Radiologic Technology: Ethical Issues in Healthcare

Ethical Issues in Healthcare

• Access to health services involves three distinct steps: gaining entry into the healthcare system, accessing a location where needed healthcare services are provided, and finding a healthcare provider whom the patient trusts and can communicate with.
• Barriers to health services include high cost of care, inadequate or no insurance coverage, lack of availability of services, and lack of culturally competent care.
• Patient privacy and confidentiality are essential, with specific provisions of HIPAA defining what information can be released and to whom.
• Public health statutes may conflict with patient confidentiality, requiring the reporting of certain diseases and events for epidemiological purposes or for the protection of society.
• Culturally sensitive healthcare is crucial, recognizing that traditional westernized medical practices may not be appropriate for many patients and families.

Cultural Sensitivity and Human Experimentation

• The Tuskegee Study of Untreated Syphilis in Negro Men is an example of unethical human experimentation, where African American men with syphilis were unknowingly left untreated to document the progression of the disease.
• Drug testing raises ethical concerns, as human volunteers cannot be fully informed of the risks involved, and their consent may not be fully informed.
• Healthcare professionals must be aware of and sensitive to cultural differences, language barriers, and personal experiences that shape a family's life.

End-of-Life Issues

• End-of-life issues involve complex moral, ethical, or legal dilemmas regarding a patient's vital physiologic functions, medical-surgical prognosis, quality of life, and personal values and beliefs.
• Resuscitation status, withholding and withdrawing medical therapies, palliative care, and coma, vegetative state, and brain death are critical considerations.

Technology and Scarce Resources

• Healthcare resources are limited, and services should be organized and distributed according to health needs and the ability to benefit.
• Every individual should have equitable access to health services, but economic disparities between the rich and poor have a significant impact on the health status of the population.

Access to Quality Healthcare

• Access to quality healthcare is essential, but financial barriers to healthcare do exist, leading to economic disparities in health status.
• The goal of palliative care is to prevent and relieve suffering, supporting the best possible quality of life for patients and their families.

Withholding and Withdrawing Medical Therapies

• Withholding support involves not initiating a treatment because it is not beneficial to the patient.
• Withdrawing support involves discontinuing a treatment, allowing disease progression to take its course.
• Fargeting treatment involves a combination of both, allowing disease progression to take its course.
• An order of "comfort measures only" (CMO) means patients receive medications for pain control or sedation to eliminate distress.

Palliative Care, Coma, Vegetative State, and Brain Death

• Palliative care aims to support the best possible quality of life for patients and their families, regardless of their condition or the need for other therapies.
• Coma involves unconsciousness without arousal or awareness, characterized by a lack of eye opening and sleep/wake cycles.
• Vegetative state involves transient wakefulness without awareness, characterized by cyclic sleep patterns and normal body temperature.
• Brain death involves the absence of brain stem reflexes or cerebral motor responses, in addition to apnea, and is irreversible.

Ethical Issues in Healthcare

• Access to healthcare means having timely use of personal health services to achieve the best health outcomes, which requires three distinct steps: gaining entry into the healthcare system, accessing a location where needed health care services are provided, and finding a healthcare provider whom the patient trusts and can communicate with.
• Barriers to healthcare include high cost of care, inadequate or no insurance coverage, lack of availability of services, and lack of culturally competent care.

Patient Privacy and Confidentiality

• The protection of private patient information is one of the most important ethical and legal issues in healthcare, as defined by the Health Insurance Portability and Accountability Act (HIPAA).
• Conversations between a physician and a patient are strictly confidential, as is information about an individual's medical condition.
• Specific provisions of HIPAA define exactly what information can be released and to whom.

Cultural Sensitivity

• A healthcare system must decrease geographic inequalities and be culturally relevant to the population it serves.
• Health professionals need to recognize the importance of culturally competent care in a multicultural society.

Human Experimentation

• The Tuskegee Study of Untreated Syphilis in Negro Men is an example of unethical research conduct, where African men with syphilis participated in a study without their knowledge or consent.

Scarce Healthcare Resources

• Healthcare resources are defined as all materials, personnel, facilities, funds, and anything else that can be used for providing healthcare services.
• Healthcare services are inherently scarce: money for services is not unlimited, facilities for delivering services are finite, and healthcare professionals are limited in time, geography, and skills.

Resuscitation Status

• Each patient has a "code status" documented officially in the medical record by the attending physician.
• Options include:
  • Full code: all appropriate efforts will be made to revive a patient after cardiopulmonary arrest.
  • Do not resuscitate (DNR): the predetermined decision to decline cardiopulmonary resuscitation, including defibrillation and pharmacologic cardioversion.
  • Do not intubate (DNI): the predetermined decision to decline intubation for the purpose of subsequent mechanical ventilation in case of respiratory arrest.

Withholding and Withdrawing Medical Therapies

• Withholding support: not initiating a treatment because it is not beneficial to the patient.
• Withdrawing support: the discontinuation of a treatment.
• Forgoing treatment: the combination of both, in which disease progression is allowed to take its course.

Palliative Care

• The goal of palliative care is to prevent and relieve suffering, and to support the best possible quality of life for patients and their families, regardless of their stage of condition or the need for other therapies.
• Key components include spirituality, family involvement, and non-traditional therapies.

Coma, Vegetative State, and Brain Death

• Coma: a state of unconsciousness, without arousal or awareness, characterized by a lack of eye opening and sleep/wake cycles with intact brain stem reflex responses.
• Vegetative state: a transient state of wakefulness without awareness, characterized by cyclic sleep patterns, spontaneous eye opening and movement, and normal body temperature, yet lack of purposeful responsiveness.
• Brain death: the absence of brain stem reflexes or cerebral motor responses in addition to apnea and is irreversible.