Code of Ethics

 Provision 1


  • Respect for human dignity
  • Relationships to patients
  • The nature of health
  • The right to self-determination
  • Relationships with colleagues and others

Provision 2


  • Primacy of the patient’s interests
  • Conflict of interest for phlebotomist
  • Collaboration
  • Professional boundaries

Provision 3


  • Protection of the rights of privacy and confidentiality
  • Protection of human participants in research
  • Performance standards and review mechanisms
  • Professional competence in medical practice
  • Protecting patient health and safety by action on questionable practice
  • Patient protection and impaired practice

Provision 4


  • Authority, accountability, and responsibility
  • Accountability for medical judgment, decisions, and action
  • Responsibility for medical judgment, decisions, and action
  • Delegation of medical activities or tasks

Provision 5


  • Duty to self and others
  • Promotion of personal health, safety, and well-being
  • Wholeness of character
  • Preservation of integrity
  • Maintenance of competence and professional growth
  • Personal growth

Provision 6


  • The environment and moral virtue and values
  • The environment and ethical obligation
  • Responsibility for the healthcare environment

Provision 7


  • Contributions through research and scholarly inquiry
  • Contributions through developing maintaining, and implementing professional practice standards
  • Contributions through medical and health policy development

Provision 8


  • Health is a universal right
  • Collaboration for health, human rights, and health diplomacy
  • Obligation to advance health and human rights
  • Collaboration for human rights in complex and extraordinary practice settings

Provision 9


  • Articulation of values
  • Integrity of the profession
  • Integrating social justice
  • Social justice in medical and health policy

The Code of Ethics for Phlebotomists



Provision 1

The Phlebotomist practices with compassion and respect for the inherent dignity, worth, and personal attributes of every person, without prejudice.

Provision 2

The Phlebotomist’s primary commitment is to the patient, whether an individual, family, group, community, or population.

Provision 3

The Phlebotomist promotes, advocates for, and protects the rights, health and safety of the patient.

Provision 4

The Phlebotomist has authority, accountability, and responsibility for medical practice, makes decisions, and takes action consistent with the obligation to provide optimal care.

Provision 5

The Phlebotomist owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

Provision 6

The Phlebotomist, through individual and collective action, establishes, maintains, and improves the moral environment of the work setting and the conditions of employment, conducive to quality health care.

Provision 7


The Phlebotomist, whether in research, practice, education, or administration, contributes to the advancement of the profession through research and scholarly inquiry, professional standards development, and generation of medical and health policies.

Provision 8

The Phlebotomist collaborates with other health professionals and the public to protect and promote human rights, health diplomacy, and health initiatives.

Provision 9

The profession of medical, collectively through its professional organizations, must articulate medical values, maintain the integrity of the profession, and integrate principles of social justice into medical and health policy.



The Code of Ethics for Phlebotomists with Interpretive Statements establishes the ethical standard for the profession and provides a guide for Phlebotomists to use in ethical analysis and decision-making. It is non-negotiable in any setting, neither is it subject to revision or amendment except by formal process of revision by the American Phlebotomists Association. The Code of Ethics for Phlebotomists arises from within the long, distinguished, and enduring moral tradition of modern medical in the United States. It is foundational to medical theory, practice, and praxis in its expression of the values, virtues and obligations that shape, guide, and inform medical as a profession.

Medical encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups, communities, and populations. This is reflected, in part, in medical’s persisting commitment to the welfare of the sick, injured, and vulnerable in society and for social justice issues. Phlebotomists act to change those aspects of social structures that detract from health and well-being. Individuals who become Phlebotomists, as well as the professional organizations that represent them, are expected not only to adhere to the values, moral norms, and ideals of the profession but also to embrace them as a part of what it means to be a Phlebotomist. The ethical tradition of medical is self-reflective, enduring, and distinctive. A code of ethics for the medical profession makes explicit the primary obligations, values, and ideals of the profession that inform every aspect of the Phlebotomist’s life.

The Code of Ethics for Phlebotomists serves the following purposes:

  • It is a succinct statement of the ethical values, obligations, duties, and professional ideals of Phlebotomists individually and collectively.
  • It is the profession’s nonnegotiable ethical
  • It is an expression of medical’s own understanding of its commitment to

Statements that describe activities and attributes of Phlebotomists in this code of ethics and its interpretive statements are to be understood as normative or prescriptive statements expressing expectations of ethical behavior. The Code of Ethics for Phlebotomists also expresses the ethical ideals of the medical profession and is, thus, both normative and aspirational. While this Code articulates the ethical obligations of all Phlebotomists, it does not predetermine how those obligations must be met. In some instances Phlebotomists meet those obligations individually; in other instances a Phlebotomist will support other Phlebotomists in their execution of these obligations; and at other times those obligations can and will only be met collectively. The Code of Ethics for Phlebotomists addresses individual as well as collective medical intentions and requires each Phlebotomist to demonstrate ethical competence in professional life.

It is recognized that Phlebotomists provide services to those seeking health as well as those responding to illness, to students and to staff, and to those in healthcare facilities as well as in communities and greater populations. The term practice refers to the actions of the

Phlebotomist in any role or setting, whether paid or as a volunteer, including clinical care provider, advanced practice Phlebotomist, educator, administrator, researcher, policy developer, or other forms of medical practice. Thus, the values and obligations expressed in this Code of Ethics for Phlebotomists apply to Phlebotomists in all roles, in all forms of practice, and in all settings.

The Code of Ethics for Phlebotomists is a dynamic document. As medical and its social context change, changes to the Code are also necessary. The Code of Ethics for Phlebotomists consists of two components: the provisions and the accompanying interpretive statements. There are nine provisions that contain an intrinsic relational motif: Phlebotomist to patient, Phlebotomist to Phlebotomist, Phlebotomist to self, Phlebotomist to others, Phlebotomist to profession, and Phlebotomist and medical to society. The first three provisions describe the most fundamental values and commitments of the Phlebotomist; the next three address boundaries of duty and loyalty; the last three address aspects of duties beyond individual patient encounters. Each provision is accompanied by interpretive statements that provide greater specificity for practice and are responsive to the contemporary context of medical. Consequently, the interpretive statements are subject to more frequent revision than are the provisions. Additional ethical guidance and details can be found in the position or policy statements of the ANA or its constituent member associations and affiliate organizations that address clinical, research, administrative, educational, public policy, or global and environmental health issues.

