DEPARTMENT: SHS - Radiography Program COURSE CODE: HLTH.245
CREDIT HOURS: 4
Course Meeting Date/Times: M/W
9:50 a.m. – 11:50 a.m.
TITLE: Medical Law and Ethics for INSTRUCTOR: Gary Gruenewald M.S., R.T(R)
PHONE: 708-237-5000 ext. 2825
COURSE DESCRIPTION: This course centers on the discussion of moral, legal and ethical concepts
which are pertinent to healthcare today. Medico legal and moral considerations
are studied as they relate to the interpersonal relationships between
radiographers, patients and fellow members of the healthcare team.
REQUIRED TEXTBOOKS: Towsley-Cook/Young, Ethical and Legal Issues for Imaging Professionals,
Second Edition, Mosby, St. Louis, MO, 2007
At the completion of this course, the student will be able to:
1. Discuss the origins of medical ethics.
2. Apply medical/professional ethics in the context of a broader societal ethic.
3. Explain the role of ethical behavior in health care delivery.
4. Explain concepts of personal honesty, integrity, accountability, competence and compassion
as ethical imperatives in health care.
5. Identify legal and professional standards and relate each to practice in health professions.
6. Identify specific situations and conditions that give rise to ethical dilemmas in health care.
7. Explain select concepts embodied in the principles of patients’ rights, the doctrine of
informed (patient) consent and other issues related to patients’ rights.
8. Explain the legal implications of professional liability, malpractice, professional negligence
and other legal doctrines applicable to professional practice.
9. Describe the importance of accurate, complete and correct methods of documentation as a
10. Explore theoretical situations and questions relating to the ethics of care and health care
11. Explain legal terms, principles, doctrines and laws specific to the radiologic sciences.
12. Outline the conditions necessary for a valid malpractice claim.
13. Describe institutional and professional liability protection typically available to the
14. Describe the components and implications of informed consent.
15. Identify standards for disclosure relative to informed consent.
16. Describe how consent forms are used relative to specific radiographic procedures.
17. Differentiate between civil and criminal liability.
18. Define tort and explain the differences between intentional and unintentional torts.
A. Attend class regularly
B. Complete all assignments
C. Complete with an average accuracy of 80% or better on all course work, including exams, quizzes and homework
Educational Assessment: The School of Health Science's radiography program may use educational methods and tools in this and other courses for the purpose of departmental, program and/or course evaluation. Educational Assessment is defined as the systematic collection, interpretation, and use of information about student characteristics, educational environments, learning outcomes and stakeholder satisfaction to improve program effectiveness, student performance and professional success.
Conduct: Failure to observe standards of academic honesty, excessive absence, or other behavior contradictory to achievement of course objectives may result in Administrative action by the instructor.
A. Class participation
B. Homework and assignments
C. Written examinations and quizzes
D. Comprehensive Final Exam
E. Attendance per the Academic Policy
1. Exams 30%
2. Quizzes 15%
3. Homework 20%
4. Comprehensive Final Exam 35%
All research papers and essays will be scored using the General Education Department guidelines and assessment
forms from the Communication courses.
GRADING STANDARDS: Grades are not curved at NC. The following standards are applied to all course work and final course grades:
A = 94% - 100%
B = 87% - 93%
C = 80% - 86%
D = 73% - 79%
F = 0% - 72%
If you have a documented disability and need an accommodation in this class, please contact the Office of Counseling and
Disability Services (OCDS) at your campus as soon as possible. You will need to provide documentation of your disability
and complete the necessary paperwork, after which the counselor will be able to determine the appropriate accommodations
available to ensure your equal access to and full participation in this class. You can contact the counselor at your campus by
stopping by the OCDS office or by calling the counselor to schedule an appointment at one of the following numbers:
Bridgeview 708-237-5030, Chicago 773-481-3170, and Naperville 630-753-9091 x2731.
- PLAGIARISM POLICY:
The Student Conduct Code in the NC Catalog lists plagiarism as an unacceptable student behavior. Northwestern College is
committed to upholding high standards of academic integrity and honesty. All students are expected to respect and adhere
to these standards, and any incident of academic misconduct is viewed by the NC community as a serious offense. Any
attempt by a student to present work as their own, when it is not, is regarded as academic misconduct. This encompasses
all written and computer-based work that may include, but is not strictly limited to, homework classroom assignments,
compositions, essays, tests, and quizzes. Copying another student’s work or assisting another student in copying or
cheating is academically dishonest and considered misconduct.
