Radiography (2008) 14, 90e97

ava i lab le at www.sc iencedi rect .com

journa l homepage: www.e l sev ie r.com/ locate/rad i

The ethical commitment of Australian radiographers:Does medical dominance create an influence?

Sarah Lewis a,*, Robert Heard b, John Robinson a,Karolyn White c, Ann Poulos a

a School of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, East Street,PO Box 170, Lidcombe, NSW 1825, Australiab School of Behavioural and Community Health Science, Faculty of Health Sciences, The University of Sydney,East Street, PO Box 170, Lidcombe, NSW 1825, Australiac Centre for Values and Ethics and the Law in Medicine, Faculty of Medicine, The University of Sydney,East Street, PO Box 170, Lidcombe, NSW 1825, Australia

Received 16 December 2005; accepted 2 January 2007Available online 8 May 2007

KEYWORDSRadiography;Ethics;Professionalism;Autonomy;Medical dominance

* Corresponding author. Tel.: þ61 0E-mail address: s.lewis@fhs.usyd.e

1078-8174/$ - see front matter Crowndoi:10.1016/j.radi.2007.01.004

Abstract There is a lack of awareness and openness surrounding ethical debate in DiagnosticRadiography literature and culture, perpetuated in part by the historical growth of the tech-nical realm of radiography, radiology and medicine. Hence, the impact of Australian radiogra-phers’ current level of professional autonomy, combined with the influence of medicaldominance and radiographers’ ethical commitment was undocumented. This study investi-gated the role, importance and attitudes of Australian radiographers towards ethics througha qualitative study following a grounded theory approach. Semi-structured interviews wereconducted with 25 Australian. A conceptual framework mapping the causal conditions affect-ing the ethical commitment was developed.

This study argues that a number of internal and external variables weave an intricate fabricof poor identity, subservience and negative workplace culture. Australian radiographers, whistattempting to set a standard of ethical commitment, are hindered by difficulties of medicaldominance, relatively poor professional autonomy and difficulty in accepting responsibility.The presence of private radiology enterprise and the association between patient referraland money has eroded the radiographer-patient relationship and introduced the potentialfor unethical practice in the radiographer-radiologist-referring practitioner relationship.Crown Copyright ª 2007 Published by Elsevier Ltd on behalf of The College of Radiographers.All rights reserved.

2 9351 9617; fax: þ61 02 9351 9146.du.au (S. Lewis).

Copyright ª 2007 Published by Elsevier Ltd on behalf of The College of Radiographers. All rights reserved.

The ethical commitment of Australian radiographers 91

Introduction

There is a lack of research-based evidence concerningradiographers’ attitudes, understanding and thoughts re-garding the relevance of ethics and ethical conduct.Additionally, it is not known how the origins of diagnosticradiography and the close occupational proximity ofradiology and medicine have affected the ethical commit-ment of radiographers. The development of radiographyhas been played out in a historical, political and pro-fessional context and has been largely controlled by thepresence of medicine. Such as been the focus on theownership of external technical rights that radiographyhas paid scant attention to more internal professionalactivities such as the development of an ethics culture,the importance of the radiographer-patient relationshipand commitment to the ideals of service essential forhealth professionals.

This article, through thematic analysis of interviewtranscripts with Australian radiographers, aims exploreethics simultaneously within the professional culture ofradiography and the close working relationship withmedicine.

