Ethics in Radiation therapy in Nigeria

2. WHAT IS LAW?
As Radiation Therapists, it is important to know what law is, its basic concept,
nature and characteristics.
Law does not have a universally acceptable definition. Different legal
scholars have different views of what law means.
Some posit that:
 Law is a rule of action.
 It state what people ought to do.
 A body of rules which regulates human conducts.

3. Characteristics Of Nigerian Law
• Duality:
English law and Customary/Islamic law being practiced side by side
• System of Precedent ( Stare Decisis)

4. The Sources Of Nigerian Law
1. English Law
2. Customary/ Islamic Law
3. Nigerian Legislation
4. Case Law/ Judicial Precedent

5. Types Of Nigerian Legislation
1. Acts
2. Decrees
3. Edicts
4. Bye – Laws
5. Regulation

6. The Hierarchy Of Courts In Nigeria
1. Supreme Court (The Apex Court).
2. Court of Appeal.
3. Federal High Court and other Courts of Coordinate Jurisdiction.

7. Fundamental Rights
It is also pertinent to know the fundamental rights an individual enjoys in Nigeria regardless of status
or capacity.
The rights that are important to a Radiation Therapist can be found as enshrine in Chapter 4 of the
1999 constitution as amended.
They include:
Section 33 – Right to life
Section 34 – Right to dignity of human person
Section 35 – Right to personal liberty
Section 36 – Right to fair hearing
Section 37 – Right to private and family life
Section 38 – Right to freedom of thought, conscience and religion
Section 42 – Right to freedom from discrimination

8. Ethical Theories and Principles
We have three major ethical theories in the medical profession which are broadly
stated as:
1. Utilitarianism
2. Moral Relativism
3. Kantian Absolutism
While the main ethical principles which are also patient’s focused can be broadly
categorized into four:
1. Beneficence
2. Non Maleficence
3. Autonomy
4. Justice

9. Ethical Theories and Principles
It is important to know that there are general rules to all matters and issues but in medical
practice/radiation therapy, general rules are not always sufficient hence the need for sub specialty
professions in medical practice to have a code of conduct for her practitioners; this code will further
streamline the required minimum standard expected of a radiation therapist.
What is Utilitarianism?
It is the practitioners attitude towards the patients’ treatment and management. It could be the right or
wrong attitude.
It is important to know that the primary reason(s) a radiation therapist is in existence or in the hospital
is for the successful treatment of the patient, hence, there is the need for the practitioner to develop
the right attitude towards the patient’s wellbeing (attitude that will produce the greatest good for all).

10. Ethical Theories and Principles
What is Moral Relativism?
This is mainly respecting patient’s rights to their cultural and religious beliefs as provided for
in Section 38 of the 1999 constitution as amended.
Hence, the need for a Radiation Therapist to maintain a good moral standard in the department and
when treating their patients.
Kantian Absolutism
This theory should be seen as the most important because it simply tells us to do the right
things always no matter what the outcome will be. This theory was propounded by the great
philosopher Immanuel Kant.

11. Ethical Theories and Principles
 What is Beneficence?
Just like all the theories stated, the primary focus of a therapist is the wellbeing of the patients
which means they must do everything possible to promote the patients wellbeing. This will include:
Caring for the patients, removing anything that can cause harm to the patient, and helping patients
with disabilities. Mainly showing kindness to the patient. This is the duty of care to the patients.
 Non Maleficence
It is important to provide standard of care to prevent risk or harm to the patient. Hence, the
need for competence and qualified professionals in the field to avoid negligent attitudes towards the
treatment of the patient.

12. Ethical Theories and Principles
 Autonomy
is the right of a patient to access the type of care he/she wants, how he/she wants it.
He/she simply makes his/her own decisions.
we must note that there is limitation to patient’s autonomy: in a case that one patient’s
autonomous action will cause harm to another patient or person.
JUSTICE
The radiation therapist must act fairly and treat patients equally not minding status or
capacity. For justice to take its place, there must not be preferential treatment.

