EDEXCEL UNIVERSITY REPUBLIC DU BENIN

STUDY MANUAL
ON
FUNDAMENTAL/ BIOETHICS IN MEDICAL LABORATORY
SCIENCE AND MICROBIOLOGY.

PREPARE
BY

OMOLOYE.T.A
 Definition of ethics

Derived from the Greek word ‘’ethos, meaning custom or character.

Ethics Is a major branch of philosophy which study values and customs of a

person or group .Is concerned with what is right or wrong, good or bad, fair or
unfair, Covers the analysis and employment of concepts such as right or wrong,
good or evil.

Professional ethics concerns one’s conduct of behavior and practice when

carrying out professional work

. Definition of profession:

Profession: A dedication, promise or commitment publicly made . profession Is a

vocation or an occupation requiring knowledge of some department of learning
or science . it is an Occupation, practice, or vocation requiring mastery of a
complex set of knowledge and skills through formal education and/or practical
experience. All professions are occupations, but not all occupations are
professions

Professional: A person who agrees to and commits his/her commitment to the

profession they chose.

Professionalism: The actions of the members of a profession based on the

accepted code of conduct.

Professionalism is based on,

• Code of Conduct:

• way of behaving

• a set of unwritten rules according to which people in a

particular group, class, or situation are supposed to behave

. Definition of Behavior: The way somebody behaves

. Definition of Moral: from the Latin moralitas "manner, character, proper
behavior“. In its descriptive use, morals are arbitrarily and subjectively created by
society, philosophy, religion, and/or individual conscience. it's possible that many
moral beliefs are due to prejudice, ignorance or even hatred.

ETHICS VS MORAL.

Ethics- "The science of morals”; the philosophical study of morality.

Moral- habits of life in regard to right and wrong conduct. The arbitrariness of
morality stems from the observation that actions that may be deemed moral in
one culture in time may not be classified as such in others or in a different time.

Morality – making choices with reasons

Ethics – the study of HOW the choices are made, i.e “ethics is the study of
morality”.Often use “ethics” and “morality” interchangeably

Definition of Legal practice: legislation having legal enforcement

. Definition of Common law: evolved law i.e., the body of law developed as a
result of custom and judicial decisions, as distinct from the law laid down by
legislative assemblies.

Definition of Civil law: law of citizen's right

HISTORY OF MEDICAL LABORATORY SCIENCE

Medical Laboratory Science (MLS): Part of healthcare > 100 years. Initially
included only pathologists or academic researchers, Formal training programs
began in mid-1920s. Development of automation and increased knowledge
expanded laboratory testing capabilities and created demand for academically
organized medical laboratory science programs (1940-1960) No formal training
programs . Many universities developed bachelor degrees, master’s and doctoral
programs in medical laboratory science by the 1980s.
HISTORY OF Ethics: this is a Major branch of philosophy that Studies values and
customs of a person or a group. Covers analysis and employment of concepts
such as right or wrong, good or evil, responsibility. History begins with Greek
philosophy

Greek Philosophy:

– Socrates: he says Any person who knows what is truly right will
automatically do it. Evil or bad actions, are the result of ignorance.

– Aristotle: he says posited an ethical system that may be termed

"self-realizationism“ ( i.e., when a person acts in accordance with his
nature and realizes his full potential, he will do good and be content).

– Hedonism: the principle ethic is maximizing pleasure and minimizing

pain

– Cyrenaic hedonism: supported immediate gratification

– Epicureanism: rejected the extremism of the Cyrenaics, believing

some pleasures and indulgences to be detrimental to human beings

– Stoicism: the foundation of Stoic ethics is that good lies in the state
of the soul itself; in wisdom and self-control.

Greatest good was contentment (happiness) and serenity (peacefulness). Peace of

mind was of the highest value.
 1.4. Classification of Ethics
Ethics is divided into three primary areas:
• Meta – ethics:
• the study of concepts of ethics
• Normative ethics:
• the study of how to determine ethical values
• Applied/Professional ethics:
• the study of the use of ethical values

29

meta- ethics: is the branch of ethics that seeks to understand the nature of ethical
properties, and ethical statements, attitudes, and judgments. concerned primarily
with the fundamental semantic (meaning of ethical judgments and/or
prescriptions ), ontological (theory of being), and epistemic (about knowledge)
nature of ethics or morality. It addresses questions such as "What is goodness?"
and "How can we tell what is good from what is bad?" seeking to understand the
nature of ethical properties and evaluations.