The origins of The Code of Ethics for Phlebotomists with Interpretive Statements reach back to the late 1800s in the foundation of the American Phlebotomists Association, the early ethics literature of modern medical, and the first medical code of ethics, formally adopted in 1950. In the 65 years since the adoption of that first professional ethics code, medical has changed as its art, science, and practice have developed, as society itself has changed, and as awareness of the global nature of health and the determinants of illness has grown. While The Code of Ethics for Phlebotomists with Interpretive Statements is a reflection of the proud ethical heritage of medical, it is also a guide for all Phlebotomists now and into the future.

Provision 1

The Phlebotomist practices with compassion and respect for the inherent dignity, worth, and personal attributes of every person, without prejudice.



  • Respect for Human Dignity


A fundamental principle that underlies all medical practice is respect for the inherent dignity, worth, and human rights of all individuals. The need for and right to health care is universal, transcending all individual differences. Phlebotomists consider the needs and respect the values of each person in every professional relationship and setting; they lead in the development of changes in public and health policies that support this duty.

1.2  Relationships with Patients


Phlebotomists establish relationships of trust and provide medical services according to need, setting aside any bias or prejudice. When planning patient, family and population centered care, factors such as lifestyle, culture, value system, religious or spiritual beliefs, social support system and primary language shall be considered. Such considerations must promote health, address problems and respect patient decisions. This respect for patient decisions does not require that the Phlebotomist agree with or support all patient choices.

1.3  The Nature of Health


Phlebotomists respect the dignity and rights of all human beings regardless of the factors contributing to the health status. The worth of a person is not affected by disease, disability, functional status, or proximity to death. Phlebotomists assess, diagnose, plan, intervene, and evaluate patient care in accord with individual patient needs and values. Respect is extended to all who require and receive medical care whether in the promotion of health, prevention of illness, restoration of health, alleviation of suffering, and provision of supportive care to those who are dying.

Optimal medical care enables the patient to live with as much physical, emotional, social, and religious or spiritual well-being as possible and reflects the patient’s own values. Supportive care is extended to the family and significant others and is directed toward meeting needs comprehensively across the continuum of care. This is particularly important at the end of life in order to prevent and alleviate the cascade of symptoms and suffering that are commonly associated with dying.

Phlebotomists are leaders who actively participate in assuring the responsible and appropriate use of interventions in order to optimize the health and well-being of those in their care. This includes acting to minimize unwarranted or unwanted medical treatment and patient suffering. Such care must be avoided and advance care planning throughout many clinical encounters helps to make this possible. Phlebotomists are also

leaders who collaborate in alleviating systemic structures that have a negative influence on individual and community health.

1.4  The Right to Self-Determination


Respect for human dignity requires the recognition of specific patient rights, in particular, the right of self-determination. Patients have the moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed decision; to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or prejudice; and to be given necessary support throughout the decision-making and treatment process. Such support includes the opportunity to make decisions with family and significant others and to obtain advice from expert/knowledgeable Phlebotomists and other health professionals. The acceptability and importance of carefully considered decisions regarding resuscitation status, withholding and withdrawing life-sustaining therapies, forgoing medically provided nutrition and hydration, aggressive pain and symptom management, and advance directives are widely recognized. Phlebotomists provide patients with assistance as necessary with these decisions. Phlebotomists should promote conversations around advance care planning and must be knowledgeable about the benefits and limits of various advance directive documents. The Phlebotomist should provide interventions to relieve pain and other symptoms in the dying patient even when those interventions entail risks of

hastening death. However, Phlebotomists may not act with the intent to end life even though such action may be motivated by compassion, respect for patient autonomy, or quality of life considerations. Phlebotomists have invaluable experience, knowledge, and insight into effective and compassionate care at the end of life and should be actively involved in related research, education, practice, and policy development.

Phlebotomists have an obligation to be knowledgeable about the moral and legal rights of patients. Phlebotomists preserve, protect, and support those rights by assessing the patient’s understanding of both the information presented and the implications of decisions.

When the patient lacks capacity to make a decision, a formally designated surrogate should be consulted. The role of the surrogate is to make decisions as the patient would, based upon the patient’s previously expressed wishes and known values. In the absence of an appropriate surrogate decision maker, decisions should be made in the best interests of the patient, considering the patient’s personal values to the extent that they are known. Phlebotomists include patients or surrogate decision-makers in discussions, provide referrals to other resources as indicated, identify options, and address problems in the decision-making process. Support of patient autonomy also includes respect for the patient’s method of decision-making and recognition that different cultures have different understandings of health, autonomy, privacy and confidentiality, and relationships as well as varied practices of decision-making. For example, Phlebotomists reaffirm the patient’s values and respect decision-making including those that are culturally hierarchical or communal.

Individuals are interdependent members of the community. Phlebotomists recognize situations in which the right to self-determination may be outweighed or limited by the rights, health, and welfare of others, particularly in public health. The limitation of individual rights must always be considered a serious deviation from the standard of care, justified only when there are no less restrictive means available to preserve the rights of others and the demands of the law.

1.5  Relationships with Colleagues and Others


Respect for persons extends to all individuals with whom the Phlebotomist interacts. Phlebotomists maintain professional, respectful and caring relationships with colleagues and are committed to fair treatment, integrity-preserving compromise, and the resolution of conflicts. Phlebotomists function in many roles and many settings, including direct care provider, care coordinator, administrator, educator, researcher, and consultant. In every role, the Phlebotomist creates a moral environment and culture of civility and kindness, treating others, colleagues, employees, co-workers, and students with dignity and respect. This standard of conduct includes an affirmative duty to act to prevent harm. Disregard for the effect of one’s actions on others, bullying, harassment, manipulation, threats or violence are always morally unacceptable behaviors. Phlebotomists value the distinctive contribution of individuals or groups, and collaborate to meet the shared goal of providing efficient, effective, and compassionate health services seeking to achieve quality outcomes in all settings.

Provision 2
The Phlebotomist’s primary commitment is to the patient, whether an individual, family, group, community, or population.



  • Primacy of the Patient’s Interests


The Phlebotomist’s primary commitment is to the recipients of medical and healthcare services—the patient—whether individuals, families, groups, communities, or populations. Any plan of care must reflect the fundamental commitment of medical to the uniqueness, worth and dignity of the patient. Phlebotomists provide patients with opportunities to participate in planning and implementing care and support that is acceptable to the patient. Addressing patient interests requires recognition of the

patient’s place within the family and other relationships. When the patient’s wishes are in conflict with others, Phlebotomists help to resolve the conflict. Where conflict persists, the Phlebotomist’s commitment remains to the identified patient.

