Course Title:

Professional Ethics

Course Number: MeLS 301

Credit Hours: 1
Lecture: 1 hour/week
Prerequisite: None
Instructor: Aster Tsegaye, PhD
tsegayeaster@yahoo.com

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 Course Information
Teaching Methods
• Lecture
• Role play
• Group discussion
• Assignments
Assessment Method:
• Assignment & Quiz (10%)
• Mid term examination (30%)
• Final examination (60%)
Time Allocation: 16 contact hours
Grading: Fixed scale

2
 Course Information, cont’d
Type of Examination:
• Theory:
– Multiple choice questions, Short answers, Essays
(minimum)
– Matching, Completion and True or false (Optional)

3
 Course Objectives
At the end of the course students will be able to:
• Define terms such as Ethics, Profession (professional, prof
essionalism), Behavior, Moral, Legal practice, Common law, Ci
vil law, Court, Precedent, Medical Laboratory Science
• Recognize how the law operates in relation to clinical
laboratory practice with regard to legal process, prin
ciples and penalties
• Apply ethical concepts to clinical laboratory practice i
n all interactions with clients
• Maintain the highest standard of care and profession
al ethics by identifying the rights and obligations of
medical laboratory professionals
4
 Course Objectives, cont’d
At the end of the course students will be able to:
• Support the interests and needs of clients and their f
amilies to exercise their rights to make informed de
cisions regarding their care
• Recognize and maintain code of ethics for medical la
boratory professionals
• Exercise good laboratory practice

5
1.0. IntroductionCourse Outline:
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 laboratory professi
onals

6
 Course Outline, cont’d
5.0. Duties and responsibilities of medical laboratory pr
ofessionals
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 Val
ues
8.0. Good Laboratory Practices (GLPs)

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 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 behav
ior

8
 I.0 Introduction
At the end of this session students will be able to:
• Define ethics, Profession (professional, professionalis
m), Behavior, Moral, Legal practice, Common law, Civ
il 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 be
havior
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 1.1. Definitions
1.1.1. Definition of ethics
– derived from the Greek word ethos, meaning custo
m 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 b
ad, fair or unfair
– Covers the analysis and employment of concepts su
ch as right or wrong, good or evil
Note: Professional ethics concerns one’s conduct of beh
avior and practice when carrying out professional wor
k
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 Why study ethics?
• When students enter the professional world, the
y will be expected to follow an explicit or implicit
ethical code.
• To responsibly confront moral issues raised by m
edical laboratory activities
• How to deal with ethical dilemmas in their profe
ssional lives?
• To achieve moral autonomy
 Definitions cont’d
1. 1.2. Definition of profession:
– Profession:
• A dedication, promise or commitment publicly
made
• Is a vocation or an occupation requiring knowle
dge of some department of learning or science
• Occupation, practice, or vocation requiring mas
tery of a complex set of knowledge and skills thr
ough formal education and/or practical experie
nce.
All professions are occupations, but not all occu
pations are professions
12
 Definitions cont’d
– Professional:
• A person who agrees to and commits his/her co
mmitment to the profession they chose
– Professionalism:
• The actions of the members of a profession bas
ed on the accepted code of conduct
– Code of Conduct:
• way of behaving
• a set of unwritten rules according to which peop
le in a particular group, class, or situation are su
pposed to behave
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 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 subj
ectively created by society, philosophy, religion, and
/or individual conscience
– it's possible that many moral beliefs are due to preju
dice, ignorance or even hatred.
– Ethics vs Moral
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 – Ethics vs MoralDefinitions cont’d
• 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 observati
on that actions that may be deemed moral in one cult
ure in time may not be classified as such in others or i
n a different time.
• Morality – making choices with reasons
• Ethics – the study of HOW the choices are made, i.e “ethics is t
he study of morality”
• Often use “ethics” and “morality” interchangeably

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 Definitions cont’d
1.1.5. Definition of Legal practice: legislation having le
gal enforcement
1.1.6. Definition of Common law
– evolved law i.e., the body of law developed as a re
sult of custom and judicial decisions, as distinct fro
m the law laid down by legislative assemblies.
1.1.7. Definition of Civil law:
– law of citizen's right

