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CSMLS Code of Ethics

The Canadian Society for Medical Laboratory Science (CSMLS) has developed a Code of Ethics in consultation with its members. The Code serves to define and expand the inherent ethical concepts7 contained in the CSMLS Code of Professional Conduct, to document expectations of ethical behaviour for all medical laboratory professionals (MLPs), and to provide a framework during professional and personal self-evaluation.

The ethical principles contained herein are not listed in order of importance, but rather, should be considered in relation to each other during their application within situations involving ethical dilemmas.

MLPs shall practise in compliance with all current provincial and federal legislation for the protection and integrity of patients and their specimens, colleagues, health care providers, society, the environment and one’s self. Within this practice, on a fundamental level, they will conduct themselves in a manner that is conscientious, compassionate, honest and equitable.

MLPs shall uphold the vision of the CSMLS Code of Ethics by adhering to the following principles of ethical conduct, as well as the underlying concepts.

Safe Practices

1.1   Practise only those disciplines within the medical laboratory profession for which CSMLS certification has been achieved.

1.2   Practise only those procedures for which qualification has been achieved or officially delegated by an appropriate institutional authority, where the member has the current requisite knowledge, skills and judgment to ensure and demonstrate competence.

1.3   Recognize risk prone situations in order to minimize harm to patients, staff and self.

1.4  Utilize professional and institutional mechanisms to intervene when witness to unsafe, incompetent or unethical practices.

1.5   Assume responsibility for errors one has committed or observed and take immediate action to prevent or minimize associated harm.

1.6   Advocate for working environments that support safe, competent and ethical practices.

Confidentiality

2.1 Understand and comply with applicable privacy legislation and policies regarding the collection, use and disclosure of confidential information.

2.2 Preserve and protect the confidentiality of any information, either medical or personal, acquired through professional contact (in person, through collegial conversations, via medical records etc.) to safeguard patients.

2.3 Abstain from using confidential information to the detriment of a patient, or with direct or indirect intent to benefit oneself or another person.

2.4 Access information relevant only to the professional task being performed.

2.5 Communicate and release information only with written or formal authorization, or where so ordered or expressly authorized by law.

2.6 Recognize and disclose conflicts of interest and resolve them in a manner which maintains the integrity of personal health information and protects the best interest of patient care.

Professional Development

3.1 Reflect on one’s fitness to practise and expand one's knowledge, skills, judgments and attitudes through continued professional development.

3.2 Contribute to the development of the profession by sharing one's knowledge and experience.

3.3 Participate in interprofessional collaborative and educational processes, and the development of partnerships which contribute to positive patient outcomes.

3.4 Contribute to the advancement of the profession by:

  • improving the body of knowledge,
  • adopting scientific advances that benefit the patient, and
  • maintaining high standards of practice and education.

Accountability

4.1 Be responsible first to the patient, then to society and the environment for safe and lawful practice and the sustainable use of resources.

4.2  Advocate one’s role as a leader in the promotion of health and delivery of quality  care.

4.3  Be responsible for the quality, integrity and reliability of the laboratory services one provides.

4.4   Ensure organizational consent processes are followed, including:

  • Patients have the right to be informed
  • Patients have the right to refuse or withdraw from procedures

Behaviour and Attitude

5.1   Provide service with dignity and respect to all, regardless of race, religion, sexual orientation, sex, gender identity, age, health status, or mental or physical disability.

5.2   Prioritize one's work to ensure that each patient receives optimum care.

5.3   Encourage the trust and confidence of the public through high standards of professional competence, conduct and deportment.

5.4   Be reasonably accessible within the confines of your duties.

5.5   Collaborate with patients, colleagues and other healthcare providers to provide effective patient care.

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CSMLS graciously acknowledges the usage of ethical codes originated by our organizational partners, including: Newfoundland and Labrador College for Medical Laboratory Science, College of Medical Laboratory Technologists of Alberta, Saskatchewan Association of Combined Laboratory and X-Ray Technicians, Ordre professionnel des technologistes médicaux du Québec, American Society for Clinical Laboratory Science, The Danish Association of Biomedical Laboratory Scientists, and Canadian Association of Medical Radiation Technologists. CSMLS reviewed all medical laboratory provincial regulators’ Code of Ethics and therefore, similarities in codes may be identified.

CSMLS commits to reviewing the Code of Ethics bi-annually to ensure its relevance and applicability to an ever evolving society and profession.

