Professional Ethics PDF

PROFESSIONAL ETHICS Acknowledgements Addisa Ababa University Haramaya University Hawassa University Jimma University University of Gondar American Society for Clinical Pathology Center for Disease Control and Prevention- Ethiopia  Course Title: Professional Ethics...

PROFESSIONAL ETHICS Acknowledgements Addisa Ababa University Haramaya University Hawassa University Jimma University University of Gondar American Society for Clinical Pathology Center for Disease Control and Prevention- Ethiopia  Course Title: Professional Ethics Course Number: MeLS 301 Credit Hours: 1 Lecture: 1 hour/week Prerequisite: None Instructor: 3  Course Information Teaching Methods Lecture Role play Case study Group discussion and presentation Assignments Assessment Method: Assignment & Quiz (10%) Mid term examination (30%) Final examination (60%) Time Allocation: 16 contact hours Grading: Fixed scale 4 Course Information, cont’d Type of Examination: Theory: – Multiple choice questions, Short answers, Essays (minimum) – Matching, Completion and True or false (Optional) 5  Course Objectives At the end of the course students will be able to: Define terms such as Ethics, Profession (professional, professionalism), Behavior, Moral, Legal practice, Common law, Civil law, Court, Precedent, Medical Laboratory Science Recognize how the law operates in relation to clinical laboratory practice with regard to legal process, principles and penalties Apply ethical concepts to clinical laboratory practice in all interactions with clients 6  Course Objectives, cont’d Maintain the highest standard of care and professional ethics by identifying the rights and obligations of medical laboratory professionals Support the interests and needs of clients and their families to exercise their rights to make informed decisions regarding their care Recognize and maintain code of ethics for medical laboratory professionals Exercise good laboratory practice 7  Course Outline: 1.0. Introduction 1.1. Definition of terms 1.2. History of medical laboratory science 1.3. History of ethics 1.4. Classification of ethics 1.5. Principles of ethics 1.6. characteristics of professional and ethical behavior 2.0. Interpersonal relationships 3.0. Principles of confidentiality and privacy responsibility 4.0. Rights and obligations of medical 8  Course Outline, cont’d 5.0. Duties and responsibilities of medical laboratory professionals 6.0. Patient’s bill of rights 7.0. Medical Laboratory code of conduct 7.1 Ethiopia Medical Laboratory Association Code of Ethics 7.2 Ethiopia Medical Laboratory Association Vision 7.3 Ethiopia Medical Laboratory Association Mission 7.4 Ethiopia Medical Laboratory Association Core Values 8.0. Good Laboratory Practices (GLPs) 9  1.0. Introduction 1.1. Definition of terms 1.2. History of medical laboratory science 1.3. History of ethics 1.4. Classification of ethics 1.5. Principles of ethics 1.6. characteristics of professional and ethical behavior 10  I.0 Introduction At the end of this session students will be able to: Define ethics, Profession (professional, professionalism), Behavior, Moral, Legal practice, Common law, Civil law, Court, Precedent, Medical Laboratory Science Discuss the history of medical laboratory science 11  Objectives continued At the end of this session the students will be able to: Discuss the history of ethics Discuss the different types of ethics Discuss principles of ethics List the characteristics of professional and ethical behavior 12 Why study ethics? When students enter the professional world, they will be expected to follow an explicit or implicit ethical code. To responsibly confront moral issues raised by medical laboratory activities How to deal with ethical dilemmas in their professional lives? To achieve moral autonomy  1.1. Definitions 1.1.1. Definition of ethics – derived from the Greek word ethos, meaning custom or character – 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 14  Definitions cont’d Final word about ethics: Professional ethics concerns one’s conduct of behavior and practice when carrying out professional work 1. 1.2. Definition of profession: – Profession: A dedication, promise or commitment publicly made Is a vocation or an occupation requiring knowledge of some department of learning or science 15  Definitions continued – 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 16 they chose  Definitions cont’d – Professionalism: The actions of the members of a profession based on the accepted code of conduct – 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 17  Definitions cont’d 1.1.3. Definition of Behavior: The way somebody behaves 1.1.4. 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 18 Definitions: 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” 19 interchangeably  Definitions cont’d 1.1.5. Definition of Legal practice: legislation having legal enforcement 1.1.6. 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. 1.1.7. Definition of Civil law: – law of citizen's right 20  Definitions cont’d 1.1.8. Definition of Court: – meeting where legal judgments are made 1.1.9. Definition of Precedent: – an action or decision that can be used subsequently as an example for a similar decision or to justify a similar action 1.1.10 Definition of Medical Laboratory Science: – A profession characterized by its own internally-defined Body of Knowledge and Scope of Practice – A profession with people educated in basic and 21 medical sciences, medical techniques and  1.2. 