History of Medical Technology in a Global Context

Early medical diagnosis treated disease as a mystery. Disease was believed to be caused by the negative
interaction between the environment and the body. By around 300 BC to 180 AD, Hippocrates,
considered the "father of medicine" and author of the Hippocratic Oath, and Galen, a Greek physician
and philosopher, instigated a rudimentary and qualitative assessment of disorder through measurement
of body fluids (also called the four humors blood, phlegm, yellow bile, black bile) in relation to seasons.
The work of these ancient Greek physicians was intended to increase the quality of life of patients.

Urine was one of the body fluids that underwent examination. Hippocrates advocated the tasting of
urine, listening to the lungs, and observing outward appearances in the diagnosis of disease. He
concluded that the appearance of bubbles, blood, and pus in urine indicated kidney disease and chronic
illnesses. Galen described diabetes as "diarrhea of urine" and established the relationship between fluid
intake and urine volume. In medieval Europe, diagnosis by "water casting" (uroscopy) was widely
practiced. Patients submitted their urine specimen in decorative flasks. Physicians who failed to examine
the urine were subjected to public beatings. By 900 AD, the first book detailing the characteristics of
urine (e.g., color, density, quality) was written.

From these early documented works, medicine and medical technology advanced because of the high
mortality rate caused by plagues and other diseases.

In the early 11th century, medical practitioners were not allowed to conduct physical examination of the
patient's body. Thus, they relied solely on the patient's description of symptoms and their observations.
By the 18th century, mechanical techniques and cadaver dissection were used to provide a more
objective and accurate diagnosis and to understand the insides of the body. In the 19th century,
physicians began using machines for diagnosis or therapeutics. Among these devices were John
Hutchinson's spirometer for measuring the vital capacity of the lungs, and Jules Herisson's
sphygmomanometer for measuring blood pressure. Also, the use of chemistry was pivotal in the
diagnosis of diabetes, anemia, diphtheria, and syphilis during this period.

The onset of mechanical and chemical devices spurred the turn from general practice to specialization.
This turn was brought about by increasing number of patients and the increasing amount of medical
knowledge which generalists could no longer handle. More complex machinery and equipment used in
medical practice required technical expertise, resulting in cooperative arrangement among specialists in
different fields. Consequently, medical service became organized in hospitals. With this setup, large
amounts of data were required in the diagnosis and treatment of patients. These volumes of patient
data prompted the need for information technology. The need for medical technicians and data
specialists also increased. In 1969, in fact, 80 percent of medical professionals were non-physicians. This
growth impelled the need for technicians to be proficient in the use of technology. Patients were
likewise needed to be educated on the tests done on them.

Technology took over face-to-face interaction between patients and physicians who relied more on
technology as basis for diagnostic assessments instead of patients subjective description of symptoms.
All these resulted in increased diagnostic accuracy at the expense of closer doctor-patient relationship.

The thermometer, stethoscope, microscope, ophthalmoscope, laryngoscope, and X-ray are some of the
breakthroughs in medical technology that allowed physicians to examine body parts used to be
observed only in cadavers.

X-ray

Stethoscope her

First diagnostic medical breakthrough invented by Rene Laennec; used to acquire information about the
lungs and heartbeats

1816

Ophthalmoscope First visual technology invented by Hermann von Helmholz

1840

1850

Invented by Wilhelm Roentgen when he

discovered by accident that radiation could penetrate solid objects of low density; allowed physicians to
view the inside of the body without surgery; used to diagnose pneumonia, pleurisy, and tuberculosis
since World War II
1855

1859

Microscope a

HILDeveloped for medical purposes due to advances in lenses and lower costs; the first practical
mircoscope was devised by Antonie van Leeuwenhoek

Laryngoscope Devised by Manuel Garcia using two mirrors to observe the throat and larynx

In mid-1800s, laboratories designed for analyzing medical specimens were organized by chemical
experts. Technical laboratories regulated by the Centers for Disease Control and Prevention (CDC) began
to be used for medical diagnostics in the US by mid-1900s.

In the early 20th century, improvements in basic sciences and integration of scientific and technological
discoveries (i.e., electrical measurement techniques, sensor development, nuclear medicine, and
diagnostic ultrasound) marked the advances in medical technology. Medical technologies also made
impacts on various surgical procedures.

