Abstract
Publication 138 (ICRP, 2018a) was the first ICRP publication dedicated to describing the ethical foundation of the System of Radiological Protection. It identified several core ethical values and procedural values already built into the System, but which had not been examined in depth previously. Importantly, it also established a common language to enhance understanding, discussion, and refinement of the role of ethics in radiological protection.
However, as mentioned in the Editorial to Publication 138 (ICRP, 2018b), ‘while this publication is a major step forward in describing one of the three pillars of the System of Radiological Protection (scientific knowledge, ethical values, and practical experience), it is much more a beginning than an end’.
The present publication builds on this largely conceptual foundation to present how it may be applied in the practical application of radiological protection in medicine. This is a good starting point, especially given the maturity of ethics in medical practice, and the strong connection between biomedical ethics and the ethical values identified in Publication 138 (ICRP, 2018b). The practical examples provided may even help in appreciating the ethical values in other settings. Nonetheless, it is likely that ICRP will develop additional publications on practical ethics in other sectors of radiological protection.
The structure of the present publication is also practical, beginning with an introduction in Section 1, followed by an overview of ethics in radiological protection, outlining practicalities of biomedical ethics, and describing the link between effects of exposure to ionising radiation and ethics in medicine in Sections 2–4. Section 5 is a bridge from the first sections to the case-based examples, describing a method used to evaluate ethical values in various case-based examples. The 21 case-based examples, 11 in Section 6 on imaging and 10 in Section 7 on therapy, form a large part of the present publication, representing approximately one-third of the main text. They draw on actual clinical practice, but do not necessarily reflect actual events. They are designed to present a wide range of plausible situations that help demonstrate varying degrees of compliance with ethical values. Section 8 concludes the publication by addressing education and training in medical ethics. Also practical are the 30 key messages identified throughout the publication and gathered in Annex A for ease of reference. They might serve as triggers to recall the lessons behind them.
Answering questions of ethics (what should we do?) can be as challenging as answering questions in science (what do we know?) – sometimes even more so. Nonetheless, both are essential to good practice of radiological protection in all domains, as the application of ‘common sense’ and practicality through experience.
Ethical dilemmas generally arise when there are different cultural values, misunderstandings, or competing interests such as advantages and disadvantages affecting different individuals. Just as difficult is the balancing of ethical values (or principles); for instance, the core ethical values of beneficence and non-maleficence, prudence, justice, and dignity. At a conceptual level, all are essential, none are absolute, and there is no a-priori ranking among them. However, when faced with a practical problem, it is often necessary to decide which are most important, and the weight that should be given to each. We hope this publication, especially through its practical case-based examples, will guide both radiological professionals and medical practitioners in navigating challenging ethical decisions.