Students found guilty of plagiarism will be disciplined by the college up to and including expulsion.
- All required reference material must be read .
- Any assigned homework must be submitted on the due date, late assignments will only be accepted on the
next scheduled course meeting date and will suffer a seven percentage point reduction in grade. Exceptions to
this rule are at the discretion of the instructor.
- All scheduled examinations/quizzes that are missed, must be taken within one week of the scheduled
exam date and will suffer a seven percentage point reduction in grade. Examinations not taken within
this time-frame will be recorded as a zero percentile. The examination must still be taken and
passed, however, as a requirement for passing the course.
- exceptions to this rule are at the discretion of the instructor and must be made in advance.
- Missed exams will be monitored and taken in the faculty reception conference room .
- Students must earn a minimum of 80% on unit examinations.
If the percentage scored is less than 80%, the student must retest on the material. The re-examination
must be taken within the week following distribution/discussion of the initial examination. Re-examinations
not taken within this time-frame will be recorded as a zero percentile. The initial
earned percentage will be recorded as the examination grade for that unit. The reexamination
percentage will be recorded and factored in as a homework assignment,
when calculating the final course grade.
Attendance and Punctuality
There are penalties for missed absences and being late for class. Students are allowed three absences per quarter without a grade reduction. Additional absences will result in course grade reductions as follows: 4th absence – 1 letter grade reduction, 5th absence – 2 letter grade reduction, 6th absence – 3 letter grade reduction. Arriving > 15 minutes after the scheduled start of the class will be recorded as an absence. Leaving >15 minutes before the conclusion of the class will also result in a documented absence.
Units of Instruction
- Ethical and Legal Foundations
- Principles of Beneficence and Nonmaleficence
- Caring and Communication
- Patient Autonomy and Informed Consent
- Truthfulness and Confidentiality
- Death and Dying
- Health Care Distribution
- Student and Employee Rights and Responsibilities
- Overview of New Technology and Future Challenges
Unit Outline and Learning Objectives
Found at the beginning of each chapter of the text.
- Ethical and Legal Foundations pg.1
- Principles of Beneficence and Nonmaleficence pg. 27
- Caring and Communication pg. 54
- Patient Autonomy and Informed Consent pg. 72
- Truthfulness and Confidentiality pg. 95
- Death and Dying pg. 116
- Health Care Distribution pg. 142
- Student and Employee Rights and Responsibilities pg.171
- Diversity pg. 196
- Overview of New Technology and Future Challenges pg. 224
Summer Quarter - 2012
W 6/6 Unit 1 pgs. 1 - 26
M 6/11 Unit 1
W 6/13 Unit 2 pgs. 27 - 52
M 6/18 Unit 2
W 6/20 Unit 3 pgs. 54 - 71
M 6/25 Unit 4 pgs. 72 - 94
W 6/27 Unit 4
M 7/2 Unit 5 pgs. 95 - 115
W 7/4 NCS - Independence Day!
M 7/9 Unit 6 pgs. 116 - 141
W 7/11 Unit 6
M 7/16 Unit 7 pgs. 142 - 170
W 7/18 Unit 7
M 7/23 Unit 8 pgs. 171 - 195
W 7/25 Unit 8
M 7/30 Unit 9 pgs. 196 – 223
W 8/1 Unit 10 pgs. 224 - 246
M 8/6 Review for Final Examination
W 8/8 Final Examination
- Lectures are based on required reading material, per the identified date
- Individual unit assignments and due dates will be discussed/distributed in class.
- Quizzes may given on previously lectured material unannounced.
The instructor reserves the right to alter the course schedule.
UNIT ONE FOCUS - ETHICAL AND LEGAL FOUNDATIONS
Ethical and legal issues have become important topics for the imaging professional in the ever- evolving environment of health care.
Today’s health care consumers are much more aware of their rights as patients. To adequately prepare imaging professionals for their roles in
patient care during imaging procedures, the curriculum for radiologic science students must include topics specific to ethics and law.
Ethical theories and models serve as tools in problem solving. The three schools of ethical thought are consequentialism, deontology, and
virtue ethics. Imaging professionals also use ethical models to guide their interactions with patients. Common models include the
engineering, priestly, collegial, contractual, and covenantal models. In addition, case study analysis is aided by a decision-making framework
in which the imaging professional asks questions about the context of an ethical problem, ascertains the significance to other parties and the
values involved, and determines a satisfactory outcome and a method for avoiding future ethical dilemmas.
