Step 1: Determine the facts
- Multiple courses of action
- Create auto-disable syringe
- Auto-disable is more expensive
- Reusing needles can spread disease
- Low resource center
- We don’t know the setting
- People in developing countries might not advocate for themselves enough and might not question health care professionals who reuse syringes
Step 2: Define the stakeholders
- Primary:
- Patients
- Designer
- Healthcare workers
- Hospitals (customers)
- Company of designer
- Secondary:
- Distributer
- Family of patient
- Tertiary:
- Community
- Companies employing patients
Step 3: Assess the motivation of stakeholders
- Patients:
- Stay alive, get cured, have a good quality of life
- Designer
- Uphold the ideals of his/her profession
- Adhere to job expectations from their employer so they stay employed
- Abide by their own morals (to the best of their ability)
- Healthcare workers
- Stay employed
- Promote safety
- Remain in good standing in the community
- Follow their own morals (to the best of their ability)
- Exemplify leadership
- Hospitals (customers)
- Profit
- Cure people
- Serve as a trusted resource in the community
- Company of designer
- Create profits
- Build brand/reputation
Step 4: Formulate (at least three) alternative solutions:
- Syringe locks after one use
- Pair this approach with the designer sharing information on major foundations such as the Bill and Melinda Gates Foundation that could help hospitals in developing countries access funding to reduce costs for auto-disable syringes.
- Tabs that flags syringe has been used before
- Leaves decision up to hospital
- Flagging system with education for patients and doctors on risks
- Completely reusable
- Open design that can be reused with education
Reusable syringes with one time use needles
Step 5: Seek additional assistance, as appropriate – engineering codes of ethics, previous cases, peers, reliance on personal experience, inner reflection
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041680/
https://pubmed.ncbi.nlm.nih.gov/10593026/
https://pubmed.ncbi.nlm.nih.gov/10593028/
https://www.unicef.org/supply/stories/right-choice-syringe
- From 2012-2018 in the US only 0.0045% of Hep B/Hep C cases in America (that we know of) were from provider-patient needle reuse
- 32% of all HIV cases in Rural egypt in 1993 could be traced to syringe reuse (National Library of Medicine)
Step 6: Select the best course of action – that which satisfies the highest core ethical values. Explain reasoning and justify. Discuss your stance vis-a-vis other approaches discussed in the class.
We have decided that the designer should proceed by still choosing the relatively expensive auto-locking syringes. According to the World Health Organization’s press release from 2003, “[t]he auto-disable syringe is the equipment of choice for administering vaccines, both in routine immunization and mass campaigns.” More recently, in 2021, UNICEF reiterated that the preferred syringe is an auto-locking syringe.
While combining education with a reusable design or flagging system can be helpful in promoting safe injections, the risk of the education not being followed by healthcare professionals in developing countries outweighs the cost benefits. Not adhering to recommended uses could cause high long term monetary and human costs to contain outbreaks of infectious diseases as a result of unsafe syringe use, which is estimated at $535 million in spending and 1.3 million deaths. For developing countries whose population may be less educated than those in higher income countries and who might put more trust in healthcare professionals, they might put more trust in these professionals rather than warning labels.
Furthermore, the Melinda & Bill Gates Foundation and other global health organizations might have resources to assist hospitals in securing auto-disable syringe funding. It would be a disservice to the world if a designer did not design their safest, most effective design option. It is their responsibility to produce the best design, and the hospital’s responsibility to distribute the best medical services they can.
Step 7: (If applicable) What are the implications of your solution on the venture. Explain the impact of your proposed solution on the venture’s technology, economic, social and environmental aspects.
The inevitable impact of choosing the more expensive auto-lock design is that these technologies may not be a reasonable option for rural areas in developing countries. Fewer injections will be affordable, which can create a social divide between areas that can afford the technology and those who are unable. However, in the long term, hundreds of millions of dollars and millions of lives will be saved by preventing the further transmission of bloodborne pathogens. Additionally, this design will have detrimental environmental effects as each syringe must be disposed of after each use. According to UNICEF, more than half a billion of their own syringes were disposed of during the covid vaccination process. Although most syringes are made from recyclable materials, the nature of their use does not allow them to be recycled.
The auto-locking design is the safest, most advanced technology available. The predicament that our designer faces may promote the research and development of more advancements in syringe reuse prevention as well as syringe technology. The more problems in this space that are encountered, the more demand there will be for new technology.