– is the branch of ethics that seeks to understand the nature of ethical

properties, and ethical statements, attitudes, and judgments.

– concerned primarily with the:

 – the fundamental semantic (meaning of ethical judgments and/or
prescriptions ), ontological (theory of being), and epistemic (about
knowledge) nature of ethics or morality

– addresses questions such as "What is goodness?" and "How can we

tell what is good from what is bad?", seeking to understand the
nature of ethical properties and evaluations.

NORMATIVE ETHICS

– is the branch of philosophical ethics that investigates the set of questions

that arise when we think about the question “how ought one act, morally
speaking?” "What should one do?", it is distinct from meta-ethics because
it examines standards for the rightness and wrongness of actions, while
meta-ethics studies the meaning of moral language and the metaphysics of
moral facts.

– Semantics of ethics divides naturally into:

– Descriptivism

– Non-descriptivism

– Descriptive ethics –

– “What IS” Prescriptive ethics –

“What OUGHT to be”

– Descriptive, or scientific, studies of professional ethics help us identify

issues that need to be included in Code of Ethics and in educational
programs. In 2002 British study by Burgess and Mullen: 77% of hygienists
had witnessed ethical misconduct by colleagues within last 5 years. Burgess
and Mullen study. Most common ethical misconducts:
 DESCRIPTIVE ETHICS

1. Plagiarism

2. Confidentiality of data

3. Faked data

4. Criticizing colleagues for gain

5. Destruction of data

6. Holding back, disguising data

7. Not reporting incident deliberately

Patricia Logan 2001, USA. Reported reasons for misbehavior, hygienists:

1. Economic pressure

2. Transition from employee to consultant results in compromises

3. Working in foreign countries

4. Lack of legal standards

5. Decrease in job security

NON DESCRIPTIVE ETHICS

contends that ethical propositions are irreducible in the sense that their
meaning cannot be explicated sufficiently in terms of descriptive truth-
conditions.

APPLIED ETHICS

• Is a discipline of philosophy that attempts to apply ethical theory to real-life

situations. There are several sub-branches of professional/applied ethics:

– Business ethics

– Medical ethics (e.g. Bioethics)

 – Medical Laboratory ethics

– Genetics

– Journalism ethics

– Engineering ethics

– Legal ethics

• One of the major areas where ethicists practice is in the field of health care.
These include:

– Medical ethics

– Nursing ethics

– Pharmacy ethics

Medical Laboratory ethics.

PROFESSIONAL ETHICS: this concerns the moral issues that arise because of the
specialist knowledge that professionals attain, and how the use of this knowledge
should be governed when providing a service to the public. is the moral principle,
which should guide members of the profession in their dealings with each other
and with their patients, the patrons (clients), the state etc. is a collective and
disciplined concern of the group

attitude of the professional should be unselfish concern for the welfare of others

Note: Professional ethics is therefore, an inherent characteristic of professional

behavior. Adherence to professional standards is expressed through taking a
professional oath and accepting professional code of ethics . The oath is usually
brief, general and intended to obligate and inspire the professional to abide by
applicable laws, codified ethics and the dictates of conscience and religious
principles.
The code of ethics, compared with an oath is normally more detailed and more
explicit.

PROFESSIONAL MORALITY AND ETHICS

Professional Morality – what we do in our occupational lives

Professional Ethics – the study of what we do in our professional lives.

PRINCIPLE OF ETHICS

• Principles are basic ideas that are starting points for understanding and
working through a problem. Ethical principles presuppose that medical
laboratory professionals should respect the value and uniqueness of
persons and consider others to be worthy of high regard. The most
commonly accepted principles of medical ethics include:

• Respect for Patient Autonomy

• Beneficence and Nonmaleficence

• Justice

Other principles include,

• informed consent, confidentiality and honesty

• The major principles of medical laboratory ethics are:

• Autonomy

• Beneficence

• Autonomy: means independence and ability to be self directed in health

care. Autonomy is the basis for the client’s right to self determination.
Infants, young children, mentally handicapped or incapacitated people, or
 comatose patient do not have the capacity to participate in decision making
about their healthcare. If the client becomes unable to make decisions for
himself/herself, a “surrogate decision maker” would act on client’s behalf.

• Beneficence: acting in the best interests of patients (doing or promoting

good). This principle is the basis for all health care providers

• Nonmaleficence: means to avoid doing harm. Health professionals should

not inflict harm on patients.

