Abstract
Although there is consensus on the fact that ionizing radiation used in radiological examinations can affect health, the stochastic (random) nature of risk makes it difficult to anticipate and assess specific health implications for patients. The issue of radiation protection is peculiar as any dosage received in life is cumulative, the sensitivity to radiation is highly variable from one person to another, and between 20 % and 50 % of radiological examinations appear not to be necessary. In this context, one might reasonably assume that information and patient consent would play an important role in regulating radiological practice. However, there is to date no clear consensus regarding the nature and content of—or even need for—consent by patients exposed to ionizing radiation. While law and ethics support the same principles for respecting the dignity of the person (inviolability and integrity), in the context of radiology practice, they do not provide a consistent message to guide clinical decision-making. This article analyzes the issue of healthcare professionals’ duty to inform and obtain patient consent for radiological examinations. Considering that both law and ethics have as one of their aims to protect vulnerable populations, it is important that they begin to give greater attention to issues raised by the use of ionizing radiation in medicine. While the situation in Canada serves as a backdrop for a reflective analysis of the problem, the conclusions are pertinent for professional practice in other jurisdictions because the principles underlying health law and jurisprudence are fairly general.
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Notes
Hetero-regulation relates to behavior regulation imposed by a third party (prescription), while self-regulation is based on the “responsible management of the levels of autonomy” (Boisvert 2012).
For the purposes of this article, the concept of freedom is left aside in order to focus on the information provided to patients.
Integrity is a broad concept that involves several dimensions (physical, psychological, etc.), so we use the definition in the UNESCO declaration: “In the biomedical context, ‘integrity’ is presented as a right that all people hold, a negative right or a right of non-interference which, as such, demands respect from others; i.e., others’ non-interference in the private sphere of the self. … The multidimensional nature of the individual is clearly stated in the idea that physical, psychological, social and spiritual dimensions cannot be separated or extracted without the loss of all that the individual understands” (Ten Have and Jean 2009).
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Funding
Doudenkova is supported by a graduate scholarship from the Bioethics Program and the Faculty of Graduate and Postdoctoral Studies of Université de Montréal. Bélisle Pipon is supported by PhD scholarships from the Institut de recherche en santé publique de l’Université de Montréal (IRSPUM), the Centre de recherche en éthique (CRÉ) and the Fonds de recherche du Québec—Santé (FRQS) & Unité SUPPORT du Québec.
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Doudenkova, V., Bélisle Pipon, JC. Duty to Inform and Informed Consent in Diagnostic Radiology: How Ethics and Law can Better Guide Practice. HEC Forum 28, 75–94 (2016). https://doi.org/10.1007/s10730-015-9275-7
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DOI: https://doi.org/10.1007/s10730-015-9275-7