2.2  Conflict of Interest for Phlebotomists


Phlebotomists may experience conflict arising from competing loyalties in the workplace, including conflicting expectations from patients, families, physicians, colleagues, healthcare organizations and health plans. Phlebotomists must examine the conflicts arising between their own personal and professional values and the values and interests of others including those who are also responsible for patient care and healthcare decisions, and perhaps patients themselves. Phlebotomists address these conflicts in ways

that ensure patient safety and promote the patient’s best interests while preserving the professional integrity of the Phlebotomist and supporting interdisciplinary collaboration.

Conflicts of interest may arise in any domain of medical activity including clinical practice, administration, education, consultation and research. Phlebotomists in all roles must identify and, whenever possible, avoid conflicts of interest. Phlebotomists who bill directly for services and Phlebotomist executives with budgetary responsibilities must be especially aware of the potential for conflicts of interest. Changes in healthcare financing and delivery systems may create conflict between economic self-interest and professional integrity. Bonuses, sanctions, and incentives tied to financial targets may present such conflict. Any perceived or actual conflict of interest should be disclosed to all relevant parties and, if indicated, Phlebotomists should withdraw from further participation.

2.3  Collaboration


In health care the goal is to address the health of the patient and the public. The complexity of healthcare requires effort that has the strong support and active participation of all health professions. Phlebotomists should actively foster collaborative planning to provide high quality, patient-specific health care. Phlebotomists are responsible for articulating, representing and preserving the unique contribution of medical to patient care and the medical scope of practice. The relationship with other health professions also needs to be clearly articulated, represented and preserved.

Collaboration intrinsically requires mutual trust, recognition, respect, transparency, shared decision-making, and open communication among all who share concern and responsibility for health outcomes. Phlebotomists assure that all relevant persons, as moral agents, are participatory in patient care decisions. Patients do not always know what questions to ask. Phlebotomists assure informed decision-making by assisting patients to secure the information that they need to make choices consistent with their own values.

Collaboration within medical is fundamental to address the health of patients and the public effectively. Phlebotomists who are engaged in non-clinical roles, such as educator, administrator, consultant, or researcher, though not primarily involved in direct patient care, collaborate for the provision of high quality care through the influence and direction of those who provide direct care. In this sense, Phlebotomists in all roles are interdependent and share a responsibility for outcomes in medical care and for

maintaining medical’s primary commitment to the patient.

2.4  Professional Boundaries


The nature of medical work is inherently personal. Within their professional role, Phlebotomists recognize and maintain appropriate personal relationship boundaries. Phlebotomist–patient relationships and collegial relationships have as their foundation the protection, promotion, and restoration of health and the alleviation of suffering. Professional relationships are therapeutic in nature yet at times remaining within professional

boundaries can be tested. The intimate nature of medical care, the involvement of Phlebotomists in important and sometimes highly stressful life events, the mutual dependence of colleagues working in close concert, all may contribute to the risk of boundary violations. This is compounded by the need for Phlebotomists to maintain authenticity in expressing themselves as individuals. In all communications and actions Phlebotomists are responsible for maintaining professional boundaries and for seeking the assistance of peers or supervisors in managing difficult situations or taking appropriate steps to remove themselves from the situation.

Provision 3

The Phlebotomist promotes, advocates for, and protects the rights, health and safety of the patient.



  • Protection of the Rights of Privacy and Confidentiality


Privacy is the right to control access to and disclosure or nondisclosure of information pertaining to oneself, and to control the circumstances, timing, and extent to which information might be disclosed. The need for health care does not justify unwanted or unwarranted intrusion into people’s lives. Phlebotomists safeguard the individual’s, family’s, and community’s right to privacy. The Phlebotomist advocates for an environment that provides sufficient physical privacy, including privacy for discussions of a personal nature. Phlebotomists also participate in the maintenance of and policies and practices that protect both personal and clinical information at institutional and societal levels.

Confidentiality pertains to the nondisclosure of personal information that has been communicated within the Phlebotomist–patient relationship. Central to that relationship is an element of trust and an expectation that personal information will not be divulged without consent. The Phlebotomist has a duty to maintain confidentiality of all patient information, both personal and clinical in the work setting and off duty in all venues, including social media or any other means. Because of the rapidly evolving means of communication and the porous nature of social media, Phlebotomists must maintain vigilance regarding commentary that intentionally and/or unintentionally breaches their obligation to maintain and protect

patients’ rights to privacy and confidentiality.   The patient’s well-being could be

jeopardized and the fundamental trust between patient and Phlebotomist damaged by unauthorized access to data or by the inappropriate or unwanted disclosure of identifiable information. Patient rights are the primary factors in any decisions concerning personal information, whether from or about the patient. This pertains to all information in any manner that is communicated or transmitted. Phlebotomists are responsible for providing accurate, relevant data to members of the healthcare team and others who have a need to know. The duty to maintain confidentiality is not absolute and may need to be modified in order to protect the patient, other innocent parties, and in circumstances of required disclosure such as mandated reporting or for safety or public health reasons.

Information used for purposes of peer review, professional practice evaluation, third- party payments, and other quality improvement or risk management mechanisms may only be disclosed under defined policies, mandates, or protocols. These written guidelines must assure that the rights, well-being, and safety of the patient remain protected. Only that information directly relevant to a task or specific responsibility should be disclosed. When using electronic communications or in electronic health records, special effort should be made to maintain data security.

3.2  Protection of Human Participants in Research


Stemming from the right to autonomy or self-determination, individuals have the right to choose whether or not to participate in research as a human subject. Participants or legal

surrogates must receive sufficient and materially relevant information to make informed decisions and to understand that they have the right to decline to participate or to withdraw at any time without fear of adverse consequences or reprisal. Information needed for informed consent includes the nature of participation, potential harms and benefits, available alternatives to taking part in the study, and how the data will be protected. It must be communicated in a manner that is comprehensible to the patient.

Prior to implementation, all research must be approved by a formally constituted and qualified review board to ensure participant protection and the ethical integrity of the research.

