Ultrasound has been and still is a medical field involved in rapid technological changes. These changes have introduced some new ethical issues to be considered by the ultrasound professionals like sonographers. Sonographers in prisons should not be restricted to only identifying the illicit drug packages but must also provide correct information about their quantity and exact placement so that no package remains in the body packer (Caserta et al., 2020). The essay examines why sonographers consider ultrasound scanning to detect intestinal drug containers in prisons unethical. A sonographer plays both a social and a medico-legal role in assessing illicit drugs’ presence in prisoners’ bodies. However, prison sonographers must comprehend the ethical dilemma of detecting intestinal drug containers by ultrasound scanning. Although detecting illicit drugs within the abdomen of prisoners is paramount for medical and legal reasons, the ultrasound scanning approach is regarded unethical for justice, beneficence, non-maleficence, and integrity reasons of prison inmates.
Drug use is directly related to incarceration and crime. Drugs impede rehabilitation efforts and disrupt the prison system due to the widespread usage of illicit drug containers as currency and the prevalence of gang activity. Internal concealment of drug smuggling in prisons is a worldwide issue. Body packing is typically used to transport heroin, cocaine, or marijuana. Body packing, stuffing, and pushing are dangerous activities with significant medical, legal, and social consequences (Cappelletti et al., 2019). Typically, the packets include latex condoms and can be disguised internally via ingestion, rectum insertion, or vaginal insertion. However, regardless of the conditions, the health care workers in prisons must continue to prioritize the safety and dignity of their patients. Important regulators in the health care industry are ethical codes. The expectation that health care practitioners adhere to ethical standards and rules is the foundation of patient confidence. Medical ethics fosters excellence and safeguards patients by motivating practitioners to deliberate on, articulate, and exhibit optimal care. Sonographers have ethical duties to their prison patients. Ethical practice warrants adherence and application of beneficence, non-maleficence, autonomy, respect for others, honesty and integrity, and fairness in the sonography laboratory.
EURATOM Directive 97/43 – now the cornerstone of legislation concerning radiation protection of patients in the member states of the European Community – states that particular attention shall be given, particularly to those exposures on medico-legal grounds. It warrants keeping the dose from the medico-legal exposure as low as reasonably achievable. The Member States shall ensure the laying down of practices to be observed in the event of medico-legal examinations (Caserta et al., 2020). Forty-three of the Austrian law on addictive drugs, for instance, stipulates that a person imprisoned on reasonable suspicion of harboring illicit narcotics within their body may request a diagnostic imaging exam to avoid additional incarceration pending trial. Instruction regarding this right must be provided at the moment of arrest and documented in writing. Principally, physicians must be mindful that they are the patient’s advocate, not state agencies.
Recent medical research indicates the unethical concerns of ultrasound scanning for detecting drug packages within the intestines of prisoners. Ultrasound and magnetic resonance imaging have limited utility, despite their advantages. The technological advancement poses non-beneficence and maleficence by causing harm to the inmate under ultrasound screening. Although sonography does not expose patients to ionizing radiation and is often considered safe, ultrasound is capable of causing biological effects (bio-effects) on the body’s tissues (Cloutier et al., 2021). While human studies have failed to prove that ultrasound exposure causes tissue damage, more recent animal experiments have demonstrated that ultrasound applied under settings comparable to those used on humans can result in detrimental bio-effects (Cloutier et al., 2021). When ultrasound interacts with biological tissue, there may also be thermal repercussions. As a result of the absorption and conversion of ultrasonic energy to heat, tissue temperatures increase. If the temperature exceeds a certain threshold, cell death may ensue.
Ultrasound scanning also potentially dehumanizes obstetrical health care among pregnant female prisoners. Because ultrasound energy poses a theoretical risk to the fetus, the principle of non-maleficence necessitates sonographers to conduct only medically indicated examinations and to undertake all examinations following ALARA (Knittel & Sufrin, 2020). Although studies show recommendations for the lowest energy exposure reasonably achievable for desired results, there is an increasingly poor perception and value of the fetus for parents.
Sonographers may also face unethical practices, given the risk of inaccurate or unreliable information. There may be problems owing to ingested foreign materials of comparable density, other than illicit drug packages, which can imitate the images of illegal drug packets if positioned in the abdomen (Jalbert et al., 2018). Research shows other swallowed foreign objects that resemble drug packs include grains, scybala, stones, and fruits. The Hounsfield unit on CT, which indicates density, can be used to identify the nature of the ingested material. The nature of the substance, such as its admixture, purity, and compression, has a significant effect on imaging; hence density measurements are not entirely reliable.
