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Ethics is a word that is difficult to define fully. One working definition is "that branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions." So ethics incorporates the subjective concepts of right/wrong, good/bad, and considers not just results, but motives as well.
There is no doubt that ethical behavior is pivotal in all areas of healthcare including medical laboratory science. Professionals use critical judgment to make and report on findings that literally affect not just health, but life and death sometimes. Many decisions are made independently without any direct oversight or immediate vetting. That reality immediately opens the door to the possibility of bending the rules -- without risk of immediate discovery, but with the possibility of an adverse outcome.
Research indicates two important findings: that among clinical laboratorians moral decision making has room for improvement and that ethics may vary depending on a professional's education and position. Therefore examination of ethical decision making in MLS is an important discussion.
Ethical decisions are arrived at in many ways; but the most common fall into three categories which may be called schools of thought or ethical systems. Deontology is based on a sense of duty and is rooted in Judeo-Christian principles of right and wrong or acting morally according to a rule of conduct. For some the rule-book is the Bible, for example. Practically applied, the laboratorian seeking guidance deontologically may consult the employee handbook or the policy and procedure manual.
Teleology is an ethical system that is based on consequences and outcomes rather than set rules of action. One would consider the end result and what action serves the greatest good regardless of what is written in a document somewhere. Because "greatest good" is open to interpretation and is situational, it may be seen as subjective. However the individual using it may be acting according to their honest interpretation of the situation.
Virtue ethics is driven by a philosophy that each person should aim to be a good person and always do good (whatever that is) regardless of the situation. An individual using this argument may look to their faith or a respected individual to figure out what is the ethical (virtue-driven) path to take when faced with an ethical dilemma.
Each individual tends to gravitate towards a certain system; which is to say they have a preferred ethical decision making style which they use most often. Two caveats must be given, however. Two different individuals looking at a single issue might use 2 different systems and both arrive at the same choice. Also individuals should not be typecast or prejudged based on the style they adopt in one situation. Individuals will sometimes change logic just for a particular argument or even argue a single issue using two different rationales.
 During analysis of an issue, certain ethical principles are reviewed. In order for an action to be considered ethical, these principles should never be violated. Conversely if any of these principles are breached, then the action cannot be considered ethical.
Autonomy is related to the right to self-determination. Each person has the right to act in their own best interest and to choose actions related to their health, wellbeing and future, without being hindered. The medical principle of informed consent is based on this ethical principle. The patient is given full information about all options, the possible consequences of each and then allowed to choose.
The principle of nonmaleficence is based on the Hippocratic Oath of "do no ill." But an ethical person goes further and ensures that each action shows beneficence. This means it is not sufficient to merely avoid harm, but one should actively seek to do good. Beneficence is therefore a much higher bar than simply abstaining from inflicting harm.
Another important ethical principle is that of justice which means treating everyone equitably. In healthcare justice is especially important because it demand ensuring equal access to a scare finite resource. It touches on access to care, quality of care and no disparity in care.
Violation of any of these principles outlined makes an action unethical. It might be noted that underlying ethics is always a respect for persons. Respecting confidentiality of information and veracity (truth telling) are also implied in the concept of respect for persons.
Here's an exercise. Can you do a quick analysis of the following three cases-all based on reality. In each case, consider
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what are the ethical principles involved?
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what would you do in each situation?
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what ethical system did you use to arrive at your decision?
One more rule: it is not acceptable to simply pass the buck to your supervisor (as the only thing you would do). Also using the cop-out of "I am only one person" or "I am just a tech" is not an option.
Case 1
The hospital CFO came to the lab to have some lab work done. While trying to understand some abnormal findings an MLS in hematology discovered the CFO's primary diagnosis is HIV. She proceeds to tell everyone in the department about the diagnosis and her findings. You overhear the conversation. What would you do?
Case 2
A lab director is charged with reporting certain laboratory quality indicators to the hospital wide Quality Council on a monthly basis. Favorable reports are publicly acknowledged and rewarded by administration. Results below an established benchmark are noted and discussed in management team meetings with all departments represented.
You discover that the director has been systematically changing findings to make the laboratory's performance appear better than it really is.
Case 3
The Chemistry supervisor has long been accused of playing favorites with one employee. Despite several complaints the director has done nothing. This past weekend you saw the supervisor in public in a compromising situation with one of your colleagues whom she favors. What is your ethical obligation, if any?
Ethics is guided by the concepts of rights and obligation. A right may be regarded as a justified claim. Consider the right to life, safety, quality healthcare, justice and so on. Each right creates a correlative obligation. If someone has a right then others have the obligation to provide that right; or at least not to actively deprive the individual of their right.
Laboratorians are faced with ethical dilemmas every single day. Remember you have an obligation to act ethically regarding your peers, the organization, customers (internal and external). But most of all, you have a sacred obligation to patients. Faced with an ethical dilemma, what do you do?
Glen McDaniel is a healthcare executive, clinical lab scientist, speaker and freelance writer. His interests include decision making, leadership, change and ethics. He can be reached at glenmcdan@aol.com.
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