Approved by the CSMLS Board of Directors (September 2015).

See the Code of Ethics Guidance Document for source references

Grounding Principles

To guide the creation of the Code of Ethics, the following principles were agreed upon by the Ethics Working Group to act as perimeter walls, focusing the goals of this document. The Code of Ethics and supplementary documents shall:

  1. Provide guidance to Medical Laboratory Professionals  1(MLPs) on CSMLS expectations of their member’s behaviour within the profession. This guidance should be in a language that allows for future changes in practice, law and society.
  2. Apply to all members (e.g., direct practice, management, education, research, industry roles).
  3. Be consistent with CSMLS values, member’s opinions and grounded in the four Principles of Bioethics.
  4. Be based on the CSMLS Code of Professional Conduct.
  5. Be based on Canadian MLP content, international MLP content and Canadian non-MLP content, in that order of priority.
  6. Be based on a holistic approach and not act as a standalone document (i.e., it should include guidance, examples and be a platform to start discussion).

Fact Sheet

A Code of Ethics is an intricate array of ideas and boundaries that work in tandem with other considerations. The following facts provide further structure around the purpose of the Code of Ethics and how it can be applied.

  • The Code of Ethics contains the minimal voluntary standards governing the ethical conduct of each CSMLS member. It is not an exhaustive list of codes.
  • The Code of Ethics is dependent upon members’ understanding and reinforcement of compliance by healthcare professionals and the public. Those who fail to comply may be subjected to disciplinary proceedings under the bylaws of a regulatory college.
  • The Code of Ethics is to be read and applied in light of the supplementary information and definitions contained in this document. Where guidance and case studies have been provided, the intent is to assist in the understanding and application of the ethical codes. However, further consultation for specific occurrences may be required.
  • The Code of Ethics should be considered in conjunction with the Code of Professional Conduct, Standards of Professional Practice and other relevant policy material locally, provincially/territorially and nationally.
    • Should an individual be accountable to multiple policy documents of the same nature, the document that is strictest in its requirements for a given situation should be adopted.
  • Each ethical code should be considered and applied in conjunction with other codes. As ethical dilemmas are complex by nature, the codes should be used relationally rather than separately.
  • CSMLS recommends continued professional development in ethics to help medical laboratory professionals develop the knowledge, skills, judgment and attitudes needed to manage or safeguard against ethical dilemmas in the workplace. Additional consultation with healthcare professionals, regulatory authorities, ethicists, or others who have relevant expertise is also recommended.

Principles of Bioethics

Comprised by Beauchamp and Childress2, the principles of biomedical ethics have become one of the most widely used frameworks worldwide for considering ethical issues in health care. Unlike some approaches that apply ethical principles to individual cases (top-down approach), these principles guide common thinking about ethical principles in general practice (bottom-up approach). The four principles of bioethics describe a set of minimum moral conditions on the behaviour of healthcare professionals.

Autonomy: Also known as the principle of human dignity, autonomy is Latin for “self-rule"3. Healthcare workers have an obligation to respect the decisions made by cognizant patients about their own treatment. Patients must be fully informed about their illness. As long as patients are competent they have the right to make their own decisions about their care, even if their family and physician do not agree (informed consent).

Beneficence: Do what’s good for the patient under all circumstances. Patients do not necessarily have to agree with their physician on their course of treatment. We must respect the good as determined by the patient (see Autonomy).

Non-maleficence: First do no harm. Disclosure of risk or side-effects of treatment is necessary, and is especially important when a cure is not possible. In treating healthy patients (e.g., preventive care, immunizations) we have to decide if the benefits outweigh the risks.

Beneficence differs “from non-maleficence in that beneficence is a positive requirement for action, whereas non-maleficence is a negative prohibition against action.” 4

Justice: Justice refers to how limited healthcare resources are distributed. We must treat all patients equally, fairly and impartially (respect their rights). Patients in similar situations should have access to the same care regardless of their financial position. This may cause a conflict between beneficence, autonomy and justice.

Corollary principles:

Autonomy: Be honest with others and keep promises. 

Autonomy and Beneficence: Beneficence and the autonomy of patients may overlap and conflict.

Non-maleficence: “When harm cannot be avoided… minimize the amount of harm that we do.”5

Beneficence and non-maleficence: “Actions must produce more good than harm.” 6

Justice: Do not create unnecessary problems. 
Justice: Do not waste limited resources that could be used for good.