History of Medical Technology Profession

Cardiac catheterization and Angiography

First operated by Forsmann in 1929; developed by Moniz, Reboul, Rousthoi between 1930 and 1940;
discovered as safe method in humans by Cournand in 1941; made seeing the heart, lung vessels, and
valves possible through inserting a cannula in an arm vein and into the heart with an injection of
radiopaque dye for X-ray visualization
Electrocardiograph

Developed by William Einthoven to measure electrical changes during the beating of the heart

1910

1939

1903

Drinker respirator Invented by Philip Drinker to help patients with paralytic anterior poliomyelitis
recover normal respiration with the assistance of artificial respirator

1927

1941

Kenny method

Served as the pioneering work for modern physical therapy; devised by Elizabeth Kenny in the treatment
of polio (then called infantile paralysis) using hot packs and muscle manipulation; prompted the
invention of a new stretcher (called Sylvia stretcher in 1927) intended for transporting patients in shock

Heart-lung machine First visual technology invented by Hermann von Helmholz

Further integration of technology with science ushered in new medical advancements such as the
electron microscope, new medical imaging technologies, and prosthetic devices. The electron
microscope gave way to the visualization of small cells including tumor cells. The adaption of computers
in medical researches led to the development of tomography and magnetic resonance imaging (MRI).
Prosthesis such as artificial heart valves, artificial blood vessels, functional electromechanical limbs, and
reconstructive skeletal joints were also developed as a result of these innovations.

Medical technology breakthroughs persist through robotics, keyhole surgery procedures, genetic
engineering, and telemedicine (information technology). Medical technology has improved quality of life
and increased life expectancy. However, this progress resulted in the reevaluation of traditional
definitions of life and death.

History of Medical Technology in the United States

In the United States, the establishment of the first clinical laboratories and the development of
laboratory practice marked the growth of the medical technology field. In 1895, the University of
Pennsylvania's William Pepper Laboratory of Clinical Medicine was opened to highlight the service role
of clinical laboratories. In 1918, John Kolmer called for the development of a method that would certify
medical technologists on a national scale Kolmer published The Demand for and Training of Laboratory
Technicians that included a description of the first formal training course in Medical Technology. It was
also in the same year when the state legislature of Pennsylvania enacted a law requiring all hospitals and
institutions to have a fully-equipped laboratory fit for routine testing and to employ a full time
laboratory technician. In 1920, the administrative units of clinical laboratories in large hospitals were
directed by a chief physician. During this time, clinical laboratories consisted of 4 to 5 divisions including
clinical pathology, bacteriology, microbiology, serology, and radiology. As clinical laboratories held more
prominence in the delivery of laboratory tests, the need for technicians and technologists that would
assist physicians became greater.

In 1922, the American Society for Clinical Pathology (ASCP) was founded with the objective of
encouraging the cooperation between physicians and clinical pathologists as well as maintaining the
status of clinical pathologists. ASCP also established the code of ethics for technicians and technologists
stating that these allied health professionals should work under the supervision of a physician and
refrain from making oral or written diagnosis and advising physicians on how patients should be treated.
The American Society for Clinical Laboratory Science (formerly the American Society for Medical
Technologists), was originally formed as a subgroup of ASCP, helped in the recognition of nonphysician
clinical laboratory scientists as autonomous professionals. In the 1950s, medical technologists in the
United States sought professional recognition from the government of their educational qualifications
through licensure laws.
History of Medical Technology in the Philippines The Spanish Empire established Manila as their capital
in late 16th century. The first

hospital the Spaniards established in 1565, Hospital Real in Cebu, was moved to Manila to cater to
military patients, Members of religious orders who came to the country alongside the occupiers
established health institutions for the poor and educational institutions for the elite. In 1578, the
Franciscans built the San Lazaro Hospital for the poor and lepers. In 1596, the Hospital de San Juan de
Dios was founded for poor Spaniards. In 1641, the Hospital de San Jose was founded in Cavite.

The Dominicans founded the University of Santo Tomas in 1611, which in 1871 established the first
faculties of pharmacy and medicine. With the establishment of both health and educational institutions,
journals of science and medicine were also published including the Boletin de Medicina de Manila
(1886), the Revista Farmaceutica de Filipinas (1893), and Cronicas de Ciencias Medicas (1895)
(Anderson, 2006). The central board of vaccination which started producing and distributing vaccine
lymph in 1806 had 122 regular vaccinators (vacunadores) in Manila and other major towns by 1898
(Anderson, 2007; Planta, 2017: Tiglao, 1998).

