ETHICAL THEORIES

The three ethical theories discussed in Chapter 1—consequentialism, deontology, and virtue ethics—serve as guidelines for ethical problem solving both for educational programs and imaging students and for imaging employers and imaging professionals. The choice of theory determines the basis on which each participant interacts within the educational and imaging environment (Table 8-1).

MODELS

Although ethical theories provide a foundation for solving problems concerning students’ and employees’ rights and responsibilities, the model of care employed also helps define the ethical structure within which decisions are made (Figure 8-2). The model chosen—engineering, priestly, collegial, contractual, or covenantal—determines the ways in which interactions take place between students and educational programs or employers and employees. (See Chapter 1 for a more thorough discussion of these models.)

Students and imaging professionals who feel as though they have lost their identity within the educational and imaging process may be working within the engineering model. An instructor or physician who displays a godlike or fatherly attitude toward students or employees may be employing the priestly, or paternal, model. A cooperative effort between students and teaching programs or imaging professionals and patients is evidence of the collegial model. When students enter an educational program, they enter into a businesslike arrangement that defines the relationship between the student and the program. Rights and responsibilities may be defined within this arrangement. Imaging professionals enter into an employment agreement with an institution or organization in a similar fashion. These are examples of the contractual model. After the contract, including aspects affecting student or employee rights, has been agreed to by both parties, an understanding based on traditional values and goals develops between the student and the program or the employer and employee (see also contract law later in the chapter). This understanding is a crucial element of the covenantal model, which is based on trust and shared experiences within the educational program or the imaging environment. The model most often employed in imaging education and the imaging department is a combination of the contractual and covenantal models. A good example of this combined approach within the radiologic sciences is the learning contract in clinical education.¹ An example of this in the imaging employment area is a contract signed by an imaging professional for tuition reimbursement.

As a result of the explosion in technology and the ever-increasing knowledge base required for clinical practice, programs are having difficulty providing students with all they need to know to function competently in a continually changing work environment. To facilitate the adequate education of students and prepare them for employment in the evolving health care system, educational programs have developed learning contracts, which are formalized and mutual agreements between instructors and students that guide learning experiences.² Because they are contracts between programs and students, they require trust. Students enter the program trusting that they will be appropriately prepared to provide high-quality imaging services, and instructors trust that students are adequately motivated to uphold their responsibilities to study and perform their duties. When used properly, learning contracts may be valuable methods to provide needed experiences for students.³

Needed Imaging Experience=Students+Programs+Learning Contracts

The rapid evolution of technology not only affects educational programs but may also affect the imaging department and the imaging professional. New equipment and new technology often require continued education for the imaging professional. When professionals are asked to increase their knowledge base and responsibility level within the imaging area, they are often reimbursed in some method. This requires trust by both parties. Each has an obligation and responsibility to uphold the agreement and to maintain high-quality imaging services.

Needed New Technology=Imaging Professional+Employer+Reimbursement Method

AUTONOMY AND INFORMED DECISIONS

The exercise and protection of student and employee rights involve autonomy and informed decisions. The individuality of each student and imaging professional is an integral aspect of the educational and employment experience. Each student and employee has the right to be respected and treated with dignity and consideration. Students have the right to expect high-quality education by high-quality instructors. Because student abilities and experiences differ, educational programs must be creative in classroom and clinical methodology. Imaging employees have the right to expect fair and equitable treatment from their employers, but they may also have differing abilities and experiences. Employers must fairly evaluate their imaging employees and provide growth opportunities for them.

Programs that respect student autonomy provide realistic and current employment opportunities for graduates. However, some programs that have noted poor results in their cost-benefit analyses face an ethical dilemma regarding employment. To maintain current faculty numbers, such programs may have to keep enrollment numbers at a maximum even if job opportunities are limited and graduates may face a very difficult job search.

The cost effectiveness of clinical education is often a concern for administrators.⁴ One of the primary concerns of administrators is whether the value of labor contributed by students offsets the cost of educating them. Indeed, the use of student labor in clinical settings is an ethical concern for educational programs and imaging students contemplating their rights in the educational environment. If students believe they are being used in place of staff radiographers for cost savings to a department, they may question their clinical assignments. Moreover, educators may have difficult ethical decisions to make concerning student rotations if they feel pressured by administrators to provide more student contact hours in the clinical setting. The rights of the students may be endangered if issues of cost savings by staff reduction are contemplated (Box 8-1). Imaging students are responsible for maintaining the safety of their patients and recognizing imaging procedures in which they are competent.