Background: professional autonomy andmedical dominance

In the present day, the ability of an occupational group toself-govern, establish monopolies of service and legislatecompetence through state-recognized registration andlicensing boards is termed ‘‘professional autonomy’’.1 How-ever, as often seen in the health care services, professionalautonomy is not wholly determined by the profession inquestion, but rather by the bureaucratic organizations forwhich people work. This includes both public (state-run)and private work organizations. Power is intrinsically linkedto professional autonomy, and the possibility exists for theprofessional autonomy of an occupation to be blatantlycontrolled by an allied profession. The monopolistic aspectsof professional autonomy frequently result in conflict be-tween neighbouring occupations. The outcome within thehealth sphere has been the establishment of medical dom-inance and patriarchy.2

Professional autonomy issues in radiography cannot bediscussed without direct reference to the relationship ofmedicine upon the scope of radiographic practice. A crucialfeature of the division of labour in health care, andparticularly in radiography, is the dominance of the medicalprofession. Medicine dominates the health care systemthrough economic, political, sociological and intellectualchannels.2 In essence, medical dominance involves a controlof the workplace environment via restricted professionalautonomy within the division of labour and in turn exertsoccupational sovereignty over the allied healthoccupations.3,4

The historical evolution of the dominance of medicineover allied health fields can be attributed to the develop-ment of theories of professions. Medicine is largely ac-cepted as the paradigm profession, and the nature of itsinstitionalized practice has significantly influenced thecriteria or traits that currently stipulate a profession under

process theory.5 The effect of medical dominance has beenanalyzed by Freidson6,7 and discussed in relation to the con-flict theory of professions. Freidson argued that medicineoccupies a central position in health care due to a carefullycontrolled monopoly over its field of work, and thus is ina powerful position to control the growth of a division of la-bour in health care.

There are three methods of dominance exerted bymedicine over the health occupations, namely subordina-tion, limitation and exclusion.2 Subordination is the mainform of domination experienced by health occupationsand consists primarily of regulation of the content ofwork and imposition of the direct supervision of doctorsover the work performed by the subordinated occupations.Historically, nursing and radiography are excellent exam-ples of occupations affected by subordination.

The conflict of ownership and monopoly of provision ofX-ray services worldwide was evident in the early days.3,8

The earliest radiographers were drawn from a range ofassociated sciences and trades such as electricians,photographers and physicists. Many were also from theunskilled sector, previously being wards-persons or me-chanical operators.9e11 Medicine began to forge divisionswithin the technical process of radiography as early as1896, where the science of radiology was separatedfrom the mechanical labour associated with the produc-tion of radiographs, effectively separating medical practi-tioners from lay people12 and by 1903, the medicalposition was well documented with regards to layreporting.13

The process of the division of labour between radiogra-phers and radiologists intensified with formal policy dictat-ing radiographic reporting.14 Radiologists claimed to haveexpertise in interpreting results with the additional abilityto integrate these results into the clinical process.11 In Feb-ruary 1924, the council of the newly founded Society ofRadiographers (SoR) in the United Kingdom issued a resolu-tion directing; ‘‘That no non-medical member shall acceptpatients for radiography, radioscopic or therapeutic workexcept under the direction and supervision of a qualifiedmedical practitioner. Neither shall any such membermake any report or diagnosis on any radiographic or screenexamination’’.15 This decree was adopted in Australia andshaped documents relating to the division of radiologyand radiology services in Australia by the Australian Insti-tute of Radiography (AIR), the Royal Australian and NewZealand College of Radiologists (RANZCR) and variousgovernments.

Today radiographic practice in Australia is still con-trolled on two distinct government levels. Medicine hasexercised supervisory power over the nature and technicalexpansion of radiography in Australia. For a Medicareradiology rebate to be issued radiographers are requiredto be supervised by radiologists whilst undertaking ultra-sound, computerized tomography and mammography.16

Current NSW licensing for radiographers also stipulatesthat radiographers undertaking CT must do so only underthe ‘‘general supervision’’ of a radiologist (EPA e I14 li-cense e CT only, p13).17 The second fundamental subordi-nating tactic is the provision of the products ofradiography. As radiologists are the designated ‘reporters’of these images and are the sole benefactor of Medicare

92 S. Lewis et al.

rebate for this service, medicine effectively controls the di-rection of its labour.18

Background: the Australian Institute ofRadiography and Ethics

Much of the development of the occupation of radiographyin Australia is intrinsically linked to the education systemand the emergence of the sole professional body ofradiography, the Australian Institute of Radiography (AIR).Political intervention and jurisdiction were less influentialin shaping the course of radiography development, mostprobably because Australian states implemented individualhealth policies, and hence little national cohesion inradiography policy has occurred.