13. Provider/Patient Relationship
As it was earlier stated, the main reason the radiation therapist is in business is because of the
patients.
The relationship between this two must be fiducial in nature.
The provider must show sense of responsibility and dedication. Under the common law, the provider
is under a duty to respect the confidence of his patient.
In some jurisdiction, the obligation is supplemented by legislation. The scope of their relationship
also covers information received directly or indirectly.
The provider must not take advantage of the patient’s condition to exploit or act in a manner
that is unbecoming of a trained radiation therapist.
The provider must also adhere strictly to department regulations and protocols.

14. Confidentiality and Health Care Informatio
The common law puts a health care provider under a duty to respect the confidence of his patient.
The legal underpinning is located in the fact that health care provider - patient relationship is
essentially characterized as fiduciary in nature.
A good case is: Attorney General V Guardian Newspaper Ltd (1990).
It also extends to information received from third party in circumstances where the third party gives
the information, knowing of the existence of the therapist - patient’s relationship.

15. Hence, the duty of confidentiality applies to all. That is the therapist must come under an obligation of confidence. The
patient trust that information about his person will be kept secret unless he permits disclosure.
TO SUCCEED IN AN ACTION FOR BREACH OF CONFIDENCE, THE PATIENT MUST SHOW:
1. That the information in the circumstance given or received was meant to be treated as confidential
2. That the obligation to keep the information confidential was breached by the therapist.
See Hunter V Mann
3. The remedy for the breach is by way of civil action for damages. While breach of confidence is criminalized in some
jurisdictions.

16. EXCEPTIONS TO THE RULES
That confidentiality is not breached in the following situations:
 Private discussions with colleagues in pursuance of treatment but this may require the
consent of the patient.
Also not breached in a common filing system if asked to present the information before a
court or tribunal ( If the information is required by law).
 Public Interest: If he acts to prevent other patients from injury.

17. Damages for Breach of Confidence
See case Furniss V Fitchett
A New Zealand case that illustrate the remedy for a breach of confidence.
The defendant doctor at the request of the plaintiff’s husband wrote a letter to the husband stating
that his wife exhibited symptoms of paranoia and he suggested an examination by a psychiatrist.
The husband later used the letter in separation proceedings against the plaintiff. That was the first
time she knew of the existence of the letter, she sued the defendant doctor for breach of
confidence Barrow Clough CJ of the New Zealand high court held the defendant doctor liable for
breach not withstanding the truth of the document.
He said I am of the opinion that on the principle of Donoghue V Stevenson (1932) there arose a
duty of care on his part. It caused both physical harm and distress.

18. Special Categories
 THE DEAD
Breach should end on the death of the patient but his survivors can still sue if disclosure
will lead to damage to his estate.
 INCOMPETENT ADULT
Breach can only be excused based on the best interest of the incompetent person
weighed against other relevant factors
 CHILDREN
Use the status and capacity approach
Gillick rule is used in capacity approach
 BY COURT SUMMONS/INJUNCTION

19. Clinical Ethics throughout the
Life Span
This is mainly to maintain competence in patient care by:
1. Acquiring necessary training with certification
2. Being cleared by the appropriate authorities to carry out the procedures i.e License to
practice
3. Having respect for the patients and their health conditions. This can be seen in the ethical
principles stated earlier.

20. Ethical Issues in Health Care
1. Malpractice and Negligence
2. Patients confidentiality/informed consent
3. Transmission of diseases during patient’s stay in the health facility/department and to prevent
harm
4. Keeping amorous relationship with patient in your care. Don’t abuse the fiduciary relationship
with the patient
5. Helping patient to commit suicide (Euthanasia)
Radiation therapist must make good judgments on how best to manage a patient in their care in
order not to run foul of the law governing the practice.