In 1876, provincial medical officers were appointed to provide health care services throughout the
country. This was followed by the establishment of the Board of Health and Charity in 1883 which was
later expanded in 1886. The Laboratorio Municipal de Manila was established by the Spanish authorities
in 1887 for laboratory examinations of food, water, and clinical samples although the laboratory was not
adequately used in the study of outbreaks (Anderson, 2007; Cardona et al., 2015). Philippine war hero,
General Antonio Luna, was employed as a chemical expert in this laboratory and pioneered water
testing, forensics, and environmental studies (Nakpil, 2008; Vallejo, 2010). At the end of the Spanish
rule, structures of health care and public health were flourishing in major cities of the country. By the
end of the 19th century, the Spaniards who were considered to be authorities in medicine, started
exploring the microbial causes of diseases.

However, advancements in medicine and health care during the Spanish colonial rule broke down
because of the Philippine-American war which lasted from 1899 to 1902. In replacement of the Spanish
health system, the Americans established public health institutions modeled after military health care
systems. After the fall of Manila, the Spanish Military hospital was converted into the First Reserve
Hospital in 1898 by Lt. Col. Henry Lipincott who was a chief surgeon of the Division of the Pacific and
Eighth Army Corps. This hospital had a diagnostic laboratory but was not fully maximized when it first
became operational due to its director contracting typhoid fever. Richard P. Strong, the successor,
utilized the laboratory to perform autopsies and to examine blood, feces, and urine along with other
laboratory services (Anderson, 2006; Planta, 2017).
By 1901, the US government, through the Philippine Commission, established a Bureau of Government
Laboratories under the Philippine Commission Act No. 156 (Anderson, 2006; Planta, 2017). The Bureau
which was located in Calle Herran (Pedro Gil), Ermita, Manila had a science library, chemical section, and
serum laboratory for the production of vaccines. The biology laboratory was designed to address and
develop methods in the diagnosis, treatment, and prevention of human and animal diseases. In the
chemical laboratory, food, plant composition, and minerals were investigated. Paul Freer, the bureau's
first director, ensured that the biological laboratory would be equipped with adequate supplies and
equipment such as incubators, sterilizers, microscopes, microtomes, stains, glassware, and chemicals.
The main laboratory was composed of two stories and divided into two wings with rooms in the
biological wing having microscope tables by the windows. The rooms had enough space for general
laboratory work and processes such as filtering, distilling, and heating. Each biological room had a
chemical worktable with gas, water, and vacuums. The opposite wall had a hood with a flue extended to
the attic. The biological wing's floors all had incubators heated by Bunsen burners and refrigerating
boxes (Anderson, 2006; Freer, 1902). Unfortunately, the building was destroyed during World War II.
Presently, the National Institutes of Health of University of the Philippines-Manila occupies the area.

With the reorganization of the Bureau of Government Laboratories 1905, the Bure of Science was
established for medical officers who sought a career in laboratory resear (Anderson 2006: Planta. 2017).
The Bureau worked with the Army Board for the Study of the Tropical Diseases until the latter was
disbanded in 1914. The Bureau also focused on pathology while the board was intent on studying white
foreigners' physiology in tropical climates. The Bureau of Science worked closely with the Philippine
General Hospital (PGH) and the University of the Philippines. It then became an active center for
scientifie research and instruction in the country. The biological laboratory of the Bureau diligently
studied samples coming from across the country. Every day, scientists would study more than a hundred
samples of body fluids to identify the racial bases of diseases through a man of the archipelago's
pathological terrain. In 1909, the laboratory received over 7000 fee specimens, 900 urine specimens,
and 700 blood specimens. The Bureau's medical research and laboratory investigations were mainly
focused on microbiology in connection with the onslaught of different diseases such as cholera, malaria,
leprosy, tuberculosis, and dysentery.

At the end of the Philippine-American War, the civilian Board of Health established by the Americans
was changed into the Bureau of Health (Planta, 2017). In 1915, it was reorganized into the Philippine
Health Service but later on reverted to the Bureau of Health by 1933. The University of the Philippines'
College of Public Health formally opened its Certificate in Public Health program in June of 1927 with the
aim to provide proper training to the Philippine Health Service's medical officers.

