Choose your Champion: Healthcare Optics vs Healthcare Ethics
Aim:
This article employs an often overlooked twist to address the breakdown in ethical practices that have been normalised in healthcare facilities with a special focus on the laboratory.
Given:
ethics, accreditation, profession, healthcare worker, rule, crime and punishment, leadership, training, procedures
Principle:
Fatai rolled to his belly as his body adjusted to his waking sequence at 3 AM. Waking up at wee hours has been his routine for several weeks now since he disrupted his circadian rhythm in the bid to prepare for his last examination. But there was something about that particular night that was different; to begin with, he woke up by 3 AM instead of the statutory 2 AM. There was something that just kept sucking him in his bed that made getting up harder than usual. As his ears picked up the whirring of his old fan, the pieces of the puzzle started to come together. It’s been 6 weeks since that fan moved its blade out of its volition. It wasn’t one of those nights he woke to beads of sweat gathering in a stampede across the groove of his back. The fan has also kept his winged bloodsucking co-inhabitants at bay. He plugged his devices and went back to sleep with a determination to savour this moment – perhaps it was a dream.
Fatai would be treated to more surprises at the clinic when he got there and met the hedges trimmed. The water in the labs has started running and there are new packs of gloves for each bench. The scientists in Medical Microbiology and Parasitology have rested their smokers’ lighters for bursen burners. He was about to hang his lab coat on a newly erected hanger when the scales fell off. An announcement printed on an A4 paper pasted on the wall calls people to extra vigilance as accreditors will be visiting soon. All that fuzz is all about accreditation. He sighed as he resigned to another wasted hope. This is a cycle he is too familiar with. One week of sanity and dutiful adherence to ethical practices that leave immediately the accreditors drive out of the gate.
No healthcare professional ever goes through school without having the 4 pillars of ethics drilled into their skull. The reality, however, is that the closer you are to practice, the less reliable these pillars and their importance are. For the ones very far into the pipeline, here are the core pillars and what they represent
1. Autonomy
Definition: Respecting a person’s right to make their own decisions
Practical Meaning in Healthcare: Patients must give informed consent and have control over their care
Ethical Obligation: Respect patients’ choices, provide full disclosure, and support independent decision-making
2. Beneficence
Definition: Actively doing good for the patient
Practical Meaning in Healthcare: Provide the best possible care, act in the patient’s best interest
Ethical Obligation: Promote health, prevent harm, and improve well-being
3. Non-maleficence
Definition: “Do no harm” — avoiding actions that cause unnecessary harm or risk
Practical Meaning in Healthcare: Avoid medical errors, ensure proper procedures, and use safe practices
Ethical Obligation: Minimize risks, avoid negligence or carelessness
4. Justice
Definition: Fair and equitable treatment of all patients
Practical Meaning in Healthcare: Distribute care fairly, regardless of status, class, gender, religion, or tribe
Ethical Obligation: Treat similar cases similarly; avoid discrimination or bias
Unfortunately, these concepts have been relegated to the annals of abstracts that are only relevant when we are preparing for professional exams or doing mental gymnastics about hypothetical case studies, such as a Jehovah’s Witness refusing blood transfusion. This is not to infer that the previously mentioned scenarios are not important, but take this as a call for us to bring it home; why is there so much glee and excitement about the glamorous hypothetical cases while we keep ignoring the everyday ethical practices we are consistently breaking? We are fluent in argument for the rare cases, but still skip that important control step in our Standard Operating Procedure. Why is it easier to gloss over the surface information rather than explain the relevant details of a test we want to perform on a patient?
Old Habits Die Hard
We must acknowledge that some ethical practices are relatively alien to the human mind. However, admitting this is by no means a suggestion that such practices are impossible to adopt. Historically, modern medicine did not become an established discipline until the 1800s. Before then, our ancestors—who have existed for about 300,000 years—relied on herbs, natural immunity, and the unpredictable outcomes determined by nature. Unsurprisingly, aseptic techniques still feel somewhat unnatural, a way of life our neurons haven’t fully assimilated. We must also recognize that the human mind is naturally wired to instinctively take the path of least resistance. This is why we might prefer to wear our regular footwear in labs, even when lab shoes are mandated. Again, this is not an argument for a return to the dark ages, but rather a guide to help us confront the reality that human nature itself can be part of the problem. And once the problem is clearly identified, it becomes much easier to chart a path toward meaningful solutions.
Out of sight, Out of mind
“The certainty, severity, and swiftness of punishment deter misconduct.”
— Cesare Beccaria
One of the reasons why major ethical cases like false positives, wrong genotyping, and transfusion errors steal the spotlight is because of how apparently tangible they seem. There is a direct link between cause and effect in most of these cases, and the outcome is almost always immediate. However, the consequences of breaking routine ethical practices often go unnoticed because their causal agents are typically microscopic. This tendency to overlook such rules is captured by a theory in classical criminology called Deterrence Theory, which is based on three components:
Certainty: The belief that breaking rules will result in punishment.