• Justice: fair, equitable and appropriate treatment. Treat all patients equally
– no unfair discrimination.

• Veracity: means telling the truth, which is essential to the integrity of the
client-provider relationship.

• Fidelity: means being faithful to one’s commitments and promises

• Confidentiality: Confidential is a secrete or private matter not to be

divulged to others.

INTERPERSONAL RELATIONSHIP WITH PATIENTS.

Medical Laboratory professionals are accountable for the quality and integrity of
the laboratory services they provide

• The medical laboratory technologist should:

• Always regard concern for the best interests or well-being of your patients
as your primary professional duty.

----- honor the trust of your patients

• be mindful that a medical laboratory science practitioner is in a

position of power over a patient and avoid abusing your position.

• respect patients’ privacy and dignity

• treat patients politely and with consideration

 • apply the principle of informed consent as an on-going process

• recognize the rights of patients to expect that you will not pass on
any personal and confidential information you acquire in the course
of your professional duties, unless they agree to disclosure or the law
demands

INTERPERSONAL RELATIONSHIP WITH FAMILY.

• Group activity

1. Have you ever accompanied a friend or family member to an hospital?

2. Were you afraid - did healthcare professionals at the hospital smile and
offer to help you? – were you treated with respect?

3. Please give examples of behaviors that were positive and also those
examples that were negative.

4. What are your own recommendation.

INTERPERSONAL RELATIONSHIP WITH VISITORS.

The medical laboratory technologist should:

• Explain to family and visitors that your first duty is to honor the trust and
confidentiality of your patients

• Be polite and respectful of family and visitors and offer to answer questions
for directions; questions about the patient’s condition should be directed to
the patient (or clinician with patient approval)

• Respect family and visitor dignity

INTERPERSONAL RELATIONSHIP WITH COLLEAGUE AND OTHER HEALTH
PROFESSIONALS.

The medical laboratory professionals

• Not make a patient doubt a colleagues’ knowledge or skills by making

comments about them that cannot be fully justified

• Actively strive to establish cooperative and respectful working relationships

with other health care professionals with the primary objective of ensuring
a high standard of care for the patients they serve.

• Not discriminate against colleagues, including professionals applying for

posts Because of race, culture, ethnicity, social status, lifestyle, perceived
economic worth, age, gender, disability, communicable disease status,
sexual orientation, religious or spiritual beliefs, or any condition of
vulnerability.

• refrain from speaking ill of colleagues or other health care professionals

• share their knowledge with colleagues and promote learning

MEDICAL LAB SCIENCE AND PATIENT RELATIONSHIP.

This is the corner stone of medical practice. Remember the health of your
patient should be your first consideration, following topics pose problems
to medical laboratory professionals in their daily practice like,

– Communication and consent

– Confidentiality
 COMMUNICATION AND CONSENT.

• The patient has the right to self- determination, to make free decisions
regarding himself/herself.

• The medical laboratory professional will inform the patient of the

consequences of his/her decisions.

• A mentally competent adult patient has the right to give or withhold

consent to any diagnostic procedure or therapy.

• The patient has the right to the information necessary to make his/her
decisions.

• The surrogate decision maker is a person designated by the patient to make

medical decisions in the event the patient is unable to.

Informed Consent:

• Definition: A patient’s willing acceptance of a medical intervention after

adequate disclosure from the health professional of the nature of the
intervention, risks, benefits and alternative treatment options.

• What constitutes informed consent?

– Disclosure: information to allow reasonable person to make a

decision

– Understanding: comprehension of the information given

– Voluntary: no coercion or incentive to accept or deny a treatment

– Agreement: verbal or written (preferred) to discussed intervention.

 CONFIDENTIALITY

• The medical laboratory professional’s duty to keep patient information

confidential has been a cornerstone of medical laboratory ethics.

• Medical laboratory professionals shall preserve absolute confidentiality on

all he knows about his patient even after the patient has died.

PRINCIPLE OF CONFIDENTIALITY AND PRIVACY RESPONSIBILITY.

ETHICAL DILLEMA

• Situations in which two or more moral obligations, duties, rights, or ideals

come into conflict. there is no clear right or wrong answer or there may be
more than one correct solution.

• To resolve we must identify the factors, gather facts, rank moral

considerations, consider alternative courses of actions, and arrive at a
judgment.

RESOLUTION OF DILLEMA.

• Some dilemmas are resolved because they are not moral dilemmas.

