Ethics for Radiation Protection in Medicine

Jim Malone is Robert Boyle Professor (Emeritus) of medical physics at Trinity College Dublin. He worked halftime with the International Atomic Energy Agency (IAEA) (Vienna) for several years and continues as a consultant with both the agency and WHO. He was dean of the School of Medicine and Faculty of Health Sciences at Trinity College Dublin; chairman of the Geneva-based International Electrotechnical Commission’s (IEC) committee for global standards for medical imaging equipment. He has over 300 publications and numerous conference papers/keynote addresses. He has wide interests in the humanities and has contributed to thinking on the ethics basis for radiation protection in medicine. He has been involved in organising numerous summer schools involving science, medicine and the humanities. Friedo Zölzer is professor and head of the Institute of Radiology, Toxicology and Civil Protection at the Faculty of Health and Social Sciences of the University of South Bohemia in České Budějovice, Czech Republic. He is a radiobiologist with a strong interest in ethics, regularly lecturing and publishing in the area. He has significantly contributed to the development of a new approach to ethics of radiation protection at the international level, among others as a member of the International Commission on Radiological Protection’s (ICRP) task group on ‘Ethics of Radiological Protection’ and has been the organiser of a widely recognised biennial series of international symposia on the ethics of environmental health, in which medical applications for radiation played an important part. Gaston Meskens is a theoretical physicist with over 15 years’ experience of research related to sustainable development, energy, climate change and radioactive waste management. He works part-time with the Centre for Ethics and Value Inquiry of the Faculty of Arts and Philosophy of the University of Ghent and with the Science and Technology Studies group of the Belgian Nuclear Research Centre SCK•CEN . His research focusses on a human rights perspective on intellectual capacity-building in the interest of global sustainable development governance. At SCK•CEN, he co-founded the Programme of Integration of Social Aspects into Nuclear Research in 1999. The programme takes nuclear technology as a case, in order to critically study the complexity of risk-inherent technology assessment from the perspective of social justice and sustainable development. Recently, he has been a key contributor to the ethics framework for radiation protection for the International Commission on Radiological Protection (ICRP). At SCK•CEN, he works as researcher, writer, lecturer and mediator of dialogue on ethics in relation to science and technology. Christina Skourou, is a clinical radiotherapy physicist at the St. Luke’s Radiation Oncology Network in Dublin, Ireland, where she is involved in numerous radiotherapy clinical trials and is a member of the network’s Research Ethics Committee. She has served as the chair of the American Association of Physicists in Medicine (AAPM) Task Group 109, revising the Code of Ethics and, as of January, 2019, is the chair of the AAPM Ethics Committee. Christina holds a PhD in biomedical engineering (Dartmouth College) and an MA in medical ethics and law (Queen’s University Belfast).

• About the SeriesPrefaceAuthors1. Introduction 2. Ethics for Radiation Protection in Medicine: Framework and Multicultural Considerations 3. The Pragmatic Value Set: Contexts and Application to Radiation Protection in Medicine 4. Ethics Analysis of Imaging Scenarios 5. Ethics Analysis of Radiotherapy Scenarios 6. Extension of the Pragmatic Value Set 7. Reflections on Uncertainty, Risk and Fairness Afterword References Appendix Index

"This is a well-structured book, giving a comprehensive view of the ethical framework for the radiological protection in medicine. It is a valuable source of information, for professionals and students, regarding the complexity of risk governance and the related ethical aspects, with reference to diagnostic and radiotherapeutic practices. Among the interesting notes, reported in the text, it can be cited for example, to consider the education on pluralist, critical and reflexive base and to give the opportunity to young people and students to develop a self-critical mind, accompanied by a sense for ethics and for intellectual solidarity."— Prof. Marie Claire Cantone in Physica Medica (69, 2020, 81)"This book extends current thinking in a crucial area for radiation protection in medicine, following on from recent initiatives at an international level. It extends current thinking into a ‘pragmatic value set’ against which practices may be judged, in addition to offering validation for this ‘set’ against historical views on ethics. There are excellent discussions regarding autonomy and dignity, especially in the context of the rise of patient-centred care and the, hopeful, demise of medical paternalism.In the light of issues such as Fukushima and conversations around the justification of medical radiation exposures, this book is a timely extension to the debate on a sound ethical foundation for radiation protection in medicine, which previously has either been lacking or assumed. I picked up this book with some trepidation but finished it feeling that it was issuing a challenge to professionals and policy makers alike to further develop the authors’ excellent work. I highly recommend this book to all such professionals and hope that we are up to that challenge."