will do the Part A. And write in point form. You can link those points and form a case study analysis.
Part A: The compulsory case study will be chosen from the cases available in this folder. Students must individually complete the following tasks (within the 2000 word limit) for a total of 20 or 30 marks, depending on how many essays are attempted in Part B:
1. Describe the facts that underpinned the ethical dilemma in the case.
2. Who is the decision-maker in the selected case, and what conflicting demands did they have to accommodate?
3. What was the initial ethical dilemma faced by the decision-maker in this case?
4. Using the Utilitarian, Kantian, Rights, and Distributive Justice approaches to ethical decision-making, provide an analysis of the ethical dilemma.
5. Present and justify the final recommendation you would have made to the decision-maker in this case had they asked you for advice on how to resolve their initial ethical dilemma.
AIDS and Needles
Becton Dickinson, one of the largest manufacturers of medical supplies, dominates
the US market in disposable syringes and needles. In 2005, a nurse, Maryann Rockwood
(a fictional name), used a Becton Dickinson 5cc syringe and needle to draw blood from a
patient known to be infected with HIV (Human immunodeficiency virus). Ms. Rockwood
worked in a clinic that served AIDS patients, and she drew blood from these patients
several times a day. After drawing the blood on this particular day, she transferred the
HIV-contaminated blood to a sterile test tube by sticking the needle through the rubber
stopper of the test tube, which she was holding with her other hand. She accidentally
pricked her finger with the contaminated needle. She is now HIV positive.
A few years earlier, in 2000, Becton Dickinson had acquired exclusive rights to a patent
for a new syringe that had a moveable protective sleeve around it. The plastic tube around
the syringe could slide down to safely cover the needle. The Becton Dickinson 5cc
syringe used by Maryann Rockwood in 2005, however, did not yet have such a protective
guard built into it. The AIDS epidemic has posed peculiarly acute dilemmas for health
workers, including doctors and nurses. Doctors performing surgery on AIDS patients can
easily prick their fingers with a scalpel, needle, sharp instrument, or even bone fragment
and can become infected with the virus. The greatest risk is to nurses, who, after routinely
removing an intravenous system, drawing blood, or delivering an injection to an AIDS
patient, can easily stick themselves with the needle they were using. Needlestick injuries
occur frequently in large hospitals and account for about 80 percent of reported
occupational exposures to HIV among health care workers. It was conservatively
estimated in 2005 that about 64 health care workers were then being infected with HIV
each year as a result of needlestick injuries.
Although the fear of HIV had heightened concerns over needlestick injuries, HIV was not
the only risk posed by needlestick injuries. Hepatitis B can also be contracted through an
accidental needlestick. In 2000, the Centre for Disease Control (CDC) estimated, on the
basis of hospital reports, that each year at least 12,000 health care workers are exposed to
blood contaminated with the Hepatitis B virus, and of these 250 die as a consequence.
Due to underreporting, however, the actual numbers may be higher. In addition to
Hepatitis B, needlestick injuries can also transmit numerous other viral, bacterial, fungal,
and parasitic infections, as well as toxic drugs or other agents that are delivered through a
syringe and needle. The total statistics on needlestick injuries in 2005 are disturbing,
although the exact incidence of contamination is unclear. It was estimated that each year,
in the United States alone, between 800,000 and 1 million needlestick injuries occurred in
hospitals – of these, between 60,000 and 300,000 resulted in Hepatitis B infection. By one
estimate, the risk of contracting HIV from a known contaminated needle could be as high
as 1 in 1000, and the risk of contracting Hepatitis B, a serious and often life-threatening
condition, could be as high as 1 in 6. These estimates would imply that as many as 600 to
1000 health care workers were at risk of contracting HIV and as many as 100,000 were at
risk of contracting Hepatitis B.
Several agencies stepped in to set guidelines for nurses, including the American Nursing
Association, the CDC, the Environmental Protection Agency (EPA), and the Food and
Drug Administration (FAD), who all developed such guidelines. The most comprehensive
guidelines were issued by the Occupational Safety and Health Administration (OSHA),
who on December 6, 2001, required hospitals and other employers of health workers to
(a) make sharps containers (safe needle containers) accessible to workers, (b) prohibit the
practice of recapping needles by holding the cap in one hand and inserting the needle with
the other, and (c) provide information and training on needlestick prevention to
The usefulness of these guidelines was controversial. Nurses work in high-stress
emergency situations requiring quick action, and they are often pressed for time both
because of the large number of patients they must care for and the highly variable needs
and demands of these patients. In such workplace environments, it is difficult to adhere to
the guidelines recommended by the agencies. For example, a high-risk source of needle
sticks is the technique of replacing the cap on a needle (after it has been used) by holding
the cap in one hand and inserting the needle into the cap with the other hand. OSHA
guidelines specifically warned against this two-handed technique of recapping and instead
required that the cap be placed on a stable surface and the nurse use a one-handed
spearing technique to replace the cap. (Note that recapping the needles in this more time
consuming way presented no risk of needlestick injury to the user). As noted above
however, nurses are often pressed for time (and are keenly aware of the added danger of
walking around with an uncapped needles) and tend to take the ‘two-handed recapping
shortcut’ when no suitable surface is readily available for the safer one-handed capping
technique. This fact is known to Hospital administrators, who regularly warn against such
practices, and offer ongoing training and retraining opportunities to their nursing staff.