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 22 Medical laboratory Science – 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. – Ethiopia since 1954 GC (Institute de Pasteur, Minellik II, UOG, JU, Har U, Haw U, Arbaminch U, Mizan Tepi, Wellega U, Wello 23  History of MLS, cont’d Medical laboratory sciences: – Today, MLS is a well-developed body of knowledge that includes basic and medical sciences, medical techniques, and research methods – This ensures the education of medical laboratory professionals and the production of quality medical diagnostic testing – As MLS plays crucial role in healthcare system, there are numerous ethical 24  1.3. History of Ethics Ethics: – Major branch of philosophy – 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 25  1.3. History of Ethics Greek Philosophy: Socrates: Any person who knows what is truly right will automatically do it. Evil or bad actions, are the result of ignorance. Aristotle: 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). 26 History of Ethics cont’d 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 27 History of Ethics continued 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. – Current day Basic definitions of ethics remain in use Varied consensus depending on location of group(s) 28  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: – 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 30  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?", 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: – 31  Descriptive vs Prescriptive Ethics 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. 2002 British study by Burgess and Mullen: 77% of hygienists had 32  Descriptive Ethics Burgess and Mullen study. Most common ethical misconducts: 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 33 Descriptive Ethics cont’d 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 34  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. 35  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 36  Applied Ethics cont’d 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 37  Professional Ethics 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 38 unselfish concern for the welfare of others  Professional Ethics, cont’d 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. 39  Professional morality vs Ethics Professional Morality – what we do in our occupational lives Professional Ethics – the study of what we do in our professional lives 40 1.5. Principles 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 41 1.5. Principles of Ethics Other principles include informed consent, confidentiality and honesty The major principles of medical laboratory ethics are: – Autonomy – Beneficence 42  Principles of Ethics cont’d 1. 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. 2. Beneficence: acting in the best interests 43 of patients (doing or promoting good).  Principles of Ethics cont’d 3. Nonmaleficence: means to avoid doing harm. Health professionals should not inflict harm on patients. 4. Justice: fair, equitable and appropriate treatment. Treat all patients equally – no unfair discrimination. 5. Veracity: means telling the truth, which is essential to the integrity of the client- provider relationship. 6. Fidelity: means being faithful to one’s commitments and promises 44  1.6. Characteristics of Professional and Ethical Behavior Professional ethics: – Deals with moral issues that arise due to specialist knowledge that professionals attain – Decides how the use of this knowledge should be governed when providing a service to the public – Is the moral principle which should guide the members of the profession in their dealings with each other, their patients, co-workers – Is a collective and disciplined concern of 45  Characteristics of Professional and Ethical Behavior Ethical Behavior – Ethics is an inherent characteristic of professional behavior – Actions by a person or a group that adhere to the commonly accepted behavioral patterns of the group – When faced with a choice of behaviors, a person exhibits behavior based on accepted behaviors of the group 46  Review Questions Who were the first scholars to discuss and define ethics? What are the different types of ethics? What are characteristics of professional and ethical behavior? The next chapter is Chapter 2: Interpersonal Relationships. 47  2.0 Interpersonal Relationships 48  2.0. Interpersonal Relationships 2.1. Interpersonal relationship with patients 2.2. Interpersonal relationship with one’s family 2.3. Interpersonal relationship with visitors 2.4. Interpersonal relationship with colleagues and other health professionals 2.5. Medical laboratory patient- relationships 49  Objectives Upon completion of this chapter the student will be able to: Define terms such as interpersonal, patient, client, surrogate, informed consent and disclosure Describe interpersonal relationship with patients, with one’s family, with visitors, with colleagues and other health professionals Explain the importance of medical 50  2.1. Interpersonal relationships 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 of51  Interpersonal relationships with patients, cont’d The medical laboratory technologist should: – 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 52  Interpersonal relationships with patients, cont’d The medical laboratory technologist should: – Ask patients’ permission before sharing information with their spouses, partners or relatives. – always seek to give priority to the laboratory diagnostic service to patients solely on the basis of clinical need. 53  2.2. Interpersonal relationships with family Group activity 1.Have you ever accompanied a friend or family member to a 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 54  2.3. 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 55 2.4. Interpersonal relationship with colleagues and other health professionals The medical laboratory technologist should: 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. 56 Interpersonal relationship with colleagues and other health professionals, cont’d The medical laboratory technologist should: 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 and57  2.5. Medical laboratory patient-relationships 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 – Communication and consent – Confidentiality 58  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. 