Imaging professionals face many legal issues in addition to the ethical dilemmas that arise. They cannot be expected to have a thorough
knowledge of all legal issues. However, a basic knowledge of law, the legal system, and the legal issues they are most likely to
encounter can prove invaluable in minimizing litigation risks.
Chapter 1 explores the law and its establishment through common law, case law, and statutes, familiarizing students with the
divisions of law and the ways that administrative, criminal, and civil law can affect imaging professionals. It also provides a basic
understanding of tort law, which is generally the basis of medical malpractice cases.
Possible defendants in medical malpractice lawsuits, including the imaging professional, the facility, and the physician, are addressed.
The three phases of a lawsuit—pleading, discovery, and trial—are examined, with a particular emphasis on the possible roles of the
imaging professional in each phase. After risk management is defined, discussion focuses on the importance of each imaging
professional’s becoming a risk manager.
common law Law encompassing principles and rules based on ancient usages and customs.
consequentialism An ethical school of thought in which decisions are based on the consequences or outcomes of a
given act; the good of an activity is evaluated based on whether immediate harm is balanced with future benefits.
critical thinking Purposeful, self-regulatory judgment resulting in interpretation, analysis, evaluation, and inference.
deontology An ethical school of thought that bases decision making on individual motives and morals rather than
consequences and examines the significance of actions themselves. Deontologic problem solving uses personal rules of
right and wrong derived from individual actions, relationships of all kinds, and society.
ethics The system or code of conduct and morals advocated by a particular individual or group.
judicial decisions Previous cases that either interpret statutes or adopt and adapt common law principles.
law, the A body of rules of action or conduct prescribed by controlling authority and having binding legal force.
Its basis is in common law from England, but it has been molded by statutes and judicial decisions since the founding of the United States.
legislation All the laws and statutes put in place by elected officials in federal, state, county, and city governments.
professionalism An awareness of the conduct, aims, and qualities defining a given profession, familiarity with professional
codes of ethics, and understanding of ethical schools of thought, patient-professional interaction models, and patient rights.
quality assurance A process to assess quality of patient care that uses hospital committees to oversee the quality of various hospital functions.
risk management The system for identifying, analyzing, and evaluating risks and selecting the most advantageous method for treating
them. Its goal is to maintain high-quality patient care and conserve the facility’s financial resources.
statutory law Law including all laws enacted by federal, state, county, and city governments.
values Qualities or standards desirable or worthy of esteem in themselves; they are expressed in behaviors, language, and standards of conduct.
virtue ethics A new ethical school of thought that focuses on the use of practical wisdom for emotional and intellectual
problem solving. It incorporates elements of teleology and deontology to provide a more holistic approach to solving ethical dilemmas.
Unit 1 Notes - Ethical and Legal Foundations
The Law - a body of rules of action or conduct, prescribed by a controlling authority, which has
binding legal force. Its basis is in common law from England but has been molded by statutes and
judicial decisions since the birth of the United States. Laws are created in
order to institute and maintain orderly coexistence.
A law is an act of Congress (state legislature) that has been signed by the president (governor) or passed over his veto
by Congress. Public bills, when signed, become public laws, and are cited by the letters 'PL' and a hyphenated number.
The two digits before the hyphen correspond to the Congress, and the one or more digits after the hyphen refer to the
numerical sequence in which the bills were signed by the president during that Congress.
In the Middle Ages, law was considered to have been dictated by Divine Will, and revealed to wise men. The most ancient
legal precedents and customs were considered to be the best law, and much of Continental Europe wound up modeling
secular law after the old Roman law. In Byzantium, secular and sacred law were somewhat intermingled, with secular law
taking precedence. In Western Europe, however, religious and secular law were separate bodies. Church law was known
as Canon Law, and applied to the clergy, to the secular world in matters of the administration of the Sacraments such as
marriage, and to the immunity of the clergy from secular law. This is the root of the conflict between Church and State.
St. Augustine arranged law through three levels:
Divine law, a perfect system comprehended through faith and reason;
Natural law, which could be understood by all creatures, lacked the perfection of faith, and could be improved by philosophy;
Temporal (secular) law, obedience to which was enjoined on all Christians, save where it conflicted with Divine or Canon law.
