Unit #4 – Medical Unit #4 – Medical EthicsEthics

Cecile M. Sanders, M.Ed., Cecile M. Sanders, M.Ed., MT(ASCP), CLS(NCA)MT(ASCP), CLS(NCA)

Unit #4Unit #4Medical EthicsMedical Ethics

What is “ethics”?What is “ethics”?– According to the American College According to the American College

Dictionary, “ethics” means:Dictionary, “ethics” means:1. The principles of morality, including both 1. The principles of morality, including both

the science of the good and the nature of the science of the good and the nature of the rightthe right

2. The rules of conduct recognized in respect 2. The rules of conduct recognized in respect to a particular class of human actions, as in to a particular class of human actions, as in “medical ethics”“medical ethics”

3. Moral principles, as of an individual3. Moral principles, as of an individual4. The science of the human character in its 4. The science of the human character in its

ideal stateideal state

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In a nutshell, “ethics” means doing In a nutshell, “ethics” means doing what is right.what is right.

So, what is “right”?So, what is “right”? ““Right” depends on your valuesRight” depends on your values ““Values”, in terms of societal Values”, in terms of societal

interaction, refer to the ideals and interaction, refer to the ideals and customs toward which a person or customs toward which a person or group of person has a positive regard.group of person has a positive regard.

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““Values” can be a positive thing, like Values” can be a positive thing, like cleanliness, freedom, education, etc. cleanliness, freedom, education, etc. or a negative thing, like cruelty, or a negative thing, like cruelty, crime, or blasphemy.crime, or blasphemy.

What are YOUR values?What are YOUR values? One can hardly argue with things like One can hardly argue with things like

cleanliness, freedom or education, cleanliness, freedom or education, but we all know there are people who but we all know there are people who don’t value these things.don’t value these things.

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In some cultures, freedom is not In some cultures, freedom is not important.important.

In some cultures, it is OK to send In some cultures, it is OK to send suicide bombers into a crowd of suicide bombers into a crowd of innocent people just because they innocent people just because they are trying to make a point or are trying to make a point or disagree with others’ values.disagree with others’ values.

So, again, what are YOUR values?So, again, what are YOUR values?

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Here are things that many people value:Here are things that many people value:– HonestyHonesty– IntegrityIntegrity– FreedomFreedom– LoyaltyLoyalty– LifeLife– FriendshipFriendship– FamilyFamily– TimelinessTimeliness– Hard-workHard-work– TruthfulnessTruthfulness– ReligionReligion– Etc., etc., etc.Etc., etc., etc.

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All of us have values even though we All of us have values even though we may not know it or admit it to may not know it or admit it to ourselves.ourselves.

Sometimes our values don’t make Sometimes our values don’t make themselves apparent until we are themselves apparent until we are confronted with a tough issue or confronted with a tough issue or decision.decision.

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For instance:For instance:– If you value honesty, If you value honesty,

Is it OK to keep extra money that a store Is it OK to keep extra money that a store clerk has returned to you accidentally?clerk has returned to you accidentally?

Is it OK to call in sick when you are not?Is it OK to call in sick when you are not? Is it OK to “fudge” laboratory results when Is it OK to “fudge” laboratory results when

you need to leave work to pick up your you need to leave work to pick up your children at day care?children at day care?

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If you value life,If you value life,– Is it OK to have an abortion?Is it OK to have an abortion?– Is it OK to disconnect a feeding tube Is it OK to disconnect a feeding tube

from a comatose patient?from a comatose patient?– Is it OK to bomb innocent people?Is it OK to bomb innocent people?– Is it OK to have capital punishment?Is it OK to have capital punishment?

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If you value friendship,If you value friendship,– Is it OK to tell a friend a lie?Is it OK to tell a friend a lie?– Is it OK to turn a friend in to the police if Is it OK to turn a friend in to the police if

he has committed a crime?he has committed a crime?