Today the AIR has assumed the role of educationassessor, via the Professional Accreditation Education Board(PAEB), and is the gatekeeper to clinical practice inradiography. The commonwealth government of Australia(Department of Education, Science and Training) statesthat professional and educational recognition for Australianradiographers is obtained by ‘‘a bachelor degree in applied(medical radiation) which includes clinical practice inaccredited centers plus a professional development yearof clinical practice following graduation before accredita-tion by the Australian Institute of Radiography’’.16 In addi-tion to this, the AIR, through the Overseas QualificationAdvisory Panel (OQAP), monitors and assesses all applica-tions for membership and hence issues a Statement of Ac-creditation to overseas trained radiographers. It should benoted that although a Statement of Accreditation is manda-tory for radiographers employed in Australia, membershipto the AIR is not and many radiographers exercise the rightnot to join.

The ethical practice of radiographers in Australia isgoverned by the two documents produced by the AIR: the‘‘Guidelines for Professional Conduct for Radiographers’’19

and the ‘‘Code of Ethics’’20 by the AIR. The AIR code ofethics covers radiographers and radiation therapists how-ever each discipline has separate guidelines for profes-sional conduct effective from April 2003. The twodocuments are intended to be complimentary in providinga directive on ethical behaviour and goals (AIR e personalcommunication, 2003).

The value statements within the AIR code of ethicsrelate to respecting ‘‘individuals’’ needs, values, cultureand vulnerability’’, ‘‘accepting the rights of individuals tomake informed choices.and uphold the provision ofquality services for all people’’, confidentiality and sharingof information, and ‘‘accountability and responsibility’’ ofthe professional role. These value statements are aspira-tional and are reflective of the altruistic nature of ‘values’,rather than directive in scope.

The AIR guidelines have two main subsections: The Prin-ciples of Conduct and Guidance notes. The AIR guidelinesdo not empower the Australian radiographer with benefi-cence options, stating only ‘‘practitioners should not carryout a procedure which may be considered dangerous with-out first confirming instructions for the procedure with theperson authorized who has made the request and satisfyingthat the instructions contain no error (p. 3)’’.19

Background: ethics in health care andradiography

For the purpose of this study, ethics was defined as ‘‘ananalytical and methodological inquiry of how moral judge-ment is and should be made’’ (p. 8).21 Ethics includes theconduct publicly displayed by the radiography professionand its applications of the principles of ethics that affirmsthe individual as an independent, autonomous and respon-sible decision maker. Inter-occupational regulations of be-haviour and collective self-discipline are also features ofethics and ethical practice. However, the most importantconsideration to be made when contemplating ethics isthat ethics is a matter of practical concern and involvesconsideration of the nature and quality of daily interactionswith other people.22

In the ever evolving health care environment, radiogra-phers must be fluent in the application of basic ethicalconcepts, ethical schools of thought and have an appreci-ation of the role of ethical practice in a clinical setting.23 Ina similar way, ethics also interacts with medical law to pro-vide safe and equitable delivery of health care. Radiogra-phers are bound by these regulations when examining andcaring for their patients.24 Thus it is vital for radiographersto elucidate a commitment to ethical practice that the pro-fession of radiography stands for, not withstanding the im-portance of a high standard of personal morality.

Radiographers are part of a health network that involvespatients. Patients, by virtue of the importance placed upongood health as a social and individual value, enter intorelationships with health carers who are bound by specificmoral obligations unique to those involved in patient-practitioner relationships.25 Radiographers engage in dailypatient/radiographer relationships that exhibit many ele-ments of human interaction, socialization and professionalbehaviour. Radiographers, like other health care em-ployees, are faced with contextual ethical quandaries.

