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

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 Objectives
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

• Discuss the history of ethics

• Discuss the different types of ethics

• Discuss principles of ethics

• List the characteristics of professional and ethical behavior

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 Why study Ethics? ….
 To recognize difficult situations and to deal with them
in rational and principled manner.
• To follow an explicit or implicit ethical code in the
professional world
• To responsibly confront moral issues raised by medical
laboratory activities
• To deal with ethical dilemmas in professional lives

• To achieve moral autonomy

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 1.1. Definitions
 Ethics
– Ethics refers to standards of conduct . . . that
indicate how one should behave based on principles
of right and wrong
– Is concerned with what is right or wrong, good or
bad, fair or unfair

– Professional ethics concerns one’s conduct of

behavior and practice when carrying out
professional work

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 Definitions cont’d
 Profession:
– A dedication, promise or commitment publicly made

– An occupation that requires extensive education or

specialized training

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Definitions cont’d
– 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

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commitment to the profession they chose 6
 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 rules according to which people are supposed to
behave

 Behavior: The way somebody behaves

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 Definitions cont’d
 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
principles
• marrying someone of the same sex
• being an atheist

– Many moral beliefs are due to prejudice(bias) and ignorance

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 Definitions: Ethics vs Moral
• Ethics- "The science of morals”; the philosophical study
of morality.
– conforming to accepted standards: consistent
with agreed principles of correct moral conduct
• Moral- habits of life in regard to right and wrong
conduct

• Morality – making choices with reasons

• Often use “ethics” and “morality” interchangeably

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 Definitions cont’d
 Legal practice: legislation having legal enforcement

 Common law (case law)

– evolved law i.e., the body of law developed as a result of
custom and judicial decisions,

 Civil law: law of citizen's right

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 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.

– Self-knowledge was considered necessary for

success and inherently an essential good

– The truly wise man will know what is right, do what

is good and therefore be happy.

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 1.3. History of Ethics

• Aristotle asserted that man had three natures:

– Physical nature can be satisfied through exercise

– Emotional nature through tolerance of instinct and urges, and

– Mental through human reason and developed potential.

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 History of Ethics cont’d
• Hedonism: the principle ethics is maximizing pleasure and
minimizing pain and that pleasure is the highest good

• Cyrenaic hedonism: Founded by Aristippus of Cyrene. supported

immediate satisfaction. "Eat, drink and be merry, for tomorrow we
die.“ they encouraged the pursuit of enjoyment and indulgence
without hesitation, believing pleasure to be the only good.

• Epicureanism: rejected the extremism of the Cyrenaics, believing

some pleasures and tolerances to be detrimental to human beings

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 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
– Stoic ethics stressed the rule: "Follow where reason leads."
– Greatest good was contentment (happiness) and serenity
(peacefulness). Peace of mind was of the highest value.

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 Nuremberg War Crimes

• Nazi doctors’ trials for medical experiments

• Conducted among civilians and Allied forces

• Without subjects consent

• Committed murders, violence, tortures, and

other inhuman acts

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 Nazi Medical Experiments
• High altitude experiments – conducted in low
pressure chambers that approximate pressure
at extremely high altitudes
• Freezing experiments – subjects remained in
ice tanks for 3 hours, severely chilled and
rewarmed
• Malaria experiments – infected healthy
humans with infected mosquitoes

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 Nazi Medical Experiments
• Gas Experiments – wounds imposed on
subjects infected with poison gas
• Sulfanilamide experiments – wounds infected
with bacteria like streptococcus, tetanus
aggravated by forcing wood shavings or glass
and treated with sulfanilamide
• Bone, nerve, muscle transplantation from one
person to another

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 Nazi Medical Experiments
• Sea water experiment – subjects deprived of
food and given chemically treated water
• Epidemic jaundice experiment – subjects
infected with organisms causing jaundice
• Sterilization of subjects by means of x ray,
surgery and drugs
• Spotted fever (typhus) germs infected healthy
subjects to develop vaccine

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 The Tuskegee Syphilis Study for blacks
• long-term study of black males conducted at
Tuskegee [Alabama] by the United States
Public Health Service.
• Study initiated in 1932 as an examination of
the natural history of untreated syphilis; it
continued until 1972.

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 The Tuskegee Syphilis Study for blacks
• More than 400 black men with syphilis
participated, and about 200 men without syphilis
served as controls
• The men were recruited without informed
consent and, in fact, were misinformed that
some of the procedures done in the interest of
research

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 Tuskegee Syphilis
• By 1936, it was apparent that many more infected
men than controls had developed complications,
and
• 10 years later, a report of the study indicated that
the death rate among those with syphilis was about
twice as high as it was among the controls.
• In the 1940s, penicillin was found to be effective in
the treatment of syphilis. The study continued,
however, and the men were neither informed nor
treated with the antibiotic

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 Nazi Medical War Crimes
In December 1946,
23 physicians and administrators, were accused
before the War Crimes Hearing at Nuremberg
for their willing participation in the systematic
torture, mutilation, and killing of prisoners in
experiments.
Despite arguments by the physicians that the
experiments were medically justified, the
Nuremberg Military Courts condemned the
experiments as "crimes against humanity";

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 Nazi Medical War Crimes
August 1947 Verdict:
16 out of 23 physicians were found guilty and
imprisoned,
7 were sentenced to death.
The judges included a section called
"Permissible Medical Experiments“. This
section became known as the Nuremberg Code
and has formed the basis for ethical codes
internationally