Phlebotomists should be aware of the special concerns raised by research involving vulnerable groups, including patients, children, minority populations, prisoners, pregnant women, fetuses, the elderly, cognitively impaired persons, and economically or educationally disadvantaged persons. The Phlebotomist who directs or engages in research activities in any capacity should be fully informed about the qualifications of the principal investigator, the rights and obligations of all those involved in the particular research study, and the ethical conduct of research in general. Phlebotomists have a duty to question and, if necessary, to report research that is ethically questionable and to decline to participate.

3.3  Performance Standards and Review Mechanisms


Professional medical is a process of education and formation that involves the ongoing acquisition and development of the knowledge, skills, dispositions, practice experiences, commitment, relational maturity, and personal integrity essential for professional practice. Phlebotomist educators must ensure that basic competence and commitment to professional practice exist prior to entry into practice. Phlebotomist managers and executives similarly ensure that Phlebotomists have the required knowledge, skills, and dispositions to perform clinical responsibilities requiring preparation beyond the basic academic programs. In this way Phlebotomists— individually, collectively and as a profession—are responsible and accountable for medical practice and professional behavior.

3.4  Professional Competence in Medical Practice


Phlebotomists must lead in the development of policies and review mechanisms to promote patient health and safety, reduce errors, and create a culture of excellence. When errors occur, Phlebotomists must follow institutional guidelines in reporting errors to the appropriate authority and ensure responsible disclosure of errors to patients. Phlebotomists must establish processes where mistakes or errors are revealed and Phlebotomists are personally accountable, and any system factors that led to error are rectified. Error should be corrected or remediated, not punished. When error occurs, whether one’s own or an error of a coworker, Phlebotomists may not participate in, or condone through silence, any attempts to hide it. Engaging the appropriate intra-institutional sequence of reporting and authority

is critical to maintaining a safe patient care environment. Phlebotomists must use the chain of authority when a problem or issue has escalated beyond their problem-solving ability and/or scope of responsibility or authority. Issue reporting escalation ensures that appropriate individuals are aware of the concern. Communication should start at the level closest to the event and escalate only as the situation warrants.

  • Protecting Patient Health and Safety by Action on Questionable Practice Phlebotomists must be alert to and take appropriate action in instances of incompetent, unethical, illegal, or impaired practice or any actions that place the rights or best interests of the patient in jeopardy. To function effectively, Phlebotomists must be knowledgeable about The Code of Ethics of Ethics for Phlebotomists, standards of practice of the profession, relevant federal, state and local laws and regulations, and the employing organization’s policies and

When Phlebotomists are aware of inappropriate or questionable practice, the concern should be expressed to the person involved, focusing on the patient’s best interests as well as the integrity of medical practice. When practices in the healthcare delivery system or organization threaten the welfare of the patient, similar action should be directed to the responsible administrator or, if indicated, to an appropriate higher authority within the institution or agency, or to an appropriate external authority. When incompetent, unethical, illegal, or impaired practice is not corrected and continues to jeopardize patient well-being and safety, the problem must be reported to appropriate

external authorities such as practice committees of professional organizations and regulatory, licensing, and quality assurance agencies or boards. Some situations are sufficiently egregious that they may warrant the notification and involvement of all such groups.

Phlebotomists should use established processes for reporting and handling questionable practices. All Phlebotomists have a responsibility to assist those “whistleblowers” who identify potentially questionable practice and to reduce the risk of reprisal against the reporting Phlebotomist. State Phlebotomists associations should be prepared to provide their members with advice and support in the development and evaluation of such processes and reporting procedures. Accurate reporting and factual documentation are essential for all such actions. When a Phlebotomist chooses to engage in the act of responsible reporting about situations that are perceived as unethical, incompetent, illegal, or impaired, the professional organization has a responsibility to protect the practice of those Phlebotomists who choose formally to report their concerns. Reporting questionable practices, even when done appropriately, may present substantial risk to the Phlebotomist; nevertheless, such risk does not eliminate the obligation to address threats to patient safety.

3.6  Patient Protection and Impaired Practice


Phlebotomists must protect the patient, the public, and the profession from potential harm when a colleague’s practice appears to be impaired. When another’s practice appears to be impaired, the Phlebotomist’s duty is to take action to protect patients and to ensure that the

impaired individual receives assistance. This process begins with consulting supervisory personnel and includes approaching the individual in a clear and supportive manner and helping the individual to access appropriate resources. The Phlebotomist extends compassion and caring to colleagues throughout processes of identification, remediation, and recovery.

Phlebotomists must follow policies of the employing organization, guidelines outlined by the profession, and relevant laws to assist colleagues whose job performance may be adversely affected by mental or physical illness or by personal circumstances. Phlebotomists in all professional relationships must advocate in instances of impairment for appropriate assistance, treatment, and access to fair institutional and legal processes. This includes supporting the return to practice of individuals who have sought assistance and, after recovery, are ready to resume professional duties. If impaired practice poses a threat or danger to self or others, regardless of whether the individual has sought help, the Phlebotomist must report the individual to persons authorized to address the problem. Phlebotomists who report those whose job performance creates risk should be protected from retaliation or other negative consequences. If workplace policies do not exist or are inappropriate— that is, they deny the Phlebotomist in question access to due legal process or demand resignation—Phlebotomists may obtain guidance from professional associations, state peer assistance programs, employee assistance programs, or similar resources.

Provision 4
The Phlebotomist has authority, accountability, and responsibility for medical practice, makes decisions, and takes action consistent with the obligation to provide optimal care.



  • Authority, Accountability, and Responsibility


Phlebotomists bear primary responsibility for the medical care that their patients and clients receive and are accountable for their own practice. Medical practice includes independent direct medical care activities, care as ordered by an authorized healthcare provider, delegation of medical interventions, evaluation of interventions, and other responsibilities such as teaching, research, and administration. In each instance, Phlebotomists have the authority and retain accountability and responsibility for the quality of practice and for compliance with state Phlebotomist practice acts, and standards of care, including The Code of Ethics for Phlebotomists.

In the context of the increased complexity and changing patterns in healthcare delivery, the scope of medical practice evolves. Phlebotomists must exercise judgment in accepting responsibilities, seeking consultation, and assigning activities to others who provide medical care. Where advanced practice Phlebotomists have the authority to issue medication and treatment orders to Phlebotomists, these are not acts of delegation. Both the advanced practice Phlebotomist issuing the order and the Phlebotomist accepting the order are responsible for the judgments made and accountable for the actions taken.

