Module 5 - Moral, ethical, and legal issues in healthcare
Scenario 1
This scenario has been taken from the following source:
Towsley-Cook, DM and Young, TA 2007, Ethical and legal issues for imaging professionals, Mosby, St Louis, p. 233.
A sonographer has been working with a couple for the treatment of infertility. In the course of their relationship over the preceding 10 months, the sonographer has become close to the couple. Unfortunately, after 10 months of treatment, the couple's chances of pregnancy appear slim.
In the eleventh month of treatment, fertilization is successful and an em
yo is formed. The couple and sonographer are overjoyed. The waiting and hoping are over. The thousands of dollars - almost their entire savings - have paid off. If anyone deserves this miracle, they do. They have had an exceptionally difficult time with the procedures and have been emotionally spent for nearly a year.
Genetic testing of the em
yo reveals a problem. A few missing chromosomes have left a pattern that indicates the child may be born with Williams' syndrome. This condition produces mild-to-severe mental retardation and genetic testing cannot predict the level of impairment. Williams' syndrome also entails health problems such as heart abnormalities and organ dysfunctions.
The physician discusses the situation with the couple, and they are devastated. He encourages them to abort and try again.
When the couple a
ive for a sonographic examination to determine fetal age, they share the unhappy news with the sonographer, who is dismayed by their consideration of abortion. He has a younger
other with Williams' syndrome and loves him very much. His interactions with his
other have made him aware of both the difficulties and joys of having a special
other. When the couple ask him for his opinion, he must decide whether to share his personal experiences with them.
Discussion questions for scenario one
1. How much of his personal life should the sonographer share?
2. Will the couple's care be compromised if the sonographer's remarks contradict those of the physician?
3. How would you deal with this situation if you were the sonographer?
4. Is there cu
ently a protocol in place in your department or practice to cover a situation similar to this one and provide specific guidelines for you to follow? If so, outline this protocol and comment whether you believe it is adequate or inadequate to deal with the particular situation, given your personal experience and reading for this module.
5. If there is no protocol cu
ently in place in your department/practice to deal with this situation, please suggest what you now consider to be a suitable set of guidelines, given your personal experience and reading for this module.
Scenario 2
You have had a very busy day, and the last patient is a hospital inpatient with extreme shortness of
eath. You are requested to examine the heart to determine the cause of the patient's extremely poor condition.
The patient is bedridden and is wearing nothing but a nightie under the sheets.
You have a million things on your mind:
· It's getting late for picking up the kids.
· You still need to organise tomo
ow's list.
· The clinic is a mess; you'll have to tidy up before you can go.
· The reporting doctor is cross with you for having taken too long this afternoon.
You fail to introduce yourself, to explain the procedure or to obtain consent, as you rush her into the room. You are very keen to get it over and done with.
The patient cries out in anguish or in pain, when you first start scanning, and your response is a quick: 'So
y, but I have to do this', as you continue with the examination.
You are inte
upted twice during the examination: first the doctor pops his head in to hu
y you up, and then the receptionist comes in and asks you over your shoulder about some bookings for tomo
ow.
The patient writes a letter of complaint, explaining that she felt violated, not respected as an individual and that her privacy was ignored. She implies that she might seek legal advice on the grounds of assault and battery.
Discussion Questions for scenario two
1. Do you think she has a case? Why/why not?
2. If you had the opportunity to perform this patient's ultrasound examination again, what are the things you would do differently and why?
3. Which 'rules' have you
oken? Consider in terms of moral, legal and ethical implications.
4. Does your department/practice have any guidelines in place to deal with patient complaints and if so, how effective do you consider them to be in light of your reading and professional experience? Justify your answer with reference to the literature and readings for this topic.
5. If your department/practice does not have specific guidelines in place, what do you consider to be the best course of action to be taken in this particular situation, in light of your reading and personal experience?
READING MATERIALS FOR SCENARIO 1 & 2
https:
www.sma.org.sg/sma_news/sma_newsmainpges/3204main.html
https:
www.sonographers.org/our-profession/professional-practice/complaints
https:
www.sonographers.org/our-profession/professional-practice
(click on Code of Professional Conduct for Sonographers , Standards of Practice)
Scenario 3: non-medical use of ultrasound and the social media trap
1. You (or your partner) are pregnant with your first child. You have had the 20 week morphology examination and this and all the blood tests and examinations appear normal. Friends ask you when you are going to have your 3D/4D 'entertainment' scan done so you can start your family photo album and get a DVD of your developing baby. What is your response and why? (if you are male, please answer this question on the assumption that you are the partner in this relationship!)
2. What do you think about the suggestion to revoke the licences of sonographers who work in clinics that perform these non-medical ultrasound scans? Do you think it is better to have trained or untrained personnel performing these scans? Justify your answer with reference to your reading on this topic.
3. You are working with one of your favourite colleagues – you each enjoy a laugh whilst on duty and can get a bit silly, “but there is no harm, it makes the session go faster”. One day whilst it’s particularly busy, you see something very funny and take an image to share with your best friend. You take an image of a person who is sometime the butt of jokes in the department, and post it quickly on your Facebook site. The image is clearly demonstrating their cleavage as they bend over to pick up an item they dropped. What you do not realise, is that in the background, you have also taken an image of a patients private details and posted that on Facebook as well. Have you
eached the privacy/ confidentiality of anyone? Do you think there is an issue with posting this photo? If not, explain, if so explain.[1]
[1] http:
www.hcpc-uk.org/mediaandevents/pressreleases/index.asp?id=971
READING MATERIALS FOR SCENARIO 3
ASUM/WFUMB safety standards: http:
www.wfumb.org/safety-statements
US Food and Drug Administration http:
www.fda.gov/ForConsumers/ConsumerUpdates/ucm095508.htm
Non-medical use of ultrasound – a case report
Non-medical fetal ultrasound
News-Medical.Net article http:
www.news-medical.net/?id=21699
Effects of frequent ultrasound during pregnancy
Why women want prenatal ultrasound in Denmark https:
obgyn-onlineli
ary-wiley-com.access.li
ary.unisa.edu.au/doi/full/10.1002/uog.2646
USA Today article http:
www.usatoday.com/news/health/ XXXXXXXXXXprenatal-portraits_x.htm
Fetal Fotos http:
www.fetalfotosusa.com
CBS News http:
www.cbsnews.com/stories/2004/11/04/eveningnews/main653766.shtml
The Age article http:
www.theage.com.au/news/pregnancy--ivf/out-now-on-dvd/2006/02/21/ XXXXXXXXXXhtml
Earlyimage (Melbourne) http:
www.earlyimage.com.au
Science Daily http:
www.sciencedaily.com
eleases/2015/01/ XXXXXXXXXXhtm