Being a radiographer means being very cautious and careful with instructions. It is especially important to follow the existing code of ethics once a patient and a radiographer do not speak the same language.
Since the radiographer was not concerned with the fact that the patient could not speak English properly, the former broke the principles of radiography ethics by conducting a procedure that could harm the patient in the case study provided.
The case of ethics in radiography, which is discussed below, is quite simple. According to the case details, an elderly (56-year-old) Asian woman, who had a feeding (nasogastric) tube implanted, was admitted into a hospital. In the hospital, she underwent a computer tomography on her brain.
Due to the specifics of her condition (a feeding tube), she had to have her chest and abdomen checked with X-rays every day for more than fifteen days, which is considered inacceptable due to exposure to great doses of radiation and the following negative effects on the functioning of the organs.
Since the radiographer was aware of the threat that the procedure poses to people, it was imperative that the procedure should have been carried out less frequently or that the patient should have given a written consent for the radiography to be carried out.
It seems that the procedure was not obligatory in the given case, since the patient supposedly felt well and did not need an urgent examination, yet the standard daily examination of the tube was still desirable (Duncan & Warwick, 2011, para. 9).
In order to avoid the threat of disclosing the patient’s personal data, including her name, it will be required that the patient should be nicknamed in order to address her without revealing her identity. The patient will be referred to as Xiu in the process of the case analysis and discussion.
The patient’s consent is, in fact, one of the key issues in the study. First and most obvious, the case study in question never mentions that the informed consent was obtained in the first place. Indeed, according to the details of the study, the patient has not been provided with the explanations concerning the procedure.
More to the point, since the patient was unable to give an informed consent in English, it is impossible to figure out if the patient actually understood what she was told; neither is it possible to define whether the radiographers actually received the confirmation for the procedure to take place.
The case description is admittedly obscure when it touches upon the discussion of the specifics of the procedure between the radiographers and the patient’ it can be suspected that there was no informed consent retrieved at all.
The ethical dilemma faced by the radiographer in the given case is, in fact, very complicated. On the one hand, it is imperative that the informed consent of the patient should be obtained before the procedure is started. Performing radiography on a patient, who does not speak English and, therefore, is most likely to be unaware of the possible negative consequences of the radiography, seems unethical.
Hence, it was obviously required that a translator should have been invited as the radiographer’s assistant. On the other hand, radiography is one of the procedures that must be carried out regularly; therefore, it was imperative that the patient should undergo the procedure as prescribed by the doctor.
Hence, the radiographer faced a difficult choice between making sure that the feeding tube, which the patient’s life depended on, was in order, and preventing the patient from receiving an additional dose of radiation.
The issue of informed consent, therefore, though doubtlessly relating directly to the case, is not the key ethical issue in it. It is the factor determining the impossibility of retrieving informed consent from the patient that matters in defining the ethical paradox in the given case.
To be more exact, the ethical concern in the case with Xiu can be defined as performing an urgent procedure on a patient, when it is clear that they do not understand what is happening due to the language barrier.
It is obvious that in the environment specified above, the patient is practically unable to give their informed consent (Seiden, Galvan & Lamm, 2006); therefore, the two ethical concerns (i.e., Xiu’s unawareness of the procedure consequences and the absence of her informed consent) should be included in the case.
After all, the Code of conduct and ethics published by the Society of Radiographers specifies that a radiographer must satisfy themselves “that the appropriate informed consent has been gained prior to undertaking any examination or procedure and follow the SCoR guidelines in Consent to imaging and radiotherapy treatment examinations: an ethical perspective and good practice guide for the radiography workforce” (The Society of Radiographers, 2008, p. 6).
Hence, both the principles of consent and communication (The Society of Radiographers, 2008, p. 5) were challenged in this case.
Handling of Ethical Dilemma
Though quite questionable, the decision made by radiographers seems quite adequate. Indeed, the negative effects of an excessive radiography session are considerably less threatening than the possible problems with the nasogastric tube and the following impossibility for Xiu to obtain food (Lamont, 2011).
Despite the adequacy of the choice made by the radiographers, one still must address the issue of informed consent and the handling of the essential information related to the patient.
Technically, the breach of the healthcare ethics is still evident, seeing that little to no investigation concerning the procedures that the patient had undergone by that time was conducted. According to the existing Code of practice for radiographers (2007), making sure that the radiography session complies with the prescriptions provided by the doctor is obligatory:
Radiographers should not carry out a procedure that may be considered dangerous without first confirming instructions for the procedure with the person authorized who has made the request, and satisfying themselves that the instructions contain no error” (Australia Institute of Radiography, 2007, p. 3)
The case study under consideration offers a lot to learn. It shows how flexible and resourceful a radiographer must be in order to facilitate the provision of the medical services of the finest quality and the protection of the patients from the possible threats to their health. More to the point, the study gives the information concerning the possible issues that a radiographer may face with a non English speaking patient.
Consequently, the study encourages a radiographer to act more cautiously and make sure that the actions to be carried out comply with the existing instructions, as well as with the healthcare ethical principles. Finally, and most importantly, the case study makes a very valid point concerning the issue of informed consent. It is a very clever way of reminding a radiographer about the workplace ethics.
What may seem a legitimate step in addressing the patient’s disorder and maintaining the patient’s safety may finally turn out to be a faulty move that will lead to drastic consequences. In a wider sense, the aforementioned piece of advice can be interpreted as a suggestion to be extremely cautious when it comes to retrieving any kind of information from non English speaking patients.
It is obvious that, had the patient provided the radiographer with the related information, i.e., the fact that she had already had two brain computer tomographies and experienced fifteen radiographies in a row by that point, the radiography would have not been carried out. Therefore, the very fact that the patient did not speak English should have been a warning sign for the radiographer.
The study, therefore, offers an important lesson in carrying out a specific procedure on a patient, who is unaware of what is going on due to the language issues. It is essential that the patient should know what is going on and what medical procedure they are going to undergo; thus, a patient will be able to inform the radiographer on the details that may conflict with the procedure in question and trigger major complexities.
Having a range of responsibilities and bound by the existing ethical code, a radiographer must be very careful in their work. It is essential to make sure that the procedures conducted meet the requirements and comply with the current medical standards.
In addition, a radiographer must be able to communicate with the patient in order to avoid making harm to the latter. Once a patient and a radiographer understand each other, the amount of mistakes and misconceptions will be reduced to nil.
Australia Institute of Radiography. (2007). Guidelines for professional conduct for radiographers, radiation therapists and sonographers. Melbourne, AU: Australia Institute of Radiography. Web.
Duncan, K. & Warwick, R. (2011). X-ray confirmation of nasogastric tube placement: documentation in patient notes. The Royal College of Radiologists. Web.
Lamont, T. (2011). Checking placement of nasogastric feeding tubes in adults (interpretation of X ray images): summary of a safety report from the National Patient Safety Agency. The British Medical Journal, 342, 1–4. Web.
Seiden, S. C., Galvan, C. & Lamm, R. (2006). Role of medical students in preventing patient harm and enhancing patient safety. Quality and Safety in Healthcare, 15(4), 272–276.
The Society of Radiographers. (2008). Code of conduct and ethics. London, UK: The Society of Radiographers.