• 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
• 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 product and its benefits
• 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: they want to save people using the product, want to help as many people as possible
• 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 with an accessible and affordable product, 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: While it reduces accessibility in the beginning, there is a guarantee of no disease spreading. From the designer’s perspective, this does grant 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.
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. 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.
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, or teaching employees how to properly sanitize the syringes between use to limit the spread of disease.

Step 5: Seek additional assistance, as appropriate

• Inner reflection: Long term, I believe investing in a safety feature to prevent the spread of disease and misuse of medical equipment is important. However, by decreasing the capacity hospitals have in treating patients with syringes that are a bit more expensive may prove to decrease the potential for beneficence hospitals intend to have. Also, it becomes more costly to waste the syringe in the event of a misinjection. From my experience, medical equipment that makes contact with bodily fluids tends to be used only once, with training on disposal to ensure it does not circulate again. With proper training regimens to help reinforce proper handling and safety procedures, the need for an auto-disable can be circumvented by focusing on the human error that accounts for the reuse of syringes.. 

Step 6: Select the best course of action

• Based on the given alternatives, I would feel best choosing the third course of action, designing the syringe without the safety feature but establishing a training protocol for employees to go learn and follow. Ideally, the syringes would be made with the safety feature, but because this limits accessibility to many, I would feel best choosing the option that helps the most people. The learning protocol would aid in limiting the spread of disease, all while keeping the product itself low-cost for buyers.

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

• By choosing the low-cost alternative, my venture will be able to reach as many people as possible. It will allow for more people to be treated, all while keeping the design simple.Through offering training, the repeatability of my product, training program, and its use can be easily achieved in other countries, achieving the greatest sense of beneficence. I can sell to more hospitals and clients, allowing for more patients to receive what they need through syringes that staff are trained to use, rather than designed for staff to use. The teaching program will allow for disease to be contained, so that there is a greater overall well-being in the communities that use the syringe.