Ethics for Radiation Protection in Medicine

Preface

During the final stages of the preparation of the manuscript for this book, two new vital related documents were published. ey were, in order of appearance, the revised Declaration of Geneva from the World Medical Association (WMA) which was published in October 2017, and the International Commission on Radiological Protection’s (ICRP) Report 138: Ethical foundations of the system of radiological protection, which appeared in early 2018.

Both are documents of great importance for ethics and radiation protection in medicine. e former, a modern- day version of the Hippocratic Oath, emphasises, among other values, the importance of the autonomy and dignity of the individual, which has not to date been a central consideration in the radiation protection of patients.

The latter identies the ethical values that underpin the system of radia-tion protection in general, for example in dealing with the Fukushima disaster. It defers to a further report in the early 2020s the value frame-work for the ethics issues specic to radiation protection in medicine.

About the Series xi
Preface xv
Authors xix

CHAPTER 1 ◾ Introduction 1

1.1 INTRODUCTION 1
1.2 SOCIETAL ISSUES AND THE HEALTH SECTOR 2
1.3 CULTURE AND PROFESSIONS 4
1.4 RADIATION IN MEDICINE 6
1.5 SCOPE 9

CHAPTER 2 ◾ Ethics for Radiation Protection in Medicine: Framework and Multicultural Considerations 11

2.1 ETHICAL ASPECTS OF RADIOLOGICAL PROTECTION 11
2.2 COMPARISON WITH THE PRINCIPLES OF BIOMEDICAL ETHICS 13
2.3 CLASSICAL ETHICAL THEORIES AS A BASIS 15
2.4 THE NEED FOR A CROSS-CULTURAL APPROACH 17
2.5 CROSS-CULTURAL ETHICS, OR COMMON MORALITY 19
2.6 THE VALUES 21

2.6.1 Respect for Autonomy 21
2.6.2 Non-Malecence and Benecence 22
2.6.3 Justice 23
2.6.4 Prudence 24
2.6.5 Transparency 25

2.7 THE IMPORTANCE OF BALANCING 26
2.8 THE ‘PRAGMATIC VALUE SET’ 27

CHAPTER 3 ◾ The Pragmatic Value Set: Contexts and Application to Radiation Protection in Medicine 31

3.1 INTRODUCTION 31
3.2 SCENE SETTING 32

3.2.1 Uncertainty, Communication, Risk and Sceptical Doctors 32
3.2.2 ICRP Recommendations and Medical Exposures 35
3.2.3 Regulation of Medical Exposures and Radiation Protection of Patients 40
3.2.4 Radiation Protection of Patients in Radiotherapy 45

3.3 THE PRAGMATIC SET IN MEDICAL/DENTAL PRACTICE 47

3.3.1 Dignity and Autonomy 49
3.3.2 Non-Malecence and Benecence 52
3.3.3 Justice 53
3.3.4 Prudence 55
3.3.5 Honesty 57

3.4 CONCLUSIONS 57

CHAPTER 4 ◾ Ethics Analysis of Imaging Scenarios 61

4.1 INTRODUCTION AND METHODOLOGY 61
4.2 SCENARIOS 63

4.2.1 Scenario 1: Professor Browne, Orthopaedic Surgeon 63
4.2.2 Scenario 2: Mr Grey, Ultrasound Referral 64
4.2.3 Scenario 3: Dr Pine, Paediatric Radiologist 65
4.2.4 Scenario 4: Mr Viridian, Mistake in Referral 67
4.2.5 Scenario 5: CT Dose Dilemma 69

4.3 SCENARIOS: SPECIAL CONSIDERATIONS FOR PREGNANT PATIENTS 70

4.3.1 Scenario 6: Ms Violet, Pregnant Patient 71
4.3.2 Scenario 7: Ms Magenta, Pregnant Patient 73

4.4 SCENARIOS: SPECIAL SITUATIONS: IHA, NON-MEDICAL EXPOSURES AND EQUIPMENT FAILURE 74

4.4.1 Scenario 8: Dr Salmon, Cardiologist in Private Practice 74
4.4.2 Scenario 9: Ms Auburn, Drug Smuggling Suspect 76
4.4.3 Scenario 10: Failed Equipment 79

4.5 CONCLUSIONS 81

CHAPTER 5 ◾ Ethics Analysis of Radiotherapy Scenarios 83

5.1 INTRODUCTION 83
5.2 ASPECTS OF SCENARIOS AND METHODOLOGY 85
5.3 SCENARIOS 88

5.3.1 Scenario 1: Dr Loeen, Imaging Frequency 88
5.3.2 Scenario 2: Mr Wilson, A Patient’s Right to Choose His Treatment 89
5.3.3 Scenario 3: Dr Celadon, Consent 91
5.3.4 Scenario 4: Mr Catreuse, Who Bears the Responsibility? 92
5.3.5 Scenario 5: Dr Oxley, Clinical Trials 94
5.3.6 Scenario 6: Ms omson, Patient Prioritisation 96
5.3.7 Scenario 7: Ms Payne, Choice of Treatment Technique 97
5.3.8 Scenario 8: Dr Alizarin, To Treat or Not To Treat 98
5.3.9 Scenario 9: Dr Garnet, Introduction of a New Technique 100
5.3.10 Scenario 10: Ms Perylene, What Nobody Knows 101

5.4 CONCLUSION 103

CHAPTER 6 ◾ Extension of the Pragmatic Value Set 105

6.1 INTRODUCTION 105
6.2 A MORE COMPLETE SET OF VALUES FOR RADIATION PROTECTION 108

6.2.1 Dignity 108
6.2.2 Solidarity 109
6.2.3 Sustainability 110
6.2.4 Accountability 111
6.2.5 Inclusiveness 112
6.2.6 Empathy 113
6.2.7 Summary 113

6.3 THE EXTENDED LIST AND SCENARIOS FROM CHAPTERS 4 AND 5 115

6.3.1 Dignity in Earlier Scenarios 115
6.3.2 Solidarity in Earlier Scenarios 117
6.3.3 Sustainability in Earlier Scenarios 118
6.3.4 Accountability in Earlier Scenarios 119
6.3.5 Inclusiveness in Earlier Scenarios 120
6.3.6 Empathy in Earlier Scenarios 121

6.4 CONCLUSION 122

CHAPTER 7 ◾ Reflections on Uncertainty, Risk and Fairness 123

7.1 ETHICS, FAIRNESS AND TRUST: THE IDEA OF FAIR RISK GOVERNANCE 123

7.1.1 Understanding Risk-Inherent Technology, from an Ethics Perspective 123
7.1.2 Justifying Risk: Concepts of Fairness and the Idea of Intellectual Solidarity 126
7.1.3 ree Reections Re: Ethics, Fairness and Trust in Relation to Risk Governance 133

7.2 AN ETHICS OF CARE FOR FAIR HEALTH RISK GOVERNANCE 136

7.2.1 Reexivity/Intellectual Solidarity as Ethical Attitudes in Face of Complexity 136
7.2.2 An Ethics of Care, ‘Bound in Complexity’ 138
7.2.3 Enabling Virtues: Intellectual Solidarity in Decision Making, Science and Education 142

7.3 CONSEQUENCES FOR RADIOLOGICAL RISK GOVERNANCE 147

7.3.1 e Importance of Considering Dierent Neutral Application Contexts 147
7.3.2 Enabling Values in Radiological Risk Governance 148
7.3.3 e Justice of Justication as a Central Concern 149

AFTERWORD 153
REFERENCES 157
APPENDIX 173
INDEX 175

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Sunday, September 18, 2022

Ethics for Radiation Protection in Medicine