Step 1: Determine the facts in the situation/Ethical Issues

• You are the designer of the syringe that is trying to prevent the spread of a disease
• With the auto-disable feature, the potential for the spread of disease and safety mishaps greatly decreases, however, some hospitals/clinics will be unable to afford the device due to the added expense. This could put people at risk.
• If the auto-disable function is scrapped from the device to make it more affordable, it will put the patients who use the syringe at a safety risk. In turn, there is also a bigger chance for mass infection if herd immunity is not established.
• Releasing a product that is not 100% safe is an ethical conundrum. Although defective products are bound to occur, they should not be the norm. The venture will already be costly, and it would be illogical to spend this much money for a product that will not provide sufficient help.
• You must decide whether or not to include the auto-disabler and find a solution that is safe, affordable and pleases stakeholders.

Step 2-3: Define the Stakeholders/Assess Their Motivations

Hospitals/Clinics: Their objective is to safely distribute the syringe to patients/consumers. Many of the hospitals/clinics are under-funded and in developing areas. They have to ensure they are spending their limited funds wisely.

Patients: Their objective is to receive a safe and effective vaccination, which is crucial as they are the direct beneficiaries.

Your Company: Their objective is to produce a syringe that has the auto-disable feature, while remaining affordable and keeping administrative costs low. However, these features seem to be unfeasible simultaneously.

The Manufacturer: At the end of the day, the manufacturer’s  main priority is to sell a lot of their product. Safety and efficacy indirectly affect sales, but they want to swiftly create and distribute the product to make money.

Doctors/Nurses: They want to limit their own risk while providing the best possible care for the patients. 

You (the designer): As the designer, you want to create an efficacious, safe product that upholds, or improves upon your reputation as a designer. Creating a product that is either not efficacious, or causes disease spread, it will damage your reputation

 

A relevant issue would be if distributing a syringe without an auto-disable feature would even be legal, nonetheless, ethically acceptable. For some hospitals/clinics it may be part of their regulations to not use syringes without an auto-disabler. 

• Would a doctor be less comfortable giving a less efficient vaccine or knowing that some people will not get the medicine they deserve?

Step 4: Formulate (at least three) alternative solutions:

• Included Training Protocol: If the company were to produce the syringes without the auto-disable feature, the company could use the saved money to include a training protocol for the employees at the hospitals/clinics it is distributed to. 

Pros:

• The third party training would increase company appeal and limit the risks of cutting the auto-disabler.
• The training could become self-sufficient for the hospitals/clinics

Cons:

• It would cost the company extra money, and that money could be going to finding a way to implement the auto-disabler
• No way to ensure hospitals/clinics follow the protocols

Impact: This potential solution could prevent a redesign of the syringe while limiting the safety risks. As long as doctors/nurses are attentive during training and conscious of the safety risks, there should not be a problem in keeping the patients safe.

• Red/Green LED Redesign: If the company decides that the addition of the auto-disable feature would exclude too many hospitals/clinics from accessing their device, they could implement a feature that mirrors that of the auto-disabler. A LED could be implemented on the body of the syringe; if the LED is red (or on), it indicates the syringe has already been used, if the LED is green (or off), it indicates the first use of the syringe. 

Pros:

• It serves as a visual adaptation of the auto-disabler
• It greatly reduces the risk of re-use, barring a blatant disregard for the LED suggestion
• The cost addition to adding an LED should be minimal

Cons:

• Might require a complete redesign of the syringe which would cost time and money
• The Red for Off and Green for On may not be a universal system for all

Impact: This redesign would be beneficial to all stakeholders barring a huge price increase. It follows bioethics guidelines of beneficence and justice as it provides a safer syringe accessible to more patients than before.

• Obtain Subsidized Funding: NGOs or government organizations may be able to help a company like ours by sponsoring our program and subsidizing funding. 

Pros:

• Would allow the addition of the auto-disabler while allowing most of the hospitals/clinics to afford the syringes
• Would allow for quick distribution/production

Cons:

• If the company accepts funding, the funders are going to want to have a say in the distribution and design of the product. This could cause more trouble than it is worth and they may have to release a product that does not align with their values.
• How would this affect the consumer’s payment/insurance?

Impact: The principal-agent problem would arise from taking funding from an NGO or private organization (like Red Cross, WHO or a government agency). It would be great for the patients if the syringe with the auto-disabler could be distributed to all the hospitals/clinics who need it though.

• Recyclable Syringes: The syringes without the auto-disabler could be made out of recyclable materials.

Pros:

• Would incentivize syringe recycling after singular use
• People may be more conscious of its uses 
• Environmental effects are an added bonus for the company

Cons:

• The recyclable material may not be as hardy/efficacious as the original material
• May be interpreted as a cop-out for scrapping the auto-disabler
• May increase production times due to a potential redesign of the syringe

Impact: Creating recyclable syringes would help product appeal and please environmentally conscious stakeholders. In addition, NGOs and private organizations may be more willing to fund this venture due to their environmental policies. 

Step 5: Seek additional assistance, as appropriate

NSPE Code of Ethics: This legislature enforces that engineers “hold paramount the safety, health, and welfare of the public” in their work. Hence, an engineer need note this when debating the inclusion of the auto-disabler.

Utilitarianism: Utilitarianism is a normative ethical theory operating under the assumption that actions are right if they benefit the majority. In this case, additional data/hypotheses should be tested to validate the best option going forward. If more people are at risk due to the lack of an auto-disabler, add the feature, but, if more people are at risk due to the syringe not being accessible, cut the feature. 

Inner Reflection: Could the company executives/designer be able to cope with selling an unsafe product? 

Step 6: Select the best course of action

I believe that the best course of action would depend on the utilitarian aspects as well as the severity of the disease that is being dealt with. However, I think it is safe to assume the best course of action would be making a recyclable syringe that has an LED in replacement of the auto-disabler, and any necessary training protocols. Hopefully, there is a manner where the LED can be implemented while keeping the syringe recyclable. This way the product is accessible and safe, barring any extreme negligence from hospital staff. 

Step 7: (If applicable) What are the implications of your solution on the venture

There are many ways to approach this problem, and a sound justification for each approach. I was very indecisive on, at face value, if the auto-disable feature should/needs to be included. Every decision has its pros and cons, and every person has their own moral compass. However, in the end, I believe that the patients deserve the best treatment possible: that is the mission of all healthcare initiatives. Some implications of my final solution are as follows:

Economic/Environmental/Social: The recyclable syringe would be good for the environment, good for the marketplace and good for stockholders. The product would have a higher COP, but I believe the additional revenues/investments would offset this. Finally, public opinion of the company would probably rise in this scenario.

Ethical: As I mentioned, barring extreme negligence, the product should be safe. This would make stakeholders happy, and no one would have to operate under a heavy conscience. The liability should fall on the hospitals/doctors rather than the company/designer for any abuses.