While trying to develop a low-cost syringe for the developing world context, you (the designer) hit a cross-roads. Constructing the syringe to auto-disable after a single use, an important safety feature, significantly adds to the cost of the design – making it potentially unaffordable for some hospitals and clinics. However, if you don’t add the safety feature, you are enabling the potential for the spread of disease. How do you as a designer proceed?

While trying to develop a low-cost syringe for the developing world context, you (the designer) hit a cross-roads. Constructing the syringe to auto-disable after a single use, an important safety feature, significantly adds to the cost of the design – making it potentially unaffordable for some hospitals and clinics. However, if you don’t add the safety feature, you are enabling the potential for the spread of disease. How do you as a designer proceed?

 

Step 1: Determine the facts in the situation – obtain all of the unbiased facts possible. Clearly state the ethical issue.

• Higher possibility of spreading diseases if not one-time use.
• Adding auto disable is a huge cost 
• Affordable and unsafe or unaffordable and safe
• The presence of the syringe will increase health outcomes, with or without the safety feature if used once  (margin is arguable) 
• Ethical issue: Should community members be compensated for providing assistance in identifying a reliable water source? If so how much? 

 Step 2: Define the Stakeholders – those with a vested interest in the outcome Step 3: Assess the motivations of the Stakeholders

• The community/ patients (primary)
• Surrounding communities (secondary) 
• Healthcare workers (primary) 
• The hospitals (primary) 
• Distributers 
• Manufacturer
• The ministry of health in the community

Step 3: Assess the motivations of the Stakeholders 

• Hospitals/Clinics
  • Cost, want to provide it to as many patients as possible 
• Company who created the syringe
  • Want to sell their product, make a profit, and have their product look appealing to hospitals. They want to maintain or increase a positive reputation 
• Specific designers who work on developing the syringe 
  • Reputation, profit, 
• Doctors and Nurses
  • Safety, readily available and successful for getting rid of the disease, keep as many people from harm 
• Hospital Administrators
  • Treat patients while keeping the cost of supplies low
• Patients
  • Safety, cost effective, readily available
• Manufacturing Company 
  • Wants to make a profit, product quickly

 

 Step 4: Formulate (at least three) alternative solutions – based on information available, using basic ethical core values as guide Approaches [1/2/3: repeat for every action] • Potential solution • Ethical Principle or code • Pros • Cons 

• Formulating a waiver that clarifies the proper use of the syringe and that any violation of such use will not be on the company.
• Government subsidies to minimize costs 
• Using cheaper alternatives,  create the syringe with a lower maximum volume of liquid it can hold (i.e. a 5 mL syringe rather than a 10 mL)
• Different way of sanitation; alcohol, burning

Revised Solutions: 

 

• Potential solution 1: Add the safety feature
  • Ethical Principle or code
    • Principle of nonmaleficence (Do no harm) – auto-disable feature helps prevent the spread of blood borne diseases like HIV.
  • Pros 
    • Safer for patients 
    • Reduces the spread of disease 
    • Protects reputation
  • Cons 
    • Not cost effective 
    • May cut out lower income areas
    • Company could look “money hungry”
• Potential solution 2: Don’t add the safety feature and use extra funds to develop training for doctors and nurses about the syringes
  • Ethical Principle or code 
    • Principle of nonmaleficence – do no harm, and when harm cannot be avoided, minimize the harm that we do and don’t increase the risk of harm to others. Reuse of syringes in LMIC is common, so patients already are being exposed to the risk of blood borne illnesses. Providing training on how to properly use and dispose of syringes may reduce the risk to the patients.
  • Pros 
    • Cost effective 
    • More readily available in the developing world 
    • Manufacturing company can begin production immediately
  • Cons 
    • May spread disease
    • Not safe
    • Ruins reputation 
• Potential solution 3: Redesign the syringe itself 
  • Ethical Principle or code 
    • Principle of beneficence (bring about good in our actions) – we’re making an effort to produce an affordable and safe product which will bring about good on both sides. However, taking the time to redesign the product will cause a delay in when it reaches the market.
  • Pros 
    • Safer for patients 
    • Reduces the spread of disease
    • More affordable (hopefully)
  • Cons 
    • Takes longer to redesign and get to market 
    • May take more money to redesign and develop 
    • May end up not working in the end 

 

Step 5: Seek additional assistance, as appropriate – engineering codes of ethics, previous cases, peers, reliance on personal experience, inner reflection 

 

• Analyzing other designs along with what materials they use

• Mushrooms 
• Hemp
• Seaweed
• Biomaterials
• Anything that could substitute for plastic
  • Is that cheaper than plastic?

 

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. 

 

I think the above solution 2 is best. This creates system wide changes by improving pedagogical approaches of medical staff which may translate into other areas besides syringe usage. 

 

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. An abridged version (6-step) of the 9-Step Process from “App

 

By not using funds to develop the safety features there is excess funding rto support to create pedagogical and methodology training that could otherwise improve health outcomes more broadly, than this single use treatment. The overall impact of improving training of healthcare providers may prove more significant than the optimization of a single tool. 

Social and environmental impacts → proper disposal of the device after use; increased skills for medical staff; increased reliability and trust between consumers (all-levels); incentivizes sustainability