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 International codes and
ethics guidelines
Nuremberg Code
• The Nuremberg Code was the first set of basic
principles that must be observed in order to
satisfy moral, ethical and legal concepts in
conduct of human participants research.
• The main points included the statement that:
• That animal experimentation should precede
human experimentation;
• "voluntary consent of the human subject is
absolutely essential."
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 International codes and
ethics guidelines
Nuremberg Code
The Code has been the model for many
professional and governmental codes
since the 1950s and has, in effect, served
as the first international standard for the
conduct of research

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 International codes and
ethics guidelines
The Declaration of Helsinki
• Originally adopted 1964
• was developed by the World Medical Association
for use by the medical community following
dissemination of the Nuremberg Code.
• 1st significant attempt by the medical community
to regulate itself
• Like the Nuremberg Code, the Declaration made
informed consent a central requirement for
ethical research while allowing for surrogate
consent when the research participant is
incompetent, physically or mentally incapable of
giving consent, or a minor.
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 International codes and
ethics guidelines
The Declaration of Helsinki
• The Declaration also states that research with
these groups should be conducted only when
the research is necessary to promote the health
of the population represented and when this
research cannot be performed on legally
competent persons.
• It further states that when the subject is legally
incompetent but able to give consent to
decisions about participation in research, assent
must be obtained

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 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

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 1. Meta – Ethics
• Is the branch of ethics that seeks to understand the nature
of ethical properties, ethical statements, attitudes, and
judgments.

• 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.

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 2. Normative Ethics
• 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

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 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:

– Medical Laboratory ethics
– Business ethics
– Medical ethics (e.g. Bioethics)
– Genetics
– Journalism ethics
– Engineering ethics
– Legal ethics

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 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

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 Professional Ethics
• concern one’s conduct of behavior and practice when
carrying out professional work.

• 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

• Attitude of the professional should be unselfish concern

for the welfare of others

Note: Professional ethics is therefore, an inherent characteristic

of professional behavior
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 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.
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 I swear by … to keep according to my
ability and judgment the following oath
 “I will follow that system of regimen which
according to my ability and judgment, I
consider for the benefit of my patients and
abstain from whatever is deleterious and
mischievous.”

Hippocratic Oath, 400

BC
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 Oath of a medical laboratory technologist

• I solemnly pledge myself to consecrate my life to the service

of humanity
• I will preserve the dignity and privacy of patients’ and others
• I will lead my life and practice my profession in uprightness
and honor
• I will exercise my profession solely for the benefit of humanity
and perform no act for a criminal purpose
• I will be loyal to the profession of medical laboratory science
• I will maintain and promote standards of excellence in
performing and advancing the art and science of medical
laboratory technology
• I will seek to establish cooperative and respectful working
relationships with other health professionals
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 1.5. Principles of Ethics
What Are Ethical Principles, and how do they help With decision
making?

• Autonomy/Freedom/ Respect for Persons

• Beneficence/generosity
• Non malfeasance
• Justice
• Veracity/truth
• Privacy/Confidentiality
• Fidelity/loyalty

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 Autonomy
• Patient has freedom of thought, intention
and action when making decisions
regarding health care procedures
• For a patient to make a fully informed
decision, she/he must understand all risks
and benefits of the procedure and the
likelihood of success.
• Independence and ability to be self directed in
health care.

• Autonomy is the basis for the client’s right to

self determination

• If the client becomes unable to make decisions

for himself/herself, a “surrogate decision
maker” would act on client’s behalf.

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 Autonomy in Research
• Voluntary participation
• Adequate information to make informed consent
• Comprehension
• Full disclosure of risks and benefits
• No undue inducement
• Voluntary termination
• Continuing disclosure
• Legally authorized representative
• Culturally appropriate consent

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 2. Beneficence
• acts of kindness or charity that go beyond strict obligation

• To do good

• Prevent evil or harm

• Effort to benefit where possible

• In health care; an obligation to improve health

• In research; Maximize benefits and minimize risks of

possible harms

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 Types of harm Types of Benefits
• Physical • Individual benefit
• Psychological • Community benefits
• Financial • Social benefits
• Harm to ones reputation

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 3. Justice
• The principle that deals with fairness, equity and
equality and provides for an individual to claim that to
which they are entitled.

–Comparative Justice: Making a decision based on

criteria and outcomes. ie: How to determine who
qualifies for one available kidney. 55 year old male
with three children versus a 13 old girl.

–Non comparative Justice: ie: a method of

distributing needed kidneys using a lottery system.
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• The four main areas that Health care
provider must consider when evaluating
justice
1. Fair distribution of scarce
resources
2. Competing needs
3. Rights and obligations
4. Potential conflicts management
Principles of distribution of burden and
benefits
• To each person with an equal share
• To each person according to individual need
• To each person according to individual effort
• To each person according to societal
contribution
• To each person according to merit

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 Principles of Ethics cont’d
4. Nonmaleficence: means to avoid doing harm. Health
professionals should not inflict harm on patients.

5. Veracity: means telling the truth, honesty which is essential to

the integrity of the client-provider relationship.

5. Fidelity: means being faithful to one’s commitments and

promises

6. Confidentiality: Confidential is a secrete or private matter not

to be divulged to others.

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