When issues of staffing and cost savings clash with student competency and clinical assignments, the student and the educator should be mindful of the accreditation requirements for student supervision set forth by the Joint Review Committee on Education in Radiologic Technology (JRCERT). JRCERT defines direct supervision as student supervision by a qualified practitioner who reviews the procedure in relation to the student’s achievement, evaluates the condition of the patient in relation to the student’s knowledge, is present during the conduct of the procedure, and reviews and approves the procedure or image. Students must be directly supervised until competency is achieved. This supervision ensures patient safety and proper educational practices. JRCERT also states that all repeat radiographs by students will be supervised by a qualified practitioner.⁵

The cost effectiveness of maintaining an imaging department is an ongoing battle for both administrators and educators. Imaging professionals may feel as if they are not regarded as individuals when they are not involved in decision making and planning. Often departments can become so hectic that imaging professionals are shifted about and schedules changed with little notice. They may regard this as less than professional treatment by their employers. It is most important to remember that the driving force and responsibility for both the employer and the employee should be the needs of the imaging patients.

An emphasis on informed decisions encourages student autonomy by providing the prospective student with important information about the educational program and its policies and procedures. This exchange of information enables the student applicant to make informed decisions concerning participation in the program. After students have chosen and entered their programs, they are typically given a vast amount of information about their future didactic and clinical educational experiences. It is their responsibility to read, digest, and question this information until they have an operative knowledge that will facilitate their educational process. Educators should review this information periodically to ensure that students are provided with current and updated information that will help them obtain the skills and knowledge necessary to become qualified imaging professionals (Box 8-2).

The exchange of information is one of the most important communication tools in the imaging department. When the administrator keeps the employees informed, they recognize their importance in departmental decision making. Imaging professionals should be aware of the location of all informational materials pertinent to their activities in the department. Staying informed is also an important responsibility of the imaging professional. The process is a two-way street. Professional literature and organizations are excellent tools in making informed decisions.

TRUTHFULNESS AND CONFIDENTIALITY

Students and imaging professionals have a right to the truth during the informed decision process when they have a contractual agreement with the educational program or their employer. They also have a right to expect confidentiality during their education or employment. Truthfulness and maintenance of student and employee confidentiality are crucial elements in the relationships among students, instructors, imaging employers, and employees. Students put their trust in their instructors, who have the power to affect their future. They must be able to believe that when they ask even ethically difficult questions, they can expect the truth. A student who shares a personal confidence with an instructor should have the reasonable expectation that this confidence will be kept. However, this expectation of truthfulness and confidentiality may give rise to ethical dilemmas if the student expects to obtain truthful information that involves the confidentiality of another, or if the student makes a statement in confidence that may cause harm to another if it is kept secret. For example, a student may reveal a drug problem to an instructor with the intention of finding assistance and treatment. After a short period the instructor becomes aware that the student often works under the influence of drugs in the clinical area. The instructor faces a dilemma regarding conflicting ethical obligations. If the instructor explains the problem to the program director, the confidence of the student will be betrayed. However, if the greater good is served, the violation of student confidentiality may be acceptable. In this case, from a legal perspective, quality of care and patient safety dictate a breach of the confidentiality between student and instructor. This situation should be covered in the policies and procedures of the educational program and the student handbook, and therefore the student should be aware of the consequences of such actions. Such questions involve a balancing of student rights and responsibilities with the rights and responsibilities of the educational program to maintain an appropriate environment for imaging education and services.

A similar situation may occur when an imaging professional shares a drug dependency problem with an administrative imaging professional. The drug-dependent professional has placed trust and confidence in someone who is being asked for assistance. As in the educational situation, the balance of the employee’s rights and responsibilities and the rights and responsibilities of the imaging organization to maintain high-quality imaging services and patient care has ethical and legal implications.

JUSTICE

A positive environment for imaging education and employment must also encourage justice and fairness (Box 8-3). Justice in imaging educational programs and imaging employment is enhanced through appropriate application of ethical theories and models and the creation of an educational and imaging environment in which student and employee autonomy, informed decisions, truthfulness, and confidentiality are valued.

Students and imaging professionals expect to be treated fairly. Fairness, however, is difficult to define. One student’s or employee’s perception of fairness may not be the same as that of another. The following examples illustrate the dilemmas resulting from differing conceptions of fairness.

Related posts:

Principles of Beneficence and Nonmaleficence Truthfulness and Confidentiality Caring and Communication Diversity Overview of New Technology and Future Challenges Health Care Distribution

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