Methodology

The methodology and results displayed in this article arepart of a larger study conducted of Australian and UnitedKingdom radiographers for the requirements of a Doctor ofPhilosophy. Therefore not all of the data collection processis to be discussed in this article. Initially a pilot study viaa survey was conducted with 8 clinical and academicradiographers. The survey was developed with the inten-tion of using the results to conduct a further qualitativeinquiry into Australian radiographers’ attitudes towardsethics. A number of key areas for investigation werederived and these were used in the construction of theinterview questions.26

An interview strategy was conceived to overcome thedifficulties with the investigation of ethical issues byradiographers using a survey alone. Interviews have beenwidely used as an effective data collection method whenstudying ethics in the health sciences27e29 and are becom-ing increasingly used in qualitative and quantitative re-search in radiography11,30e33

The interview was designed in a semi-structured formatwith the interviewer seeking to engage the participants in

Interviews (Case Studies)

of individual participants

Case by case analysis(thematic analysis)

Cross-case contentanalysis(constant comparative

analysis)

Conceptual Framework

Figure 1 Thematic analysis of interview data.

The ethical commitment of Australian radiographers 93

conversation regarding ethical practice, whilst generallyfollowing a set of questions, statements and words. Theprimary author was considered most suitable for the role ofinterviewer as it was suggested that as well as having someexperience at interviewing radiographers, the intervieweralso needed to be a clinical radiographer. This ensured thatthe interviewer was capable of extending and challengingthe participants when a valuable comment arose, inkeeping with the philosophy of theoretical sensitivity.34

The interview was structured in two halves. The first halfof the interview combined brainstorming and generaldiscussion about key words/concepts dealing with ethics.

The second half of the interview was designed to bemore structured in approach. Participants were informedthat they would be asked six questions. The six questionsincluded the concepts of personal and workplace commit-ment to ethics, the value of ethics, the frequency of ethicalsituations, the relationship between morale and profes-sional standing and the impact of medical dominance (bothmedicine and radiology) upon radiographers.

The duration of the interviews was approximately 1 h,with each interview audio-taped recorded and transcribedby an independent medical typist. Five participants werepurposively sampled, with the remaining 20 being the resultof snowball or chain sampling through professional contactswith the original five participants. Both the interviewschedule and method of sampling was approved by the Uni-versity of Sydney Human Ethics Research Committee.

The categorization of themes was performed usinga stratified approach where initially case by case analysiswas undertaken followed by cross-case analysis, also knownas constant comparative analysis.35 The preliminary stagesof categorization included coding of the raw data; that is,the Australian transcribed interviews and notes made inthe reflective journal recording the interviewers’ thoughts,perceptions and observations of participants and the inter-view process (Step 1). The resultant concepts were thencollated and supported with evidence of transcriptionquotes (Step 2). After describing the concepts, a patternof more dominant yet abstract themes emerged from crosscase analysis and these are known as key concepts (Step 3).The key concepts were then examined for cross case anal-ysis and the emergence of themes allowed the responses tobe integrated into a conceptual framework (Step 4).

From this system of open coding, properties or charac-teristics emerged about themes relating to radiography,radiographers, ethics and medical dominance. Fig. 1 illus-trates the process of content analysis stratification.

Table 1 Key concepts and concepts

Key concepts Concepts

Subordination Radiographer-radiologist relationshipMedical dominance

Workplace culture Workplace commitment to ethicsPrivate practice enterpriseRole expansion

Responsibility Poor identity

Results

Seven concepts and four key concepts were derived fromthe data. The key concepts are abstract in nature andrepresent a holistic approach to the problems and condi-tions that affect Australian radiographers’ ethical commit-ment in the workplace. The key concepts transcend fromthe macro community level (‘subordination’) through to themicro interactive level where radiographers have thepotential to influence patients’ experiences in accordancewith their own personal morality. For Australian radiogra-phers, the most powerful influences affecting ethics are

largely negative in nature and include ‘subordination’,‘workplace culture’ and ‘responsibility/duty’. The conceptsare more tangible in nature and represent the dynamics andlogistics of working in a radiology department. The Keyconcepts and concepts can be viewed in Table 1.