Body stuffers should be frequently asked if they swallowed other substances to aid in the expulsion of the packages, and their medical history should aid in interpreting CT scans. Sonographers can serve community interests by executing only clinically indicated, physician-prescribed operations. Unfortunately, given the legal reasons for detecting illegal drugs within prisons, without medical benefit to the patient, ultrasound scanning becomes unethical.
However, the counterarguments to the claim are also valid. Sonographers primarily use open X-rays and computed tomography scans to examine body packing for imaging purposes. Before the arrest, body packers visit medical institutions for internal obstruction, gastrointestinal perforation, drug-induced toxic consequences, or medical evaluation. Consequently, the conditions require surgical therapy. The leakage of illegal substances may precipitate the onset of signs and symptoms of systemic poisoning by transporters. Identifying these characteristics is essential for averting an imminent catastrophe (Cloutier et al., 2021). Moreover, many body packers die due to leaking of the packs within the intestinal tract, frequently preceded by intestinal blockage. Thus, imaging potential body packers may also be ethical for medical reasons. Moreover, if the individuals agree to have the procedure and sign a declaration of consent, it is regarded as moral.
Additionally, ultrasonography was shown to have a great sensitivity in suspected cases despite the low specificity. Negative ultrasonography cannot exclude the possibility of a body packing diagnosis. As a radiation-free, simple-to-use, and cost-effective technology, it may be used as the first imaging method or for the follow-up of suspected cases. Its non-maleficence proves ethical consideration in practice (Cappelletti et al., 2019). Many sonographers question imaging for medico-legal purposes, unlike medically justifiable investigations. Therefore, alternative methods for accurately detecting illicit drugs within inmates’ bodies are vital to curbing the drug trafficking issue in prisons.
Conclusion
I believe ultrasound scanning for detecting intestinal drug packages among prison sonographers should be considered unethical. Drug use is directly related to incarceration and crime. They impede rehabilitation efforts and disrupt the prison system due to the widespread usage of illicit drug containers as currency and the prevalence of gang activity. Although the medical practice is paramount for medical and legal reasons, the medical professionals should consider the ultrasound scanning approach unethical for justice, beneficence, non-maleficence, and integrity reasons of prison inmates. Sonographers encounter a drug smuggling problem when individuals suspected of trafficking drugs within their bodies are brought to their institution for radiological imaging due to a consistently high or increasing supply and demand for illegal narcotics in prisons.
Ultrasound scanning for detecting intestinal drug packages among prison inmates is valid and ethical on medical grounds. Given that many body packers die due to leaking of the packs within the intestinal tract, frequently preceded by intestinal blockage, imaging potential body packers may also be acceptable. Ultrasound scanning is also a radiation-free, simple-to-use, and cost-effective technology. However, there are more adverse implications for ultrasound scanning among inmates.
The medical practice is immoral because it causes adverse biological effects (bio-effects) and thermal impacts on the body’s tissues. It also poses potential dehumanization of obstetrical health care among pregnant female prisoners. Sonographers may also face unethical charges due to inaccurate or unreliable information during ultrasound scanning. There may be problems owing to ingested foreign materials of comparable density, other than illicit drug packages, which can imitate the images of illegal drug packets if positioned in the abdomen. Additionally, ultrasound scanning becomes unethical due to legal reasons for detecting illegal drugs within prisons without medical benefit to the patient.
References
Cappelletti, S., Piacentino, D., & Ciallella, C. (2019). Systematic review of drug packaging methods in body packing and pushing: a need for a new classification. The American Journal of Forensic Medicine and Pathology, 40(1), 27-42.
Jalbert, B., Tran, N. T., von Düring, S., Poletti, P. A., Fournier, I., Hafner, C., … & Wolff, H. (2018). Apple, condom, and cocaine–body stuffing in prison: a case report. Journal of Medical Case Reports, 12(1), 1-5.
Cloutier, G., Destrempes, F., Yu, F., & Tang, A. (2021). Quantitative ultrasound imaging of soft biological tissues: a primer for radiologists and medical physicists. Insights into Imaging, 12(1), 1-20.
Knittel, A., & Sufrin, C. (2020). Maternal health equity and justice for pregnant women who experience incarceration. JAMA network open, 3(8), e2013096-e2013096.
Caserta, M. P., Bonnett, S. L., La Valley, M. C., De Meo, S., & Bowman, A. W. (2020). Ultrasound
practice redesign to improve image quality: implementation of a quality control sonographer. Journal of the American College of Radiology, 17(12), 1644-1652.
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