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 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 subsequentl
y 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-de
fined Body of Knowledge and Scope of Practice
– A profession with people educated in basic and me
dical sciences, medical techniques and research m
ethods
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1.2. History of Medical Laboratory Science
• Medical Laboratory Science (MLS):
– Part of healthcare > 100 years
– Initially included only pathologists or academic resea
rchers
– Formal training programs began in mid-1920s
– Development of automation and increased knowledg
e expanded laboratory testing capabilities and create
d demand for academically organized medical labora
tory science programs (1940-1960) No formal trainin
g programs
– Many universities developed bachelor degrees, mast
er’s and doctoral programs in medical laboratory scie
nce by the 1980s.
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 History of MLS, cont’d
• Medical laboratory sciences:
– Ethiopia since 1954 GC (Institute de Pasteur, Minellik II,
UOG, JU, Har U, Haw U, Arbaminch U, Mizan Tepi, Well
wga U, Wello U, (New: Jijiga U, Ambo U, Semera U)
– Today, MLS is a well-developed body of knowledge that
includes basic and medical sciences, medical technique
s, and research methods
– This ensures the education of medical laboratory profes
sionals and the production of quality medical diagnostic
testing
– As MLS plays crucial role in healthcare system, there ar
e numerous ethical questions that have arrived in the p
rofessional practices
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• Ethics: 1.3. History of 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
• Socrates: Any person who knows what is truly righ
t will automatically do it. Evil or bad actions, are th
e result of ignorance.
• Aristotle: posited an ethical system that may be te
rmed "self-realizationism“ ( i.e., when a person act
s in accordance with his nature and realizes his full
potential, he will do good and be content).
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 History of Ethics cont’d
• Hedonism: the principle ethic is maximizing pleasure an
d minimizing pain
• Cyrenaic hedonism: supported immediate gratification
• Epicureanism: rejected the extremism of the Cyrenaics,
believing some pleasures and indulgences to be detrim
ental to human beings
• Stoicism: the foundation of Stoic ethics is that good lies
in the state of the soul itself; in wisdom and self-control
– greatest good was contentment (happiness) and serenity (pe
acefulness). 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)

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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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 Meta – Ethics
• is the branch of ethics that seeks to understand the
• nature of ethical properties, and ethical statements, a
ttitudes, and judgments.
• concerned primarily with the:
– the fundamental semantic (meaning of ethical judgm
ents and/or prescriptions ), ontological (theory of bei
ng), and epistemic (about knowledge) nature of ethic
s or morality
– addresses questions such as "What is goodness?" and
"How can we tell what is good from what is bad?", se
eking to understand the nature of ethical properties
and evaluations.
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 Normative Ethics
• investigates the set of questions that arise when we t
hink about the question “how ought one act, morally
speaking?” "What should one do?",
• distinct from meta-ethics because it examines standa
rds for the rightness and wrongness of actions, while
meta-ethics studies the meaning of moral language a
nd the metaphysics of moral facts.

• Semantics of ethics divides naturally into:

– Descriptivism
– Non-descriptivism
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• Descriptive ethics – “What IS”
• Prescriptive ethics – “What OUGHT to be”
• Descriptive, or scientific, studies of professional e
thics help us identify issues that need to be includ
ed in Code of Ethics and in educational programs.

• 2002 British study by Burgess and Mullen: 77% of

hygienists had witnessed ethical misconduct by c
olleagues within last 5 years

25
 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
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 Descriptive Ethics
Patricia Logan 2001, USA. Reported reasons for
misbehavior, hygienists:
1. Economic pressure
2. Transition from employee to consultant resu
lts in compromises
3. Working in foreign countries
4. Lack of legal standards
5. Decrease in job security

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 Non-Descriptive Ethics
• contends that ethical propositions are irreducibl
e in the sense that their meaning cannot be expli
cated sufficiently in terms of descriptive truth-co
nditions.

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 Applied Ethics
• Is a discipline of philosophy that attempts to apply ethica
l theory to real-life situations
• There are several sub-branches of professional/applied e
thics:
– Business ethics
– Medical ethics (e.g. Bioethics)
– Medical Laboratory ethics
– Journalism ethics
– Engineering ethics
– Legal ethics
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 Applied Ethics cont’d

• One of the major areas where ethicists practice is in t

he field of health care. These include:
– Medical ethics
– Nursing ethics
– Pharmacy ethics
– Medical Laboratory ethics

30
 Professional Ethics
• concerns the moral issues that arise because of the speci
alist knowledge that professionals attain, and how the us
e of this knowledge should be governed when providing
a service to the public.
• is the moral principle, which should guide members of th
e profession in their dealings with each other and with th
eir patients, the patrons (clients), the state etc
• is a collective and disciplined concern of the group
• attitude of the professional should be unselfish concern f
or the welfare of others
Note: Ethics is therefore, an inherent characteristic of prof
essional behavior
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 Professional Ethics, cont’d
• Adherence to professional standards is expressed thr
ough taking a professional oath and accepting profes
sional code of ethics
• The oath is usually brief, general and intended to obli
gate and inspire the professional to abide by applica
ble laws, codified ethics and the dictates of conscienc
e and religious principles
• The code of ethics, compared with an oath is normall
y more detailed and more explicit.

