d. Legal Accountability as a Stimulus to the Proper Practice of Skills. In
addition to the ethical responsibilities health care providers have towards their patients,
they also have a legal responsibility to provide the best care possible. When the level of
care falls below acceptable standards and injury occurs, the health care professional
and health care facility can be held legally accountable. Consider the seemingly routine
procedure of taking x-rays. A radiographer will take many x-rays in the course of a
career. These procedures should never become so automatic that the x-rays taken are
less than first-rate. Sloppy work can have serious effects on the patient's condition, as
the following anecdotes illustrate.
(1) The case of the missing anatomical structures. Radiologists commonly
use x-rays to diagnose fractures. A failure to include the relevant anatomical structures
could have serious medical implications for the patient and legal and ethical implications
for the health care team and hospital. Legal action was brought against a hospital for
personal injuries resulting from the alleged negligence of the radiographer in taking x-
rays of a patient's right leg. The film tailed to include the ankle joint. The attending
physician, finding no fracture on the film, treated the patient for a sprained ankle. An x-
ray exam, taken 3 months later, revealed that the patient had fractured ankle bones that
had united in poor position. The radiographer, as an employee of the hospital, made
the institution liable for damages to the patient. And the attending physician, the
radiologist, and the hospital were named in the resulting lawsuit.
(2) The case of the mislabeled x-ray. In another instance, an x-ray
technologist, employed by a radiologist in private practice, took an x-ray of an infant's
lungs, but she got confused on the labeling. She incorrectly marked the left lung with an
"R" and the right lung with an "L." As a result, the attending physician made an
unnecessary intervention (fluid removal) on the healthy lung and left the problem lung
(the one with fluid build-up) untreated, causing the infant to die. In the resulting lawsuit,
the radiographer, the radiologist, and the hospital were named.
e. Enforcing Ethical and Legal Standards.
(1) Hospital ethics committees routinely evaluate actions taken in the
hospital, and thus provide a mechanism for reviewing actions against established
ethical and legal standards. (There are certain procedures that they routinely evaluate,
e.g., taking someone off a respirator. Other issues are brought before the committee for
resolution on a case-by-case basis.)
(2) Professional organizations like the American Medical Association
attempt to enforce standards by establishing official positions on controversial issues.
For example, in 1989 the AMA came out with a statement saying that doctors do not
have the right to refuse treatment to someone who has tested HIV-positive for AIDS.
"When an epidemic prevails, a physician must continue his labors without regard to the
risk of his own health."'15 On the other hand, of 41,000 physicians polled on this issue,
50 percent believed they did have the right to deny care, and 15 percent said they
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