i NORTHERN CARIBBEAN UNIVERSITY COLLEGE OF ALLIED HEALTH AND NURSING DEPARTMENT OF MEDICAL TECHNOLOGY

Title: Ethics Portfolio Presented in partial fulfillment of the course: MTCH200: professional Ethics in Health

Done by: Unknown

April 12, 2013

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Table of Content

Page Acknowledgement ---------------------------------------------------------------------------------------------- 1 Introduction ------------------------------------------------------------------------------------------------------ 2 Summary of my experience ------------------------------------------------------------------------------------ 3 Incidents of poor ethical conduct that were observed ------------------------------------------------------ 5 Incident #1 ---------------------------------------------------------------------------------------------- 5 Incident #2 ---------------------------------------------------------------------------------------------- 5 Incident #3 ---------------------------------------------------------------------------------------------- 6

Incidents of good ethical practices observed ---------------------------------------------------------------- 7 Incident #1 ---------------------------------------------------------------------------------------------- 7 Incident #2 ---------------------------------------------------------------------------------------------- 8 Incident #3 ---------------------------------------------------------------------------------------------- 9

Incidents of ethical dilemmas faced by Dr. Edwards------------------------------------------------------- 10 Incident #1 ---------------------------------------------------------------------------------------------- 10 Incident #2 ---------------------------------------------------------------------------------------------- 11 Incident #3 ---------------------------------------------------------------------------------------------- 12

Appendices ------------------------------------------------------------------------------------------------------- 13 References -------------------------------------------------------------------------------------------------------- 16

Acknowledgement

I express my gratitude to my lecturer, Ms. Walker for allowing for me to have this opportunity. Through the experience of my voluntary service, I have learnt a lot and have gained practical insight as to what the true nature of the medical technology working environment is like. I also thank my colleagues for finding the time to participate in discussions of ethics and morals with me, because through these discussions, I was able to find logical explanations and good reasoning behind the good and bad ethical practices that I observed. Lastly, I thank the Healthcare professionals of the Medical Associates Laboratory for facilitating me for the duration of my 10 hours. Through this opportunity, and the use of the appropriate books, I was able to properly compose the contents of this portfolio.

Introduction

The aim of this portfolio was to observe and report on the ethical practices of the staff at a medical facility during ten hours of voluntary services that I was required to complete. These ten hours was done at the Medical Associates Hospital in Kingston. The portfolio entails incidences of poor ethical conduct as well as the good ethical practices of the staff that was observed. Also, a healthcare practitioner was interviewed and incidences of ethical dilemmas faced by this practitioner were discussed and the means by which these dilemmas were resolved was explained; after which the findings were elaborated on and critiqued. Pictures of my work experience within the laboratory were also taken and placed in the portfolio. Ethics is the systematic study of and a reflection on morality. Systematic because it is a discipline that uses special methods and approaches to examine moral situations and a reflection because it consciously calls into question assumptions about existing components of our moralities that fall into the category of habits, customs and traditions (1). Healthcare professionals are defined by a standard of conduct deep-rooted in commitment, confidentiality and relationships. Committed to performance improvement and maintaining integrity. Healthcare quality professionals recognize personal accountability and moral obligations to all customers, clients, employees, employers, physicians, organizations and the public. They promote the dignity of the profession and are committed to practicing the profession with honesty, as well as respecting all laws and refusing to participate in or conceal any unethical, false, fraudulent or deceptive activity. The importance of good ethics is that it builds the integrity of an institution, it is integral to success and it allows for awareness as it regards the consequences of our actions; this is why it is recommended that good ethical conduct be practice at all times.