32
 Professional morality vs Ethics
• Professional Morality – what we do in our occ
upational lives
• Professional Ethics – the study of what we do i
n our professional lives

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 1.5. Principles of Ethics
• Principles are basic ideas that are starting points for un
derstanding 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 re
gard
• The most commonly accepted principles of medical et
hics include:
– Respect for Patient Autonomy
– Beneficence and Nonmaleficence
– Justice
• Other principles include informed consent, confidentia
lity and honesty 34
 Principles of Ethics cont’d
The major principles of medical laboratory ethics are:
1. Autonomy: means independence and ability to be self dir
ected 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 partici
pate in decision making about their healthcare. If the client bec
omes unable to make decisions for himself/herself, a “surrogat
e decision maker” would act on client’s behalf.
2. Beneficence: acting in the best interests of patients (doin
g or promoting good). This principle is the basis for all he
alth care providers

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 Principles of Ethics cont’d
3. Nonmaleficence: means to avoid doing harm. Health pr
ofessionals should not inflict harm on patients.
4. Justice: fair, equitable and appropriate treatment. Trea
t all patients equally – no unfair discrimination.
5. Veracity: means telling the truth, which is essential to t
he integrity of the client-provider relationship.
6. Fidelity: means being faithful to one’s commitments an
d promises
7. Confidentiality: comes from Latin fide: trust. Confidenti
al is a secrete or private matter not to be divulged to ot
hers.

36
1.6. Characteristics of Professional an
d Ethical
• Professional ethics:
Behavior
– Deals with moral issues that arise due to specialist knowle
dge that professionals attain
– Decides how the use of this knowledge should be governe
d when providing a service to the public
– Is the moral principle which should guide the members of t
he profession in their dealings with each other, their patie
nts, co-workers
– Is a collective and disciplined concern of the group
– Should be altruistic and unselfish concern for the welfare o
f others
– Ethics is an inherent characteristic of professional behavior

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Characteristics of Professional and Ethical Behavior

• Ethical Behavior
– Actions by a person or a group that adhere to the
commonly accepted behavioral patterns of the gr
oup
– When faced with a choice of behaviors, a person e
xhibits behavior based on accepted behaviors of t
he group

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 2.0
Interpersonal Relationships

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 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 oth
er health professionals
2.5. Medical laboratory patient- relationships

40
2.1. Interpersonal relationships w
ith patients
• Medical Laboratory professionals are accountable for
the quality and integrity of the laboratory services th
ey provide
• The medical laboratory technologist should:
– always regard concern for the best interests or we
ll-being of your patients as your primary professio
nal duty.
– honor the trust of your patients
– be mindful that a medical laboratory science prac
titioner is in a position of power over a patient an
d avoid abusing your position.
41
Interpersonal relationships with p
atients, 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-g
oing process
– recognize the rights of patients to expect that you
will not pass on any personal and confidential infor
mation you acquire in the course of your professio
nal duties, unless they agree to disclosure or the la
w demands
42
Interpersonal relationships with p
atients, cont’d
• The medical laboratory technologist should:
– Ask patients’ permission before sharing informatio
n with their spouses, partners or relatives.
– always seek to give priority to the laboratory diag
nostic service to patients solely on the basis of clin
ical need.

43
2.2. Interpersonal relationships wi
th family
• Group activity
1.Have you ever accompanied a friend or family me
mber to a hospital
2. Were you afraid - did healthcare professionals at t
he hospital smile and offer to help you? – were you
treated with respect?
3. Please give examples of behaviors that were positi
ve and also those examples that were negative

44
 2.3. Interpersonal relationship wi
th 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 off
er to answer questions for directions; questions abou
t the patient’s condition should be directed to the pa
tient (or clinician with patient approval)
• Respect family and visitor dignity

45
2.4. Interpersonal relationship with colle
agues 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 cann
ot be fully justified

• Actively strive to establish cooperative and respectf

ul working relationships with other health care prof
essionals with the primary objective of ensuring a hi
gh standard of care for the patients they serve.

46
Interpersonal relationship with colleagues
and other health professionals, cont’d
The medical laboratory technologist should:
• Not discriminate against colleagues, including profession
als applying for posts
– Because of race, culture, ethnicity, social status, lifestyle, perc
eived 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 car
e professionals

• share their knowledge with colleagues and promote lear

ning
47
2.5. Medical laboratory patient-rel
ationships
• 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

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 Communication and consent
• The patient has the right to self- determination, to m
ake free decisions regarding himself/herself.
• The medical laboratory professional will inform the p
atient of the consequences of his/her decisions.
• A mentally competent adult patient has the right to g
ive or withhold consent to any diagnostic procedure
or therapy.
• The patient has the right to the information necessar
y to make his/her decisions.

