Cassandra Louise Vu 311206794

MRTY3106 Clinical Education 3DR

Ethics case study report
Clinical history
Patient A, an in patient presented remaining asleep in a hospital bed situated at the
bed bay of the radiology department. The clinical history stated that Patient A had a
fall onto arm, querying fracture and request form indicated that an x-ray of Patient As
right wrist with all standard views AP, oblique and lateral to be performed. The x-rays
requested deemed medically justifiable because it was directly relevant to the clinical
history stated and the area of concern on the patients body.
As Patient A was a current in-patient at the hospital, we viewed the hospital notes to
retrieve any further valuable information of the patients current state. The hospital
notes outlined that Patient A has dementia and said that she was cooperative and
responsive.
Informed consent
Informed consent is directly related to the ethical concern for client autonomy. It is
the responsibility of the health care worker to provide information disclosure to the
patient so that a decision can be deduced on whether to proceed with the x-ray
procedure. It is important that the patient understands the key issues of the
procedure and before the examination; patient must have made an informed and
voluntary decision to proceed. It is also necessary to respect the patients individual
choices. A respect for autonomy presupposes a sense of beneficence. (Loewy,
1996)
Before patient A arrives to the x-ray department bed bay, consent should have
already been sought through a communicating doctor. Radiographer went to the bed
bay to introduce himself and to take the patient for their examination but found that
patient A was asleep. The radiographer checked the patients wristband for
identification. Before commencing the x-ray examination, a verbal routine check of
the patients identity and birthdate was needed but it was not possible to confirm
when the patient was asleep and unconscious. It was therefore necessary to wake
Patient A, especially as she was a dementia patient to introduce themselves as a
radiographer and further reiterate that they will be taken into an x-ray room for the
examination to commence, this was also to confirm their informed consent. The
radiographer proceeded to wake Patient A verbally with exceptional volume in his
voice. Patient A awoke angry and confused as the radiographer then introduced
himself and clarified that she will be taken into another room for her x-ray
examination. The patient was still in a daze and the radiographer repeated his words.
Patient A complained of the volume and insisted the radiographer to stop yelling at
her. Radiographer took her into the examination room already set up and further
confirm that the clinical history was met with the patient by asking which wrist was
affected by the injury and how long ago the injury took place. Patient A became very
agitated but was responsive she further complained of the rudeness of the staff that
she was met with. The patient was non-compliant during the examination, and would
not keep her right arm still for the exam when asked to do so.

Cassandra Louise Vu 311206794

Ethical dilemma
The radiographers encountered resistance even though it was clear the patient heard
and understood what needed to be performed. The patient was initially noncompliant and would not keep her right arm still for the exam when asked to do so. It
was clear that Patient A was reluctant to begin the examination. The hospital notes
mentioned patient was present with dementia including that she was cooperative and
responsive.
The radiographers involved were challenged with the principles of autonomy and
non-maleficence. A negative relationship between the radiographer and the patient
had been established. Patient A displayed signs of agitation and reluctance,
furthermore, informed consent could not be sufficiently obtained. This lack of consent
challenges the principle of autonomy, which leaves the radiographer to decide
whether or not he should fulfil the request sent by the general practitioner. The
current standards on informed consent generated by the Australian NHMRC
guidelines state that patients are entitled to make their own decisions and that in
order to do so, they must have enough information about their condition, options for
investigation and treatment, benefits of treatment, possible adverse effects of
treatment or investigation, likely results if treatment is not undertaken, time and cost
of treatment. (Berglund, 1998) Another challenging issue arises, how is autonomy
maintained for the patient with dementia? According to the Alzheimers association
(2011), autonomy is handled by an assessment of the individuals competence and
capacity to understand the consequences of a task and the alternatives that can be
chosen in relation to their individual values and beliefs. Allowing the person with
Alzheimers disease to feel that his or her autonomy is being respected is ethically
important. (2011)
Handling of ethical dilemma
The involving radiographer quickly picked up on the patients state of mind and
calmly communicated to the patient why the examination was going to be performed
and how long the procedure would take. The radiographer was obligated to protect
the patient from harmful consequences and also to respect the dementia patients
decisions and choices, taking into account that the hospital notes outlined that she
was responsive and therefore a competent individual in making decisions
(autonomy). In a sense, the radiographer acted towards the principle of beneficence
by trying to promote as much understanding of the nature of the procedure with an
explanation that the medical procedure would be valuable in providing adequate
diagnosis and determining required treatment. (Loewy, 1996) However, the
radiographer also recognised the importance of respecting the patients autonomy,
acting on behalf of the patients best interests. The patient agreed to continue further
but was still irritable. The radiographer apologised in interrupting her sleep earlier
and intended not to cause harm (non-maleficence), afterwards the patient was less
agitated and slightly more cooperative, allowing for positive communication to
progress.
The radiographer performed the examination as quick as possible as the patient
would not keep her right hand still and it was unnecessary to use restraints. An AP,
oblique and lateral of the right wrist was obtained with minimal distress.
The overall situation was handled well as the qualified radiographer acted rationally
and on behalf of the patients greater good and interests. The radiographer did not
intend to cause harm when interrupting the patients sleep at the beginning, and this
was necessary to first gather informed consent. One improvement is that the
radiographer could have been less abrupt when speaking to the patient initially as
the patient had just woken up and slowly regaining consciousness of their

Cassandra Louise Vu 311206794

surroundings. It was well handled in that the radiographer took on an obligation in
promoting the benefit of the procedure in providing a diagnosis and an answer to the
query at hand. He was able to aid the patients understanding of the situation and
therefore legally perform the examination by obtaining true consent. The
radiographer upheld ethical and moral values through treating the dementia patient
just as any other patient with respect and respect of their choices with the intent to
cause no harm and aiming to perform with minimal distress to the patient.
(Alzheimers association, 2011)
Learning outcome
From this ethical dilemma, I have come to terms with the values of autonomy,
beneficence and non-maleficence and have recognised with clarity, the importance
of maintaining these ethical standards in the medical setting. I have learnt that
obtaining informed consent from the patient is significant in maintaining the patients
right to choice. Communication and the way radiographers communicate to patients
play a big role in maintaining positive practitioner-patient relationship to understand
the needs and interests of the patient with a degree of professionalism. Through this
situation, I can strive to achieve on working for the best interests of the patient
through improving on patient care and empathy. Ethical dilemmas will always be
encountered in the medical setting, and this situation has provided me with insight
into exercising a sense of autonomy, especially in maintaining autonomy for the
dementia patient, while also understanding to use minimal force if a patient is noncompliant in order to preserve the individuals dignity.

Cassandra Louise Vu 311206794

References
Alzheimers association. Respect for autonomy. Approved September 2011 from
http://www.alz.org/documents_custom/statements/respect_for_autonomy.pdf
American nurses association. Ethics definitions. From
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethic
s-Definitions.pdf
Berglund, C. (1998) Ethics for health care. Melbourne : Oxford University Press, Ch.
3.
Beauchamp, T. & Childress, J. (2001) Principles of Biomedical Ethics, 5th Ed, Oxford
University Press, Oxford.
Edge, R. (2006) Ethics of health care: a guide for clinical practice. 3rd ed. Clifton
Park, NY: Thomson Delmar Learning
Loewy, Erich H. Textbook of healthcare ethics / Erich H. Loewy. New York: Plenum
Press, c1996. Ch. 6.