59  Communication and consent The patient should understand clearly the purpose of any test or treatment, what the result would imply, and what would be the implication of withholding consent. Competent patients have the right to refuse treatment, even when the refusal will result in disability or death. As an ethical concern if a patient is not mentally capable to make a decision, a surrogate decision maker needs to be part of the discussion. 60  Communication and Consent 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 61  Informed Consent 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 62  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. 63  Confidentiality Patient confidentiality must be upheld Breaching patient confidentiality may be merited only: – When ordered by court of law – a court case – Where statutory/legal requirement – public health laws – Where required in health professional’s defense –malpractice suit – Where necessary 64for appropriate patient  Review Questions What is informed consent? What is confidentiality? How do laboratory workers help to seek informed consent from patients? What is disclosure? When is a surrogate decision maker involved? Next is Chapter 3: Confidentiality 65  3.0. Principles of confidentiality and privacy responsibility 66 3.0. Principles of confidentiality and privacy responsibility 3.1. Ethical dilemma in decision making 3.1.1. Moral theories 3.1.2. Ethics and Law 3.1.3. Ethics and Medical Laboratory Science 3.1.4. Professional ethics and the law 3.2. Responsibility and accountability to the profession 3.2.1 Professional Responsibility 67  Objectives Upon completion of this chapter the student will be able to: Define terms such as ethical dilemma, moral and legal Discuss moral theories Differentiate ethics from law Describe ethical situations involving the laboratory Describe health law involving the 68 laboratory  Ethical Dilemma 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. 69  Resolution of Dilemmas 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 70  Ethical Dilemma 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 71 Ethical / Moral Theories 72  3.1.1 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. 73  How We Come by Moral Theories Family Religion Culture Experience and reflection Education 74 Moral Action Theories – “Doing” Based on: 1. consequences for community 2. rights of individuals 3. duties of individuals 4. virtues What correct course of action should I take? 75  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 76  1. 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, what77 Consequentialism cont’d – 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. 78  2. Rights-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 79  3. 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 for80  Kantianism Decide if an act is right or wrong without looking at consequences – non-consequentialist Duty to: – “Always tell the truth” – “Always avoid taking an innocent life” – “Always treat others as ends in themselves and never as means solely” Basis of respect for persons “Deontological” = prior to action Motivated by reason alone “Universal moral imperatives” 81  4. 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 Virtues may be culturally specific 82  Virtues Examples: Benevolence (kindness) Justice Friendliness Honesty Integrity 83  Ethical Dilemma Group Activity*: The hijacked plane with 200 people is approaching a building with 50,000 people Vote! Will you shoot down the plane? You cannot subscribe to both principles in the case. A true moral dilemma Which position has the greatest weight in the circumstances? 84  3.1.2 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 85  3.1.2 Ethics and Law 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. 86  3.1.2 Ethics and Law cont’d 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 87  Ethics and Law Ethics is not adopted into law, but is a major professional & moral guiding principle, even though it is unenforceable. Simply stated, ethics represents what we should do, not what we must do. It represents an expression of conscience rather than the obligatory fulfillment of governmental fiat. 88  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 89  Ethics vs Law Be very careful not to embark in an exercise in ethical analysis when there is a clear legal rule in the situation that trumps the entire process of ethical analysis. Be very careful not to assume that there is a legal rule for every situation. Often the gaps between legal rules require one to switch to an ethical analysis. 90 3.1.3 Ethics and Medical Laboratory Science Health professional’s ethics emanated and expressed through: – Law – Institutional policies – Policy of professional organization – Professional standards of care 91  3.1.3. Ethics and medical laboratory science, cont’d 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 92  3.2.1. Professional Responsibility 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. 93  Review Questions What is the difference between ethics and law? What is a moral dilemma including an example? What are some example ethical situations involving the laboratory? What are specific health laws affecting the laboratory 94  References for Chapters 1- 3 Ethiopian Medical Laboratory Association (Ethiopia Medical Laboratory Association) Code of Ethics for Medical Laboratory Technologists Practicing in Ethiopia, 2008 Medical Ethics Manual, World Medical Association, 2005 James M. Gripando. Nursing Perspectives and Issues; Delmar publishers INC 3rd edition International Federation of Biomedical Laboratory Science (IFBLS) code of ethics IFBLS general assembly of delegates, 1992 95  CHAPTER-4 RIGHTS AND OBLIGATIONS OF MEDICAL LABORATORY PROFESSIONALS 96  Objectives Upon completion of this session the student will be able to: Describe rights of medical laboratory professionals Discuss