In its most general and comprehensive sense, law signifies a rule of action, and is applied indiscriminately to all kinds of action;
whether animate or inanimate, rational or irrational. In its more confined sense, law denotes the rule, not of actions in general, but of
human action or conduct.
Law is generally divided into four principle classes, namely: Natural law; The law of nations; Public law; and, Private or civil law.
Current Law = Common Law + Statutes/Judicial Decisions
Common law is the basis for current law in 49 of 50 states.
Exception is Louisiana which uses Roman Law and the Napoleonic Code rather then the common case law
background of England.
Common Law - encompasses principles and rules based on ancient usage and customs.
Tort Action - one party asserts that the wrongful conduct of another has caused harm - the injured
party seeks compensation for the harm suffered.
Fact - First common law malpractice suit in the US - 1794
The tort of negligence can only be found if:
1. a duty was owed
2. the duty was breached
3. demonstrable harm resulted from the breach
Statutory Law - all laws enacted by federal, state, city and county governments
Legislation - all the laws and statutes put into place by elected officials in federal, state, city and county governments
Judicial Decisions - precedents that have been established via previous cases that have either interpreted
statutes or adopted or adapted common law principles.
Example of a standard adopted through judicial decisions:
In some states:
Physician Based Standard of Disclosure - a physician must disclose to a patient, information
that a reasonable medical practitioner similarly situated would disclose
In other states:
Reasonable Patient Standard of Disclosure - the physician must disclose information that a reasonable
patient needs to make an informed decision
Branches of the Law:
Administrative Law - Deals with licensing and regulation
Criminal law - Addresses wrongs against the state - penalties include fines,
restitution, community service and incarceration
Civil Law - Addresses wrongs committed by one party harming another - penalties include monetary
damages to compensate for loss and to punish
Tort Law is a subdivision of civil law.
Types of torts that could possibly be encountered by the imaging professional:
- False imprisonment
- Lack of informed consent
- Breach of patient confidentiality
As providers of medical imaging services, the radiographer may be required to participate in litigation.
Lawsuit - definition: A legal action started by a plaintiff against a defendant based on a complaint
that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
A lawsuit must begin within a given timeframe - statute of limitations.
Most lawsuits are settled before trial - Settlements usually occur before a lawsuit is ever filed.
The phases of a lawsuit:
1. Pleading Phase - complaint lodged and answer given
2. Discovery Phase - facts sought in two ways 1. Written questions (interrogatories)
2. oral questions (depositions)
3. Trial - presentation of facts to a judge or jury
4. Decision - guilty or innocent
Risk Management: definition - a system for analyzing, and evaluating risks and selecting the most
advantageous method for treating them. Its goal is maintain quality patient care and conserve the
facility's financial resources.
Ways in which risk is minimized: thorough documentation, obtaining informed consent,
maintaining patient confidentiality, practicing radiation protection, maintaining a safe
environment for patients, visitors and employees
3 goals of an effective risk management program:
1. elimination of the causes of loss experienced by the hospital and its patients, employees and visitors
2. lessening of the operational and financial effects of unavoidable losses
3. covering of inevitable losses at the lowest cost
Health care facilities generally employ a risk manager.
Unit 2 - Principles of Beneficence and Nonmaleficence
- Distinguish between beneficence and nonmaleficence.
- Identify the four conditions used to assess the proportionality of good and evil in an action.
- Demonstrate an ability to make appropriate decisions by applying the principles of beneficence and nonmaleficence.
- Identify medical indicators involved in imaging.
- State the imaging professional’s role in doing good and avoiding evil.
- Provide patients the knowledge necessary to ensure their participation in decision making.
- Identify and define the legal concept of standard of care.
- List the many sources of standards of care.
- Define negligence, medical negligence, and res ipsa loquitur.
- Identify methods to decrease risk, including documentation, technical detail issues, radiation protection, and safety.
- Identify and justify which information is appropriate and inappropriate for documentation.
Differences Between Beneficence and Nonmaleficence
Medical Indications Involving Principles of Beneficence and Nonmaleficence
Imaging Professional’s Role
Standard of Care
Methods to Decrease Risk
Two integral components of decision making and accountability for the imaging professional
to consider when interacting with patients are beneficence, the performance of good acts,
and nonmaleficence, the avoidance of evil. The values of beneficence and nonmaleficence
have been respected since the times of the earliest health care providers who tried to promote
good by aiding the sick and injured. These two values provide a system of checks and balances
for health care providers and patients to aid in decision-making processes concerning medical care.