21. Malpractice and Illegal Implications
This operate on two basic principles:
1. Patient consent to treatment
2. Treatment undertaken without proper care and skill
If a patient does not consent to treatment, it will be actionable assault and or battery.
Also, if a radiation therapist fails to exercise proper care and skills in the treatment of the
patient, the therapist will be liable to compensate the patient for any harm resulting: by an action in
negligence.
Negligence remain the most common basis for liability in radiation therapy malpractice
whether the claim lies in contract or delict (violation of the law).
Breach of contract could mean failure to carry out the exact treatment already agreed upon.

22. From the above, one can safely say: that the malpractice is the failure to exercise a reasonable degree of
skill and care. That a reasonable man should exercise in a given circumstance.
A therapist that is negligent exposes himself to disciplinary action from the body controlling the
profession (The RRBN) and the law court.
The actions that are obtainable are for:
1. Civil Negligence
2. Criminal Negligence
It will be civil if it does not involve death. But if it involves death of the patient, he may be charged
for murder ( Culpable Homicide punishable by death) or manslaughter.
The Nigerian courts have held that the degree of negligence required to convict for manslaughter
or murder must be higher than that required for civil actionable negligence. See the case: R V Bateman.

23. That the degree of negligence required in criminal cases must go beyond that for civil liability. E.g:
1. Showing disregard for life and safety of others which could be said to be the highest degree of
negligence
2. Intermediate degree for rash and negligent acts which may not result in death but serious bodily harm
3. The lowest degree required in civil liability which may lead to payment of damages
The legal basis for radiation therapists civil liability is founded on the ground that the public entrust itself to
their care and so are entitled to demand and expect a reasonable degree of skills and care. Hence, the
question whether a radiation therapist is negligent will therefore depend on the facts of each case using the
legal principle of res ipsa loquitur.
Whatever the facts, the following requirements must be established:

24. 1. The therapist hold the duty of care to the patient
2. That the duty was breached
3. That it resulted in harm or death
Also, to prove the therapist liability, the patient must prove harm suffered through a wrongful or
negligent act of the therapist by showing that:
1. The therapist conduct caused the harm
2. The therapist should have taken reasonable steps to guard against the injury
3. The therapist failed to take the reasonable steps expected

25. Biomedical Ethics and Health Policy
This can be evaluated from the Helsinki Declaration of 1964. it states that all clinical research
involving human objects must conform to normal and general scientific principles.
Flowing from this, all care providers who may be involved in research must give
consideration to risk – benefit factors. They are also enjoined to be weary in performing research
where the personality or the subject is liable to be altered by the experimental procedures.

26. WHAT IS THE ROLE OF THE RADIATION THERAPIST
IN HEALTH CARE ISSUES?
Their primary role is to administer radiation treatments to patients with cancer. This is
done in conjunction with other specialists. E.g the oncologist, radiation physist, radiotherapy
nurse. Each of these specialists have their specific roles in the department which must be
carefully and succinctly stated to avoid clashes and legal liabilities. Hence, the radiation
therapists operates the machine and apply radiation dose to the patient as prescribed by the
oncologist.
The purpose of work description is in the institution of possible litigation.

27. The Rationale For Medical Ethics
Many feats have been achieved in the area of medical science and many are still
evolving, thereby throwing up many ethical questions. Every informed person is aware of the
amazing accomplishments and dramatic increase in both improved ways of treating illness
and injuries and possible dangers also encountered by the patient in the course of it.
All of these developments in medical science are bound to have corresponding legal
implications.
Hence, the need for the radiation therapist to act within the scope of his/her
competence and good morality to avoid litigation.

28. In Conclusion
Litigation is gradually emerging in Nigeria Medical Practice. With literacy improving, it
is expected that the rate is bound to increase and there would be a need for guidance on the
best procedure to be employed.
There is dearth of cases in radiation therapy in Nigeria. It will be instructive to the
radiation therapist not to be used as the locus classicus case.

29. Thank you for the audience