obligations of medical laboratory professionals 97 Rights of Medical Lab Professionals  safe working environment  appropriate wage, allowance  legal protection  security  Insurance for occupational hazard  access to medication  professional risk allowance  standard work load 98 Rights of Medical Lab Professionals  proper annual leave (maternity/paternity leave)  Right to exercise our profession ethically and legally  Testing by the professionals not non-lab  License for Med Lab personnel (not necessarily pharmacists)  Procurement of lab commodities  the right to participate in health facility management and policy making  Vaccination 99 Right and obligation of medical laboratory professionals: 4.1. Honesty 4.2. Dependability 4.3. Kindness and firmness 4.4. Humanity and Justice 4.5. Maintaining good reports 4.6. Adaptability 4.7. Co-operation 4.8. Ethical behaviors 100  Right and obligation of medical laboratory professionals: Honesty  In performing lab testing  In reporting lab results Dependability  Taking your position seriously  Being at work when you assigned to be Kindness and firmness  Use compassion with patients and co-workers  Remain firm in your duties and in doing what is right and best for your patient 101  cont.… 4.4. Humanity and Justice  Be fair in running all patients’ laboratory tests  Put yourself in the patient’s position before you argue or say something you will regret  Put yourself in your co-worker’s position before you argue or say something you will regret 4.5. Maintaining good reports  Use good handwriting when signing out patient results  Take your time to record all patient information in all log books  Be honest in all your reporting 102  Cont…. Adaptability  Be willing to change work hours to help a co-worker  Be willing to stay at work a little longer if patient work is not completed  Be willing to make changes in testing procedures and other areas as needed 103  Cont….. Co-operation  If you expect others to co-operate with you, you need to co-operate with them  Team work will finish lab work quicker than an individual Ethical behaviors  In all that you do, base your actions and decisions on ethical behavior 104  Chapter 5.0. Duties and responsibilities of Medical Laboratory Professionals: 105  Objectives Upon completion of this session the student will be able to: List the duties of a medical laboratory professional Describe the responsibilities of medical laboratory professionals. 106 5.1.1. Duties to yourself The medical laboratory technologist should: Maintain and improve the standard of your performance by keeping your professional knowledge and skills up to date throughout your working life. Acknowledge the limits of your professional knowledge and competence. Do not pretend to know everything. Use equipment and laboratory ware correctly and with care 108  cont.…. The medical laboratory technologist should: refrain from engaging in activities that may affect your health and lead to impairment be aware of laws and regulations governing medical laboratory technology not waste reagents and other laboratory supplies not drink alcohol during laboratory working hours or when on emergency stand-by follow safety procedures and know how to apply first aid 109  5.1.2. Duties to your profession The medical laboratory technologist should: uphold and maintain the dignity and respect of medical laboratory profession strive to maintain a reputation of honesty, integrity and reliability. contribute to the advancement of the profession by – improving the body of knowledge, – adopting scientific advances that benefit the patient – maintaining high standards of practice and 110 education, and  Cont….. promote the image and status of your profession by maintaining high standards in your professional practice and through active support of your professional bodies. take responsibility for your professional acts not misuse your professional skills or knowledge for Personal gain 111  5.1.3. Duties to Society The medical laboratory technologist should: Deal responsibly with scarce health care resources Dedicate themselves to serve the healthcare needs of the public 112  2.6. Duties to the environment The medical laboratory technologist should: protect the environment and the public by assuring that health care waste is disposed of legally and in an environmentally friendly manner 113  5.1.5 Duties to Patients Medical laboratory professionals Obligations: 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 114  cont.….. Medical laboratory professionals should: 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 ask your patients’ permission before sharing information with their spouses, partners or relatives. always seek to give priority to the laboratory diagnostic service to patients solely on the basis of clinical need. 115 “Remember the patient is the reason, and the only reason for your professional existence: In order for a patient to receive the best care possible, you must 116  Chapter 6 The Patient’s Bill of Rights and Law 117  Objectives Upon completion of this session the students will be able to: Define terms such as bill of rights, malpractice, tort law, licensure, accreditation and certification Describe example patient bill of rights such as from the American Hospital Association Discuss how Ethiopia is addressing the patient’s bill of rights. 