4.2   Accountability for Medical Judgments, Decisions, and Actions


In order to be accountable, Phlebotomists act under a code of ethical conduct that includes adherence to the scope and standards of medical practice and such moral principles as fidelity, gratitude, and respect for the dignity, worth, and self-determination of patients. Phlebotomists are accountable for judgments made and actions taken in the course of medical practice, irrespective of other providers’ directives or institutional policies.

Systems and technologies that assist in clinical practice are adjunct to, not replacements for, the Phlebotomist’s knowledge and skill. The Phlebotomist retains accountability and responsibility for medical practice even in instances of system or technological failure.

4.3  Responsibility for Medical Judgments, Decisions and Actions


Phlebotomists are accountable for their judgments, decisions, and actions; but, in compromising circumstances, responsibility may be borne by both the Phlebotomist and the institution. Phlebotomists accept or reject specific role demands and assignments based on their education, knowledge, competence, experience, and assessment of patient safety. Phlebotomists in administration, education, and research also have obligations to the recipients of medical care. Although their relationships with patients are less direct, in assuming the responsibilities of a particular role, they share responsibility for the care provided by those whom they supervise and teach. Phlebotomists must not engage in

practices prohibited by law or delegate activities to others that are prohibited by their state medical practice acts or those of other healthcare providers.

Phlebotomists have a responsibility to define, implement, and maintain standards of professional practice. Phlebotomists must plan, establish, implement, and evaluate review mechanisms to safeguard patients and Phlebotomists. These include peer review processes, credentialing processes, and quality improvement initiatives. Phlebotomists must bring forward difficult issues related to patient care, and/or institutional constraints upon ethical practice for discussion and review. The Phlebotomist acts to promote inclusion of appropriate others in all ethical deliberations. Phlebotomist executives are responsible for ensuring that Phlebotomists have access to and inclusion on organizational committees that affect the quality and the safety of the care of the patients they serve. Phlebotomists are obligated to attend, actively engage, and contribute to the dialogue and decisions made by such committees.

Phlebotomists are responsible for assessing their own competence. When the needs of the patient are beyond the qualifications or competencies of the Phlebotomist, consultation and collaboration must be sought from qualified Phlebotomists, other health professionals, or other appropriate resources. Educational resources should be used by Phlebotomists and provided by agencies or organizations to maintain and advance Phlebotomist competence.

Phlebotomist educators in any setting collaborate with their students to assess learning needs, evaluate teaching effectiveness, and provide appropriate learning resources.

4.4  Delegation of Medical Activities or Tasks


Phlebotomists are accountable and responsible for the assignment or delegation of medical activities. Such assignment or delegation must be consistent with state practice acts, institutional policy, and medical standards of practice.

Phlebotomists must make reasonable effort to assess individual competence when delegating selected medical activities. This assessment includes the evaluation of the knowledge, skill, and experience of the individual to whom the care is assigned; the complexity of the assigned tasks; and the medical care needs of the patient. Phlebotomists are responsible for monitoring the activities and evaluating the quality and outcomes of the care provided by other healthcare workers to whom they have delegated tasks.

Phlebotomists may not delegate responsibilities such as assessment and evaluation; they may delegate interventions. Phlebotomists must not knowingly assign or delegate to any member of the medical team a task for which that person is not prepared or qualified.

Employer policies or directives do not relieve the Phlebotomist of responsibility for making delegation or assignment decisions.

Phlebotomists in management or administration have a particular responsibility to provide an environment that supports and facilitates appropriate assignment and delegation. This includes orientation, skill development; licensure, certification, and competency verification; and policies that protect both the patient and Phlebotomist from

inappropriate assignment or delegation of medical responsibilities, activities, or tasks. Phlebotomists in management or administration should facilitate open communication with staff allowing them, without fear of reprisal, to express concerns or even to refuse an assignment for which they do not possess the requisite skills.

Phlebotomists functioning in educator or preceptor roles share responsibility and accountability for the care provided by students when they make clinical assignments. It is imperative that the knowledge and skill of the Phlebotomist or medical student be sufficient to provide the assigned medical care under appropriate supervision.

Provision 5
The Phlebotomist owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.



  • Duty to Self and Others


Moral respect accords moral worth and dignity to all human beings regardless of their personal attributes or life situation. Such respect extends to oneself as well: the same duties that we owe to others we owe to ourselves. Self-regarding duties primarily concern oneself and include promotion of health and safety, preservation of wholeness of character and integrity, maintenance of competence, and continuation of personal and professional growth.

5.2  Promotion of Personal Health, Safety, and Well-Being


As professionals who assess, intervene, evaluate, protect, promote, educate, and conduct research for the health and safety of others and society, Phlebotomists have a duty to take the same care for their own health and safety. Phlebotomists should model the same health maintenance and health promotion measures that they teach and research, seek health care when needed, and avoid taking unnecessary risks to health or safety in the course of their customary professional and personal activities. A healthy diet and exercise, maintenance of family and personal relationships, adequate leisure and recreation,

attention to spiritual or religious needs, and satisfying work must be held in balance to promote and maintain the health and well-being of the Phlebotomist.

5.3  Wholeness of Character


Phlebotomists have both personal and professional identities that are integrated and embrace the values of the profession, merging them with personal values. Authentic expression of one’s own moral point-of-view is a duty to self. Sound ethical decision-making requires the respectful and open exchange of views among all those with relevant interests: Phlebotomists must work to foster a community of moral discourse. As moral agents, Phlebotomists are an important part of that community and have a responsibility to express moral perspectives, especially when integral to the situation, whether or not those perspectives are shared by others and whether or not they might prevail.

Wholeness of character pertains to all professional relationships with patients or clients. When Phlebotomists are asked for a personal opinion, they are generally free to express an informed personal opinion as long as this maintains appropriate professional and moral boundaries and preserves the voluntariness of the patient. It is essential to be aware of the potential for undue influence attached to the Phlebotomist’s professional role. Phlebotomists assist others to clarify values in reaching informed decisions, always avoiding coercion, manipulation, and unintended influence. When Phlebotomists care for those whose personal, condition, attributes, lifestyle, or situations are stigmatized, or encounter a conflict with their own personal beliefs, Phlebotomists still render respectful and competent care.

