c. Criticism of Professional Codes.
(1) Failure to reflect the full range of moral principles. Do codes specific to
the areas of science, medicine, and health care express all of the essential principles
and rules that are important to society? Many medical codes have a lot to say about
doing what is right or good, and about confidentially. But only a few have anything to
say about other important principles and rules, such as truthfulness and respect for
patient autonomy (self-rule or self-determination).
(2) Not enough emphasis on patient's rights. There have been attempts of
late to incorporate some of the overlooked principles and rules by formulating
statements of a patient's rights, which cover the principles of respect for autonomy and
rules of truthfulness. But such statements are usually incomplete and fail to present the
whole range of moral principles.
(3) Codes written by the professionals themselves and not subject to
outside scrutiny. Since the time of Hippocrates, physicians have generated narrow
codes that involve no scrutiny by those whom physicians serve. These codes have
rarely appealed to more general ethical standards or to any authority beyond the
deliberations of physicians. Says ethicist Ruth Macklin, "...the medical expertise of
physicians does not automatically confer moral expertise on their decisions and actions.
Any reflective, thoughtful person is potentially as good a decision-maker as any other."37
(4) Too vague and abstract. Codes have been traditionally expressed in
abstract terms that are subject to completing interpretations. Jay Katz is a psychiatrist
who complied materials on human experimentation and the fate of victims of Nazi
Germany's Holocaust. He maintains that training which health care providers receive in
the complex issues of ethics and legal rights in inadequate, and that the codes are
vague and abstract in comparison with the intricacies of the law on such issues as the
right to privacy and confidentiality. He believes that more training in this area, beyond
what is covered in traditional codes, is needed to provide meaningful guidance for
research involving human subjects.38
1-8.
THE PATIENT'S BILL OF RIGHTS
a. Specific Aspects of the Patient's Hospital Stay. As stated earlier, it has
been recognized that if the patient's rights were addressed, the result would be better
quality and more efficient care, as well as increased patient satisfaction. A comparison
between the code of ethics for x-ray technologists adopted by the American Registry of
Radiologic Technicians and the patient's bill of rights will reveal some obvious
differences in content and style (see Appendixes A and B). The professional code
covers ethics, good conduct, and responsibilities to other members of the profession.
The language of the code is abstract. By comparison, the bill of rights is worded much
more concretely. It zeroes in on specific aspects of the patient's stay, for example,
treatment in an emergency, access to records. In addition, it spells out not only ethical
rights (ethical standards of the profession that aren't actually required by law), but also
legal rights (recognized by statute).
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