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Case 3

A 65 year old man with cancer of the bladder was treated by external beam radiation. The total dose was 60Gy in 30 daily fractions. An empty bladder is the routine for ca. bladder cases.

On the day of the 1st treatment for this patient, many new cases started coincidently. Therefore, the radiographers were too busy to fully explain to each patient what they should notice and take more care of. Rather, they just handed out brochures about precautions to take and descriptions of side effects to patients. The patient with cancer of the bladder could not remember the information provided and he forgot to empty his bladder before treatment.

For the 1st treatment, the radiographers did not ask for his bladder status, even though the treatment record remarked about the need to empty the bladder and treatment was carried out without any problem in beam alignment. Therefore, staff did not notice any problem. After 5 fractions, the patient asked why other patients tended to visit the toilet before their treatment. The staff then reminded him that he should do this also, as told in the brochures. The patient asked about the consequences if he did not do this, but the staff did not give him a direct answer and just told him not to worry about it.

Discuss the ethical issues relating to this case.