49
 Communication and consent
• The patient should understand clearly the purpose of a
ny 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 capab
le to make a decision, a surrogate decision maker need
s to be part of the discussion.
• The surrogate decision maker is a person designated b
y the patient to make medical decisions in the event th
e patient is unable to.

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 Informed Consent
• Definition: A patient’s willing acceptance of a medical intervention
after adequate disclosure from the health professional of the natur
e of the intervention, risks, benefits and alternative treatment optio
ns
• What constitutes informed consent?
– Disclosure: information to allow reasonable person to make a de
cision
– Understanding: comprehension of the information given
– Voluntary: no coercion or incentive to accept or deny a treatmen
t
– Agreement: verbal or written (preferred) to discussed interventio
n

51
 Confidentiality

• The medical laboratory professional’s duty to

keep patient information confidential has bee
n a cornerstone of medical laboratory ethics.
• Medical laboratory professionals shall preserv
e absolute confidentiality on all he knows abo
ut his patient even after the patient has died.

52
 Confidentiality
• Patient confidentiality must be upheld
• Breaching patient confidentiality may be merite
d only:
– When ordered by court of law – a court case
– Where statutory requirement – public health laws
– Where required in health professional’s defense –
malpractice suit
– Where necessary for appropriate patient care-spea
king to another provider in the medical care system

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3.0. Principles of confidentiality and pr
ivacy responsibility

54
3.0. Principles of confidentiality and privacy resp
onsibility
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

55
 Ethical Dilemma
• Situations in which two or more moral obligations, d
uties, rights, or ideals come into conflict
– there is no clear right or wrong answer or there m
ay be more than one correct solution
• To resolve we must identify the factors, gather facts,
rank moral considerations, consider alternative cours
es of actions, and arrive at a judgment.

56
 Resolution of Dilemmas

• Some dilemmas are resolved because they are not m

oral dilemmas.
• Some MORAL dilemmas can be resolved through a cr
eative third alternative that satisfies both moral outc
omes.
• Or, possible to sequentially act on each one.
• Or, evaluation will show which is strongest moral exp
lanation and decision

57
 Ethical Dilemma Group Activity*:
• The hijacked plane with 200 people is approac
hing 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?
Ethical / Moral Theories

59
 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, vir
tues, etc.)
• helps us resolve conflicts between rules and between
values.

60
 How We Come by Moral Theories

• Family
• Religion
• Culture
• Experience and reflection
• Education

61
 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?

62
 Human Goods
• Human life considered to be fundamental goo
d, pre-conditional good

• Human life is not measurable, “life is priceles

s”

• Leads to dilemmas in the workplace

63
 1. Consequentialism
• argues that the morality of an action is contingent on t
he 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 n
et good
• all acts are potentially permissible; depends on conse
quences
• all persons count equally
• difficult to determine which consequences, what prob
ability, what weight?
• May sacrifice individuals for greater good
64
 Consequentialism cont’d
– Utilitarianism:
• one forms of Consequentialist theories which h
olds that an action is right if it leads to the most
happiness for the greatest number of people.

65
 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 indivi
dual

66
 3. Duty-Based Theories
• Duty = obligation, responsibility
• Considers motive or intention of decision-maker, plus nat
ure of act, rights, consequences
• Good motive, means are acceptable, nature of act is good
• Consequences are of secondary consideration
• Recognizes complexity
• Value of individual is important
• May sacrifice community good for the sake of individual d
uty

67
 Kantianism
• Decide if an act is right or wrong without looking at c
onsequences
• Duty to:
– “Always tell the truth”
– “Always avoid taking an innocent life”
– “Always treat others as ends in themselves and ne
ver as means solely” Basis of respect for persons
• “Deontological” = prior to action
• Motivated by reason alone
• “Universal moral imperatives”

68
 Virtue-Based Theories
• Act for the sake of virtue, or as a virtuous person wo
uld
• 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 othe
rs
• Virtues may be culturally specific
69
 Virtues
Examples:

• Benevolence (kindness)
• Justice
• Friendliness
• Honesty
• Integrity

70
 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 b
reach of law
• Breach of ethical obligation may be used to prove medi
cal malpractice or medical negligence
• Ethics consists of far more than abiding by rules, proced
ures, and guidelines. Even the most detailed of laws can
not govern every aspect of our laboratory experience or
keep pace with the explosion of knowledge and technol
ogy we have seen in the medical field.
71
 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 con
flicts in a way to preserve the basic societal order
• Legal codes set a general standard of conduct which must
be adhered to in civil law
• Ethics 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 w
hat we must do. It represents an expression of conscience
rather than the obligatory fulfillment of governmental fiat.