I think you get the idea that although I think you get the idea that although one may say they hold a certain one may say they hold a certain value doesn’t mean that they would value doesn’t mean that they would always act to hold that value.always act to hold that value.

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Most professions have established a Code Most professions have established a Code of Conduct or a Code of Ethics for people of Conduct or a Code of Ethics for people in the fieldin the field– Example: Doctors take the Hippocratic Oath, Example: Doctors take the Hippocratic Oath,

Nurses take the Florence Nightingale OathNurses take the Florence Nightingale Oath– The American Society for Clinical Laboratory The American Society for Clinical Laboratory

Sciences has established a Code of Ethics for Sciences has established a Code of Ethics for clinical laboratory professionals. It can be clinical laboratory professionals. It can be found atfound athttp://www.ascls.org/?page=Code

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The ASCLS Code of Ethics basically The ASCLS Code of Ethics basically states that all laboratory states that all laboratory professionals have:professionals have:– I. Duty to the PatientI. Duty to the Patient– II. Duty to Colleagues and the ProfessionII. Duty to Colleagues and the Profession– III. Duty to SocietyIII. Duty to Society

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ASCLS Pledge to the ProfessionASCLS Pledge to the Profession

As a clinical laboratory professional, I strive As a clinical laboratory professional, I strive to:to:– Maintain and promote standards of excellence in Maintain and promote standards of excellence in

performing and advancing the art and science of my performing and advancing the art and science of my profession profession

– Preserve the dignity and privacy of others Preserve the dignity and privacy of others – Uphold and maintain the dignity and respect of our Uphold and maintain the dignity and respect of our

profession profession – Seek to establish cooperative and respectful working Seek to establish cooperative and respectful working

relationships with other health professionals relationships with other health professionals – Contribute to the general well being of the community. Contribute to the general well being of the community. I will actively demonstrate my commitment to theseI will actively demonstrate my commitment to theseresponsibilities throughout my professional life.responsibilities throughout my professional life.

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The ASCLS Code of Ethics and Pledge to The ASCLS Code of Ethics and Pledge to the Profession can serve as a “moral the Profession can serve as a “moral compass” to guide clinical laboratory compass” to guide clinical laboratory professionals in their jobs and even in professionals in their jobs and even in their interactions with friends and family.their interactions with friends and family.

Decision-making can be tough in any Decision-making can be tough in any situation, but particularly tough when you situation, but particularly tough when you are a recent graduate or when you are the are a recent graduate or when you are the only person working in the lab when a only person working in the lab when a decision is needed.decision is needed.

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Here is one of many decision-making models, Here is one of many decision-making models, based on personal and/or professional based on personal and/or professional values:values:– 1. State the problem1. State the problem– 2. Determine personal or professional values 2. Determine personal or professional values

regarding the problemregarding the problem– 3. List the possible alternative solutions to the 3. List the possible alternative solutions to the

problemproblem– 4. Frame a choice from the possible alternative 4. Frame a choice from the possible alternative

solutions and compare it with personal or solutions and compare it with personal or professional valuesprofessional values

– 5. List the short and long term consequences of 5. List the short and long term consequences of the choicethe choice

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Example of using the Value-Based Example of using the Value-Based Decision-Making ModelDecision-Making Model– The Lead MLT is the only staff person The Lead MLT is the only staff person

left in the lab on a Saturday evening. left in the lab on a Saturday evening. Two technicians arrive for the midnight Two technicians arrive for the midnight shift. One of the technicians seems to shift. One of the technicians seems to be under the influence of something; be under the influence of something; her gait is unsteady and her speech is her gait is unsteady and her speech is slurred. slurred.

– What to do?What to do?

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Example of using the Value-Based Example of using the Value-Based Decision-Making Model (cont’d)Decision-Making Model (cont’d)– Using the Decision-Making Model outlined on Using the Decision-Making Model outlined on

slide #15, this is what the Lead MLT decided:slide #15, this is what the Lead MLT decided: 1. The problem is that this midnight tech might 1. The problem is that this midnight tech might

be drunk or under the influence of some drug be drunk or under the influence of some drug and her ability to function may be impaired.and her ability to function may be impaired.