On December 8, 1941, Japan attacked the whole of Manila through aerial assault and deployment of
troops just ten hours after bombing Pearl Harbor. It was the beginning of the Second World War that
resulted in massive casualties. Amid this turmoil, the Medical Laboratory unit of the US Army provided
medical services with the available laboratory supplies, supplemental laboratory examinations, and
epidemiological and sanitary investigations. It was also tasked to perform routine water analyses,
examination of food supplies, distribution of special reagents and solutions, culture media, and
investigation of epidemics and epizootics. The unit also performed special serological, bacteriological,
pathological, and chemical examinations, post-mortem examinations, and preservation of pathological
specimens of value to the US Army Medical Department (WW2 US Medical Research Centre, 2018).

On June 18, 1942, the 3d Medical Laboratory was the first laboratory unit to be assigned in the South
West Pacific Area (SWPA). Then in 1944, when the US forces landed in Leyte, the laboratories including
the 3rd, 5th and 8th Medical Laboratories and the 19th Medical General Laboratory were relocated to
the West Pacific Area. Added to the list were the 26th and 27th Medical Laboratories and the 363rd
Medical Composite Detachment. These medical units were not merged but deployed separately as small
detachments or mobile laboratory sections to military bases in different islands. The 19th Medical
General Laboratory, 3rd Medical Laboratory, and the 363rd Medical Composite Detachment operated in
Leyte. The 27th Medical Laboratory operated in Tacloban and the 26th Medical Laboratory operated in
Lingayen Gulf (the only laboratory unit in Luzon for six months following the US invasion on January 9,
1945).

The first clinical laboratory in the Philippines was established during World War II by the 6th Infantry
Division of the US army at Quiricada St., Sta. Cruz, Manila. It is now known as the Manila Public Health
Laboratory (Cardona et al., 2015; Moraleta, 2012; Rabor, 2016; Suba & Milanez, 2017). When the US
army left in June of 1945, the laboratory was endorsed to the National Department of Health and was
non-operational until it was reopened in October of the same year by Dr. Pio de Roda with the help of
then Manila City Health Officer Dr. Mariano Icasiano.

After instituting the public health laboratory in Manila, Dr. Pio de Roda along with Dr. Prudencia Sta.
Ana, conducted a training program for aspiring laboratory workers. Later on, Dr. Sta Ana was asked to
prepare a six-month formal syllabus for the training program with certificate for the trainees upon
completion. Dr. Tirso Briones joined the two later on (Moraleta, 2012). The training program ended in
1954 when the Bureau of Private Education approved a four-year course in Bachelor of Science in
Medical Technology. In the same year, the Manila Sanitarium and Hospital (MSH) opened the first
School of Medical Technology in the Philippines under the leadership of Mrs. Willa Hedrick, wife of Dr.
Elvin Hedrick. Soon after, MSH started its medical internship and residency training program which was
affiliated with Loma Linda University in California.

In 1954, the Philippine Union College (PUC) in Baesa, Caloocan City (now Adventist University of the
Philippines) absorbed MSH's School of Medical Technology. What was left with MSH was the facility for
its clinical division. Dr. Jesse Umali was the first graduate of the medical technology program. He later
graduated as a Doctor of Medicine at the Far Eastern University (FEU) and became a successful OB-
gynecologist in the US (Puno, 2014; Rabor, 2016). University of Santo Tomas initially offered the Medical
Technology course as an elective for pharmacy students in 1957. It was only in 1961 that Medical
Technology was recognized as an official program in UST (Cardona et al., 2015).
Inventions and Innovations in the Field of Medical Laboratory

Edward Jenner

Discovered vaccination to establish immunity to small pox; Impact of contribution: Immunology

Agos o Bassi

Produced disease in worms by injection of organic material-the beginning of bacteriology

1660

1796

1880

1835

1857

Antonle van Leeuwenhoek

The father of microbiology: known for his work on the improvement of the microscope

Marie Francois Xavier Bichat Identified organs by their types of tissues;

Impact of contribution: Histology

Louis Pasteur Successfully produced immunity to rables

Gregor Mendel

Enunciated his law of inherited

characteristics from studies on plants

Robert Koch

Presented the first pictures of bacilli (anthrax), and later tubercle bacilli

Ernst von Bergmann Introduced steam sterilization in surgery

August von Wassermann Developed Immunologic tests for syphilis

Hans Fischer

Worked out the structure of hemoglobin

James Westgard

Introduced the Westgard Rules for quality control in the clinical laboratory

Kary Mullis

Developed the Polymerase Chain Reaction (PCR)