A summary of my experience

I completed a total of 10 hours and 37 minutes of voluntary service at the Medical Associates hospitals Medical Technology Laboratory in Kingston. The laboratory was very small and it consisted of four major departments; urinalysis, microbiology, special chemistry and hematology. I also conducted an interview with a medical Practitioner, Dr. Robert Edwards, for duration of 30 minutes. He stated and elaborated on three of many ethical dilemmas he has encountered in his field of practice while attending to patients. He also gave the solutions he used to resolve these dilemmas. I began my first two hours at the laboratory on Friday March 15, 2013. I started in the urinalysis department where I observed urine samples using the microscope. I was able to identify the few formed elements that were present in the sample. The medical technologist carried out her job effectively and efficiently as it regards the timely testing of each sample and the recording of the results. I spent most of my 10 hours in the area of blood collection where I observed the ethical conduct of the phlebotomists. I became more familiar with the various types of tests that are usually conducted in the lab. I was also taught the use of the chemical analyzer machine that is found in the special chemistry department. This machine is used to determine the concentration of analytes such as electrolytes, urine, proteins, CSF, and other body fluids. I became more aware of the significance of each of the departments and how they aid in proving accurate, reliable and optimum test results for the diagnosis and treatment of diseases. Each healthcare practitioner treated their fellow employee equally and with respect, each employee was notified of any changes that were to take place in the lab. I enjoyed my time spent at this lab facility; the employees were quite warm and welcoming. They were willing to answer any questions I had, and shared their knowledge as it regards the field of study and their experiences in their field of practice. I felt welcomed and at home working alongside these healthcare professionals.

4 Both the good and bad ethical practices that I have observed during the duration of my hours, has impacted my perspective on the conduct of healthcare professionals. I have come to realize the true nature and importance of good ethical practice as well as healthcare practitioners. I will do my best to put into practice what I have been taught as it relates to good ethical conduct, in any facility I may be employed as well as in my day to day activities. My only regret was that the laboratory was not larger and had more departments where I could have been more exposed to the other areas of medical technology.

3 incidents of poor ethical conduct that were observed

Incident #1 The phlebotomist was observed wearing slippers in the lab and also while collecting blood from patients. The ethical resolution The wearing of proper personal protective equipment (PPEs) is essential in the laboratory. Proper footwear plays a very important role in protecting healthcare workers from exposure to bloodborne pathogens as well as the possibility of being injured by sharps and additionally becoming infected. The wearing of slippers in the laboratory is also unprofessional and lackadaisical. The phlebotomist at the laboratory should have been wearing the correct footwear. A closed toe shoes is always recommended especially during the collection of blood from a patient. A needle stick could have occurred in an incident that the needle had fallen. Healthcare professionals should be properly attired when in the work environment and this should be practiced at all times. Incident #2 On more than one occasions, no gloves were worn during the collection of blood samples from patients. In one instance, after identifying and cleansing the venipuncture area, the health care practitioner felt the site again with her finger then proceeded to stick the patient in that same area and collected the sample. The ethical resolution

6 Personal protective equipment should be worn at all times in the laboratory. In practical terms, gloves play an important role in protecting healthcare workers from exposure to blood-borne viruses. It is important to remember that the collection of a specimen by venipuncture may involve the potential exposure to these pathogens as well as other safety considerations for both the phlebotomist and the patient. Also, as it relates to the touching of the venipuncture site after decontamination, this put the patient at risk of being exposed to any pathogen that may have been present due to the recontamination of that area, and therefore should not be practiced. The correct action of the phlebotomist should first and foremost be that she is wearing a pair of gloves. After the vein is identified and the area is cleansed with isopropyl alcohol, it should be left to air dry and should not be touched again. The phlebotomist should have had a visual image in her mind of where she intended to stick the patient so as to avoid having had to relocate the vein. Or, since this was not done, she should have cleansed the area again after she had felt it the second time before going ahead and sticking the patient. Incident #3 On one occasion while collecting blood from a patient, the blood stopped flowing, the medical technologist/phlebotomist, that was collecting the blood at the time, removed the tourniquet and the needle from the patients vein after unsuccessful attempts to get the blood to start to flow again. She then opened the tube, placed it at the venipuncture area, then used her index finger to squeeze the blood through the puncture site and into the tube in an attempt to acquire adequate amount of blood. However, even at the end of such an attempt, the tube still did not contain enough blood to be used for testing. Even then it was not discarded; it was labeled and placed in the test tube holder. The ethical resolution

