“Ethics” word has been derived from the Greek adjective 'Ethica' which comes from
the Greek substantive 'ethos' meaning customs, usages and habits. It is also
known as 'Moral Philosophy'. The word moral is derived from the Latin substantive
'mores' which also means customs or habits. Customs are not merely habitual ways
of acting. They are ways approved by the group or society. Thus 'Ethics' is the
science of rightness and wrongness of conduct. Conduct is purposive action, which
involves choice and will. It is the expression of character which is a settled habit
of will.
Character is the permanent habitual inner bent of mind, and naturally reflected
in habitual conduct. This is how any text book of 'Ethics' will explain the term;
a term intimately connected with the 'science of ideal involved in human life'.
Blood transfusion is a complex science that links healthy blood donor with the ailing
patient in quest of a new lease of life with various intermediaries and a system.
The first requirement is the blood donor. Only four out of a thousand people in
India
can think of donating blood. Dearth of donors prompted many people to trade in human
misery, to open commercial blood banks engaged in buying and selling of blood. Nowhere
in the world can paid professional sellers ensure the quality of blood in spite
of sophisticated post donation tests. So, all over the world stress is given on
voluntary blood donors and switching over to total voluntary blood programme. To
achieve this, the culture of blood donation should be the custom of the community.
This can be done by converting the Egoism of individuals to Altruism. The ideal
life of one requires others to complement it, and it is by mutual help that the
whole develops towards perfection. An individual is a member of a social unit, his
supreme will should not simply be the perfecting of his own life, or the realisation
of what appeals to him as the most fundamental values but also the perfecting of
the society to which he belongs. To a great extent one end will coincide with the
other.
When we seek simply our own individual ends, this attitude is called 'egoism' while
the term 'altruism' has been used to devotion to the ends of others. We can realise
the true self or the complete good only by social end. In order to do this, we must
negate the merely individual self, which is not the true self. We must realise ourselves
by becoming worthy of the society to be useful for others. The more fully we do
so realise ourselves, the more do we reach an universal point of view - i. e.,
a point of view from which our own private good is no more to us than the good of
anyone else. This is self-realisation — self realisation for the sake of the
whole. This good is clearly a social good.
With conviction and faith in this philosophy, any individual, group and organisation
can take up the task of blood donor motivation, recruitment and retention by converting
'egoism' of individuals to altruism, remembering all the time that motive means
what moves us or causes us to act in a particular way.
The means should not be overlooked. Education of soul is the only tool. The donor
should be assured of absolute confidentiality about identity and blood test results
and reasons of deferral.
Then comes the blood bank to collect blood to ensure safety of the donor and safety
of the recipient. Scientific donor screening, maintaining confidentiality at every
stage should be the creed of blood bank personnel to collect blood and maintain
adequate stock. In storing and distribution of blood the administrative or personal
balance of convenience should not get precedence but the need of the patient should
be the supreme. For this, development of personnel at all levels through training,
education and self-development would be necessary. The community should have appreciation
for the blood donor, blood bank personnel including those behind the public eyes
working faithfully in the laboratory, counter and other places. Then comes the doctors,
the users of blood. Blood transfusion is transplanting from outside in large quantity
to human circulation system. There are some hazards which may be fatal too. Unnecessary
transfusion should be avoided to ensure safety of the recipient. In case of planned,
cold or chronic cases, the attending doctor can deter a patient's relatives
from going' to commercial blood sellers. He/she can inspire the patient's friends
and relatives to donate blood for some one whom they love. He/ she can help the
blood bank by sending the report of blood transfusion through feed back/reaction
forms. One more thing. Asking for the so-called fresh blood every now and then puts
the patient in the hands of paid donors in disguise and also to the hazard of untested
blood transfusion. This ethics
can be implanted among the doctors from their student days through education and
demonstration and culture of the elders.
International Society of Blood Transfusion, International Federation of Red Cross
and Red Crescent Societies, World Health Organization between the period 1948 and
2000 have released various documents on the ethics of blood transfusion service.
Finally, it may be said, that the laws of a country are made by the rulers and are
therefore changeable. Laws of nature are constant, inviolable, all pervading and
unchangeable. The laws of ethics evolve and cannot be changed but they may be violated.
On the attitude of the community about the ethical laws/practices depends the quality
of life of the people of the country.
A Code of Ethics for Blood Donation and Transfusion
formulated
by International Society of Blood Transfusion on July 12, 2000.
The objective of this code is to define the ethical principles and rules
to be observed in the field of Transfusion Medicine.
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Blood donation including haematopoietic tissues for transplantation shall, in all
circumstances, be voluntary and non-remunerated; no coercion should be brought to
bear upon the donor. The donor should provide informed consent to the donation of
blood or blood components and to the subsequent (legitimate) use of the blood
by the transfusion service.
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Patients should be informed of the known risks and benefits of blood transfusion
and/or alternative therapies and have the right to accept
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or refuse the procedure. Any valid advance directive should be respected.
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In the event that the patient is unable to give prior informed consent, the basis
for treatment by transfusion must be in the best interests of the patient.
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A profit motive should not be the basis for the establishment and running of a blood
service.
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The donor should be advised of the risks connected with the procedure: the donor's
health and safety must be protected. Any procedures relating to the administration
to a donor of any substance for increasing the concentration of specific blood components
should be in compliance with internationally accepted standards.
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Anonymity between donor and recipient must be ensured except in special situations
and the confidentiality of donor information assured.
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The donor should understand the risks to others of donating infected blood and his
or her ethical responsibility to the recipient.
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Blood donation must be based on regularly reviewed medical selection criteria and
not entail discrimination of any kind, including gender, race, nationality or religion.
Neither donor nor potential recipient has the right to require that any such discrimination
be practised.
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Blood must be collected under the overall responsibility of a suitably qualified,
registered medical practitioner.
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All matters related to whole blood donation and haemapheresis should be in compliance
with appropriately defined and internationally accepted standards.
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Donors and recipients should be informed if they have been harmed.
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Transfusion therapy must be given under the overall responsibiliiy of a registered
medical practitioner.
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Genuine clinical need should be the only basis for transfusion therapy.
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There should be no financial incentive to prescribe a blood transfusion.
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Blood is a public resource and access should not be restricted.
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As far as possible the patient should receive only those particular components (cells,
plasma, or plasma derivatives) that are clinically appropriate and afford optimal
safety.
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Wastage should be avoided in order to safeguard the interests of all potential recipients
and the donor.
Blood transfusion practices established by national
or intemational health bodies and other agencies competent and authorised to do
so should be in compliance with this code of ethics.