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J Med Ethics 34:446-449 doi:10.1136/jme.2006.019307
  • Clinical ethics

Moral principles and medical practice: the role of patient autonomy in the extensive use of radiological services

  1. B Hofmann1,2,
  2. K B Lysdahl2
  1. 1
    University College of Gjøvik, Faculty of Health Care and Nursing, Gjøvik, Norway
  2. 2
    University College of Oslo, Faculty of Health Sciences and Section for Medical Ethics, Faculty of Medicine, University of Oslo, Norway
  1. Bjørn Hofmann, Section for Medical Ethics, Faculty of Medicine, University of Oslo, PO Box 1130, Blindern N-0318, Oslo, Norway; b.m.hofmann{at}medisin.uio.no
  • Received 27 September 2006
  • Revised 6 February 2007
  • Accepted 13 February 2007

Abstract

There has been a significant increase in the use of radiological services in the past 30 years. There are many reasons for this, but one has received little attention: the increased role of patient autonomy in healthcare. Patients demand x rays, CT scans, MRI, and positron emission tomography scans. The key question in this article is how a moral principle, such as respect for patient autonomy, can influence the extension of radiological services. A literature review reveals how patient autonomy is acknowledged in radiology, and how it is used both to explain and to justify the increase in radiological examinations. Furthermore, it also shows how the premises favouring patients’ exercise of their autonomy are not always present, which makes patient autonomy subject to adverse side effects and even abuse. Patient autonomy can be used to reduce the professionals’ responsibility for radiological examinations (by avoiding complaints and lawsuits), to increase the popularity of the profession (by giving the people what they want), to increase the income of the professionals or their institutions, and to promote professional activity. Patient autonomy intended to reduce paternalism, to legitimise otherwise morally unjustifiable actions (such as exposure to radiation), and to protect patients, can easily be used as a moral means for opposite ends. These adverse effects are not peculiar to radiology. However, they emerge particularly clearly in explanations and justifications of the substantial increase in radiological services, as well as in debates on overuse of radiological services.

Footnotes

  • Competing interests: None declared.

  • i The estimated level of unnecessary examinations is reported to be between 10% and 40% in industrialised countries,611 and it is argued that increased medical imaging does not result in better healthcare outcomes.12 13 Although overuse of radiological examination is morally relevant, it is relevant here only with respect to highlighting the role of patient autonomy in the increase of radiological examinations.