20.3 Bioethical Principles in Practice, Professional Virtues & Interprofessional Relationships
Key Takeaways
- The four principles of biomedical ethics are autonomy, beneficence, non-maleficence and justice, and most radiographic dilemmas are conflicts between two of them rather than a choice between right and wrong.
- Autonomy in radiography is operationalised as informed consent, the right to refuse, the right to an interpreter and a chaperone, and the right to withdraw consent at any point during a procedure.
- Justice governs the allocation of limited scanner time, contrast stock and staff, and requires that a patient's ability to pay, occupation, religion, gender identity or infectious status must not determine the quality of the examination performed.
- Confidentiality is both an ethical duty and a statutory one under Republic Act No. 10173, the Data Privacy Act of 2012, and extends to images, requests, verbal discussion in corridors and lifts, and any capture of patient images on personal devices.
- Professional virtues expected of a radiologic technologist include competence, honesty, compassion, accountability, respect for confidentiality, and the discipline to work strictly within the scope of practice defined by Republic Act No. 7431.
20.3 Bioethical Principles in Practice, Professional Virtues & Interprofessional Relationships
Guiding Principles of Ethical Practice to Different Situations is worth 10 of the 15 items in Professional Ethics and Jurisprudence — twice the weight of the law sub-topic. Its three competencies are: implement the general principles of bioethics as applied in radiologic technology, carry out the virtues and values of the radiologic technology practice, and demonstrate good working relationships with peers, other personnel in the department, physicians and other health professionals. These are applied competencies, examined as scenarios in which two defensible values collide.
1. The Four Principles, Applied
| Principle | Definition | What it looks like in the imaging room |
|---|---|---|
| Autonomy | Respect for the patient's right to self-determination | Informed consent; the right to refuse; interpreters; chaperones; explaining before touching; permitting withdrawal of consent mid-procedure |
| Beneficence | Acting for the patient's benefit | Producing a diagnostic image the first time; optimising the protocol to the clinical question; advocating for the right examination |
| Non-maleficence | Primum non nocere — first, do no harm | ALARA; correct patient and correct side; contrast screening; safe transfer; infection control; not repeating an image for cosmetic reasons |
| Justice | Fair distribution of benefits and burdens | Equitable scheduling; no discrimination by ability to pay, religion, occupation, gender identity, HIV status or nationality; honest triage of urgent cases |
Two further principles complete the standard list used in Philippine bioethics teaching:
- Veracity — truthfulness. You do not tell a patient "there's nothing to worry about" when you have seen an obvious lesion, and you do not tell them the result either. The honest answer is that the radiologist will interpret the images and the referring physician will discuss the findings.
- Fidelity — faithfulness to commitments and to the trust placed in the profession.
Worked dilemmas
| Scenario | Principles in tension | Defensible resolution |
|---|---|---|
| A competent adult refuses a barium enema after the bowel prep is complete | Autonomy against beneficence | Autonomy wins. Confirm understanding, document the refusal, notify the requesting physician. Never proceed. |
| A ward patient with confusion cannot consent to an urgent CT for suspected intracranial haemorrhage | Autonomy against beneficence and non-maleficence | Proceed under the emergency doctrine / presumed consent for a life-threatening condition, with the treating team's documentation. |
| A private patient offers to pay extra to be moved ahead of a public-ward patient with the same urgency | Justice | Refuse. Clinical urgency, not payment, determines order. |
| A radiologist asks you to repeat a technically adequate image because a colleague prefers a different look | Non-maleficence against deference | Every repeat is unnecessary dose. Raise it professionally; if a genuine diagnostic deficiency exists, repeat; if it is preference alone, discuss rather than expose. |
| A friend asks you to check their relative's chest x-ray on the workstation | Confidentiality and fidelity | Refuse. Access without a care relationship is a breach, and the audit trail records it. |
| A student wants to practise cannulation on a patient who has not been told a student is involved | Autonomy and veracity | The patient must be informed and must consent to student involvement. |
2. Informed Consent as the Operational Form of Autonomy
For consent to be valid it must be informed, voluntary, and given by a person with capacity.
Informed means the patient has been told, in language they understand: the nature of the procedure, its purpose, what will be done to them, the material risks and benefits, the reasonable alternatives, and what happens if they decline.
Three types operate in radiology:
- Implied consent — the patient presents, is told what will happen, and cooperates. Sufficient for a plain radiograph.
- Express (verbal) consent — explicitly stated. Appropriate for a barium study.
- Written consent — required for invasive procedures, intravenous contrast administration, sedation, and interventional work.
Who obtains it? The person performing the procedure — that is, for an interventional procedure, the operator, not the technologist. The radiologic technologist's role is to confirm that consent has been obtained and documented, to answer questions within scope, and to stop and escalate if the patient is clearly not informed.
Special situations
- Minors — consent from a parent or legal guardian, with assent from the child where the child is old enough to understand.
- Emergency — presumed consent for immediately necessary, life-preserving intervention when the patient cannot consent.