72
 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 caveat
s)
• Professional ethics covers more issues than the law
• One can be unethical without behaving illegally
• Rare – ethically must resist the law
73
 Ethics vs Law
Be very careful not to embark in an exercise in e
thical analysis when there is a clear legal rule in t
he situation that trumps the entire process of et
hical analysis.

Be very careful not to assume that there is a leg

al rule for every situation. Often the gaps betwe
en legal rules require one to switch to an ethical
analysis.

74
3.1.3 Ethics and Medical Laborator
y Science
• Health professional’s ethics emanated and expressed
through:
– Law

– Institutional policies

– Policy of professional organization

– Professional standards of care

75
3.1.3. Ethics and medical laboratory science, co
nt’d
Responsibility/ethical duty of Medical Laboratory Pro
fessionals:
• 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

76
 3.2.1. Professional Responsibility
Professional responsibility:
– is the area of practice that encompasses the dutie
s/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 in
terests.

77
Professional Responsibility cont’d
Medical laboratory professionals
1. Have a responsibility to never disclose confidenti
al patient or co-worker information
2. Are under a strict duty of confidentiality to keep
information received in the course of their work
secret.
3. Have the ethical responsibility to make the best
decision in every situation

78
4.0. Rights and Obligations of Me
dical Laboratory Professionals:

79
4.0. 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

80
4.0. Right and obligation of medic
al laboratory professionals:
4.1. Honesty
• In performing lab testing
• In reporting lab results
4.2. Dependability
• Taking your position seriously
• Being at work when you assigned to be
4.3. 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
81
Right and obligation of medical laboratory prof
essionals cont’d
4.4. Humanity and Justice
• Be fair in running all patients’ laboratory tests
• Put yourself in the patient’s position before you argue o
r say something you will regret
• Put yourself in your co-worker’s position before you arg
ue 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 l
og books
• Be honest in all your reporting
82
Right and obligation of medical laboratory prof
essionals cont’d:
4.6. Adaptability
• Be willing to change work hours to help a co-worker
• Be willing to stay at work a little longer if patient work i
s not completed
• Be willing to make changes in testing procedures and ot
her areas as needed
4.7. Co-operation
• If you expect others to co-operate with you, you need t
o co-operate with them
• Team work will finish lab work quicker than an individu
al
83
Right and obligation of medical laboratory prof
essionals cont’d:
4.8. Ethical behaviors
• In all that you do, base your actions and decisions on et
hical behavior

84
 5.0.
Duties and responsibilities of Med
ical Laboratory Professionals:

85
 5.0 Duties and responsibilities of
medical laboratory professionals:
5.1. Discuss duties and responsibilities of medical laboratory pr
ofessionals
5.2. Research Role Play situations:
5.2.1. that might occur in the laboratory workplace
5.2.2. involving patients, their families, and medical laboratory
professionals
5.3. In small groups Role Play:
5.3.1. examples of situations when making a professional decisi
on is difficult
5.3.2. examples of situations when making an ethical decision i
s difficult
86
5.0 Duties and responsibilities of medical labor
atory professionals:
5.1. Discuss duties and responsibilities of medical labo
ratory professionals
5.1.1. duty to self
5.1.2. duty to profession
5.1.3. duty to society
5.1.4. duty to environment
5.1.5. duty to patients

87
 5.1.1. Duties to yourself
The medical laboratory technologist should:
• Maintain and improve the standard of your performan
ce by keeping your professional knowledge and skills u
p 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
• Refrain from engaging in activities that may affect your
health and lead to impairment
• Be aware of laws and regulations governing medical la
boratory technology
88
 5.1.1 Duties to yourself, cont’d
The medical laboratory technologist should:
• 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

• never taking anything from place of work that does n

ot belong to you
89
 5.1.2. Duties to your profession
The medical laboratory technologist should:
• uphold and maintain the dignity and respect of med
ical 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 education,
and
– seeking fair socioeconomic working conditions for m
embers of the profession.
90
 5.1.2. Duties to your profession
• promote the image and status of your profession by
maintaining high standards in your professional prac
tice and through active support of your professional
bodies.
• take responsibility for your professional acts
• not misuse your professional skills or knowledge for
Personal gain

91
 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 o
f the public

92
 5.1.4 Duties to the environment
The medical laboratory technologist should:
• protect the environment and the public by assuring t
hat health care waste is disposed of legally and in an
environmentally friendly manner

93
 5.1.5 Duties to Patients
Medical laboratory professionals Obligations:
• always regard concern for the best interests or well-being o
f 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 you
r position.
• respect patients’ privacy and dignity
• treat patients politely and with consideration
• apply the principle of informed consent as an on-going pro
cess