Several analysts suggested that the peculiar features of the nurse’s work environment
made it unlikely that needlesticks would be prevented through mere guidelines alone: The
problem was not the worker, but the design of the needle and syringe. Experts on
needlestick injuries argued that, rather than trying to teach health care workers to use a
hazardous device safely, the focus should be on the hazardous product design and that a
whole new array of devices in which safety is an integral part of the design was required.
Regulators also urged manufacturers to provide the health care worker with devices in
which safety was built into the design.
The risks of contracting life-threatening diseases by the use of needles and syringes in
health care settings had been well documented since the early 1980s. Well over half of all
the needles and syringes used by U.S. health care workers since 1980 were being
manufactured by Becton Dickinson. Despite the emerging crisis, however, Becton
Dickinson decided not to modify its syringes, although it did include in each box of
needled syringes an insert warning of the danger of needlesticks and of the dangers of
two-handed recapping. On December 23, 2000, the U.S. Patent office issued patent
number 4,631,057 to Charles B. Mitchell for a syringe with a tube surrounding the body
of the syringe that could be pulled down to cover and protect the needle on the syringe. At
the time, at least four other patents for needle-shielding devices existed. As Mitchell
noted in his patent application, those devices all suffered from serious drawbacks. One of
them would not lock the protective cover over the exposed needle, one was extremely
complex, another was much longer than a standard syringe and difficult to use, and a
fourth was designed primarily for use on animals.
It was Mitchell’s assessment that his invention was the only effective, easily usable, and
easily manufactured device capable of protecting users from needlesticks, particularly in
emergency periods or other times of high stress. Unlike other syringe designs, Mitchell’s
was shaped and sized like a standard syringe so nurses already familiar with standard
syringe design would have no difficulty adapting to it. Shortly after Mitchell patented his
syringe, Becton Dickinson purchased from him an exclusive license to manufacture it. A
few months later, Becton Dickinson began field tests of early models of the syringe using
a 3cc model. Nurses and hospital personnel were enthusiastic when shown the product.
However, they warned that if the company priced the product too high, hospitals, with
pressures on their budgets rising, could not buy the safety syringes. With concerns about
HIV rising fast, the company decided to market the product.
In 2001, with the field tests completed, Becton Dickinson had to decide which syringes
would be marketed with the protective sleeves. Sleeves could be put on all of the major
syringe sizes, including 1cc, 3cc, 5cc, and 10cc syringes. However, the company decided
to market only a 3cc version of the protective sleeve. The 3cc syringes account for about
half of all syringes used, although the larger sizes-5cc and 10cc syringes-are preferred by
nurses when drawing blood. This 3cc syringe was marketed in 2002 under the
trademarked name Safety-Lok Syringe. It was promoted as a device that “virtually
eliminates needlesticks.” The 3cc safety syringe with the protective sleeve was sold in
2001 to hospitals and doctors’ offices for between 50 and 75 cents. By 2003, the company
had dropped the price to 26 cents per unit. At the time, a regular syringe without any
protective device was priced at 8 cents per unit and cost 4 cents to make. Information
about the cost of manufacturing the new safety syringe is unavailable but is estimated at
between 13 and 20 cents each. The difference between the price of a standard syringe and
the price of the safety syringe was an obstacle for customers. To switch to the new safety
syringe would increase the hospital’s costs for 3cc syringes by a factor of three. An
equally important impediment to adoption was the fact that the syringe was available in
only one 3cc size, and it was perceived to be of limited application. Hospitals are
reluctant to adopt and adapt to a product that is not available for the whole range of
applications the hospital must confront. In particular, hospitals often needed the larger 5cc
and 10cc sizes to draw blood, and Becton Dickinson had not made these available with a
For 5 years, Becton Dickinson manufactured only 3cc safety syringes. During that period,
Becton Dickinson did not license its new safety syringe technology to another
manufacturer that might have produced a full range of syringe sizes. Most hospitals and
clinics, including the medical facility where Maryann Rockwood worked at drawing
blood from many patients with Hepatitis B or HIV, did not stock the Becton Dickinson
safety syringe. Most nurses in the United States continued to use unprotected syringes.
Maryann Rockwood sued Becton Dickinson, alleging that, because it alone had an
exclusive right to Mitchell’s patented design, the company had a duty to provide the
safety syringe in all its sizes, and that by withholding other sizes from the market it had
contributed to her injury. The case was settled out of court.
Velasquez, M.G. 2006. Business Ethics: Concepts and cases (6th ed.). Sydney:
Pearson. pp. 292-296.
6 pages / 1650 words
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