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Ethics in Interventional Radiology: A Case-Based Primer

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Abstract

As the field of interventional radiology assumes a larger role in patient care, the specialty has a growing responsibility to recognize and understand ethical dilemmas within the field. We present a case-based primer on common ethical issues in IR, including requests for potentially inappropriate procedures, surrogate decision making, informed consent, and managing conflicts of interest and procedural complications. This primer is intended to be used as a guide for discussion-based training in ethics in IR while inspiring further research in applied ethics in IR.

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Notes

  1. Reprinted by permission from Springer Nature: Springer Nature CardioVascular and Interventional Radiology “Perceptions of Futility in Interventional Radiology: A Multipractice Systematic Qualitative Analysis,” Keller, E.J., Rabei, R., Heller, M., et al., Copyright 2020.

  2. The Society of Critical Care Medicine (SCCM) Ethics Committee established a framework for approaching potentially inappropriate interventions in the critical care setting. The committee recommends the following approach to manage such cases, which may provide some helpful guidance: (1) enlisting expert consultation to continue negotiation during the dispute-resolution process; (2) giving notice of the process to surrogates; (3) obtaining a second medical opinion; (4) obtaining review by an interdisciplinary hospital committee; (5) offering surrogates the opportunity to transfer the patient to an alternate institution; (6) informing surrogates of the opportunity to pursue extramural appeal; and (7) implementing the decision of the resolution process [9].

  3. e.g., a physician may exercise therapeutic non-disclosure to protect the patient from the emotional harms that may result from learning certain information about his medical indication and/or treatment if such harms are a salient threat.

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Acknowledgements

This work was supported by the Society of Interventional Radiology’s Applied Ethics Committee, the Society of Interventional Oncology’s Applied Ethics Task Force, and the Interventional Initiative.

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Authors and Affiliations

  1. Albany Medical College, 75 New Scotland Avenue, Albany, NY, 12208, USA

    Sara Silberstein

  2. Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA

    Michelle M. Shnayder-Adams

  3. Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

    Eric J. Keller

  4. Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Mina S. Makary

Authors
  1. Sara Silberstein
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  2. Michelle M. Shnayder-Adams
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  3. Eric J. Keller
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  4. Mina S. Makary
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Correspondence to Sara Silberstein.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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No IRB approval was needed for the creation of this work. All cases presented are fictionalized.

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Silberstein, S., Shnayder-Adams, M.M., Keller, E.J. et al. Ethics in Interventional Radiology: A Case-Based Primer. Cardiovasc Intervent Radiol 44, 1510–1517 (2021). https://doi.org/10.1007/s00270-021-02894-2

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  • DOI: https://doi.org/10.1007/s00270-021-02894-2

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