- Withdrawal — consent can be withdrawn at any moment, including part-way through a procedure. "You already signed" is not an answer.
3. Confidentiality and the Data Privacy Act
Confidentiality is simultaneously a virtue, a professional duty and a statutory obligation under Republic Act No. 10173, the Data Privacy Act of 2012, which classifies health information as sensitive personal information.
Practical rules:
- Discuss patients only with those involved in their care, and only where you cannot be overheard. Corridors, lifts and canteens are public.
- Never photograph a patient, a monitor or a radiograph with a personal phone, and never send images through consumer messaging applications. This is the most frequent breach pathway in busy departments.
- Never access a record you have no care relationship with. Audit trails are permanent.
- Position the workstation so that waiting patients cannot read the screen; lock it when you step away.
- Requests, worksheets and printed images are identifiable data — do not leave them on a counter.
- Social media: no patient details, no images, no identifiable descriptions of cases, however anonymised they feel.
Legitimate disclosure occurs with the patient's consent, to those directly involved in care, in response to a lawful court order, and in mandated public-health reporting. It does not include curiosity, family, or colleagues who simply want to know.
4. Virtues and Values of the Profession
The Board asks you to carry out these, so learn them as behaviours, not as abstractions.
| Virtue | Behaviour that demonstrates it |
|---|---|
| Competence | Knows the protocol; maintains continuing professional development; refuses to perform an examination outside training |
| Integrity / honesty | Reports the true exposure factors, an accidental over-exposure, a mislabelled marker, or a contrast extravasation without concealment |
| Compassion | Explains before touching; keeps the patient warm and covered; manages pain and anxiety; treats the dying and the difficult patient the same as anyone else |
| Respect for dignity | Adequate draping; closes the door; no unnecessary observers; addresses the patient by name and by preferred pronouns |
| Accountability | Owns errors, completes incident reports, does not deflect responsibility to a student or a colleague |
| Justice | Applies the same standard of care to every patient regardless of status |
| Confidentiality | See Section 3 above |
| Scope discipline | Does not interpret images to patients, does not administer drugs beyond the licensed scope, does not perform modalities RA 7431 does not authorise for the credential held |
The trap most often examined: a patient asks, "Is it cancer? You must be able to see it." The professionally correct answer acknowledges the anxiety, explains the roles, and refers the question — it neither reassures falsely nor discloses. Interpreting an image to a patient is outside the radiologic technologist's scope and can constitute negligence.
5. Working Relationships
With the radiologist
The radiologist is responsible for interpretation and for the medical conduct of contrast and interventional procedures. The technologist supplies diagnostic-quality images and accurate clinical context, flags critical findings — a tension pneumothorax, free intraperitoneal air, a displaced fracture, a suspected aortic dissection — immediately rather than at the end of the list, and does not leave an unexpected finding for someone to notice later.
With the referring physician
The technologist may professionally question an inappropriate or ambiguous request: wrong side, no clinical indication, a pregnant patient, a duplicate examination, or a study for which another modality is clearly indicated. Justification of exposure is a shared responsibility, and "the doctor asked for it" is not a defence for an unjustified exposure.
With nurses and ward staff
Coordinate transfers, drips, drains, oxygen, monitoring and infection precautions before moving the patient. Handover both ways: what the patient needs during the examination, and what happened during it.
With peers and students
- Support, do not undermine. Give feedback privately and specifically.
- Never sign for work you did not perform, and never let a student perform unsupervised what they are not competent to do.
- Speak up about unsafe practice — a colleague not collimating, skipping pregnancy enquiry, or working impaired. Reporting it is an obligation, not disloyalty.
With other health professionals and the public
Represent the profession accurately, avoid claims beyond the credential, refer questions to the appropriate professional, and contribute to public understanding of radiation safety.
6. A Decision Framework for Any Ethical Item
- Identify the facts. What is actually known, and what is assumption?
- Identify who is affected — patient, family, staff, other patients, the institution.
- Name the principles in conflict.
- Check the law and the scope of practice. RA 7431 and the Data Privacy Act set outer limits that ethics cannot override.
- Check institutional policy.
- Choose the option that protects the patient's safety and dignity first, then document and escalate.
Applied to an examination item, this framework nearly always eliminates the two options that involve concealment or acting outside scope, and then chooses between the remaining two on the basis of patient safety.
A competent adult patient has completed the bowel preparation for a barium enema but states at the table that she has changed her mind and no longer wants the procedure. What is the correct action?
A radiologic technologist photographs an unusual chest radiograph on a personal phone, removes the patient's name from the image, and sends it to a colleague through a messaging application for a second opinion. Which statement is correct?
A patient having a chest radiograph says, 'You saw the picture. Is it cancer?' What is the professionally correct response?
Limited CT scanner time must be allocated between a private patient who offers an additional payment and a ward patient with an identical clinical urgency. Which principle governs the decision and what is the correct outcome?