outcomes of a given act. It evaluates the good of an activity by assessing whether immediate harm is balanced with future benefit. For example, a patient undergoing radiation therapy for cancer may experience some discomfort now, but the palliation or cure of the cancer is the desired beneficial consequence of the therapy. Consequentialism advocates providing the greatest good for the greatest number.

Within a teleologic framework, an imaging technologist assisting in triage for trauma patients would assign services to the most critically injured patient last to serve a greater number of less seriously injured patients. Are decisions based on final outcomes appropriate? Is this a reasonable philosophy for health care providers? In what way would an imaging director using consequentialist ethics determine ways to cut staffing in a department?


Deontology bases decision making on individual motives and morals rather than consequences. It is therefore the opposite of teleology. Deontology examines the significance of actions themselves. For example, members of certain religious groups refuse blood transfusions because they believe the act is morally wrong. Although they may be concerned about the consequences of this refusal, they are making the choice based on their religious beliefs regarding blood transfusions. Personal rules of right and wrong derived from individual actions, duties, relationships of all kinds, and society are used for reasoning and problem solving in the deontologic school of thought.

Drawing from the previous example, would the imaging technologist find deontology any more useful in decision making regarding triage for victims of a radioactive spill? Can absolute rights and wrongs in triage be determined? In what way would an imaging director using deontologic ethics determine ways to reduce staff? Should the moral significance of each individual be considered in department restructuring?

Virtue Ethics

Virtue ethics is a relatively new school of thought. It focuses on the use of practical wisdom and moral character for emotional and intellectual problem solving. Virtue ethics incorporates elements of teleology and deontology to provide a more holistic approach to solving ethical dilemmas. Careful analysis and consideration of consequences, rules established by society, and short-term effects play significant roles in decision making in virtue ethics.

Feb 27, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Ethical and Legal Foundations
Premium Wordpress Themes by UFO Themes