ICRP Publication 157
Ethics in Radiological Protection for Patients in Diagnosis and Treatment
Recommended citation
ICRP, 2024. Ethics in radiological protection for patients in diagnosis and treatment. ICRP Publication 157. Ann. ICRP 53(3).
Authors on behalf of ICRP
F. Bochud, M-C. Cantone, K. Applegate, M. Coffey, J. Damilakis, F. Fahey, C. Kurihara-Saio, B. Le Guen, J. Malone, L. Reid, M. del Rosario Perez, F. Zölzer
Abstract - Publication 138 defines the ethical foundations of the ICRP System of Radiological Protection based on core values (beneficence and non-maleficence, dignity, justice, and prudence) and procedural values (accountability, transparency, and inclusiveness). The purpose of the present publication is to propose a practical application of values for medical radiological protection professions. As medicine has a long history and strong culture of ethics, this publication starts by identifying the shared values, and defines a common language between biomedical ethics and radiological protection. The core values are very similar, with the autonomy of biomedical ethics, which can be seen as a corollary of dignity, and the precautionary principle, which can be understood as the implementation of prudence. In recent years, medical education and training has emphasised the values of solidarity, honesty, and, above all, empathy. All these values are defined and interpreted in the specific context of the use of ionising radiation in medicine. For those more familiar with radiological protection, the ethical implications of their actions are described. Conversely, for those who already have a good background in ethics, this publication highlights the specificities of ionising radiation that also deserve consideration. In order to emphasise the coherence between the values involved in biomedical ethics and those involved in radiological protection, this publication proposes to combine them: dignity and autonomy; beneficence and non-maleficence; prudence and precaution; justice and solidarity; transparency, accountability, and honesty; and inclusiveness and empathy. This allows a structured review of practical situations from an ethical perspective. For the sake of both example and education, this publication proposes 21 realistic scenarios (11 in imaging procedures and 10 in radiation therapies). Sensitising questions are provided to stimulate reflection and discussion.
The ultimate goal is to be able to use ethical values in clinical imaging and therapy situations. Required education and training in ethics is essential for medical radiological workers throughout their career span. An example of a framework of knowledge, skills, and competencies is proposed. In order to assist the reader in a theoretically complex subject, key messages are distributed throughout the text as fixed points that can be easily understood. Although primarily aimed at medical radiological protection professionals, this publication is also intended for authorities, patients, and the public.
MAIN POINTS
· An understanding of the basic principles of radiological protection is an absolute prerequisite for all health professionals working with radiation for the purpose of diagnosis or treatment. This understanding is necessary but not sufficient without also including ethical training.
· In order to establish a common ground and to pave the way for an ethically based analysis of practical situations, the values of biomedical ethics and those identified in Publication 138 (ICRP, 2018a) are paired: autonomy is linked to dignity, beneficence to non-maleficence, precaution to prudence, solidarity to justice, honesty to transparency and accountability, and empathy to inclusiveness. These values are defined and interpreted in relation to biomedical ethics, professional codes of ethics, and the practice of medicine.
· Professionals working in radiological protection in medicine are expected to adhere to the code of ethics of their regulatory and professional bodies, and to that of their employer, which may include values of accountability, transparency, safety, and patient-centredness.
· Everyone in the diverse groups of relevant stakeholders in health care is responsible for assuring strong shared radiological protection and ethical values. Each target group needs to be empowered and educated to ensure that patients are imaged and treated correctly.
· Radiation dose estimates should be recorded in a patient’s medical record. Patients should have access to the doses they receive, and have the dose explained, just as they have access to records for all their care. The degree and approach of dose, benefit, and risk communication depend on the needs and cultural background of each patient and family, which are explored in shared decision-making.
· Risks should be defined explicitly as those that are known with certainty, those that are potential, and those where there is uncertainty in the scientific community (or that are not yet fully understood).
· A method for analysing real or hypothetical situations from an ethical perspective is proposed. It consists of reviewing the conformity and non-conformity of a situation in terms of paired ethical values. This highlights the strengths and weaknesses of a situation, and thus makes it easier to identify what could be improved. The method can be used retroactively in a pedagogical setting, but also proactively to solve a problem in progress.