James Thomson
Derived the first human Stem Cell line

1866

1870

1877

1886

1886

Elie Metchnikoff

Demonstrated that surgical infections are cause by airborne organisms

Described phagocytes in blood and their role in fighting infection

Karl Landsteiner

1902

Distinguished blood groups through the development of the ABO blood group system

Howard Ricketts

1906
1906

1929

1954

1973

1980

1985

1992

1998

Joseph Lister

Discovered microorganisms whose range lies between bacteria and viruses called rickettsiae

Jonas Salk

Developed poliomyelitis vaccine

Baruch Samuel Blumberg Introduced the Hepatitis B vaccine

Andre van Steirteghem Introduced the intracytoplasmic sperm injection (IVF)

KEY POINTS
The history of medical technology can be traced back to the ancient times.

. In the United States, the establishment of the first clinical laboratories and the development of the
laboratory practice marked the growth of the medical technology field.

• The history of medical technology in the Philippines can be traced back to the establishment of the
country's first clinical laboratory by the 6th infantry Division of the US army.

Nature of Medical Technology

The medical technology profession continues to develop over the years. Nowadays, the science of
medical technology has evolved tremendously because of the development of modern equipment and
new procedures aimed at helping in the diagnosis and treatment of diseases.

In understanding the nature of medical technology, it is important to understand the connection

between science and technology. Science is primarily concerned with the study of the natural world and
the interrelationship among the biological, psychological, and even the social world. Disciplines in the
sciences constantly evolve to adapt to the changing needs of human beings. Many principles of medical
technology are highly dependent on developments in the scientific disciplines and areas such as
chemistry, electronics, optics and mechanics, among others, in order to develop a utilizable
biotechnology that will aid in the diagnosis of diseases.

Technology, on the other hand, is the application of science in ways that are considered beneficial to
society. Technology can be defined in three ways: first, as a physical artefact, machine, or instrument;
second, as an activity or a means to accomplish a goal; and third, as knowledge (Howell, 1996). Rogers
(1983) asserts that "technology is a design for instrumental action that reduces the uncertainty in the
cause-effect relationships involved in achieving a desired outcome." Technology also consists of physical
elements such as equipment, materials, or products, and intangible elements, such as knowledge, skills,
procedures, principles, or information base required to successfully implement the technology. To sum
up, technology is an avenue for humans to alter or modify the environment in order to extend their
abilities to create, invent, discover, or innovate to make the world a better place to live in.

Medical technology is designed to improve the detection, diagnosis, treatment, and monitoring of
diseases. As such, it has linkages with many other disciplines for specific diagnostic or therapeutic
purposes (Evans et al., 2003). Its nature is contextual, interdisciplinary, interdependent, and systems-
based. It is dependent on the application, purpose, environment, and setting in which it is applied.

Clinical laboratory testing plays a crucial role in the detection, diagnosis, and treatment of diseases.
Clinical laboratory scientists who perform most of these laboratory tests, are involved in the
examination and analysis of body fluids, tissues, and cells. Laboratory scientists usually look for the
presence of bacteria, parasites, and other microorganisms in the body. They analyze the chemical
contents of fluids, match blood for transfusions, and test for drug levels in the blood to show a patient's
response to a specific treatment. They also prepare specimens for examination, to count cells, and look
for abnormal cells in the blood and other body fluids. They use microscopes, cell counters, and other
sophisticated laboratory equipment. They also use automated equipment and computerized
instruments capable of performing a number of tests simultaneously. After testing and examining a
specimen, laboratory scientists analyze the results and relay them to physicians.

With increasing automation and innovations in computer technology, the work of technologists and
technicians has become less hands-on and more analytical. The complexity of tests performed, the level
of judgment needed, and the amount of responsibility assumed by the laboratory personnel are
grounded on extensive education and experience.