—Andy Rogers, Honorary (Consultant) Assistant Professor, University of Nottingham, School of Medicine"The excellent book ‘Ethics for Radiation Protection in Medicine’ fills a critical gap in our understanding of the ethical values in our society and within our professional workplace and organizations in the Radiation Professions that guide our practice and behavior. By Radiation Professions, I refer to the stakeholders that comprise workers in the radiation sciences: from medical physicists to radiologists and nuclear medicine specialists; administrators to radiation researchers; radiographers to epidemiologists; and regulators to radiation oncologists. Whether we fully know it or not, our shared history, culture, and professional guidelines drive current practice in how we care for patients, how we design our research studies, and how we communicate with each other. This concise, easy to read book, provides introductory chapters on the ethical foundations of medicine and international radiation protection guidance, followed by a deeper insight into why we do what we do every day - practice medical imaging and radiation therapy. The seeming simplicity of the text is a kudo to the expertise of the authors in providing a clear summary of a complex and evolving topic. The importance of pragmatic scenarios in medicine invites the reader to reflect on possible responses in a wide variety of situations that medicine invariably creates. In the Radiation Professions, new technologies will continue to advance, creating uncertainties that users must communicate to both patients and other medical professionals. This book ends with an exploration of uncertainty, risk, and fairness. In conclusion, this short, well written book should be required foundational reading for all medical practitioners."— Kimberly E. Applegate, Professor of Radiology and Pediatrics, University of Kentucky"This book serves as an excellent introduction and textbook on general ethics applied to medicine, and more specifically applied to radiological protection for medical exposures to ionising radiation (radiotherapy, and x-ray and nuclear medicine imaging). The authors provide a review of the classical ethical concepts, as well as proposing an extended and more pragmatic set for use in decision making around medical exposures. A series of worked examples are provided in both diagnostic imaging and radiotherapeutic procedures, providing a critique of the approach taken by the clinicians and other staff involved to demonstrate compliance and non-compliance with the ethical value set. This book will provide a very useful reference for radiologists, radiotherapists, medical physicists and anyone concerned with the radiological protection of patients."—Jim Thurston, Head of Radiation Protection and Dosimetry Service, Royal Marsden Hospital, London"At first glance of the title of 'Ethics for Radiation Protection in Medicine' your first thoughts might be that this book simply explores topics such as dose optimization, justification, dose reference values, radiation damage and cancer risk. However, it actually goes far beyond such a basic approach. Ethical aspects of radiological protection are compared with principles of biomedical ethics. Ethical values like autonomy, non-maleficence, justice, prudence, and transparency are discussed in the framework of a cross-cultural view. A patient’s fear of radiation, risk communication, and economic issues are also addressed. This book is a must-have for anyone who is involved in the dissemination and teaching of medical radiation protection."—Reinhard W.R. Loose, Professor of Radiology, University Erlangen-Nuremberg, Germany"This book introduces medical ethics applicable to diagnostic imaging examinations and treatments in which ionising radiation is used. It starts by taking the reader through the bigger societal and historical roots of ethical principles, then provides a framework on how medical activities can be looked upon, by applying a cross-cultural set of pragmatic values. How this could be applied in practice is then illustrated in two chapters, one using medical imaging scenarios, the other scenarios from radiotherapy. The pragmatic value set developed in the first chapters is then extended. The application of this completed list of values in everyday clinical practice is illustrated by re-examining the imaging and therapy scenarios presented earlier. A final chapter is devoted to broader reflexions related to the ethics of fair risk governance. It is presented in a concise and easy-to-read form, making it a book that can fit in the tight time schedules of busy professionals, students, and laypersons alike. One should not expect to find a book full of ready-to-use recipes, but rather a toolbox, enabling the reader to analyse each practice situation in its uniqueness from an ethics point of view. I would highly recommend this book for all those professionally involved in the varied applications of ionising radiation in medical settings or in regulating and controlling this field of activities."