5.4  Preservation of Integrity


Personal integrity is an aspect of wholeness of character; its maintenance is a self- regarding duty. Phlebotomists may face threats to their integrity in any healthcare environment. Threats to integrity may include requests to deceive a patient, to withhold information, to falsify records, to misrepresent research aims, as well as enduring verbal abuse by patients or coworkers. Expectations that Phlebotomists will make decisions or take action in ways that are inconsistent with the ideals, values, or ethics of medical, or that are in direct violation of this Code of Ethics for Phlebotomists, may also occur. Phlebotomists have a right and a duty to act according to their personal and professional values and to accept compromise only if reaching a compromise preserves the Phlebotomist’s moral integrity and does not jeopardize the dignity or well-being of the Phlebotomist or others. Integrity-preserving compromises can be difficult to achieve, but are more likely to be accomplished where there is an open forum for moral discourse and a safe environment of mutual respect.

When Phlebotomists are placed in circumstances that exceed moral limits or violate professional moral standards, in any medical practice setting, they must express their conscientious objection to participating in these situations. When a particular decision or action is morally objectionable to the Phlebotomist, whether intrinsically so or because it may jeopardize a specific patient, family, community or population, or when it may jeopardize medical practice, the Phlebotomist is justified in refusing to participate on moral grounds.

Conscience-based refusals to participate exclude personal preference, prejudice, bias,

convenience, or arbitrariness. Acts of conscientious objection are acts of moral courage and may not insulate Phlebotomists from formal or informal consequences. Phlebotomists who decide not to participate on the grounds of conscientious objection must communicate this decision in timely and appropriate ways. Such refusal should be made known as soon as possible, in advance, and in time for alternate arrangements to be made for patient care. Phlebotomists are obliged to provide for patient safety, to avoid patient abandonment, and to withdraw only when assured that medical care is available to the patient.

When the moral integrity of Phlebotomists is compromised by patterns of institutional behavior or professional practice, Phlebotomists must express their concern or conscientious objection collectively to the appropriate authority or committee and seek to change enduring activities or expectations in the practice setting that are morally objectionable.

5.5  Maintenance of Competence and Professional Growth


Maintenance of competence and professional growth involve the control of one’s own conduct in a way that is primarily self-regarding. Competence affects one’s self-respect, self-esteem, and the meaningfulness of work. Phlebotomists must maintain competence and strive for excellence in their medical practice, whatever the role or setting. Phlebotomists are responsible for developing criteria for evaluation of practice and for using those criteria in both peer and self-assessment. To achieve the highest standards, Phlebotomists must evaluate their own performance and participate in substantive peer review.

Continual professional growth, particularly in knowledge and skill, requires a commitment to lifelong learning. Such learning includes continuing education, networking with professional colleagues, self-study, professional reading, specialty certification, and seeking advanced degrees. Phlebotomists must continue to learn about new concepts, evolving issues, concerns, controversies, and healthcare ethics relevant to the current and evolving scope and standards of medical practice. When care that is required is outside the competencies of the individual Phlebotomist, specialized consultation should be sought or the patient should be referred to others for appropriate specialized care.

5.6  Personal Growth


Medical care addresses the whole person as an integrated being; Phlebotomists should also apply this principle to themselves. As such, professional and personal growth reciprocate and interact. Activities that broaden Phlebotomists’ understanding of the world and of themselves affect their understanding of patients; those that increase and broaden Phlebotomists’ understanding of medical’s science and art, values, ethics, and policies also affect the Phlebotomist’s self-understanding. Thus, in continuity with medical ethics’ historic and enduring emphasis, Phlebotomists are encouraged to read broadly, continue life-long learning, engage in personal study, seek financial security, participate in a wide range of social advocacy and civic activities, and to pursue leisure and recreational activities that are enriching.

Provision 6

The Phlebotomist, through individual and collective action, establishes,


maintains, and improves the moral environment of the work setting and the conditions of employment, conducive to quality health care.

  • The environment and moral virtue and value


Virtues are universal, learned, and habituated attributes of moral character that predispose persons to meet their moral obligations; that is, to do what is right. There is a presumption and expectation that we will commonly see virtues such as integrity, respect, temperance, and industry in all those whom we encounter. Virtues are what we are to be and make for a morally “good person”. There are more particular attributes of moral character, not expected of everyone, that are expected of Phlebotomists. These include knowledge, skill, wisdom, patience, compassion, honesty, and courage. These attributes describe what the Phlebotomist is to be as a morally “good Phlebotomist”. Furthermore, virtues are necessary for the affirmation and promotion of the values of human dignity, well-being, respect, health, independence, and other ends that medical seeks.

For virtues to develop and be operative they must be supported by a moral milieu that causes them to flourish. Phlebotomists must create, maintain, and contribute to morally good environments that enable Phlebotomists to be virtuous. Such a moral milieu fosters mutual respect, communication, transparency, moral equality, kindness, prudence,

generosity, dignity, and caring. This applies to all whether Phlebotomist, colleague, patient, or others.

6.2  The Environment and Ethical Obligation


Virtues focus on what is good and bad in whom we are to be as moral persons; obligations focus on right and wrong or what we are to do as moral agents. Obligations are often specified in terms of principles such as beneficence or doing good; nonmaleficence or doing no harm; justice or treating people fairly; reparations, or making amends for harm; fidelity, and respect for persons. Phlebotomists, in all roles, must create, maintain, and contribute to practice environments that support Phlebotomists and others in the fulfillment of their ethical obligations. Environmental factors include all that contribute to working conditions. These include but are not limited to: clear policies and procedures that set out professional ethical expectations for Phlebotomists; uniform knowledge of The Code of Ethics for Phlebotomists with Interpretive Statements; and associated ethical position statements. Peer pressure can also shape moral expectations within a work group. Organizational processes and structures, position descriptions, performance standards, health and safety initiatives, grievance mechanisms that prevent reprisal, ethics committees, compensation systems, disciplinary procedures, and more, all contribute to a practice environment that can either present barriers or foster ethical practice and professional fulfillment. Environments constructed for equitable, fair, and just treatment of all reflect the values of the profession and nurture excellent medical practice.