94
 5.1.5 Duties to Patients, cont’d
Medical laboratory professionals should:
• recognize the rights of patients to expect that you will n
ot pass on any personal and confidential information yo
u acquire in the course of your professional duties, unle
ss they agree to disclosure or the law demands
• ask your patients’ permission before sharing informatio
n 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.
• Medical Laboratory professionals are accountable for t
he quality and integrity of the laboratory services they
provide

95
“Remember the patient is the reas
on, and the only reason for your
professional existence: In order f
or a patient to receive the best c
are possible, you must make pro
per diagnosis.”
96
 Ethics Role Play Activity (Assignment)

• Students are divided into groups of two or three and

given 1-2 class period to research and plan their Role
Play Activity
• The class will present and be graded according to the
Role Play Rubric on the next slide.
• Those students not presenting will be allowed and en
couraged to ask questions to the presenting group a
fter the presentation

97
 Role Play Assignment Criteria
• Each group must decide on an Ethical Dilemma/Issue to Role
Play both the proper and improper way to handle the situatio
n (see examples listed in lecture # 4)
• Ethical Dilemma/Issue should be stated in the introduction al
ong with the names of the student participants
• All participants (2-3 students) must work together and contrib
ute to assignment
• Presentation time should be exactly 14-16 minutes
• Students should speak clearly and in loud enough voice for cla
ss to understand

98
 Ethics Role Play Activity Grading Rubric

Grading Point 0-2 points 3-6 points 7-10 points Points

Earned
Organization of No organization Generally Organized
materials organized, but understandable
difficult to follow
All students Only one both students did All students
participated student work, one > 50% of participated on
participated work assignment
Presentation Time <10 minutes >16-20 minutes 14-15 minutes

Role Play stated No identifiable Stated dilemma Role Play stated

Ethical Dilemma Ethical Situation stated but was not clearly
clearly understood portrayed
Clarity of speech Could not 50% or less too loud Participants
understand or too soft to hear easy to
participants clearly understand
99
TOTAL POINTS EARNED:
 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 di
agnosis, treatment
6.6. Right to know Ethiopian medico-Legal issues (code
of law)

100
 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
101
 A patients bill of rights, cont’d
• As the setting for the provision of health services, ho
spitals must provide a foundation for understanding
and respecting the rights and responsibilities of patie
nts, their families, physicians, and other caregivers
• Hospitals must ensure a health care ethic that respec
ts the role of patients in decision making about treat
ment choices and other aspects of their care
• Hospitals must be sensitive to cultural, racial, linguis
tic, religious, age, gender, and other differences as w
ell as the needs of persons with disabilities

102
 A patients bill of rights, cont’d
Example: The American Hospital Association
•presents A Patient's Bill of Rights with the expectation that it
will contribute to more effective patient care and be supported
by the hospital on behalf of the institution, its medical staff,
employees, and patients

•encourages health care institutions to tailor this bill of rights to

their patient community by translating and/or simplifying the
language of this bill of rights as may be necessary to ensure
that patients and their families understand their rights and
responsibilities
•These rights can be exercised on the patient’s behalf by a
designated surrogate or proxy decision maker if the patient
lacks decision-making capacity is legally incompetent, or is a
minor.
103
 Bill of Rights

6.1. Right to truth

• The patient has the right to considerate and respectf
ul care
• The patient has the right to ask and be informed of t
he existence of business relationships among the hos
pital, educational institutions, other health care provi
ders, or payers that may influence the patient's treat
ment and care
• Patients are responsible for providing information ab
out past illnesses, hospitalizations, medications, and
other matters related to health status
104
 Bill of Rights

6.2. Right to refuse treatment

• The patient has the right to make decisions about th
e plan of care prior to and during the course of treat
ment and to refuse a recommended treatment or pla
n of care to the extent permitted by law and hospital
policy and to be informed of the medical consequenc
es of this action.

105
 Bill of Rights

6.3. Right to know about Informed consent

• The patient has the right to have an advance directiv
e (such as a living will, health care proxy, or durable p
ower of attorney for health care)
• Health care institutions must advise patients of their
rights under state law and hospital policy to make inf
ormed 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
106
6.4. Right to privacy Bill of Rights
• The patient has the right to every consideration of privacy
• The patient has the right to expect that all communications a
nd records pertaining to his/her care will be treated as confi
dential 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 emp
hasize the confidentiality of this information when it release
s it to any other parties entitled to review information in the
se records

107
 Bill of Rights
6.5. Right to get complete information concerning his diagnos
is, treatment
• The patient has the right to and is encouraged to obtain fro
m physicians and other direct caregivers relevant, current, a
nd understandable information concerning diagnosis, treatm
ent, and prognosis
• The patient has the right to consent to or decline to participa
te in proposed research studies or human experimentation
• The patient has the right to expect reasonable continuity of c
are when appropriate and to be informed by physicians and
other caregivers of available and realistic patient care option
s when hospital care is no longer appropriate

