Back to: Linking to Care, Point of Care Testing (POCT). Aotearoa Edition
Defining by-products: For our purpose, we will define by-products as blood and any item contaminated with blood from our testing. We will extend this to any bodily fluid or sample that may have been produced from the testing session(s). These are, together with our personal protective equipment (PPE), biohazardous materials.
In lesson 25, Disposal of Personal Protective Equipment, we discussed biohazardous materials and disposal of such items. In this lesson we will explore some aspects of cultural and ethnic implications on body waste materials and matter.
In very broad general terms, speak to your local medical professional, hospital, community nurse team, pharmacy or health providers and follow their process and procedure for disposal of by-products. In most instances they will be able to provide assistance if not disposal.
In the context of Aotearoa, New Zealand: For Māori, all genetic material is tapu (sacred)in Māori tikanga (custom, tradition). Some may consider samples following testing tākoha (a gift with tapu (sacred) connotations) that you will dispose of respectfully. In other instances, your wai ora may request the samples for their own disposal in accordance with their tikanga. As a tester this is something you will need to have awareness of and be prepared for in advance.
- Sharps are always disposed of in the sharp’s container.
- The test cassette, pipette, and any contaminated swabs, gauze or Band-Aids can be placed into a suitable container, such as a sealable plastic bag, and taken by your wai ora for their disposal.
Potential conflict: Let’s set a scenario.
Your wai ora has come in for a test accompanied by family. At the end of the test you ask if they wish to take their test by-products for disposal and they say “no thank you”. A family member say’s “no actually we will take them so we can respect our tikanga”
Here is the conflict, we want to respect the family wishes, it fits with our Health Network Collective kaupapa, (purpose, policy). We must respect our patient rights, (section 2 lessons 6 and 7), in particular;
- From the Four Pillars; referenced from The Principles of Biomedical Ethics
- Autonomy; giving the patient the freedom to choose freely, where they are able
- Non-maleficence; to do no harm
- Beneficence; doing good
- Justice; ensuring fairness
- From Medical Ethics; referenced from Te Toihau Hauatanga (Health and Disability Commissioner New Zealand)
- Right One (1) The right to be treated with respect.
- Right Two (2) The right to freedom from discrimination, coercion, harassment, and exploitation.
- Right Three (3) The right to dignity and independence.
- Right Four (4) The right to services of an appropriate standard.
- Right Five (5) The right to effective communication.
- Right Six (6) The right to be fully informed.
- Right Seven (7) The right to make an informed choice and give informed consent.
- Right Eight (8) The right to support.
- Right Nine (9) Rights in respect of teaching or research.
- Right Ten (10) The right to complain.
The important issues here are Autonomy; giving the patient the freedom to choose freely, where they are able. And Right Seven (7) The right to make an informed choice and give informed consent. Essentially this is the patients right and their decision.
This may be a time where you inform the wai ora and their family “let me give you a few moments to discuss and I will be right back“.
This could be labelled as very clear medicolegal issue where the patient’s decision is final. And it really is. However… the family can be given some time to discuss the issue and arrive at a decision that still allows our wai ora to be the consenting (or not) individual that are entitled to be.
Consider pre-empting this scenario, make some time to have a chat with your local marae, or in the case of other cultures and ethnic populations find out who is the knowledgeable persons(s), and have a conversation. As a side note, these community interactions and conversations may open doors for other wai ora to testing and improve their health access and general population education around HCV and more.