118  6.0. Patient’s bill of rights: All patients have the: 6.1. Right to truth 6.2. Right to refuse treatment 6.3. Right to know about Informed consent 6.4. Right to privacy 6.5. Right to get complete information concerning his diagnosis, treatment 6.6. Right to know Ethiopian medico-Legal issues (code of law) 119  A patients bill of rights is a statement of the rights to which patients are entitled as recipients of medical care articulates the positive rights which doctors and hospitals ought to provide patients, thereby providing information, offering fair treatment, and granting them autonomy over medical decisions is an effective health care collaboration between patients and physicians and other health care professionals Includes: – Open and honest communication, respect for personal and professional values, and sensitivity to differences are integral to optimal patient care 120  Cont…. Hospitals must ensure a health care ethic that respects the role of patients in decision making about treatment choices and other aspects of their care Hospitals must be sensitive to cultural, racial, linguistic, religious, age, gender, and other differences as well as the needs of persons with disabilities 121  Bill of Rights 6.1. Right to truth The patient has the right to considerate and respectful care The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient's treatment and care Patients are responsible for providing information about past illnesses, hospitalizations, medications, and other 122 matters related to health status  Bill of Rights 6.2. Right to refuse treatment The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. 123  Bill of Rights 6.3. Right to know about Informed consent The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) Health care institutions must advise patients of their rights under state law and hospital policy to make informed medical choices The patient has the right to timely information about hospital policy that may limit its ability to implement fully a legally valid advance directive 124  Bill of Rights 6.4. Right to privacy The patient has the right to every consideration of privacy The patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential by the hospital – except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize the confidentiality of 125 this information when it releases it to any other  Bill of Rights 6.5. Right to get complete information concerning his diagnosis, treatment The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis The patient has the right to consent to or decline to participate in proposed research studies or human experimentation 126  6.5 Bill of Rights The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate 127  Bill of Rights 6.6. Right to know Ethiopian medico- Legal issues (code of law) The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution 128  Bill of Rights The patient has the right to be informed of the hospital's charges for services and available payment methods Patients are responsible for providing necessary information for insurance claims and for working with the hospital to make payment arrangements, when necessary. 129  6.6.1. Legal concepts in Medical Laboratory General Legal Concepts Law: – defined as those rules made by humans who regulated social conduct in a formally prescribed and legally binding manner – based upon concerns for fairness and justice 130  Functions of Law in Medical Laboratory It provides a framework for establishing which medical laboratory action in the care of client are legal It differentiates the medical laboratory professionals responsibilities from those of other health professionals It helps to establish the boundaries of independent medical laboratory action It assists in maintaining a standard of medical laboratory practice by making medical laboratory professional 131  Types of law Law governs the relationship of private individuals with government and with each other Public Law: refers to the body of law that deals with relationships between individuals and governmental agencies. Private Law: is the body of law that deals with relationship between individuals Contract Law: involves the enforcement of agreements among private individuals or the payment of compensation for failure 132  Types of law cont’d Tort Law: the word tort means “wrong” or “bad” in Latin. It defines and enforces duties and rights among private individuals that are not based on contractual agreements. Example of tort law applicable to medical laboratory, negligence and malpractice. 133  Legal Aspects of Laboratory Medicine A. Malpractice: legally, a failure to provide the standard of care that is due a patient, i.e. professional negligence B. Three distinct elements must be present 1. Patient must have sustained measurable injury 2. Court must find negligence on the part of the defendant that professional standards of care was not followed 3. There must be proof the negligence 134 was the cause (legal term: proximate  Most Common Areas of Potential Negligence Misidentification, mislabeling Instrument failure: poor Quality Control, failure to standardize instrument, jammed key on automatic printout device, misplaced decimal points on calculations, inversion of numeric values. Specimen validity: proper collection and handling Venipuncture 135  Legal issues in Medical Laboratory Medical Laboratory Practice Act: regulate the practice of medical laboratory Legally define and describe the scope of medical laboratory practice, which the law seeks to regulate, there by protecting the public as well It protects the user’s professional capacity Each country may have different acts but they all have common purpose: to protect the public It grants the public a mechanism to ensure minimum standards for entry into the 136  Standards of professional Practice attempts to ensure that its practitioners are competent and safe to practice through the establishment of standard practice Establishes and implements standards of practice are major functions of a professional organization The profession’s responsibilities inherent in establishing and implementing standards of practice include: – To establish, maintain, and improve standards – To hold members accountable for using137  Standards of professional Practice cont’d – To educate the public to appreciate the standard – To protect the public from individual who have not attended the standards or will fully do not follow them – To safeguard individual members of the profession When standards of professional practice are implemented, they serve as unit for the measurements used in licensure, certification, accreditations, quality assurance, peer review, and public policy. 