Key concept: subordination

Medical dominance and the effects of ‘subordination’represent a key concept in understanding the attitudesand experiences of ethics in clinical radiographers. Radiog-raphers constantly referred to the effects of subordinationupon ethical behaviour, morale, professional identity andprofessional autonomy. Medical dominance dictates theworkplace hierarchy, where poor professional autonomyhas seen radiographers capitulate to the demands anddecrees of radiologists. One radiographer (A26) believed,

94 S. Lewis et al.

There is a paternalism and a dominance that radiolo-gists have over radiographers in the workplace that isin some cases probably bordering on being an unethicalrelationship

A common theme across concepts is that radiographersreported feeling inferior (‘‘just the radiographer’’ syn-drome), not only to radiologists but also to medicalpractitioners in general. In turn, this subservience hasaffected radiographers’ ability to enter into ethical debatewhen necessary (‘‘I just felt that ethically, that was a verywrong comment. I didn’t actually do anything about it atthe time’’ (A17)), to uphold ethical conduct in the face of‘‘professional abuse’’ (A16) and to have a positive influenceon patient outcome. Subordination has created a moraleand identity crisis and radiographers openly spoke aboutthe perception of their place in the radiology hierarchy,

Radiographers, for lack of a better word, going backmany years were the lowest of anything really (A11)

It harks back to the early days.they [radiographers]were put down the bottom of the heap, treated thatway and you see it hand over to this day in the older ra-diographers (A21)

Radiographers expressed feelings of intimidation, underappreciation and worthlessness when they identified thatan unethical situation had arisen. The authority that wascommanded by radiologists was perceived to be detrimen-tal to patient care and ethical standards. A number ofradiographers reported a conflict of personal morals,particularly when confronted with a worrying situation,

You will buckle from your ethical beliefs e you willbuckle to someone in a higher authority (A03)

Certainly the ethical behaviour of the radiographer isaffected by the relationship with the referring doctor(A17)

Key concept: workplace culture

The ‘workplace culture’ represents a key concept encom-passing the negativity of the workplaces towards ethics,professionalism, the resignation to subordination and theculture of litigation. At times, radiographers as a whole hasillustrated a reliance on others, particularly medicine, fordecision-making (A14, A26). Some responses to reflect thisattitude include,

As a radiographer, I am critically aware of the in-housefighting (A03)

We are guilty of the lowest common denominator effect(A02)

Radiographer A10 summed up the perpetuation of theinappropriate culture, noting that radiographers are often‘‘our own worst enemy because how we behave’’ (A10).

The radiography workplace has been shown to exhibita lax and negative attitude to embracing ethics education.

Radiographers spoke of the ingrained workplace culturethat perpetuates a lack of understanding about ethics anddiscourages ethical decision-making. Akin to this concept isthe poor perception of the ethical conduct of workcolleagues, where some radiographers placed the bar at50% of the workforce and stated,

‘‘the rest of them are into getting in, getting out andgetting home and the near enough is good enough syn-drome’’ (A08)

In investigating the lived experiences of radiographers,the contextual conditions of their employment serve asindicators of the conditions and complexities within anethical framework. In the data, radiographers nominateda number of workplace responsibilities and expectationsthat potentially impacted upon their ethical commitmentto the patient. The most dominant theme of ‘workplaceculture’ was constructed around the pressures of working ina private practice environment, where the roles andresponsibilities of the radiographer were measured in pro-ductivity, financial gain, ‘‘bums on seats’’ and ‘‘the al-mighty dollar’’ (A16). Radiographers described privateworkplaces as ‘‘pressure cookers’’ (A02) and identified se-nior management and radiologists as the perpetrators ofthis culture,

