Copyright the Radiological Society of South Africa. January 2002
Health providers are constantly under pressure from social, economic and ideological forces. It is therefore crucial that there are clear guidelines to allow fair allocation of resources, the identification of priorities and informed decision-making. Ethical practice would be the most important factor influencing decisions at all levels.
Ethics is the study of morality. It is the careful and systematic reflection and analysis of moral decisions and behaviour, whether past, present or future. Ethics and the law are not synonymous. Ethics usually has higher standards than the law and even sometimes requires challenging unjust laws. The law is often the minimum standard for ethical behaviour. What constitutes ethical behaviour could differ from individual to institutional to government level. Ethical issues bear upon the rights and wrongs of human decision-making and behaviour.
These guidelines, in the form of a 'Code of Conduct' have been developed by the Radiological Society of South Africa, for the use of its members.
These guidelines have been submitted to the Health Professions Council of South Africa for approval.
Code of ethics
Radiologists have individual and collective ethical responsibility to:
- Consider the well being of the patient.
- Practise the art and science of medicine competently and without impairment.
- Engage in lifelong learning to maintain and improve your professional knowledge, skills and attitudes.
- Conduct all personal and professional activities with honesty, integrity, respect, fairness and good faith.
- Avoid the exploitation of professional relationships for personal gain.
- Respect professional confidences.
- Ensure transparency in all aspects relating to the conducting of the radiology practice in the interest of patient care.
- Comply with all laws.
- Uphold the values, ethics and mission of this Code.
Responsibilities to the Patient
- Treat all patients with respect; do not exploit them for personal advantage.
- Provide whatever appropriate assistance you can to any person with an urgent need for medical care.
- In providing medical service, do not discriminate against any patient on such grounds as age, sex, marital status, medical condition, national or ethnic origin, physical or mental disability, political allegiance, race, religion, creed, sexual orientation, social standing or socio-economic status. This does not abrogate the doctor’s right to refuse to accept a patient for legitimate reasons.
- Inform your patient when your personal morality would influence the recommendation or practice of any medical procedure that the patient needs or wants.
- Having accepted professional responsibility for a patient, continue to provide services until they are no longer required or wanted; until another suitable doctor has assumed responsibility for the patient; or until the patient has been given adequate notice that you intend to terminate the relationship.
- Make every reasonable effort to foster a good relationship with your patients based on mutual respect, communication and trust. Appropriate communication may be extended to family and close friends if this is on the patient’s interest.
- Recommend and perform only those diagnostic and therapeutic procedures that you consider to be beneficial to your patient or to others. If a procedure is recommended for the benefit of others, as for example in matters of public health, inform your patient of this fact and proceed only with explicit informed consent or where required by law.
- Respect the right of a competent patient to accept or reject any medical care recommended.
- Recognize the need to balance the developing competency of children and the role of families in medical decision-making.
- Respect your patient's reasonable request for a second opinion from a doctor of the patient's choice.
- When the intentions of an incompetent patient are unknown and when no appropriate proxy is available, render such treatment as you believe to be in accordance with the patient's values or, if these are unknown, the patient's best interests.
- Be considerate of the patient's family and significant others and cooperate with them in the patient's interest.
- Ensure the existence of a process to evaluate the quality of care or services rendered;
- Ensure the existence of a process that will advise patients or others served of the rights, opportunities, responsibilities and risks regarding available healthcare services;
- Provide a process that ensures the autonomy and self-determination of patients or others served; and
- Limit treatment of yourself or members of your immediate family to minor or emergency services and only when another doctor is not readily available; there should be no fee for such treatment.
Confidentiality and Access to Records
- Ensure the existence of procedures that will safeguard the confidentiality and privacy of patients or others served.
- Respect the confidentiality of information entrusted to you, unless law or ethical duty prevents this, in which instance all steps must be taken to inform the patient that confidentiality will be breached.
- Upon a patient's request, provide the patient or a third party with a copy of his or her medical record or a brief factual written report regarding the patient’s health status, unless there is a compelling reason to believe that information contained in the record will result in substantial harm to the patient or others and/or the law prohibits disclosure.
- Comply with the legal requirements relating to the compilation, ownership and storage of medical records.
- Respect the rights of patients, including the right to informed consent
- Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability.
- In determining professional fees to patients, consider both the nature of the service provided and the ability of the patient to pay, and be prepared to discuss the fee with the patient.
- Be prepared to provide quotes for services to be rendered when so requested and adhere to the quote given unless compelling circumstances merit a deviation. Such deviation must be explained to the patient.
- Do not engage in practices of fraudulent billing and fee splitting against the rules and rulings of the Health Professions Council of South Africa.
ReferralsRecognize your limitations and the competence of others and when indicated, recommend to a patient that additional opinions and services be obtained when this is considered in the best interests of the patient or when requested by a patient.
Make all relevant information available to the colleagues concerned.
Report your findings and recommendations back to a colleague when asked to consult about a patient.
Preferably only accept patients who have been referred by another practitioner.
Radiation SafetyEnsure that the radiation dosage to which patients are exposed is minimized and does not exceed the prescribed safety levels.
