Step 1: Determine the facts in the situation

• A low-cost syringe must be designed for use in the developing world.
• Adding an auto-disable feature significantly increases the cost. However, without the safety feature, there is potential for spread of disease.

The ethical issue is that with the safety feature, the syringe may be inaccessible to some hospitals and clinics, affecting the quality of care that patients in those hospitals can receive. On the other hand, not including the safety feature presents an opportunity for the syringe to be used more than once, contributing to the spread of disease. In either case, lives may be at risk.

Step 2: Determine the Stakeholders

• hospitals and clinics
• doctors or nurses using the syringes
• patients
• company manufacturing the syringes
• designer.

Step 3: Assess the motivations of the stakeholders

The hospitals and clinics want syringes with a low cost, so they are attainable. They also want to avoid the spread of disease and any associated liability. The doctors and nurses want to ensure that their patients have the highest survival rate possible. The patients also want to ensure their survival and do not want to contract any diseases. The company manufacturing the syringes wants to ensure the success of the product and does not want to be held liable for their failure. They also want to ensure they can make a profit. The designer does not want to be responsible for causing any deaths, or the spread of disease, with a poorly designed product.

Step 4: Formulate alternative solutions

1. Adapt the syringe design so that it can be sanitized and has a replaceable needle, so it is appropriate for multiple uses. This solution would increase the amount of labor necessary because the syringes would need to be sanitized, but it may reduce the overall cost to the hospitals because new syringes will not need to be purchased as frequently. This would keep the syringes attainable while decreasing the likelihood for disease, fulfilling the needs of the hospitals, doctors, and patients. Reuse of syringes would be discouraged because clean ones become more accessible.
2. Creating educational material for the individuals using the syringes, sharing the dangers of using a syringe more than once. This solution reduces liability for the designer and the manufacturing company because they explicitly advised against multiple uses of the syringe and presented the associated risks for disease. However, this option would still allow a used syringe to be used again to treat a patient in a life-or-death situation where the spread of disease may not be the top priority. In this option, the syringes remain affordable for hospitals, allowing doctors to perform safe procedures and patients to receive good care.
3. A “pay what you can” system could be adopted, allowing the syringes to be sold at a lower cost to clinics with less funding. This option allows the safety feature to remain intact while removing the cost barrier. The doctors will still be able to provide proper care, and patients will not have to worry about contracting diseases. The manufacturer can still profit because the overall cost of the devices will still be covered, the price will just be adjusted based on ability to pay. The designer cannot be held liable for the spread of disease.

Step 5: Seek additional assistance, as appropriate

The Aravind Eye Hospital uses a business model reliant on each patient paying what they are able toward the cost of their treatment. Additionally, economics dictates that market efficiency is achieved when individuals are charged their full willingness to pay. This is evidence that the “pay what you can” model is viable.

Step 6: Select the best course of action

The best course of action seems to be redesigning the syringes to be conducive to reuse. The new design could reduce the cost to the hospitals and clinics, making them more accessible. The syringes will still function as intended, allowing doctors and patients to achieve their goal. This model is profitable for the manufacturer. This syringe design would still allow them to be used more than once, opening up the possibility for the spread of disease; however, the decreased overall cost would reduce the cost barrier that is typically the motivation for reuse of syringes.

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

This solution will require more technological expertise because a sanitization chamber or method will need to be designed in addition to the syringe itself. Producing fewer syringes because they can be reused will decrease the environmental impact of the venture because a lesser volume of raw material will be required. It is important to note that sanitizing the syringes for reuse may create hazardous waste that could create environmental contamination if not handled properly.