138  Credentialing is the process of determining and maintaining competence-medical laboratory practice. Credentials include: Licensure Registration Certification Accreditation 139  Credentialing, cont’d Licensure: it is a legal permit a government agency grants to individuals to engage in the practice of a profession and to use particular title. Registration: is listing of an individual’s name and other information on the official roster of a governmental agency. 140  Credentialing, cont’d Certification: is the voluntary practice of validating that an individual medical laboratory professional met minimum standards of medical laboratory competence. Accreditation: is a process by which a voluntary organization or governmental agency appraises and grants accredited status to institutions and/or programs. 141 Chapter 6 Review Questions What are malpractice and negligence? How can a medical laboratory professional avoid malpractice and negligence situations? What is the difference between licensure, accreditation and certification? How Ethiopia is addressing patient’s rights? 142  References Ethiopian Medical Laboratory Association (Ethiopia Medical Laboratory Association) Code of Ethics for Medical Laboratory Technologists Practicing in Ethiopia, 2008 Medical Ethics Manual, World Medical Association, 2005 James M. Gripando Nursing Perspectives and issue; Delmar publishers INC 3rd edition International Federation of Biomedical Laboratory Science (IFBLS) code of ethics IFBLS general assembly of delegates, 1992 143  Acknowledgements Addisa Ababa University Haramaya University Hawassa University Jimma University University of Gondar American Society for Clinical Pathology Center for Disease Control and Prevention-Ethiopia Chapter 7 CODE OF ETHICAL CONDUCT  Objectives: Upon completion of this chapter the student will be able to: Describe the medical laboratory code of conduct Describe the IFBLS code of conduct Describe the EMLA code of conduct  7.0. Medical Laboratory code of conduct Code of ethics is a formal statement of a group’s ideas and values that serve as standards and guidelines for the groups’ professional actions and informs the public of its commitment. A code of ethics provides members of a profession with standards of behavior and principles to be observed regarding their moral and professional obligations toward one another, their clients, and society in general. 147  7.0. Medical Laboratory code of conduct continued. Code of ethics is generally developed by a professional society within a particular profession. The higher the degree of professionalism required of society members, the stronger and therefore more enforceable the code. 148  Medical laboratory code of conduct cont’d Purpose of medical laboratory code of ethics: To inform the public about the minimum standards of profession and to help them understand professional medical laboratory conduct To provide a sign of the profession’s commitments to the public it serves To outline the major ethical considerations of the profession To provide general guidelines for 149 Medical Laboratory code of conduct cont’d To guide the profession in self regulation To remind medical laboratory professionals on the special responsibility they assume when they perform their duties. 150 Medical Laboratory code of conduct International Federation of Biomedical Laboratory Science (IFBLS) Code of Ethics The need for medical laboratory is universal Inherent in medical laboratory is respect for life, dignity, and rights of human It is unrestricted by considerations of nationality, race, color, age, sex, politics or social status 151  IFBLS Medical laboratory professionals render services to the individual as well as to the community at large IFBLS is an independent non- governmental association of national of national societies in 35 countries, representing more than 165,000 medical laboratory scientists and technologists worldwide. 152  IFBLS Code of Ethics: Biomedical Laboratory Scientists shall: Be dedicated to the use of clinical laboratory science to benefit mankind Actively seek to establish cooperative and specific working relationships with other health professionals Provide expertise to advise and council other health professionals Maintain strict confidentiality of patient information and test results 153  IFBLS Code of Ethics: Biomedical Laboratory Scientists shall: Safeguard the dignity and privacy of patients Be responsible for the logical process from the acquisition of specimen to the production of data and the final report of the test result Be accountable for the quality and integrity of clinical laboratory 154  IFBLS Code of Ethics: Biomedical Laboratory Scientists shall: Exercise professional judgment, skill and care while meeting established standards Uphold and maintain the dignity and respect of the profession and strive to maintain a reputation of honesty, integrity and reliability Strive to improve professional skills and knowledge and adopt scientific advances that benefit the patient and improve the delivery of test results 155 Medical Laboratory Ethics in Ethiopia Ethiopian Medical Laboratory Association (EMLA) prepared code of ethics for Medical Laboratory Professionals practicing in Ethiopia. It comprises of six parts. 