Responsibilities to the Profession
- Recognize that the self-regulation of the profession is a privilege and that each doctor has a continuing responsibility to merit this privilege.
- Teach and be taught.
- Avoid impugning the reputation of colleagues for personal motives; however, report to the appropriate authority any unprofessional conduct by colleagues.
- Be willing to participate in peer review of other doctors and to undergo review by your peers.
- Avoid promoting, as a member of the medical profession, any product for personal gain.
- Do not keep secret from colleagues the diagnostic or therapeutic agents and procedures that you employ.
- Collaborate with other doctors and health professionals in the care of patients and the functioning and improvement of health services.
- Conduct yourself in a professional manner that is beyond reproach and take the necessary steps to correct unethical behaviour by colleagues
- Ensure that you maintain your professional independence and integrity when entering into any contract or association regarding professional services; recognise that you remain personally responsible to your patients for care and ensure that the terms and conditions of your contract are fair.
- Enhance the dignity and image of the medical and radiology professions through positive public information programs; and
- Refrain from participating in any activity that demeans the credibility and dignity of the medical and radiology professions.
Advertising, Marketing And Touting
- Market your practice and services provided in a professional manner and subject to the ethical rules, rulings and marketing guidelines of the Medical and Dental Professional Board and the Health Professions Council of SA.
- Ensure that information about you in the course of presenting medical topics to the media or to audiences does not imply that they are the only, the best, or most experienced practitioners in a particular field. They should also avoid activities that could be regarded as canvassing or touting for patients.
- Do not subsidise by way of a monetary payment or any other valuable consideration any medical practitioner’s rental for consulting rooms or other professional facilities, or the salaries of staff employed by such practitioner from whom the radiologist receives referrals.
- Do not pay rental for floor space or the use of equipment or other facilities at a rate or rates which is/are not market related.
- Do not enter into any scheme or arrangement in terms of which a medical practitioner, a group of medical practitioners or a funder requesting radiology services on behalf of patients receives any financial or material benefit, including free shares in any company or shares at a price substantially below market value, or any other valuable consideration whatsoever, or directly or indirectly shares in the income derived by the radiologist for such service requests.
- Do not remunerate a medical practitioner directly or through any other person, in any manner, which could be regarded as an indirect payment or other benefit for referring patients to or requesting radiology services from the radiologist.
- Do not pay or offer to pay any remuneration by way of monetary payment or any other valuable consideration to any member of the staff of a hospital, or any person, natural or juristic, contracted to a hospital.
- Do not purchase or offer to purchase for or supply to or provide free of charge or at a nominal charge to another practitioner any clinical or other equipment, such as computers and related hardware and software programmes, telefax machines or cellular telephones.
- Create a working environment conducive for underscoring employee ethical conduct and behaviour.
- Ensure that individuals may freely express ethical concerns and provide mechanisms for discussing and addressing such concerns.
- Ensure a working environment that is free from harassment (sexual and other), coercion of any kind (especially to perform illegal or unethical acts); and discrimination on the basis of race, creed, colour, gender, ethnic origin, age, disability or any other ground.
- Ensure a working environment that is conducive to proper utilisation of employees’ skills and abilities.
- Pay particular attention to the employee’s work environment and job safety; and
- Establish appropriate grievance and appeals mechanisms.
- Comply with all legal requirements related to leave, pension and other employment benefits.
- Ensure that reasonable and market related payment is made to deserving employees.
- Foster a learning environment to improve the skills of employees.
Responsibilities to Society
- Recognize that community, society and the environment are important factors in the health of individual patients.
- Accept a share of the profession's responsibility to society in matters relating to public health, health education, environmental protection, legislation affecting the health or well being of the community, and the need for testimony at judicial proceedings.
- Recognize the responsibility of doctors to promote fair access to health care resources.
- Use health care resources prudently.
- Refuse to participate in or support practices that violate basic human rights.
- Recognize a responsibility to give the generally held opinions of the profession when interpreting scientific knowledge to the public; when presenting an opinion that is contrary to the generally held opinion of the profession, so indicate.
- Work to identify and meet the health care needs of the community.
- Work to ensure that all people have reasonable access to health care services.
- Participate in public dialogue on health care policy issues and advocate solutions that will improve health status and promote quality health care.
- Provide prospective consumers with adequate and accurate information, enabling them to make enlightened judgements and decisions regarding services.
Responsibilities to OneselfSeek help from colleagues and appropriately qualified professionals for personal problems that adversely affect your service to patients, society or the profession.
- Ensure that any research in which you participate is evaluated both scientifically and ethically, is approved by a responsible committee and is sufficiently planned and supervised that research subjects are unlikely to suffer disproportionate harm.
- Inform the potential research subject, or proxy, about the purpose of the study, its source of funding, the nature and relative probability of harms and benefits, and the nature of your participation.
- Before proceeding with the study, obtain the informed consent of the subject, or proxy, and advise prospective subjects that they have the right to decline or withdraw from the study at any time, without prejudice to their ongoing care.
Copyright the Radiological Society of South Africa