Even though our mission statement says that patients’well being is our highest priority, it doesn’t seem tobe the case. That seems to be, while the slogan is tossedaround quite a lot, it seems to only be true in words,and on coffee cups rather than actually in practice (A16)

Medical dominance overlaps into ‘workplace culture’ asit subordinates the autonomous intentions of the profes-sion. In reference to private radiology centres, their goalwas predominantly defined as getting ‘‘the patient and themoney through the door’’ (A01). Radiographers spoke ofthe foundations of the patient-radiographer relationshipbeing eroded by situations where quality time spent withthe patient was superseded by the demands to workquickly,

Yes, you take short cuts because you’re under pressurelike that and short cuts and be unethical. They can de-crease the quality of care (A26)

Key concept: responsibility

Radiographers defined ‘responsibility’ in terms of causalconditions upon their behaviour and autonomy. There isa degree of rebellion, for some radiographers believesubordination bred contempt for responsibility,

.They see themselves in such a lesser position, thatwhy take responsibility. Why should I put myself out,why should I leave myself open when all these peoplewalking around tell me that I am only the dogsbody any-way (A02)

Conversely, some radiographers perceived ‘responsibil-ity’ to be an obligation, a duty to care and act in the bestinterests of the patient (‘‘as radiographers we’ve got theduty of care to patients’’ A20). To combat the effects of

The ethical commitment of Australian radiographers 95

subordination and negativity, radiographers responded withideals of advocacy, altruism and credibility, recognizingthat these can only serve to enhance their professionalideals and ethic.

The key concept of ‘responsibility’, largely defined thenature of the patient-radiographer relationship. Despitethe negative variables that potentially influence radiogra-phers’ ethical commitment, responsibility can be enactedat an individual level and personality plays an importantrole,

Radiographers are accepting more and more responsibil-ity as they go.if you become more responsible andyou’re given a bit more credibility for what you do, Ithink your ethics will automatically increase with that(A14)

A conceptual framework was developed in order tographically display the relationships between the keyconcepts and selected concepts. Fig. 2 illustrates the con-ceptual framework for the impact of medical dominanceupon Australian radiographers’ commitment to ethics. Theframework displays the key concepts through the radio-graphic community, radiographers’ workplace and personalinteractive layers. The radiographic community level repre-sents the more abstract key concept of ‘subordination’ aswell as the overarching theme of medical dominance andis designed to reflect the whole radiography profession inAustralia and its generalized culture and occupationalmovements.

The workplace level within the conceptual frameworkrepresents more tangible entities that define radiographerssuch as ‘private practice pressures’, localized ‘lack ofautonomy’ and the ‘workplace culture’. These key con-cepts and concepts were the most frequently discussed asthey shape the logistics and dynamics of their workplaceand are in many ways unique to the Australian radiographyhealth care system. Within this layer is the potential forspecific changes in radiographers practice in terms of roleprofessional autonomy, morale and the ability to builda more positive workplace culture.

The bottom level is termed the personal interactivelayer. It is in this layer that the key concept of ‘re-sponsibility’ lies. Throughout the interviews radiographersrecognized the role individuals might play in determiningtheir attitudes towards obligation, responsibility andethics. Responsibility, whilst affected by medical

Private enterprisepressures Poor identity

Medical Dominance

Responsibility

Figure 2 Conceptual framework of medical dominance

dominance at the community level, can be embraced orrejected by the radiographer.

Discussion

It is clear from the transcripts and the resultant conceptualframework that a number of influences affect the ethicalcommitment of radiographers, including a negative work-place culture towards understanding ethics and the master-servant relationship between radiographers and radiolo-gists/referring clinicians.