7 As medical technologists it is our duty to ensure that no harm is inflicted upon the patient. The principle of non-maleficence speaks to this. It imposes the duty to avoid or refrain from harming the patient. The practitioner who cannot bring about good for the patient is bound by duty to at least avoid harm. By squeezing the puncture area in an attempt to increase blood flow so as to obtain blood is a poor ethical practice and is therefore deemed unprofessional. This action puts the patient at risk of developing a hematoma or any other health ricks that may be associated with such. Though the sole purpose of the phlebotomy procedure is to obtain blood, this should be done using the correct procedure while ensuring that the patient is not harmed in any way. The correct action that the phlebotomist should have taken was to withdraw the needle, discard of the partially filled tube as well as the needle and redo the procedure. The patient can be stuck a second time granted that the patient does not object to this. Furthermore, the phlebotomist should not have labeled the incorrectly filled tube and deemed it valid for testing, because an inadequate volume of blood may result in incorrect additive to blood ratio and this can produce inaccurate and erroneous results.

3 Incidents of good ethical conduct that were observed

Incident #1 On my second and third day at the facility, I observed that the phlebotomist/ receptionist followed proper protocol as it regards the entering of the test requests from the requisition forms onto the computer database where all the tests are electronically stored. She also confirmed with the patient to ensure that the name on the requisition form matched that of the patient before conducting the phlebotomy procedure.

8 Proper and adequate medical documentation is essential for quality medical care and healthcare services throughout the industry and for receiving payment benefits from your healthcare service provider. Without medical documentation, healthcare would be compromised. Medical documentation is essential for standards of health care to be met. Doctors, nurses, as well as lab personnel and other specialists are all involved in the care of a patient, and they all need to be kept up to date with what everyone else is doing. Without such coordination, patients medical care would suffer. Also, failure to make such documentation compromises medical ethics and professional conduct Prior to any patient procedure, proper identification of the patient is a crucial aspect of patient safety and a top priority. Confirming the patients identity prevents errors; the name of the patient must match that which is on the requisition form; otherwise, a patient can be misdiagnosed and mistreated. These errors can destroy the integrity of the organization. This is why the adherence of these procedures is important and is therefore deemed good ethical practices. Incident #2 The policy regarding the privacy and confidentiality of patients results in the laboratory was adhered to. Patients results were not discussed or displayed among healthcare workers. Confidentiality is a term that indicates preserving the privacy of the individuals who receive healthcare. It is an important aspect of trust that patients place in healthcare professionals. There are several reasons why medical records confidentiality is so important. A main reason is because this type of protection benefits both patients and medical professionals. If a patient fears that the information he/she discloses to a health care provider will be shared with others, he/she may keep secrets. To his detriment, he may not receive proper treatment. This situation can also

9 present disadvantages to the healthcare professional because the absence of information that could lead to an easy and accurate diagnosis will require them to work harder. Another reason is that a patient is entitled to privacy. The consequences of disclosing health information are often greater than the embarrassment of the patient. Any medical professional who does this may be ordered to pay damages and in addition to this, the facility would have to compensate the patient as well. The employment of the healthcare professional would be terminated and his/her professional license would be suspended. A breach of confidentiality and patient privacy can result in a costly lawsuit for the healthcare providers and the facility. This is why maintaining confidentiality in the laboratory is a good ethical practice; it helps to build the trust and integrity of the organization. Incident #3 Each patient was treated with courtesy and respect and was also adequately informed. The healthcare professionals took the time out to provide patients with any information that they required and the information was given in a clear, simple and concise manner with which they were able to understand and comply. As healthcare workers, it is our duty not only to respect our colleagues but also our patient/clients. The ability to communicate and provide good customer service should be important skills of a healthcare provider. Customer service involves providing customer satisfaction through professionalism, positive communication, and an attitude that promotes resolution to problems when they occur. Healthcare professionals must be capable of explaining procedures to patients of various ages in order to gain their confidence and cooperation. Concise information is also important because excessive talking may tend to be annoying to some patients, it is also best to speak in a calm voice in a tone appropriate to patient need. The

10 healthcare industry is service oriented; we want our customers or patients to be pleased with both the services provided as well as the manner in which they are delivered. Having patients is what provide healthcare workers with a job so your patients/customers should be satisfied with your service. In addition to my 10 hours of voluntary service, I interviewed Dr. Robert Edwards, a health care practitioner for duration of 30 minutes. During the interview, Dr. Edwards stated and elaborated on three of many ethical dilemmas he has encountered in his field of practice while attending to patients. He also gave the solutions he used to resolve these dilemmas.