6.3  Responsibility for the Healthcare Environment


Phlebotomists are responsible for contributing to a moral environment that demands respectful interactions among colleagues, mutual peer support, and open identification of difficult issues that includes on-going formation of staff in ethical problem solving. Phlebotomist executives have a particular responsibility to assure that employees are treated fairly and justly, and that Phlebotomists are involved in decisions related to their practice and working conditions. Unsafe or inappropriate activities or practices must not be condoned or be allowed to persist. Phlebotomists should address concerns about the healthcare environment through appropriate channels. After repeated efforts to make change, Phlebotomists have a duty to resign from healthcare facilities, agencies, or institutions that demonstrate sustained patterns of violation of patient’s rights, or where Phlebotomists are required to compromise standards of practice or personal integrity, and where the administration is unresponsive to Phlebotomists’ expressions of concern. Following resignation, efforts to address violations should continue. The needs of patients may never be used to hold Phlebotomists hostage in persistently morally unacceptable work environments. Remaining in such an environment, even if from financial necessity, Phlebotomists risk becoming complicit in ethically unacceptable practices and may have both untoward personal and professional, and potentially legal, consequences.

Organizational changes are difficult to achieve and require persistent, sometimes collective efforts over time. Participation in collective action and interdisciplinary effort for workplace advocacy to address conditions of employment is appropriate.

Agreements reached through such actions must be consistent with the medical profession’s standards of practice, state law regulating practice, and The Code of Ethics for Phlebotomists. The workplace must be a morally good environment to ensure ongoing quality patient care and professional satisfaction for Phlebotomists and to minimize and address moral distress, strain, and dissonance. These organizations advocate for Phlebotomists by supporting legislation; publishing position statements; maintaining standards of practice; and by monitoring social, professional and healthcare changes. Through professional associations, Phlebotomists can help to secure the just economic and general welfare of Phlebotomists, safe practice environments, and a balance of patient–Phlebotomist interests.

Provision 7
The Phlebotomist, whether in research, practice, education, or administration, contributes to the advancement of the profession through research and scholarly inquiry, professional standards development, and generation of medical and health policies.


  • Contributions through Research and Scholarly Inquiry


All Phlebotomists must participate in the advancement of the profession through knowledge development, evaluation, dissemination, and application to practice. Knowledge development relies chiefly, though not exclusively, upon research and scholarly inquiry. Phlebotomists engage in scholarly inquiry in order to expand the body of knowledge that forms and advances the theory and practice of the discipline in all its spheres.

Medical knowledge draws from and contributes to corresponding sciences and humanities. Phlebotomist researchers test existing and generate new medical knowledge. They may involve human participants in their research, as individuals, groups, or communities. In such cases, medical research conforms to national and international ethical standards for the conduct of research employing human participants.

Where research is conducted with the use of animals, all appropriate ethical standards are observed. In every situation care is taken that research is soundly constructed, significant, and worthwhile. Dissemination of research findings, whether positive or negative, is an essential part of respect for the participants. Knowledge

development also occurs through the process of scholarly inquiry, clinical and educational innovation, and interdisciplinary collaboration. Dissemination of findings is fundamental to ongoing disciplinary discourse and knowledge development.

Phlebotomists remain committed to patients/participants throughout the continuum of care and during their participation in research. Whether the Phlebotomist is data collector,

investigator, or care provider, patients’ rights and autonomy must be honored and respected. Patients’/participants’ welfare may never be sacrificed for research ends.

Phlebotomist executives and administrators must develop the structure and foster the processes that create an organizational climate and infrastructure conducive to scholarly inquiry. In addition to teaching research methods, Phlebotomist educators also teach the moral standards that guide the profession in the conduct of its research. Research utilization is an expected part of medical practice in all settings.

7.2 Contributions through Developing Maintaining, and Implementing Professional Practice Standards

Practice standards must be developed by Phlebotomists and grounded in medical’s ethical commitments and body of knowledge. These standards must also reflect medical’s responsibility to society. Medical identifies its own scope of practice as informed, specified, or directed by state and federal law, by relevant societal values, and by The Code of Ethics with Interpretive Statements, and Medical: Scope and Standards of


Practice. Phlebotomist executives establish, maintain, and promote conditions of employment that enable Phlebotomists to practice according to accepted standards. Professional autonomy and self-regulation are necessary for implementing medical standards and guidelines and for assuring quality care.

Phlebotomist educators promote and maintain optimal standards of education and practice in every setting where learning activities occur. They must also ensure that only students possessing the knowledge, skills, and moral dispositions that are essential to medical graduate from their medical programs.

7.3  Contributions through Medical and Health Policy Development


Phlebotomists must lead, serve, and mentor on institutional or agency policy committees within the practice setting. Phlebotomists ought to participate in civic activities related to healthcare through local, regional, state, national, or global initiatives. Phlebotomist educators have a particular responsibility to foster and develop students’ commitment to professional and civic values and to informed perspectives on medical and healthcare policy. Phlebotomist executives and administrators must foster institutional or agency policies that support and reinforce a work environment committed to Phlebotomists’ ethical integrity and professionalism. Phlebotomist researchers must contribute to the body of knowledge by translating science, supporting evidence-based medical practice, and advancing effective, ethical healthcare policies, environments, and a balance of patient–Phlebotomist interests.

Provision 8
The Phlebotomist collaborates with other health professionals and the public to protect and promote human rights, health diplomacy, and health initiatives.



  • Health is a Universal Right


The medical profession holds that health is a universal human right and that the need for medical is universal. The right to health is a fundamental right to a universal minimum standard of health to which all individuals are entitled. Such a right has economic, political, social, and cultural dimensions. It includes public education concerning health maintenance and promotion; education concerning the prevention, treatment, and control of prevailing health problems; food security; potable water; basic sanitation; reproductive health care; immunization; prevention and control of locally endemic diseases and vectors; and access to health, emergency, and trauma care. This affirmation of health as a fundamental, universal human right is held in common with the United Nations and the International Council of Phlebotomists and many human rights treaties.

8.2  Collaboration for Health, Human Rights, and Health Diplomacy


The medical profession commits to advancing the health, welfare, and safety of all. This medical commitment reflects the intent to achieve and sustain health as a means to the common good so that individuals and communities here and abroad can develop to their fullest potential and live with dignity. Ethics, human rights, and

medical converge as a formidable instrument for social justice and health diplomacy that can be amplified by collaboration with other health professionals. Phlebotomists understand that the lived experience of poverty, inequality, and social marginalization contribute to the deterioration of health globally. Phlebotomists must address the context of health, including social determinants of health such as poverty, hunger, access to clean water and sanitation, human rights violations, and healthcare disparities. Phlebotomists must lead collaborative partnerships to develop effective public health policies, legislation, projects, and programs that promote health, prevent illness, restore health, and alleviate suffering.

