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?

Using the Ethical Decision-Making Methodology:

Step 1: Determine the facts in the situation

• Task: develop low-cost syringe for use in a developing world
• Possible safety feature: Auto-disable after a single use
  • Pros: limits the spread of disease from one person to another
  • Cons: adds a significant cost to the design, reducing accessibility
• If the safety feature isn’t added, syringes will have to be reused
• Ethical Issue: If the safety feature is added, less people will have access to the syringe, but there is a guarantee that disease won’t spread through the syringe. If the safety feature isn’t added, more people will have access to the syringe due to its lower cost, but there is a risk of disease spreading.

Step 2: Define the Stakeholders

• Hospitals/Clinics/Doctors: will be the ones using the product
• Patients: will be the ones receiving the benefits of the product
• Manufacturer: produces the product and sells to hospitals and clinics
• Designer: is the one in charge of designing the product and determines whether or not the safety feature is added

Step 3: Assess the motivations of the Stakeholders

• Hospitals/Clinics/Doctors:
  • want to save people using the product
  • want to help as many people as possible
  • adds to both patient wellbeing and also could increase reputation of hospital
• Patients:
  • want to safely receive vaccines using the syringe
• Manufacturer:
  • wants to optimize sales and profit
  • make as many and sell as many as possible
  • isn’t concerned about what the purpose of the product is, more focused on the money tied to it
• Designer:
  • wants to help people in developing countries with an accessible and affordable syringe
  • ultimate goal is to contribute to greater good with the product

Step 4: Formulate (atleast three) alternative solutions

1. Design the syringe with the safety feature:
   • Reduces accessibility in the beginning, but there is a guarantee of no disease spreading. This can both excite and upset the hospitals because they have to buy less, but have a guarantee of no disease spreading.
   • From the designer’s perspective, this grants peace of mind on one end, with disease not spreading, but it is upsetting that not as many people will be able to access it.
   • As time goes on, the designer hopes that hospitals will see how effective the single use syringe is and be incentivized to invest in it.
   • These are all concerns more for the manufacturer though, since they will be the ones producing the physical product and selling it to hospitals. If sales go up, so will demand, so maybe the manufacturer will be able to mass produce it to give a lower cost per unit.
   • Patients who are able to use the syringe would feel safest with this feature, adding to its appeal; on the other hand, patients who aren’t going to be treated due to a lack of supply are going to be very upset.
   • The manufacturer is wary of this option since there will be less sales on a more costly product to produce, this leading to little to no profits.
2. Design the syringe without the safety feature:
   • Designing it without the safety feature allows for the syringe to be accessed by a lot more people.
   • Hospitals and clinics will be more willing to purchase the syringe if it’s made this way, but the trade off is that there is a greater risk of disease spreading if the hospital workers don’t use it properly. They feel happy that they can treat more patients.
   • One of the purposes of the syringe development is for it to be low cost for developing countries, so this design allows for greater affordability, thus leading to greater accessibility. Because of this, the designer is happy about the fact that this reaches more people, but upset it isn’t as safe as the version with the safety feature.
   • More patients are being treated so they are happy they are receiving treatment, but they may be wary about the implications of using a syringe that has been used previously. Even if they do not know they are being re-used, they are at risk of catching disease.
   • The manufacturer likes this idea because he/she will be able to sell more product to the hospitals.
3. Design the syringe without the safety feature but establish a training protocol for use:
   • One of the main concerns about the syringe not having the safety feature is that it will be used improperly and spread disease. The safety feature is too costly to reach the number of people desired, but it is important.
   • To balance out the lack of the safety feature, a teaching program could be designed to show hospital workers who will be using the syringes how to use them in a way to prevent spread of disease. This can include re-using the syringe only on the same person by keeping it stored under their name so they have the same one during their next visit, and/or teaching employees how to properly sanitize the syringes between use to limit the spread of disease. Patients would be told about the use of the protocol, so they know they are getting the best care possible.
   • Hospitals and clinics would love this alternative, as it allows them to purchase low-cost syringes but still be safe. The training program would be no-cost to the hospitals, so they have no reason not to use it. They are able to treat more patients and prevent a disease outbreak, also adding to the credibility of the hospital.
   • Patients would feel at peace knowing they are being treated with syringes that are disease-free and properly sanitized. More patients will be able to be treated, and overall well-being and happiness will increase.
   • The manufacturer likes this idea because he/she will be able to sell more product to the hospitals.

Step 5: Seek additional assistance, as appropriate

• Inner reflection: I think that there needs to be some measure of safety, whether that be enabling the auto-lock feature or having some type of teaching program.
• Peers: When working with my group, we all though this would be a good alternative that satisfies the most people.
• NAHQ Code of Ethics for Healthcare Quality Professionals and Code of Conduct – The Healthcare Quality Professional’s Commitment to Stakeholders: “Healthcare quality professionals understand that recipients of healthcare services are the most vulnerable stakeholders in the system. They treat recipients with empathy and respect, honoring their autonomy and privacy. They support positive health outcomes for healthcare recipients.”
  • Looking at this commitment, it is clear that a positive outcome is of utmost importance to hospital staff. Because of this, the second option, to use the syringe without the feature and with no training protocol, is eliminated. This leaves option 1 and 3 still in the running, in accordance to the code of ethics.

Step 6: Select the best course of action

• Based on the given alternatives, I, as the designer and someone who wants to contribute to the greater good, would feel best choosing the third course of action, designing the syringe without the safety feature but establishing a training protocol for employees to learn and follow. This is because I would feel best choosing the option that helps the most people.
• Initially, I wanted to choose the option with the safety feature, but after thinking more about it, I realized that as long as there is some protocol in place that promotes sanitation and proper use of the syringe, the disease will be contained.
• The learning protocol would aid in limiting the spread of disease, all while keeping the product itself low-cost for buyers. This eliminates the fear of disease, so there is no more need to debate on the use of the auto-lock feature.
• Hospital staff won’t incur any additional costs when obtaining the training protocol, so they have no issue in following it. They are happy with the affordable cost of the syringe and are able to buy as many as they need. This adheres to the code of ethics for healthcare professionals, and adds to their overall goal of helping as many patients as possible.
• In addition, patients will put more trust into the staff treating them if they know they are following the correct sanitation process, which will be outlined in the training protocol.
• Manufacturers will be content with this course of action, as they will be able to maximize their profit.

Step 7: What are the implications of your solution on the venture?

• Economic:
  • Manufacturer is able to sell more product and make more profits
  • Hospitals will be able to afford the product
  • Increased sales can add to the overall economy of the country the syringe is sold in
• Social:
  • More people are treated
  • Disease is contained, so that there is a greater overall well-being in the communities that use the syringe
  • Hospital reputation is maintained, or even increased, since they effectively decrease disease while treating more people
  • Patients are more confident in the treatment they are receiving and trust the hospital staff more, which gives both parties involved better peace of mind
  • Manufacturer is happy, hospital staff is happy, patients are happy 🙂