Severity: The harshness of the punishment.
Celerity: The speed at which the punishment is delivered.
For effective deterrence to occur, these 3 factors have to be established. In essence, for every sample handled without gloves or non-disinfected lab pen used without gloves, as long as we continue to look the other way and effect no consequence, compliance is going to be difficult.
Garbage in, Garbage Out
When it comes to studying the intricacies of the human mind, the disconnection between information retention and knowledge acquisition offers a compelling case study. One inherent burden faced by students in healthcare-related courses is the pressure to cover voluminous coursework within a short timeframe and with precision. This is a culture that heavily rewards speed, while more methodical learners are left behind. Consequently, many students succumb to the temptation of cramming just to pass. This habit often leads to the emergence of healthcare professionals who are book-smart but unable to apply their knowledge in real-world scenarios unfolding right before them.
On the other hand, there are instructors—often victims of the same dysfunctional system—who pass along knowledge devoid of context. While it is easy to blame discouraging learning environments, we must also admit that even with sufficient time and resources, some instructors still fail to deliver. Some remain trapped in theoretical precision, disconnected from the practical realities that students must eventually navigate.
Body is Willing but Mind is Weak
The bottlenecks introduced by limited resources in healthcare facilities are often the prime suspects when it comes to the lack of adherence to routine ethics. However, an equally culpable factor is the mental conditioning that working in such environments can have on the psyche. It is entirely possible for facilities to improve while the mental shift needed to maximize that improvement never happens. This explains why many healthcare institutions struggle with the migration to digital ecosystems—such as the low penetration of Electronic Health Records—despite the proven advantages of ease and efficiency.
A more dangerous consequence of this insistence on the old ways is not just non-adherence, but in certain cases, active sabotage of improved systems. A relevant example is the case of Keda Industrial Company, where management introduced systems to better manage inventory, but some managers—feeling the new structure threatened their autonomy—rebelled and disrupted its implementation. Similar scenarios can be seen in healthcare, where supervisors and directors take custody of molecular diagnostic tools only to lock them away in storerooms, refusing to integrate them into lab workflows. Despite knowing that molecular diagnostics are the gold standard, the inconvenience of change becomes a discouraging factor.
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Recommendations
As elusive as our adversary may seem, we are not helpless in this fight. As long as we can trace the consequences of our actions and inactions to nosocomial infections, public health crises, and incorrect diagnoses, there remains sufficient incentive to keep fighting this battle for a return to sanity. And no, we don’t have to wait until Elon Musk makes contact with Martians before we start exploring strategies to address our disregard for practices we swore to uphold. Here are a few we should consider:
To continuously retrain our neurons on the critical role of following guidelines, we must vividly and consistently remind healthcare workers of the implications of neglect. All staff must be intentional about learning and teaching the consequences of their actions through visual demonstrations—animations, posters, and other materials—because showing is a more effective form of communication than simply telling. Studies show that visual aids significantly enhance the learning process.
Once we’ve established a system of vivid, continuous education, the next step is to implement structures that actively punish violations of these learned values. While it’s true that deterrence theory may not apply uniformly in every setting, a baseline system that discourages unethical behavior through action—not just rhetoric—is essential. Some argue for the power of social norms, where peer influence reinforces adherence. For example, public displays that highlight how a lab values and follows its SOPs may be more effective than threats. Context will dictate which method works best, but passivity is not an option.
Addressing the dearth of holistic and contextual knowledge must begin at the top. Institutions must create environments that support relevant and practical teaching. Expecting one academic staff member to handle three courses, along with administrative duties, personal research, advanced studies, and side hustles just to make ends meet, does not encourage innovation. Leadership at all levels must reduce these burdens and make teaching more rewarding. When the pressure cooker is lifted, creativity thrives—and so do the students.
Finally, the harsh truth: some individuals may need to be removed. There will always be personalities welded to the old ways, who cannot see the good in innovation when it threatens their comfort or gain. Leadership must exhaust all means to train, reorient, and model sound ethical practices. But if a healthcare worker continues to divert patients to their private practice after being exposed to the right training and systems, they must be let go. They do not just harm the system—they metastasize within it, recruiting others in their rampage like a cancer spreading through healthy tissue.
In the theatre of healthcare, it’s easy to be dazzled by the optics—polished surfaces, rehearsed routines, and ethical codes recited like catechism—but real integrity lies in what happens when no one is watching. What Fatai witnessed was not transformation, but performance, a familiar cycle where standards rise for accreditation and fall with the curtains. Ethics isn’t just about rare moral dilemmas; it’s in the everyday decisions—the skipped SOP, the unwashed hands, the ignored protocol. Until we treat ethical practice as daily hygiene rather than occasional heroism, we will keep circling the drain of temporary compliance. The real choice before every healthcare worker, especially in systems like ours, is simple but profound: will we remain champions of appearance, or will we do the harder work of becoming custodians of the invisible, often inconvenient, but deeply necessary ethic that sustains our profession?