—Lodewijk A K Van Bladel, MD, Special Missions at Federal Agency for Nuclear Control (FANC), Brussels, Belgium. Member of International Commission of Radiological Protection (ICRP) Committee 3, Protection in Medicine. "Ethics for radiation protection in medicine provides an ethical toolbox to facilitate complex decisions and advice. The title may suggest an esoteric book that could have previously been confined to lofty discussions in the hospital departments or over a few glasses of wine after dinner. Malone et al’s book is remarkably specific with many case studies in both diagnostic imaging and radiotherapy. It builds on earlier papers from the group of leading experts in radiation protection both in medicine and industry. The book also builds on presentations which I have been lucky to attend. The book presents a set of five pragmatic values: dignity and autonomy, Non Maleficence/benefice; Justice, Prudence precaution and Honesty transparency. The book is even more useful when considering the new obligations under EU 59/13 around justification, risk information and open disclosure. Chapter one outlines the rational and scope. However the book is more than a manual and chapter two deals with the cultural and philosophical basis of the pragmatic value set. Chapters three to five provide well worked scenarios in medicine and dental practices, focusing on Imaging and Radiotherapy. Chapter seven discusses the cultural basis of the pragmatic value set. Ethics for radiation protection in medicine and the value set presented provides a necessary springboard for outlining arguments in the wider public context. Some of the writing style in the more philosophy based and cultural chapters is different from that used in regulatory reports or scientific papers and it may take the medical physics reader longer to digest those chapters…Overall I would highly recommend this book be available in all medical physics departments and a keystone reference on radiology and medical physics syllabi."—Associate Professor Paddy Gilligan, UCD School of Medicine"Ethics is a required competency for certification in Medical Physics, and the publication of this book is timely and relevant. It fills a need for a profession-specific exploration of ethics. The authors create a unique ethical tool kit for the analysis of complex scenarios and include a range of test cases relevant to clinical practice in both radiation therapy and imaging. The content is up-to-date and consistent with the changing sensibilities of our profession, as well as being well-grounded in the rich history of Medical Ethics. An excellent resource for graduate students and residents in Medical Physics, the depth of exploration also makes the content appropriate to a broader audience, including more seasoned practitioners, researchers, educators, and policy makers in radiation protection, therapy and imaging."— K. Sunshine Osterman, Assistant Professor and Medical Physics Residency Director, Department of Radiation Oncology, NYU Langone Health"Ethics for Radiation Protection in Medicine is a relatively short volume providing a detailed overview of the current ethical principles and values associated with radiation protection in medicine…The text is accessible and conversational in style while providing a foundation and springboard for ongoing discussion. Several groups should find this publication educational and useful, including radiologists, radiation oncologists, medical physicists, referring medical practitioners, technologists, radiographers, radiation therapists, nurses, and others interacting directly with patients, as well as hospital ethics committees, committees on radiation, or institutional review boards. Other groups that would benefit from the discussion include students, academic researchers in the sciences, humanities, and social sciences… Many of the great thinkers of the past attempted to bring philosophy, theology, and the hard sciences into a shared conversation; this text applies such a cross-cultural approach to the important subject of ethics for radiation protection in medicine. The topic lends itself well to a scenario-based coverage for patients. The authors have succeeded in opening up an important dialogue, provided interesting and thought-provoking suggestions, while leaving room for further development and conversation."—Lawrence T. Dauer, Ph.D in Med. Phys. 47 (2), February 2020