3 incidents of ethical dilemmas faced by Dr. Edwards

Incident #1 Dr. Edwards stated that there have been cases of individuals who are truly ill but have no money and wishes to use someone elses health card. Resolution He indicated that his resolutions were often either one of the following; he would provide free healthcare to the patient or free medications if he has it; or if the patient would be able to pay in portions over a period of time or at a later date, he would provide healthcare with deterred payment; or otherwise, he would provide less expensive options. Dr. Edwardss resolution to this dilemma was based solely on beneficence. This is the principle that imposes on the practitioner a duty to seek the good for patients under all circumstances. It suggests acts of mercy and charity. He also acted in accordance with the Hippocratic Oath; which states I will not withdraw from my patients in their time of need, and that above all else, I will serve the highest interests of my patients through the practice of my science and my

11 art.(2). I agreed with how Dr. Edwards handled this situation as he showed compassion and understanding towards these patients. Also, the use other persons health card is illegal so Dr. Edwards did the right thing by not complying with such a request. If I were to be placed in a similar situation, this also would have been my course of action. Incident #2 Individuals who he does not know sometimes visits his office seeking references Resolution His resolution to these instances is no compromise. He explained that it is dishonest, unethical and illegal to write references for individuals that you do not know. According to the consequence oriented theories, the rightness or wrongness of decisions are judged based on the outcome or the predicted outcome. The ethical theory of consequentialism aided in Dr. Edwardss decision to not write these recommendations. The implications of doing so could be more negative than positive. He would be placing his name and signature on a document for someone to which he has no affiliation or that he does not know. This could put him in trouble with the law and that is a chance he is clearly not willing to take. Also, the action of writing that recommendation would be in violation with the principle of verosity/integrity and the professional code of ethics where it state that, I shall not engage in illegal work or participate with anyone so engaged. Dr. Edwards moral as an individual, that is, what he believes is write and good also aided in his decision, and based on his decision, he clearly believes that writing the letter would be the wrong thing to do. Based on these reasoning, I am in total agreement with the decision made by Dr. Edwards. It was in the best interest of the individual, himself, and his profession. He honored his vows and it was the right and ethical thing to do.

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Incident #3 Dr. Edwards stated that he has had pregnant female who come in for their pregnancies to be terminated stating that they had been raped. Resolution He exclaimed that conducting an abortion, even in cases of rape, goes against his religious beliefs. He stated that abortion is the taking of a life which is an immoral act. That God is the giver and sustainer of life and he therefore should be the one to decide whether or not it should be taken. Dr. Edwards said that his solution in cases such as these was to refer the individual to a competent practitioner. According to the reasoning of the ethical theory; divine command ethics, there is a divine being who sets down a finite series of rules that believers claims can provide guidance to most, if not all, moral decisions(1). One such example is the Ten Commandments. It includes key moral prohibitions as well as a set of rules that are adhered to by a particular religion; rules such as, thou shall not kill. These rules are what guides to behavior of individuals and their reasoning behind making good ethical decisions. Therefore, the rule against murder is claimed by some to imply that abortion is wrong, and Dr. Edwards is of the same belief and reasoning; hence, the reason for his statement and the decision that he made. I am in total agreement with the decision made by Dr. Edwards. This is because I am of the same religious and moral views. Abortion in itself is illegal in some countries like Jamaica. However, although the law states that abortion may be allowed in cases such as rape as well as if continued pregnancy poses harm to the mother, this still does not justify the fact that it is wrong. Dr.

13 Edwards made an excellent choice in referring the individual to another practitioner. By this action, no laws were broken.

Appendices

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Reference 1. Edges RS, Groves JR. Ethics of health care, a guide for clinical practice. 3rd edition. Clifton Park, New York: Delmar, Cengage Learning. 2006. 2. DiMichelle D, Storey-Johnson C L, et al. Hippocratic Oath. Weill cornel medical college. [online] 2005.Available from http://www.med.cornell.edu/deans/pdf/hippocratic_oath.pdf Accessed 2013 April 10.