The most problematic phase in the l

The most problematic phase in the laboratory examination process proved to be the pre-analytic phase, in which patient autonomy and confiden- tiality figured especially in the sub-phases 1) deciding to organise the examination; 2) inform- ing the patient and gaining consent and, 4) collecting the specimen. In sub-phase 3) ordering the examination and preparing the patient, no problems were mentioned. The reason for this could be that these activities might also be consid- ered as belonging to the previous or following sub-phase. The number of ethical problems reported in the analysis phase was much smaller, mainly problems in the banking of genetic samples. It is worth noting that the interpretation of results in sub-phases was not seen as problem- atic, even though laboratory medicine is a rapidly advancing field and many special examination types need expert skills for the interpretation of the results. Since health care resources at present appear insuYcient even for patient care, it is sur- prising that ethical questions concerning the last sub-phase 12), applying the results to patient care, received no attention. Ethical problems in the use of examination results proved to be mostly value conflicts between the individual and society.
When considering the validity of this literature
review, it must be remembered that the review
data comprised only articles dealing with exami-
nations analysed in a laboratory. Administrative
and legal articles were not taken into considera-
tion, so problems involving society and organisa-
tions were mentioned less often. The same applies
to problematic situations between diVerent
professional groups. It is also probable that more
varied and more detailed information could have
been obtained by performing the literature search
without “ethic” as a keyword. Practical ethical
problems will have been examined using empirical
methods without connecting the concept “ethic”
to the problem.
The literature reviewed here clearly reveals
which examinations and which phases of these
examinations are ethically most problematic, as
well as identifying the problems involved. This can
be seen as evidence that we need more discussion
concerning ethical values in patient examination
and concerning the use of examination results.
Because of rapid advances in laboratory examina-
tions and the lack of empirical ethical research, it
is important to chart empirical knowledge about
present value conflict situations involved in the
laboratory examination process in health care.
Identification of the ethical conflicts would help to
develop procedures which would take the views of
patients and diVerent professional groups more
comprehensively into consideration. At the same time it would advance the development of legitimate and ethically just examination proce- dures.

Tarja Nyrhinen, MNSc, is a Medical Laboratory Technologist at the University Central Hospital of Turku. Helena Leino-Kilpi, PhD, RN, is Professor of Nursing Science at the University of Turku, Faculty of Medicine, Department of Nursing. Address for correspondence: Tarja Nyrhinen, Medical Laboratory Technologist, University Central Hospital of Turku, Central Laboratory, Department 931, Kiinamyllynk
4-8, 20520 Turku, Finland.