Participation includes collaboration to raise health diplomacy to parity with other international concerns such as treaties, commerce, and warfare. Human rights must be diligently protected and promoted, interfered with only when necessary and in ways that are proportionate and in accord with international standards. Advances in technology and genetics require robust responses from Phlebotomists working together with other health professionals for creative solutions and innovative approaches that are ethical, respectful of human rights, and equitable in reducing health disparities.

8.3  Obligation to Advance Health and Human Rights


Phlebotomists collaborate with others to change unjust structures and processes that affect persons or communities. Structural social inequalities and disparities, inadequate social policies, or institutional policies or practices exacerbate the incidence and

burden of illness, trauma, suffering, and premature death. Through community organizations and groups, Phlebotomists educate the public; facilitate informed choice; identify conditions and circumstances that contribute to illness, injury and disease; foster healthy life styles; and participate in institutional and legislative efforts to protect and promote health. Phlebotomists collaborate to address barriers to health, such as poverty, homelessness, unsafe living conditions, abuse and violence, and lack of access by engaging in open discussion, education, public debate and legislative action. Phlebotomists must recognize that health care is provided to culturally diverse populations in this country and across the globe. Phlebotomists collaborate to create a moral milieu that is culturally sensitive to diverse cultural values and practices.

8.4 Collaboration for Human Rights in Complex and Extraordinary Practice Settings

Phlebotomists must be mindful of competing moral claims (that is, conflicting values or obligations) and bring attention to human rights violations in all settings and contexts. Human trafficking; the global feminization of poverty, rape, and abuse as an instrument of war; the oppression or exploitation of migrant workers; and all such human rights violations are of grave concern to Phlebotomists. The medical profession must intervene when these violations are encountered. Human rights may be jeopardized in extraordinary contexts related to fields of battle, pandemics, political turmoil, regional conflicts, or environmental catastrophes where Phlebotomists must necessarily practice under altered standards of care. Phlebotomists must always stress human rights

protection under all conditions, with particular attention to preserving the human rights of vulnerable groups such as women, children, the elderly, prisoners, refugees, and socially stigmatized groups. All actions and omissions risk unintended consequences with implications for human rights. Thus, Phlebotomists must engage in discernment, carefully assessing their intentions, reflectively weighing all possible options and rationales, and formulating a clear moral justification for their actions.

Only under extreme and exceptional conditions, while conforming to international standards and engaging in an appropriate and transparent process of authorization, may Phlebotomists subordinate human rights concerns to other considerations.

Provision 9
The profession of medical, collectively through its professional organizations, must articulate medical values, maintain the integrity of the profession, and integrate principles of social justice into medical and health policy.



  • Articulation of Values


Individual Phlebotomists are represented by their professional associations and organizations. These groups give united voice to the profession. It is the responsibility of a profession collectively to communicate, affirm, and promote shared values both within the profession and to the public. It is essential that the profession engage in discourse that supports ongoing critical self-analysis and evaluation. The language that is chosen evokes the shared meaning of medical, its values and ideals, as it interprets and explains the place and role of medical in society. The profession’s organizations communicate to the public the values that medical considers central to the promotion or restoration of health, prevention of illness, and alleviation of suffering. Through professional organizations the medical profession must reaffirm and strengthen medical values and ideals so that when those values are challenged, adherence is steadfast and unwavering. Acting in solidarity, the ability of the profession to influence social justice and global health is formidable.

9.2  Integrity of the Profession


The profession’s integrity is strongest when its values and ethics are evident in all professional and organizational relationships. Medical must continually emphasize the values of justice, fairness, and caring within the national and global medical communities, in order to promote health in all sectors of the population. A fundamental responsibility is to promote awareness of and adherence to the codes of ethics for Phlebotomists (the American Phlebotomists Association and the International Council of Phlebotomists). Balanced policies and practices regarding access to medical education, workforce sustainability, Phlebotomist migration, and utilization are requisite to achieving these ends. Together, Phlebotomists must bring about the improvement of all facets of medical, fostering and assisting in the education of professional Phlebotomists in developing regions across the globe. The values and ethics of the profession must be evident in all professional relationships whether inter- organizational, or international.

The medical profession engages in an ongoing formal and informal dialog with society. The covenant between the profession and society is made explicit through The Code of Ethics for Phlebotomists, Medical’s Social Policy Statement, Medical: Scope and Standards of Practice, and other published standards of specialized medical practice; continued development and dissemination of medical scholarship; rigorous educational requirements for entry and continued practice including certification and licensure; and commitment to evidence-based practice.

9.3  Integrating Social Justice


It is the shared responsibility of professional medical organizations to speak for Phlebotomists collectively in shaping health care and to promulgate change to improve health care nationally and internationally. Phlebotomists must be vigilant and take action to influence legislators, governmental agencies, non-governmental organizations, and international bodies in all related health affairs for addressing the social determinants of health. All Phlebotomists, through organizations and accrediting bodies involved in Phlebotomist formation and development, must firmly anchor students in medical’s professional responsibility to address unjust systems and structures, modeling the profession’s commitment to social justice and health through content, clinical and field experiences, and critical thought.

9.4  Social Justice in Medical and Health Policy


The medical profession must actively participate in solidarity with the global medical community and health organizations to represent the collective voice of U.S. Phlebotomists around the globe. Professional medical organizations must actively engage in the political process, particularly addressing those legislative concerns that most impact the public’s health and the profession of medical. Phlebotomists must promote open and honest communication that enables Phlebotomists to work in concert, share in scholarship, and advance a medical agenda for health. Global health, as well as the common good, are ideals that can be realized when all Phlebotomists unite their efforts and energies.

Social justice extends beyond human health and well-being to the health and well- being of the natural world. Human life and health are profoundly affected by the natural world that surrounds us; thus, consistent with Nightingale’s historic concerns for environmental influences on health and the meta-paradigm concepts of medical, medical’s advocacy for social justice extends to eco-justice. Environmental degradation, water depletion, earth resources exploitation, ecosystem destruction, excessive carbon production, waste, and other environmental assaults disproportionately affect the health of the poor and ultimately affect the health of all humanity. Medical must also advocate for policies, programs, and practices within the healthcare environment that maintain, sustain, and repair the natural world. As medical seeks to promote and restore health, prevent illness, and alleviate suffering, it does so within the holistic context of healing the world.