Professional Ethics & Standards
Medical Laboratory Professionals, including Cytogenetic Laboratory scientists, are held to high standards of professional conduct. They serve as the bridge between the patient’s biological sample and the diagnosis that will guide life-altering decisions (e.g., terminating a pregnancy, starting chemotherapy). Adherence to a Code of Ethics (such as that provided by the American Society for Clinical Laboratory Science - ASCLS) ensures that patient welfare remains paramount
Duty to the Patient
The primary ethical obligation is to the patient. Even though cytogeneticists often do not meet patients face-to-face, their actions directly impact patient safety and outcomes
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Quality and Integrity
- The “Standard of Care”: A laboratory scientist must perform tests with the highest level of skill and accuracy. It is unethical to take shortcuts (e.g., reducing incubation times below validated limits) to finish a shift early
- Knowing Limitations: It is an ethical duty to stop testing if a system is out of control. If the QC on the FISH probe failed, reporting patient results anyway is a violation of trust and safety
- Reporting Errors: If a mistake is made (e.g., switching samples), the ethical response is immediate disclosure to the supervisor so it can be fixed. Hiding an error to avoid reprimand places the patient at risk of mistreatment
- Confidentiality: Maintaining the privacy of genetic information (as discussed in HIPAA) is a core ethical tenant
- Impartiality: Patients must be treated equally regardless of race, religion, economic status, or the nature of their disease. A sample from a prisoner or a VIP receives the same priority and care
Duty to Colleagues & the Profession
Cytogenetics is a collaborative science. Laboratory scientistsrely on the work of phlebotomists, accessioners, and other techs
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Integrity of Conduct
- Honesty: Falsifying QC data (e.g., “dry-labbing” or writing down a temperature without checking the thermometer) is fraudulent and grounds for immediate termination and revocation of certification (ASCP)
- Respect: Treating colleagues with dignity and respect creates a safety culture where people feel comfortable asking questions or pointing out potential hazards
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Competence and Continuous Learning
- The field of genetics evolves rapidly (e.g., the shift from Karyotype to Microarray)
- Ethical Standard: It is the professional’s duty to maintain their competence through Continuing Education (CE). Continuing to use outdated nomenclature or methods because “that’s how we always did it” is unethical if it compromises diagnostic clarity
- Mentorship: Experienced laboratory scientist s have an ethical obligation to train and mentor students and new employees, passing on knowledge to ensure the future quality of the profession
Duty to Society
Laboratories operate within a broader legal and social framework
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Resource Stewardship
- Ethical laboratory scientist s use laboratory resources (reagents, equipment) efficiently to minimize waste and cost, contributing to the sustainability of the healthcare system
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Compliance
- Strict adherence to laws (CLIA, OSHA) and regulations is not just about avoiding fines; it is about upholding the social contract that allows laboratories to operate
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Conflict of Interest
- Laboratory scientistsshould avoid situations where their professional judgment could be compromised
- Example: Accepting expensive gifts from a reagent vendor in exchange for recommending their product is an ethical violation (and often a violation of the Stark Law/Anti-Kickback Statute)
Specific Ethical Dilemmas in Cytogenetics
Genetic testing raises unique ethical questions that laboratory scientist s should be aware of, even if the final counseling is done by a genetic counselor or physician
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Incidental Findings
- Scenario: A microarray ordered for developmental delay reveals non-paternity (the father is not the biological father) or consanguinity (parents are closely related)
- Standard: The lab must have a policy on reporting incidental findings. Typically, the lab reports the findings to the ordering physician, who then bears the ethical burden of disclosure to the family
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Prenatal Diagnosis
- Scenario: Testing reveals a condition compatible with life but associated with disability (e.g., Down Syndrome, Turner Syndrome)
- Standard: The laboratory’s role is to provide an unbiased, accurate scientific result. The laboratory scientist must not let personal beliefs about pregnancy termination influence the speed or wording of the report
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Variants of Uncertain Significance (VUS)
- Scenario: Finding a small deletion that has never been described in the literature
- Standard: The lab must honestly report the uncertainty. It is unethical to definitively call a VUS “Pathogenic” without evidence, as this could lead to unnecessary medical intervention
Certification Standards (ASCP)
The American Society for Clinical Pathology (ASCP) Board of Certification sets the gold standard for the profession
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Credential Maintenance Program (CMP)
- To maintain the CG(ASCP): credential, laboratory scientist s must complete 36 hours of CE every 3 years
- This requirement reinforces the ethical mandate for continuous learning
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Revocation
- Certification can be revoked for conviction of a felony related to medical practice or for gross incompetence/negligence