2.1 Ethical Principles & Patient Rights

Ethics in the Radiography Exam

The ARRT Radiography exam folds ethics into the Patient Care category (33 scored questions, 16.5% of the scored exam). You are tested on how a Registered Technologist applies professional values at the point of care, not on abstract philosophy. Expect vignettes: a patient refuses an exam, a family member asks for results, a minor arrives without a guardian.

Your job is to identify the principle in play and the response that protects the patient. Ethics items reward the answer that respects the patient as a person while keeping care safe and lawful. That combination -- respect plus safety -- is the thread running through every correct answer in this section.

The Four Core Principles

Four principles anchor healthcare ethics, and nearly every clinical dilemma maps to one or more of them.

• Autonomy is the patient's right to self-determination -- to accept or refuse care after being informed. Honoring a competent adult's refusal, even one you disagree with, respects autonomy.
• Beneficence is the duty to act for the patient's good -- positioning skillfully, comforting an anxious child, producing a diagnostic image on the first attempt.
• Nonmaleficence is the duty to do no harm -- the ethical root of ALARA, of checking pregnancy status, and of never performing a procedure you are not competent to do.
• Justice is fairness -- allocating care and attention without discrimination. ARRT Code of Ethics principle 3 lists protected bases such as race, religion, sex, disability, sexual orientation, gender identity, and age.

Supporting Principles

Three further principles appear often. Veracity is truthfulness -- you do not deceive the patient about what an exam involves, yet you also do not interpret images, because diagnosis is outside your scope. Fidelity is faithfulness to promises and to the trust the patient places in you. Confidentiality protects information shared in the clinical relationship; it is both an ethical duty and, under HIPAA, a legal one covered in Section 2.2.

Informed Consent as Applied Autonomy

Informed consent is autonomy in action: the patient agrees to a procedure after understanding it. It is required for invasive or higher-risk exams -- contrast studies, angiography, myelography, arthrography, and biopsies. A valid informed consent has recognizable elements you should be able to spot on the exam.

The physician performing the procedure is responsible for obtaining informed consent; the technologist commonly witnesses the signature and confirms the form is complete, but does not explain material risks. If a patient says 'I don't really understand what this dye will do,' the correct action is to stop and notify the radiologist -- not to reassure and proceed.

Types of Consent

• Expressed consent is stated directly, in writing or orally. A signed contrast-study form is written expressed consent.
• Implied consent is inferred from conduct or circumstance. A patient who walks to the table and positions for a routine chest x-ray implies consent. In a true emergency involving an unconscious patient, consent is implied by law because a reasonable person would agree to life-saving care.
• Simple consent grants permission without full risk disclosure and suits routine, low-risk imaging.
• Informed consent adds the disclosure elements above and is required for invasive procedures.

Who may consent matters. A competent adult consents for themselves. For a minor, a parent or legal guardian consents, with exceptions for emancipated minors and some state-defined services. For an incapacitated adult, a legal guardian or healthcare proxy consents.

Patient Rights and Advance Directives

Modern patient rights descend from the American Hospital Association's Patient Care Partnership, which replaced the 1973 Patient's Bill of Rights in 2003. It promises high-quality care, a clean and safe environment, involvement in care decisions, protection of privacy, help after discharge, and help with billing. Technologists uphold these daily by draping for modesty, explaining each step, and safeguarding images and reports.

Advance directives let patients direct future care if they cannot speak for themselves:

• A living will states which treatments a patient does or does not want.
• A durable power of attorney for healthcare (healthcare proxy) names a person to decide.
• A DNR (do-not-resuscitate) order directs that CPR be withheld.

A DNR does not mean 'do not treat.' You still image, position, and comfort the patient normally; the order only governs resuscitation. Confusing a DNR with a withdrawal of routine care is a common exam trap.

Common Ethical Traps

• Discussing findings -- even 'it looks fine' -- breaches your scope and can mislead. Refer all questions about results to the physician.
• Overriding a competent refusal violates autonomy and can become battery.
• Sharing information with a spouse or employer without authorization breaches confidentiality.

Keep the mnemonic A-B-N-J -- Autonomy, Beneficence, Nonmaleficence, Justice -- and ask which principle a scenario stresses; the ethically correct ARRT answer almost always protects patient autonomy and safety together.