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Medical Sonography Ethics

Module by: Ziyad Aljarboua

Medical Sonography Ethics
In the medical community in general, several ethical values always apply 4:
  • Self Determination: Patient’s right to accept or refuse treatment.
  • Justice: fairness and equality in treatment.
  • Dignity: worthiness of honor and respect throughout diagnosis and treatment
  • Honesty: truthfulness in informing the patient.
  • Confidentiality: “ensuring the information is accessible only to those authorized to have access”. (ISO).
  • Beneficence: Striving to do good.
  • Safety (Non-maleficence): “first, do no harm”.
Medical Sonography, which includes ultrasound diagnosis and therapy, is one of the most controversial medical fields that have its one strict code of ethics. Medical Sonography Code of Ethics provides guidelines aimed at maintaining the integrity of the profession of diagnostic/therapeutic medical sonography. Society of Diagnostic Medical Sonography is one of the active organizations in that field. Following is a summary of their ethical principles 5:
Principle I: Promote patient’s well being through:
  1. Inform patient about purpose of sonography procedure.
  2. Respond to patient’s questions and concerns.
  3. Respect patient’s autonomy and right of refusal.
  4. Recognize patient’s individuality.
  5. Respect patient’s privacy, dignity throughout sonography procedure.
  6. Maintain confidentiality.
  7. Insure safety first.
Principle II: promote highest level of competence through:
  1. Acquire appropriate education and clinical skills and maintain it through continuous learning.
  2. Maintain specific sonography credentials.
  3. Maintain professional standards.
  4. Take responsibility.
Principle III: Promote professional integrity and public trust through:
  1. Truthfulness.
  2. Patient rights.
  3. Conflict of interest avoidance.
  4. Equal treatment and non-discriminatory care providence.
  5. Collaboration.
While these principles are comprehensive, they are not specific for my biological model of ultrasound effect. Next, “the ten step method for decision-making” 6 is implemented to arrive at ethical decision regarding my specific model.
1-Key Facts:
  1. Ultrasound is used for imagining and therapy.
  2. Ultrasound waves can affect and damage healthy cells when used for imaging or treatment.
  3. Biological alternation of cells depends on intensity or ultrasound and type of tissue.
  4. Ultrasound is being used despite the fact that it can damage healthy cells under the assumption that side effects are minimal and worthiness of treatment.
2-Major Stakeholders:
Stakeholder Desired outcome
Patient -Successful diagnosis and treatment-Recovery
Physician -Successful diagnosis and treatment-Safety or patient-Accurate diagnosis
hospital staff serving patient -patient’s comfort
Hospital or clinic -Successful diagnosis and treatment-Safety or patient
Patient’s relatives -Patient’s recovery
Manufacturer of ultrasound system -Accurate diagnosis and effective treatment-durability of system-Safety of system
Hospital management -Successful diagnosis and treatment-Safety or patient-Accurate diagnosis-Cost effective diagnosis and treatment-lawsuit avoidance
3-Underlying driving forces:
  1. Identify process of tissue heating via ultrasound and mechanism of tissue damage.
  2. Study means and ways of ultrasound current usage and ways for improvement.
  3. Minimize, or completely avoid, effect of ultrasound wave and tissue damage during diagnosis and treatment.
4-Inentify/prioritize ethical principles:
  1. Ensure not to affect or lower chances of successful treatment or diagnosis by ultrasound while trying to avoid or minimize tissue damage.
  2. Ensure that outcome of this model prevents damage of tissue.
  3. Ensure that this model does not cause other side effects.
  4. Model should take in consideration different tissue types to develop a comprehensive model for ultrasound diagnosis/treatment tissue damage minimization process.
  5. Carry out testing of model’s out come before fully implementing it.
  6. Take in consideration patient’s individuality while developing model.
5-Involvement in decision making process: Most of stakeholders should play a role in decision making. Their roles, however, varies depending on their position as follows:
Stakeholder Role in decision making
Patient should be involved in all steps of decision making process
Physician should be involved in all steps of decision making process
hospital staff serving patient Should be involved in decision making steps that are directly relevant to their job and directly impact them
Hospital or clinic should be involved in all steps of decision making process
Patient’s relatives No involvement expect for helping the patient in his/her decision
Manufacturer of ultrasound system No involvement
Hospital management should be involved in all steps of decision making process
6-Viable alternatives: There are several alternatives for this model:
  1. Keep current procedure of using diagnostic/therapeutic ultrasound that carries risk of tissue damage.
  2. Minimize tissue damage.
  3. Completely avoid tissue damage.
These possible alternatives can be investigated with respect to the stakeholders:
Stakeholder Alternative 1 Alternative 2 Alternative 3
Patient Tissue damage and possibility of developing an illness Minimizing tissue damage and possibility of developing an illness Avoiding tissue damage and possibility of developing an illness
Physician Not delivering safest diagnosis/treatment Delivering safer gnosis/treatment Delivering safest diagnosis/treatment
hospital staff serving patient Unaffected Unaffected Unaffected
Hospital or clinic Not sufficient Level of health care Better health care providence Best health care providence
Patient’s relatives Patient’s suffers consequent illness Minimizing chances of consequent illness illuminating chances of consequent illness
Manufacturer of ultrasound system Unaffected Cost to improve system Cost to improve system
Hospital management Not sufficient Level of health care but keep cost low Better health care providence but might cost more Best health care providence but might cost more
7-Testing Preferred Alternative: Preferred alternative is 3rd one that completely prevents tissue damage. Worst case scenario is that completely preventing tissue damage also creates another side effect. This scenario is certainly worrying because it violates one of the most critical ethical principles: “first, do no harm”.
Stakeholder Consequences of worst case scenario
Patient possibility of developing an illness or even death
Physician Failure in treatment and possible lawsuit
hospital staff serving patient unaffected
Hospital or clinic Failure in treatment and possible lawsuit
Patient’s relatives possibility of patient developing an illness or even death
Manufacturer of ultrasound system unaffected
Hospital management Failure in treatment and possible lawsuit
8-Preventive component: A preventive component to the preferred alternative is to completely an thoroughly understand the nature of ultrasound in order to perfectly predict any consequent side effects before implementing model. Also, to run comprehensive and through testing on patients before implementing model to determine any possible complications.
9-Short & Long Term Action Plan:
Short term plan: Develop a model for ultrasound effect on human tissue.
Long term plan: Implement findings to minimize or completely prevent tissue damage while ensuring that no side effects are created.
10-Decision Making Checklist:
Effective Decision Making Tests 0 1 2 3 4 5 6
Relevant Information Test       X      
Involvement Test           X  
Consequentialist Test         X    
Ethical Principles Test         X    
Fairness Test           X  
Universality Test   X          
Preventive Test       X      
Light of Day Test       X      

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