2. The Lead MLT values excellent patient care 2. The Lead MLT values excellent patient care and accurate laboratory testing. He also values and accurate laboratory testing. He also values maintaining a good working relationship with the maintaining a good working relationship with the midnight tech and her friendship. Too, he values midnight tech and her friendship. Too, he values his free time and a good night’s sleep.his free time and a good night’s sleep.

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Example of using the Value-Based Example of using the Value-Based Decision-Making Model (cont’d)Decision-Making Model (cont’d)

3. The Lead MLT could:3. The Lead MLT could:– A. Stay for a double shift, assigning the midnight A. Stay for a double shift, assigning the midnight

MLT to harmless tasksMLT to harmless tasks– B. He could warn the other midnight tech about B. He could warn the other midnight tech about

this possibly impaired MLT, leave, and hope for this possibly impaired MLT, leave, and hope for the bestthe best

– C. He could call his supervisor for a decisionC. He could call his supervisor for a decision– D. He could ignore the situation and hope for the D. He could ignore the situation and hope for the

bestbest

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Example of using the Value-Based Example of using the Value-Based Decision-Making Model (cont’d)Decision-Making Model (cont’d)

4. This Lead MLT chose alternative D 4. This Lead MLT chose alternative D (ignored the situation and hoped for the (ignored the situation and hoped for the best). He decided that his friendship with best). He decided that his friendship with this person and maintaining a good working this person and maintaining a good working relationship with her, along with wanting his relationship with her, along with wanting his free time and a good night’s sleep, was free time and a good night’s sleep, was priority.priority.

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Example of using the Value-Based Example of using the Value-Based Decision-Making Model (cont’d)Decision-Making Model (cont’d)

5. Short-term consequences of his decision 5. Short-term consequences of his decision include:include:

– A. The Lead MLT could go home and not work a A. The Lead MLT could go home and not work a double shift.double shift.

– B. His supervisor would not have to be disturbed.B. His supervisor would not have to be disturbed.– C. The impaired employee could work with no C. The impaired employee could work with no

reprimands.reprimands.6. Long- term consequences are that 6. Long- term consequences are that

laboratory errors could affect patient care.laboratory errors could affect patient care.

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Example of using the Value-Based Example of using the Value-Based Decision-Making Model (cont’d)Decision-Making Model (cont’d)– Is this the decision you would have Is this the decision you would have

made? Maybe, maybe not. It is difficult made? Maybe, maybe not. It is difficult to know until you are actually in that to know until you are actually in that situation.situation.

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In the Assignment for this Unit, go to In the Assignment for this Unit, go to http://virtualmentor.ama-assn.org/

On the home page for this website, click the “Ethics Poll” On the home page for this website, click the “Ethics Poll” tab at the top of the page.tab at the top of the page.

Then click on “all polls”; it is a tiny link beneath the “Ethics Then click on “all polls”; it is a tiny link beneath the “Ethics Poll” heading and next to the “print” link.Poll” heading and next to the “print” link.

Click on the April 2008 poll on “Immigrants and Medical Click on the April 2008 poll on “Immigrants and Medical Care”.Care”.

Take the Poll, as directed. Click the “Vote” button at the Take the Poll, as directed. Click the “Vote” button at the bottom to view the results.bottom to view the results.

Copy and paste the results in a Word document AND, using Copy and paste the results in a Word document AND, using the 5 step decision-making model in this PowerPoint, the 5 step decision-making model in this PowerPoint, outline the steps you used to arrive at your voting results.outline the steps you used to arrive at your voting results.

Send the Assignment to the instructor by the scheduled Send the Assignment to the instructor by the scheduled deadline.deadline.