Beneficence and justice: Support those who are not treated fairly.

Other Ethical Standards: Informed Consent, Disclosure, Confidentiality, Integrity, Honesty/Veracity, Fidelity, Respect

Frequently Asked Questions

I don't know which Code of Ethics to follow. CSMLS has one but so does my provincial association or regulator. Which one is the right one?

Based on the methodology used to create the CSMLS Code of Ethics (which included a national review of all available medical laboratory specific Code of Ethics at the time), it is unlikely that the national version will contradict a provincial or territory version. However, your employer may defer to one or the other document and determine the minimum requirement from these.

CSMLS holds the position that the document that should be considered for a specific situation is the one that is strictest in application.

Some of the ethical codes don't apply to me in my current job. Are they supposed to apply?

Each code should be examined in relation to the other ethical codes, Code of Professional Conduct, Standards of Professional Practice, and relevant policy material locally, provincially and nationally. Although the Code of Ethics is meant for all professionals as defined in the guiding principles, it is recognized that some individuals may not practise in a manner that requires all codes be applied to them. However, the golden rule is that all codes should apply to each individual and only with evidence-based reasoning may a code not be applied.

  • As students, Code 1.1 does not apply as they have not completed their certification exam. However, Code 1.2 states that the procedures they are practicing should only be those which they are qualified to so. A student should not complete any procedure or task unsupervised unless qualified in addition to being delegated the procedure or task by the proper authority.

How can I take immediate action for errors I have committed? Is it not my manager's responsibility to deal with errors? Reference Code 1.4 and 1.5.

It is your professional responsibility to report any ethical violation you observe or conduct to your immediate supervisor.  While this may prove challenging, by making others aware of the ethical violation, you are doing your due diligence to rectify the situation. Furthermore, while your manager may be ultimately responsible for actions such as policy or standard operating procedure shift, they must first be aware of the violations in order to take next step measures.

  • Violations may be as straightforward as a staff member not washing their hands when leaving the lab area or not cleaning benches properly. In these cases, it may be appropriate to speak to the person directly first and if they comply you do not need to contact a supervisor further. However, if you continue to observe the violation then contacting a supervisor would be appropriate.
  • A violation may be a breach in confidentiality. It is interesting and informative to discuss unique cases to improve one’s knowledge and potentially enhance patient care. However, this must be done under strict guidelines so that confidentiality is observed. It is easy to get caught up in conversation and transform a learning experience into discussion about a patient’s life or situation that does not involve or impact their medical care. One should always attempt to stop inappropriate conversation such as this and if not possible, immediately inform a supervisor.

Can I release confidential information if it is not detrimental to the patient? How can I know if information will be detrimental or not? Reference Code 2.3.

While it is understood that information may be communicated between health care professionals, only information that is medically relevant to the care of the patient should be communicated. You must use your professional judgment to determine what is considered medically relevant in each case.

  • In teaching hospitals it is understood and written into policy documents that a case may be discussed with your permission amongst other medical personnel (e.g., medical rounds where staff indirectly involved in your case or for educational purposes are invited to attend). Also, interesting cases are often discussed in the laboratory for educational purposes.
  • See question, "How can I take immediate action for errors I have committed? Is it not my manager's responsibility to deal with errors?" and review the second bullet point.

Am I leaking confidential information? I wrote something on a social media platform about a patient but I didn't mention their name. I let a friend know about a new lab instrument we have that the hospital is going to let the media know about next week.

It is important to remember that when information is shared on any type of social media, it is difficult if not impossible to completely remove.  Furthermore, social media is in essence a form of public communication which may grossly violate confidentiality through indirect means. Information from one person can be correlated with information from another to allow piecing together a situation that identifies a very private matter or individuals. Professionals must use diligence in remembering that social media is rarely, if ever, a form of private communication. Providing information, in full or in part, about a patient, policy or work situation on social media that has not been approved for release can be considered a violation of confidentiality.

  • Mentioning a case in social media (without patient identifiers) is no different than talking in an elevator or cafeteria about the same case, except that it reaches a larger audience. All of these situations are considered inappropriate and have the possibility that the patient could be identified.
  • Your organization might be considering a new piece of technology that could help contribute to better patient care and/or diagnostic testing. You may have heard about this potential purpose through hallway discussions, meetings or read in minute notes. Although the concept of enhancing patient care is positive and something you may want to communicate to others, there are other considerations such as fiscal responsibilities, changes in patient flow between organizations, and vendor interests that are also important. It is possible that disseminating such information prior to approval may lead to a violation in confidentiality.