108
 Bill of Rights
6.6. Right to know Ethiopian medico-Legal issues (cod
e of law)
• The patient has the right to be informed of hospital p
olicies and practices that relate to patient care, treat
ment, and responsibilities
• The patient has the right to be informed of available
resources for resolving disputes, grievances, and con
flicts, such as ethics committees, patient representati
ves, or other mechanisms available in the institution
• The patient has the right to be informed of the hospi
tal's charges for services and available payment meth
ods
109
 Bill of Rights
• Patients are responsible for providing necessary infor
mation for insurance claims and for working with the
hospital to make payment arrangements, when nece
ssary.
•

110
6.6.1. Legal concepts in Medical La
boratory
General Legal Concepts
• Law:
– defined as those rules made by humans who regul
ated social conduct in a formally prescribed and le
gally binding manner
– based upon concerns for fairness and justice

111
Functions of Law in Medical Labor
atory
• It provides a framework for establishing which medica
l laboratory action in the care of client are legal
• It differentiates the medical laboratory professionals r
esponsibilities from those of other health professional
s
• It helps to establish the boundaries of independent m
edical laboratory action
• It assists in maintaining a standard of medical laborato
ry practice by making medical laboratory professional
accountable under the law

112
 Types of law
Law governs the relationship of private individuals wit
h 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 relatio
nship between individuals
• Contract Law: involves the enforcement of agreeme
nts among private individuals or the payment of com
pensation for failure to fulfill the agreements.

113
 Types of law cont’d
• Tort Law: the word tort means “wrong” or “bad” in L
atin. It defines and enforces duties and rights among
private individuals that are not based on contractual
agreements. Example of tort law applicable to medic
al laboratory, negligence and malpractice.

114
Legal Aspects of Laboratory Medic
ine
A.Malpractice: legally, a failure to provide the standard
of care that is due a patient, i.e. professional neglige
nce
B. Three distinct elements must be present
1. Patient must have sustained measurable injury
C. 2. Court must find negligence on the part of t
he defendant that professional standards of care was
not followed
D. 3. There must be proof the negligence was th
e cause (legal term: proximate cause) of the patient's
injury
115
 Most Common Areas of Potential
Negligence
• Misidentification, mislabeling
• Instrument failure: poor Quality Control, failure to st
andardize instrument, jammed key on automatic prin
tout device, misplaced decimal points on calculations,
inversion of numeric values.
• Specimen validity: proper collection and handling
• Venipuncture
•

116
Legal issues in Medical Laboratory
Medical Laboratory Practice Act:
• regulate the practice of medical laboratory
• Legally define and describe the scope of medical labora
tory 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 st
andards for entry in to the profession and to distinguis
h the unqualified.
117
Standards of professional Practice
• attempts to ensure that its practitioners are compet
ent and safe to practice through the establishment
of standard practice
• Establishes and implements standards of practice ar
e major functions of a professional organization
• The profession’s responsibilities inherent in establis
hing and implementing standards of practice includ
e:
– To establish, maintain, and improve standards
– To hold members accountable for using standard
s
118
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 th
em
– To safeguard individual members of the profession
• When standards of professional practice are implemen
ted, they serve as yardstick for the measurements use
d in licensure, certification, accreditations, quality assu
rance, peer review, and public policy.
• The profession maintains standards in practice in part t
hrough appropriate entry.

119
 Credentialing
• is the process of determining and maintaining compe
tence-medical laboratory practice. Credentials includ
e:
• Licensure
• Registration
• Certification
• Accreditation

120
 Credentialing, cont’d
• Licensure: it is a legal permit a government agency gra
nts to individuals to engage in the practice of a profess
ion and to use particular title.
• Registration: is listing of an individual’s name and othe
r information on the official roster of a governmental a
gency.
• Certification: is the voluntary practice of validating tha
t an individual medical laboratory professional met mi
nimum standards of medical laboratory competence.
• Accreditation: is a process by which a voluntary organi
zation or governmental agency appraises and grants a
ccredited status to institutions and/or programs.

121
 7.0. Medical Laboratory code of co
nductof a group’s ideas and values t
• Code of ethics is a formal statement
hat serve as standards and guidelines for the groups’ professional a
ctions 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 an
d professional obligations toward one another, their clients, and so
ciety in general.
• Code of ethics is generally developed by a professional society with
in a particular profession. The higher the degree of professionalism
required of society members, the stronger and therefore more enf
orceable the code.