156  Code of Ethics for Medical Laboratory Technologists Practicing Deals in Ethiopia with medical laboratory professional duties to patients (Part I) Explains medical laboratory professional duties to colleagues and other professionals (Part II) Clarifies medical laboratory professional duties to himself/herself (Part III) Focuses on medical laboratory professional duties to society (IV) Deals with medical laboratory professional duties to the medical laboratory profession (Part V) Explains medical laboratory professional 157  Professional Values and Virtues 158  Professional Codes and Justice Accountability: punish professionals who violate standards Duty to report colleagues’ wrong- doing for retributive justice to be carried out Fairness in distribution of professional services (no discrimination) – warning, reprimand, suspension,159  Compassion Two rules: Alleviate suffering Act in other person’s actual (to them) best interest 160  Confidentiality Confidentiality regarding: 1. Whose interests 2. Which interests 161  Confidentiality Confidential information of: 1. Worker 2. Employer 3. Colleague 4. Competitor 162 Chapter 7 Review Questions What is a code of conduct? What are some similarities and some differences in the Ethiopian Medical Laboratory association code of conduct and that of the IFBLS? Next is Chapter 8: Good Laboratory Practice 163  Chapter 8: Good Laboratory Practices (GLPs) 164  Objectives Upon completion of this chapter the student will be able to: Define Good Laboratory Practice Describe what constitutes good laboratory practice Discuss situations in which good laboratory practice is not exhibited 165  8.0 Good Laboratory Practices (GLPs) Laboratory services are an integral part of disease diagnosis, treatment, monitoring response to treatment, disease surveillance programs and clinical research. Laboratory test results, therefore, should be reliable, accurate and reproducible. Generation of such 'quality' results involves a step wise process of meticulous planning, perfect execution and thorough checking of results by the whole team involved. 166  Good Laboratory Practices In the clinical and research arena, the phrase good laboratory practice or GLP generally refers to a system of management controls for laboratories and research organizations to ensure the consistency and reliability of results Good Laboratory Practice (GLP) embodies a set of principles that provides a framework within which laboratory studies are planned, performed, monitored, recorded, reported and archived. 167  GLP includes – Infrastructure Infrastructure of laboratories should be planned according to the services provided by the laboratory. – Equipment – Reagents and materials – Specimen collection – Requisition form – Accession list – Worksheet – Reporting test results – Specimen rejection record 168  GLP includes – Data management (recording, reporting and archiving) – Standard operating procedure (SOP) – Safety in laboratories (to protect both staff and the environment) – Ethical considerations – Quality assurance: the total process whereby the quality of laboratory reports can be guaranteed. – IQC – External quality assessment – Internal audit (identify problems and weak points in the system and suggest remedial 169  Summary and Review Questions There are many elements of GLP. What is needed to provided good laboratory practice? What is a safety practice that would prevent GLP? What is an ethical situation when GLP is not maintained? Next is chapter 9: Legal and Ethical Issues In HIV/AIDS patients 170  Chapter 9: Legal and Ethical Issues in HIV/AIDS 171  Objectives Upon completion of this chapter the student will be able to: Discuss the rights and privileges of HIV infected persons; Explain the features of HIV that raise legal and ethical issues; Discuss international guidelines on HIV/AIDS legal and ethical issues 172  Introduction Various ethical and legal controversies have arisen in relation to HIV/AIDS. These include issues on:  Testing for HIV and the debate on whether or not it should be voluntary or mandatory;  Confidentiality of HIV test results with ethical dilemmas on medical technologist/Patient relationship, employer/employee situation, partner notification to mention but a few; 173   Introduction Cont’d  Gender issues to do with wife inheritance, marital rape, property rights of women and inheritance and wills;  Criminalization of what is popularly referred to as deliberate infection with HIV;  Ethics of research. 174  Introduction Cont’d Epidemiological data shows that the spread of HIV/AIDS is disproportionately high among some populations e.g. women, children, those living in poverty, minorities, migrants, etc. This can be attributed to lack of human rights protection which dis-empowers these groups to avoid infection and cope with HIV/AIDS. 175  Introduction Cont’d Transgression of human rights such as the use of coercion or discrimination drives infected individuals underground where they further spread the virus. That is why in 1998 the United Nations came up with the HIV/AIDS and Human Rights International guidelines. 176  Human Rights Principles relevant to HIV/AIDS The right to non-discrimination, equal protection and equality before the law; The right to life; The right to the highest attainable standard of physical and mental health; The right to liberty and security of person; The right to freedom of movement; 177  Human Rights Principles relevant to HIV/AIDS The right to seek and enjoy asylum; The right to privacy; The right to freedom of opinion and expression and the right to freely receive and impart information; The right to freedom of association; The right to work; The right to marry and to found a family; 178  Human Rights Principles relevant to HIV/AIDS The right to equal access to education; The right to an adequate standard of living; The right to social security, assistance and welfare; The right to share in scientific advancement and its benefits 179  Human Rights Principles relevant to HIV/AIDS The right to participate in public and cultural life; The right to be free from torture and cruel, inhuman or degrading treatment or punishment. 