ICRP, 2024. Ethics in radiological protection for patients in diagnosis and treatment. ICRP Publication 157. Ann. ICRP 53(3).
Authors on behalf of ICRP
F. Bochud, M-C. Cantone, K. Applegate, M. Coffey, J. Damilakis, F. Fahey, C. Kurihara-Saio, B. Le Guen, J. Malone, L. Reid, M. del Rosario Perez, F. Zölzer
Abstract - Publication 138 defines the ethical foundations of the ICRP System of Radiological Protection based on core values (beneficence and non-maleficence, dignity, justice, and prudence) and procedural values (accountability, transparency, and inclusiveness). The purpose of the present publication is to propose a practical application of values for medical radiological protection professions. As medicine has a long history and strong culture of ethics, this publication starts by identifying the shared values, and defines a common language between biomedical ethics and radiological protection. The core values are very similar, with the autonomy of biomedical ethics, which can be seen as a corollary of dignity, and the precautionary principle, which can be understood as the implementation of prudence. In recent years, medical education and training has emphasised the values of solidarity, honesty, and, above all, empathy. All these values are defined and interpreted in the specific context of the use of ionising radiation in medicine. For those more familiar with radiological protection, the ethical implications of their actions are described. Conversely, for those who already have a good background in ethics, this publication highlights the specificities of ionising radiation that also deserve consideration. In order to emphasise the coherence between the values involved in biomedical ethics and those involved in radiological protection, this publication proposes to combine them: dignity and autonomy; beneficence and non-maleficence; prudence and precaution; justice and solidarity; transparency, accountability, and honesty; and inclusiveness and empathy. This allows a structured review of practical situations from an ethical perspective. For the sake of both example and education, this publication proposes 21 realistic scenarios (11 in imaging procedures and 10 in radiation therapies). Sensitising questions are provided to stimulate reflection and discussion.
The ultimate goal is to be able to use ethical values in clinical imaging and therapy situations. Required education and training in ethics is essential for medical radiological workers throughout their career span. An example of a framework of knowledge, skills, and competencies is proposed. In order to assist the reader in a theoretically complex subject, key messages are distributed throughout the text as fixed points that can be easily understood. Although primarily aimed at medical radiological protection professionals, this publication is also intended for authorities, patients, and the public.
MAIN POINTS
· An understanding of the basic principles of radiological protection is an absolute prerequisite for all health professionals working with radiation for the purpose of diagnosis or treatment. This understanding is necessary but not sufficient without also including ethical training.
· In order to establish a common ground and to pave the way for an ethically based analysis of practical situations, the values of biomedical ethics and those identified in Publication 138 (ICRP, 2018a) are paired: autonomy is linked to dignity, beneficence to non-maleficence, precaution to prudence, solidarity to justice, honesty to transparency and accountability, and empathy to inclusiveness. These values are defined and interpreted in relation to biomedical ethics, professional codes of ethics, and the practice of medicine.
· Professionals working in radiological protection in medicine are expected to adhere to the code of ethics of their regulatory and professional bodies, and to that of their employer, which may include values of accountability, transparency, safety, and patient-centredness.
· Everyone in the diverse groups of relevant stakeholders in health care is responsible for assuring strong shared radiological protection and ethical values. Each target group needs to be empowered and educated to ensure that patients are imaged and treated correctly.
· Radiation dose estimates should be recorded in a patient’s medical record. Patients should have access to the doses they receive, and have the dose explained, just as they have access to records for all their care. The degree and approach of dose, benefit, and risk communication depend on the needs and cultural background of each patient and family, which are explored in shared decision-making.
· Risks should be defined explicitly as those that are known with certainty, those that are potential, and those where there is uncertainty in the scientific community (or that are not yet fully understood).
· A method for analysing real or hypothetical situations from an ethical perspective is proposed. It consists of reviewing the conformity and non-conformity of a situation in terms of paired ethical values. This highlights the strengths and weaknesses of a situation, and thus makes it easier to identify what could be improved. The method can be used retroactively in a pedagogical setting, but also proactively to solve a problem in progress.