• Some MORAL dilemmas can be resolved through a creative third alternative

that satisfies both moral outcomes. Or, possible to sequentially act on each
one. Or, evaluation will show which is strongest moral explanation and
decision
ETHICAL DILLEMA GROUP ACTIVITY.

• The hijacked plane with 200 people is approaching a building with 50,000
people

• Vote! Will you shoot down the plane?

• A true moral dilemma

• Which position has the greatest weight in the circumstances?

• Note: further discussion after the theories

MORAL THEORY: Is a broad perspective which helps us decide which element of a

moral problem is most important (e.g. consequences, rights, goods, virtues, etc.)
helps us resolve conflicts between rules and between values.

HOW WE COME BY MORAL THEORY

. Family

• Religion

• Culture

• Experience and reflection

• Education

MORAL ACTION THEORIES is Based on:

1. consequences for community

2. rights of individuals

3. duties of individuals

4. virtues
 • What correct course of action should I take?

HUMAN GOODS

• Human life considered to be fundamental good, pre-conditional good

• Human life is not measurable, “life is priceless”

• Leads to dilemmas in the workplace

CONSEQUENTIALISM

• argues that the morality of an action is contingent on the action's outcome

or result.

• The greatest good for the greatest number

• an act is right only if it tends to result in the greatest net good

• all acts are potentially permissible; depends on consequences

• all persons count equally

• difficult to determine which consequences, what probability, what weight?

May sacrifice individuals for greater good

Utilitarianism: one forms of Consequentialist theories which holds that an action

is right if it leads to the most happiness for the greatest number of people.

Utilitarianism finds the ethical criterion in the greatest good for the greatest
number.
 RIGHT BASED THEORIES

• Right = justified claim on someone

• Right-holder may or may not claim right

• An act is morally right if it respects and upholds rights

• Respects individuals, bearers of rights

Good of community may be sacrificed for right of individual

DUTY BASED THEORIES

• Duty = obligation, responsibility

• Considers motive or intention of decision-maker, plus nature of act, rights,

consequences. Good motive, means are acceptable, nature of act is good

• Consequences are of secondary consideration

• Recognizes complexity

• Value of individual is important

• May sacrifice community good for the sake of individual duty

VIRTUE BASED THEORIES

• Act for the sake of virtue, or as a virtuous person would. A virtue is a good
character trait or disposition. Tendency to act in a way that promotes
human good or human flourishing. More people affected by virtue than
fewer. More virtues expressed than fewer BUT, some virtues may be more
important than others it may be culturally specific.
Examples:

• Benevolence (kindness)

• Justice

• Friendliness

• Honesty

• Integrity

ETHICS AND LAW

Description of Ethics and Law:

• Medical ethics and the law are not the same, but often help define each
other. Breach of ethical obligation may not necessarily mean breach of law

• Breach of ethical obligation may be used to prove medical malpractice or

medical negligence

• Ethics consists of far more than abiding by rules, procedures, and guidelines.
Even the most detailed of laws cannot govern every aspect of our
laboratory experience or keep pace with the explosion of knowledge and
technology we have seen in the medical field.

Description of Ethics and Law:

• Much of what is ethical is unaddressed by legal rules

• The law from its inception was meant for adjudicating conflicts in a way to
preserve the basic societal order

• Legal codes set a general standard of conduct which must be adhered to in

civil law
ETHICS VS LAW

• Law – the authority is external

• Ethics – the authority is internal

• Much of law, but not all, is based in morality

Sometimes law is unethical

• Much of what is ethical is unaddressed by legal rules

• There is a moral duty to obey the law (with some caveats)

• Professional ethics covers more issues than the law

• One can be unethical without behaving illegally

• Rare – ethically must resist the law

ETHICS AND MEDICAL LABORATORY SCIENCE.

• Health professional’s ethics emanated and expressed through:

– Law

– Institutional policies

– Policy of professional organization

– Professional standards of care

Responsibility/ethical duty of Medical Laboratory Professionals:

• A moral duty to obey the law

• Professional ethics covers more issues than the law

• Behaving unethically without behaving illegally

 • Ethical decision rarely must resist the law

PROFESSIONAL RESPONSIBILITIES.

Professional responsibility is the area of practice that encompasses the

duties/ethics of medical laboratory professionals to:

 Act in a professional manner

 Obey the law

 Avoid conflicts of interest

 Put the needs of patients ahead of their own interests.