What if I am unfit to practice but I am not able to recognize? Reference Code 3.1.

As a professional practitioner, it is your responsibility to be self-aware and to critically reflect on your skills, abilities and any changes that have occurred in your life that may impact your ability to practise. This can be accomplished through external evaluation as well as internal self-reflection.  Furthermore, it is your responsibility to identify to your supervisor if you feel a coworker is unfit to practice. They may be unconsciously incompetent and have no malicious intent; however, you are ethically bound to make them aware of their potential inability to practice properly in a respectful manner. Using both self-reflective practice and external formal and informal evaluation is important in recognizing fitness to practice.

  • It is possible that someone can develop a mental or physical illness or disorder that inhibits him or her from performing duties that were once considered routine or easy. For example, when a person becomes stressed or experiences burnout from work or home life stress, he/she may find completing the most simple of tasks at work as arduous and/or may begin to cut corners to relieve some stress. We don’t always know that we are not performing at our best and may believe that we will be able to make up for our shortcomings at a later date. However, this may not be the case. If a coworker or supervisor brings the shortcomings to you, it is best to recognize the issue and seek help.

How can I contribute to the advancement of my profession by 'improving the body of knowledge'? Reference Code 3.4.

Improving the body of knowledge can be considered in any number of scenarios (formal, informal to non-formal perspectives).  As a professional, you learn not only from your initial training but from your daily experience.  While we commonly believe that improving the body of knowledge involves formalized tasks, it can also be as simple as informing your colleagues of a new method, idea, or opportunity. Improving the body of knowledge is about engagement in your own learning and the learning of others. 

  • Examples might include sharing your gained knowledge from attending a conference or being responsible for a quality improvement project, writing the report and presenting findings to your coworkers. In sharing and possibly having to defend our findings, we are reinforcing our knowledge and understanding.

How can I be responsible to the environment? Reference Code 4.1

Your environment is all around you and includes your place of work as well as the external larger global environment. As professionals we are ethically responsible to the public, not just to patients but also to members of a larger community. Consider the notion of waste management and the cost that wastefulness can have on the patient, the public and the environment. Would it be environmentally ethical to dispose of mercury containing materials down the sink?  The same concept may be applied to any number of laboratory policies that may be unnecessarily wasteful.

  • Over the years, for the sake of health and safety, many organizations use plastic disposable containers for much of our work. This was not an issue when glassware was being used, washing and sterilizing in the past. It is appropriate to consider our local policies and national guidance on how to dispose of products and consider new alternative methods for this.

What does the word 'inform' mean? Should I give the results of a test or only how the test is completed? Reference Code 4.4

To inform is to give or impart knowledge of a fact or circumstance; to supply (oneself) with knowledge of a matter or subject; to give evident substance, character, or distinction to someone.

  • A patient might want to be informed of what a particular test is for or why it has to occur at specific intervals. It is your professional duty to be prepared to explain the answer or seek the answer in a timely manner from another healthcare profession as required. Patients have the right to accept or refuse testing after being provided with the information as it may be new to the individual or they may consider the information in a new light.

Discuss the concept of formal and informal education in relation to the code. Reference Code 3.3

The Organization for Economic Co-operation and Development (OECD) defines formal learning as a type of learning that is intentional, organized, structured and usually arranged by institutions (e.g., college, university course, or CSMLS course). Non-formal learning may or may not be intentional or arranged by an institution, but is usually organized in some way, though lacks granting of formal credit. Workplace based approaches to learning will often fall within this category (e.g. LABCON). In contrast to these, informal learning is never organized, and rather than being guided by a rigid curriculum is often thought of as experiential or spontaneous. The concept of networking for example could be considered an informal approach to learning. Therefore, education approaches may utilize any of these forms of learning incorporating components such as article review, mentoring, networking, or other informal learning which can be documented or demonstrated as being completed.

Explore:

Course:

Check out “The Science of Morals: Understanding the CSMLS Code of Ethics” course to further your comprehension of the Code and how to apply these principles in real-life situations.

PEP hours will be assigned after successful completion of this course.

Discuss:

Have an opinion on how to deal with an ethical dilemma? How do you face with the 'grey zone'? Talk with members and support your profession.

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