122
Medical laboratory code of conduct c
ont’d
Purpose of medical laboratory code of ethics:
• To inform the public about the minimum standards
of profession and to help them understand professi
onal 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 p
rofession
• To provide general guidelines for professional beha
vior
123
Medical Laboratory code of conduct c
ont’d
• To guide the profession in self regulation
• To remind medical laboratory professionals on the sp
ecial responsibility they assume when they perform t
heir duties.

124
Medical Laboratory code of conduct ….
International Federation of Biomedical Laboratory Sci
ence (IFBLS) Code of Ethics
• The need for medical laboratory is universal
• Inherent in medical laboratory is respect for life, dig
nity, and rights of human
• It is unrestricted by considerations of nationality, ra
ce, color, age, sex, politics or social status
• 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, represe
nting more than 165,000 medical laboratory scientists a
nd technologists worldwide.
125
 IFBLS Code of Ethics:
Biomedical Laboratory Scientists shall:
• Be dedicated to the use of clinical laboratory science to benefi
t mankind
• Actively seek to establish cooperative and specific working rel
ationships with other health professionals
• Provide expertise to advise and council other health professio
nals
• Maintain strict confidentiality of patient information and test r
esults
• Safeguard the dignity and privacy of patients
• Be responsible for the logical process from the acquisition of s
pecimen to the production of data and the final report of the t
est result

126
 IFBLS Code of Ethics:
Biomedical Laboratory Scientists shall:
• Be accountable for the quality and integrity of clinical
laboratory services
• Exercise professional judgment, skill and care while
meeting established standards
• Uphold and maintain the dignity and respect of the p
rofession and strive to maintain a reputation of hone
sty, integrity and reliability
• Strive to improve professional skills and knowledge a
nd adopt scientific advances that benefit the patient
and improve the delivery of test results
127
Medical Laboratory Ethics in Ethiopia
Ethiopian Medical Laboratory Association (EMLA) p
repared code of ethics for Medical Laboratory Pr
ofessionals practicing in Ethiopia. It comprises o
f six parts.

128
Code of Ethics for Medical Laboratory
Technologists Practicing in Ethiopia
• Deals with medical laboratory professional duties to
patients (Part I)
• Explains medical laboratory professional duties to co
lleagues and other professionals (Part II)
• Clarifies medical laboratory professional duties to hi
mself/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 duties to en
vironments (Part VI)
129
 Professional
Values and Virtues

130
 Professional Codes and Justice
• Accountability: punish professionals who viol
ate standards
• Duty to report colleagues’ wrong-doing for r
etributive justice to be carried out
• Fairness in distribution of professional servic
es (no discrimination)
– warning, reprimand, suspension, expulsion from
group
– More than one form of justice can be in play at s
ame time
131
 Compassion
Two rules:
• Alleviate suffering
• Act in other person’s actual (to them) best int
erest

132
 Confidentiality
Confidentiality regarding:
1. Whose interests
2. Which interests

133
 Confidentiality
Confidential information of:
1. Worker
2. Employer
3. Colleague
4. Competitor

134
 Lecture # 8:
Good Laboratory Practices (GLPs)

135
8.0 Good Laboratory Practices (GL
Ps)
• Laboratory services are an integral part of disease dia
gnosis, treatment, monitoring response to treatment,
disease surveillance programmes and clinical researc
h.
• Laboratory test results, therefore, should be reliable,
accurate and reproducible. Generation of such 'qualit
y' results involves a step wise process of meticulous
planning, perfect execution and thorough checking o
f results by the whole team involved.

136
 Good Laboratory Practices
• In the clinical and research arena, the phrase good la
boratory practice or GLP generally refers to a system
of management controls for laboratories and researc
h organisations to ensure the consistency and reliabil
ity of results
• Good Laboratory Practice (GLP) embodies a set of pri
nciples that provides a framework within which labor
atory studies are planned, performed, monitored, re
corded, reported and archived.

137
 GLP includes
– Infrastructure
• Infrastructure of laboratories should be planned ac
cording to the services provided by the laboratory.
– Equipment
– Reagents and materials
– Specimen collection
– Requisition form
– Accession list
– Worksheet
– Reporting test results
– Specimen rejection record

138
 GLP includes
– Data management (recording, reporting and archivin
g)
– Standard operating procedure (SOP)
– Safety in laboratories (to protect both staff and the e
nvironment
– Ethical considerations
– Quality assurance: the total process whereby the qua
lity of laboratory reports can be guaranteed.
– IQC
– External quality assessment
– Internal audit (identify problems and weak points in t
he system and suggest remedial measures

139
Professional Ethics Case studies

140
 References

• Ethiopian Medical Laboratory Association (Ethiopia Medical L

aboratory 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 p
ublishers INC 3rd edition
• International Federation of Biomedical Laboratory Science (IF
BLS) code of ethics IFBLS general assembly of delegates, 1992

141