180  Special Features of HIV/AIDS And Their Consequences Feature Consequences New epidemic infection  Fear, misunderstanding, stigma and denial Long asymptomatic  Infected persons are often unaware, therefore no period & life-long action is taken until people become ill infectivity No cure, life-long  Intensifies fear over testing, burden on family & treatment, potential health services treatment failure and  Demands exceptionally high standard of laboratory side effects of drugs services because of potential for false HIV positive & negative results and the consequences that may follow HIV is a sexually  Associated with guilt & shame transmitted disease  This is a neglected area of health services STI which can be  Diagnosis in child implies a diagnosis in the mother & vertically transmitted often the father 181  Special Features of HIV/AIDS And Their Consequences Cont’d Perception that initial spread  Core groups neglected by health services/hard to associated with "deviant" reach behaviour and marginalized groups Associated with stigma and  Patients reluctant to come forward for testing; myths  Health care workers reluctant/afraid to provide services Affects young adults  Severe secondary costs due to loss of productive years of life and burden on the family Multi-system disease  Multiple medical problems  Multiple drugs needed  Unpredictable  Needs very active palliative care and diagnosis of opportunistic infections 182  Legal framework for HIV/AIDS Care Non-Discrimination and Equality before the Law  All forms of negative discrimination against persons infected or affected by HIV/AIDS by reason of their health status, relation or association with infected persons are unconstitutional and unallowable. 183  Legal framework for HIV/AIDS Care Testing for HIV  Mandatory testing for HIV/AIDS should be prohibited.  HIV testing must be carried out with the specific, prior and informed consent of those being tested, with pre-counselling and post- counselling, and with the guarantee of confidentiality.  Counselling should be culturally and contextually appropriate, sensitive to issues of sexual identity and orientation, and ought to be conducted in a language best understood by the persons counselled. 184  Legal framework for HIV/AIDS Care  Testing without prior and informed consent may be permissible on grounds of necessity and only, for the patient’s health interests, where the patient is without the ability to consent within the period available, or in emergencies 185  Legal framework for HIV/AIDS Care Informed consent  Recognizing the fundamental ethical and legal principle of autonomy as the basis of the doctrine of informed consent, every human person has the right to determine what should happen to, or to be done with, his/ her body in accordance with his/her chosen values and priorities, even in poor physical health. 186  Legal framework for HIV/AIDS Care Indirect Testing, Screening of Blood, Semen and Body parts Donated.  Screening blood and body parts for HIV/AIDS without the consent of the donor may be unlawful and actionable in law;  Anonymous screening of blood and human organs for HIV/AIDS may be objectionable for reasons of compelling human safety.  No blood should be transfused or human organ transplanted without ascertainment of its seronegativity. 187  Legal framework for HIV/AIDS Care Anonymous and Unlinked Testing of Populations and Groups.  Whereas anonymous and unlinked testing of populations and groups for HIV/AIDS may not cease to be unlawful by reason of the ignorance of the action or injury of each or all constituted in the populations tested, such anonymous and unlinked testing of populations or groups for HIV/AIDS may be allowable out of necessity for epidemiological purposes to enable surveillance and control. 188  Legal framework for HIV/AIDS Care Pre-Natal Testing and Testing of Newborns  All pregnant women or girls should be routinely counselled about the advantages and disadvantages of HIV testing and offered voluntary HIV testing. 189  Legal framework for HIV/AIDS Care Confidentiality – The noble principle of confidentiality in doctor- patient relationships has raised a dilemma in the developing countries where the need to encourage HIV testing and the need to prevent transmissions are central to the strategy for control of the scourge. The predominant mode of transmitting HIV (through sexual intercourse) has attached a stigma to the scourge, and many would rather not know their status, and where they know, they would not disclose their status because of the discrimination and stigmatization that is likely190  Legal framework for HIV/AIDS Care  People who are known to be living with HIV and those with AIDS have suffered discrimination at all levels; in the family, in schools, in employment, in treatment facilities, in social places and in other places and situations. 191  Legal framework for HIV/AIDS Care Health care workers at risk of infection  Do they need to know the HIV status of their patients and vice versa?  Do they need post-exposure ARV prophylaxis?  How does one deal with issues of consent and confidentiality of HIV results in these special circumstances?  Do Health Workers require protective gear at workplace? 192  Legal framework for HIV/AIDS Care Health Care Workers need not know the HIV status of their patients and must at all times adopt the safety measures provided by the universal standards. Equally there is no legal justification for the patient to know the HIV status of the Health Care Provider. 193  Summary of Chapter 9 Review Questions: What rights and privileges do persons infected with HIV have? Why are there special legal and ethical issues for patients with HIV/AID? What are the international guidelines on HIV/AIDS legal and ethical issues? 194  References for Chapters 7- 9 Ethiopian Medical Laboratory Association (Ethiopia Medical Laboratory Association) Code of Ethics for Medical Laboratory Technologists Practicing in Ethiopia, 2008 Medical Ethics Manual, World Medical Association, 2005 James M. Gripando. Nursing Perspectives and Issues; Delmar publishers INC 3rd edition International Federation of Biomedical Laboratory Science (IFBLS) code of ethics IFBLS general assembly of delegates, 1992 195