Conflicts may arise between beneficence and nonmaleficence and often affect patient
autonomy. Such conflicts may occur when good intentions have negative consequences.
They may also result from friction between the notion that all people deserve good health
care and the reality of limited resources, power struggles, quality-of-life decisions, and
surrogate obligations. These conflicts must be addressed to provide society with appropriate
health care. This chapter provides the imaging professional with an ethical foundation to address these conflicts.
The ethical concepts of beneficence and nonmaleficence are not usually connected with
legal theories involving health care. However, both concepts, to do good and avoid harm,
seem to be incorporated into the duty of a health care professional—to do no harm and to
provide reasonable care to the patient. This chapter explores the legal concept of
standard of care, examining the reasonable care that is expected and the negative results
that occur when less than reasonable care is provided.
Every profession establishes standards of care to define the parameters within which that
profession is obligated to practice. The legal standard of care is the degree of skill or care
employed by a reasonable professional practicing in the same field. Negligence is an unintentional
tort (that is, an unintentional injury or damage) resulting from actions not intended to do harm.
It occurs in situations in which a duty to use reasonable care is owed to another, and an injury
results from a failure to use reasonable care. The elements of negligence, medical negligence,
and res ipsa loquitur are examined in this chapter. Scenarios are used to identify possible roles
of the imaging professional in litigation based on medical negligence and res ipsa loquitur. An
extended discussion of vicarious liability doctrines is also included.
Risk management and tools to decrease litigation risk are considered, among them documentation,
radiation protection, and safety. Documentation is addressed extensively, including suggestions for
information to be obtained, a chart of documentation basics, and a discussion of what information
is appropriate and inappropriate for documentation and why.
beneficence Performance of good acts.
medical negligence A breach of the health care provider’s obligation to follow the appropriate
standard of care, which results in harm to the patient.
negligence An unintentional tort involving duty, breach of duty, injury, and causation.
nonmaleficence The avoidance of evil.
principle of double effect A person may perform an act that has evil effects or risk such
effects as long as four certain conditions are met.
reasonable care The degree of care a reasonable person,
similarly situated, would use.
res ipsa loquitur Latin term meaning “the thing speaks for itself.” It is a legal
concept invoked in situations in which a particular injury could not have occurred in the absence of negligence.
standard of care The degree of skill or care practiced by a reasonable professional practicing in the same field.
Unit 3 - Caring and Commuinication
- Identify the nature of care and its ethical and legal implications.
- Provide examples of the impact of communication on imaging.
- Define human care, professional care, and communication.
- Explain care and communication as a context for imaging practice.
- Develop a more caring and communicative demeanor.
- Identify what health literacy is and how it affects imaging.
- Implement the legal aspects of caring and communication.
Definition of Caring
Examples of Caring and Communication
Caring is essential for life and growth; it is a crucial ingredient in the imaging professional’s
ability to serve the needs of self and others. Caring requires the developmental strengths of
trust, autonomy, initiative, identity, justice, industry, and intimacy, all of which play a role
in ethics and ethical problem solving for the imaging professional.
Health care professionals, including imaging professionals, refer to therapy and other
services they provide in their practices as care. Care is shown to the patient through
appropriate communication. Therefore caring and communication are the primary tasks
of the imaging professional. A caring attitude should influence the imaging professional’s
feelings and ethical problem solving arising from interactions and communication with
patients. This chapter defines caring and communication, describes their ethical implications
for imaging practice, and provides methods to help the imaging professional develop a
more caring and communicative demeanor.
Caring may not appear to be a topic with many legal implications, and strictly speaking
this is true. However, patient care does indeed have legal aspects. Data indicate that
only a fraction of the patients who suffer injuries because of negligence file malpractice
claims. Data further indicate that it is the patients dissatisfied with the “care” they
receive who are more likely to consult attorneys and file malpractice claims. This chapter
explores the connection between “caring” and the reduction of the risk of malpractice litigation.
caring - A function of the whole person in which concern for the growth and
well-being of another is expressed in an integrated application of the mind, body,
and spirit that seeks to maximize positive outcomes.
existential care - Compassion arising from an awareness of common bonds of
humanity and common expressions, fates, and feelings.
health literacy - The ability to read, understand, and act on health care information to make
effective health care decisions and follow instructions for treatment.
professional care - The application of the knowledge of a discipline, including its science, theory, practice, and art.