The Australian radiography workplace has adopteda relatively negative attitude towards understanding ethics(‘‘the belief you don’t need to understand those things isrife in the system’’ A26) and this can be attributed to thegeneral disregard for the value of work performed by ra-diographers. Australian radiographers’ talk of being ‘‘over-looked’’ (A21) when a radiologist is available and theyrelated feelings of being underappreciated and underval-ued. Therefore there is a correlation between the commit-ment to ethics, the value attached to radiographers ingeneral and the professional status of Australianradiographers.

Australian radiographers experienced feelings of sub-ordination and this was coined the ‘‘just the radiographer’’syndrome. For Australian radiographers, this crisis of inferi-ority influenced morale, perpetuated their lack of profes-sional autonomy and at times appeared inescapable. Asdemonstrated through the pilot study and the interviewtranscripts, Australian radiographers identified a numberof potentially unethical situations involving conflict be-tween themselves and other occupational groups. In theseinstances, it is inferred that, although the radiographersrecognised a professional indiscretion, they were relativelypowerless to prevent the outcome.

Australian radiographers also believed that role devel-opment, such as image reporting, would enhance theirprofessional status. Radiographers participating in thestudy perceived that the ability to formally interpretradiographs would improve morale and serve to formallyrecognise their medical imaging expertise. This finding iscongruent with current Australian radiography literature,AIR policy and sentiment regarding role development.36e40

The lack of professional autonomy was directly relatedto Australian radiographers’ unwillingness to accept

Workplace Culture

Subordination

Community

Workplace

Personal Level

and Australian radiographers commitment to ethics.

96 S. Lewis et al.

greater responsibility for the elements of the patient-radiographer relationship, such as duty of care andconsent. Additionally, some radiographers noted thatthis caused radiographers in general ‘‘to tend to relyon other people around them to make decisions forthem. An example of that would be with radiologists’’(A26). The attitude of Australian radiographers towardsaddressing this mixture of subservience and reliancewas polarised. Whilst some radiographers chose to focuson ensuring they meet a standard of care, including tak-ing an active interest in departmental decisions, otherswere resignatory and stubborn with regards to challengingprofessional boundaries.

Evidence from both the interviews and literature reviewprovide insight into the role the professional bodies play inshaping the professionalism of radiography. The AIR hasa strong responsibility for the professional identity ofradiographers, however Australian radiographers spoke ofbeing unsure and unclear of their identity. Medical do-minance, together with a lack of strong association toa professional community or organization, have impactednegatively upon the identity of Australian radiographers.They talk of being in the ‘‘never-never land’’ (A02), a collo-quial Australian term meaning ‘‘in the wilderness’’.

The transcripts support the suggestions radiographers’attitudes towards ethics and the scope for applied ethicsin clinical radiography is influenced by codes of ethics/conducts issued by the professional bodies. The AIR code ofethics19 and guidelines for professional conduct20 do notaddress concerns of beneficence in radiographic examina-tions. Again, evidence from the transcripts supports the in-ference that this has perpetuated a culture of subservienceto authorized referrers. Australian radiographers repeat-edly made reference to unethical situations relating tothe justification of radiographic examinations and feelinguncertain of their legal and moral responsibilities (‘‘they[radiographers] don’t have a leg to stand on. He’s the doc-tor, you’re the radiographer. It is not the way we’d like itto be but legally that’s the way it is’’, A14).

Conclusion

The Australian radiography community illustrates a mostlynegative attitude toward ethics, compounded by theeffects of wide spread medical dominance and professionalidentity problems. Ethical commitment by Australian ra-diographers is stifled by paternalism, subordination and anunequal working relationship between radiographers andmedical practitioners (and especially radiologists) thatdiscourage radiographers from acting autonomously. Thepatient-radiographer relationship is devalued by constantbelittling of radiographers’ authority and in turn, a lack ofwillingness to accept responsibility. The transcripts illus-trate a communication problem between radiographers,medical practitioners and radiologists.

Acknowledgements

The authors wish to thank the Faculty of Health Sciences,The University of Sydney for funding this article.

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