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Patient Misconceptions and Ethical Challenges in Radioactive Iodine Scanning and Therapy^*

Program for Bioethics and Patients' Rights, University of Kentucky College of Medicine, Lexington, Kentucky

Correspondence: For correspondence or reprints contact: M. Sara Rosenthal, PhD, Program for Bioethics and Patients' Rights, University of Kentucky College of Medicine, 131 College of Medicine Office Bldg., Lexington, KY 40536-0086. E-mail: msrose2{at}uky.edu

ABSTRACT

The use and nature of radioactive iodine (RAI) are complex topics for patients with thyroid conditions to understand. Fear and anxiety over its use, misinformation in patient advocacy books and on the Internet, medical jargon, confusion regarding postscanning and posttreatment procedures, patient literacy, thyroid health status, and several other socioeconomic factors can create serious barriers to genuine informed consent in RAI scanning and treatment. The following discussion will review the origins of patient misconceptions and misinterpretations, including international differences in physician attitudes regarding RAI usage. Next, this article will present the core ethical duties, problems, and moral dilemmas that can arise in the RAI setting. Upon completion of this article, the reader should be able to describe the core ethical principles of respect for persons (patient autonomy), beneficence, nonmaleficence, and justice; describe the 3 components of informed consent; identify common barriers to informed consent and describe how such barriers can lead to misconceptions, misinformation, and refusal of treatment with RAI; and summarize where RAI candidates and patients first look for information and identify the common ways in which misinformation surfaces.

Key Words: radioactive iodine; thyroid; patient misconceptions; ethical challenges; bioethics; informed consent