Focusing ethical dilemmas of evidence-based practice in SMF-exposed MRI-workers: a qualitative analysis

To analyze ethical dilemmas for occupational health physicians and other stakeholders involved in the implementation of a surveillance program in workers exposed to static magnetic fields (SMF) used in magnetic resonance imaging. The ethical analysis was carried out according to the model proposed by Westerholm and others, which takes into account two elements: (i) the stakeholders involved in the decision process and (ii) the ethical principles of beneficence, autonomy and justice. The analysis is based on the assessment of ethical costs (violating the consistent principle) and ethical benefits (fulfillment of the consistent principle) for workers, employers, occupational health physicians, community, workers' representatives and medical inspectors. According to the European Directive 2004/40/EC (Official Journal of the European Union, Luxemburg), employers must ensure that health surveillance is carried out to prevent adverse health effects in SMF-exposed workers. However, limited scientific evidence on health effects from SMF influences the decision of undertaking appropriate health surveillance. The uncertainties entail a number of ethical conflicts, such as the choice of reliable indicators, the interpretation of abnormal data, the complexity of the decision-making process resulting in a fitness judgment and the diversion of funds for more effective practices. The analysis shows that the decision-making process aiming at the provision of evidence-based health surveillance to SMF-exposed workers is characterized by controversial ethical costs and ethical benefits for workers and the other stakeholders.