Medical Technology Practice Defined

In the Philippines the medical technology profession and its practice is governed and defined in section
two (2) of R.A. 5527, also known as the Medical Technology Act of 1969. Section 2 of the Republic Act, as
amended by R.A. 6132, P.D. 498, and P.D. 1534, defines the practice of medical technology:

Section 2. a. Practice of Medical Technology - A person shall be deemed to be in the practice of medical
technology within the meaning of this Act, who shall for a fee, salary or other compensation or reward
paid or given directly or indirectly through another, renders any of the following professional services
for the purpose of aiding the physician in the diagnosis, study and treatment of diseases and in the
promotion of health in general:

1. Examination of tissues, secretions and excretions of the human body and body fluids by various
electronic, chemical, microscopic, bacteriologic, hematologic, serologic, immunologic, nuclear, and other
laboratory procedures and techniques either manual or automated;

2. Blood banking procedures and techniques;

3. Parasitologic, mycologic and microbiologic procedures and techniques;

4. Histopathologic and cytotechnology; provided that nothing in this paragraph shall inhibit a duly
registered medical laboratory technician from performing histopathologic techniques and procedures;

5. Clinical research involving patients or human beings requiring the use of and/or

application of medical technology knowledge and procedures;

6. Preparations and standardization of reagents, standards, stains and others, provided such reagents,
standards, stains and others are exclusively for the use of their laboratory;

7. Clinical laboratory quality control; 8. Collection and preservation of specimens;

Provided, That any person who has passed the corresponding board examination for the practice of a
profession already regulated by existing law, shall not be subject to the provisions of the last four
preceding paragraphs if the performance of such acts or services is merely incidental to his profession
(Section 2, a.).

All aforementioned are commonly observed in a clinical laboratory (Cardona et al., 2015). However,
some of these may not be exclusive to medical technologists. Microbiologists,

biologists, chemists, and even sanitary engineers may be involved in some activities usually done by
medical technologists. A medical technologist must first become licensed before he or she is permitted
to practice the profession. Practicing as a medical technologist without a license is punishable by law. It
should also be considered that the medical technology practice should be bound by the accepted pledge
of oath in accordance with the Code of Ethics of Medical Technology which states that the Medical
Technology professional should accept the responsibilities inherent to being a professional and shall not
engage in any illegal activities. The following are the original and revised versions of the medical
technology code of ethics.

Original version (by Dr. Nardito Moraleta)

Upon entering into the practice of medical technology let it be known that:

I accept the responsibilities associated with my duties. I shall uphold the ideals of my profession.

I am aware that since the physician relies upon my work in the diagnosis and treatment of diseases, any
error may affect the health or even the life of the patient. Every procedure and observation therefore
must be carried out with absolute reliability, accuracy, fairness, and honesty.

I am aware of the need for mutual understanding and cooperation among my fellow workers in the
medical and paramedical field in the pursuance of a worthy cause.

I shall strive to preserve the integrity of myself and the professionals from

whom we expect the same.

I shall strive to develop necessary virtues needed in my work and shall

place my service above any other considerations.

I shall restrict my phrases, criticisms, values, and opinions, within constructive limits and I shall not use
the knowledge I know as a tool for my selfish personal ends.

I realize that the knowledge I acquired about any individual in the course of my work must be treated as
confidential. And since the physician has the ultimate responsibility in the diagnosis and treatment, my
result must be known only by him. I shall neither make diagnosis nor interpretations other than this in
the report made by me nor shall I advice the physician or others on how to treat diseases.

I shall believe in full and equal opportunities in the pursuance of our

ideals within the context of the principles of human rights.

To these principles, I hereby subscribe, promising to conduct

Revised version (by Prof. Rodolfo Rabor)

As I enter into the practice of Medical Technology, I shall accept the responsibilities inherent to being a
professional; I shall uphold the law and shall not engage in illegal work nor cooperate with anyone so
engaged; I shall avoid associating or being identified with any enterprise of questionable character;

I shall work and act in a strict spirit of fairness to employer, clients,

contractors, employees and in a spirit of personal helpfulness and fraternity

toward other members of the profession;

I shall use only honorable means of competition for professional employment or services and shall
refrain from unfairly injuring, directly or indirectly, the professional reputation, projects or business of a
fellow medical technologist; I shall accept employment from more than one employer only when there
is no conflict of interest;

I shall perform professional work in a manner that merits full confidence and trust carried out with
absolute reliability, accuracy, fairness, and honesty; I shall review the professional work of other medical
technologists, when requested, fairly and in confidence whether they are subordinates or employees,
authors of proposals for grants or contracts, authors of technical papers or other publications or
involved in litigation;

I shall advance the profession by exchanging general information and experience with fellow medical
technologists and other professionals and by contributing to the work of professional organizations;

I shall restrict my praises, criticisms, views, and opinions within constructive limits and shall not use the
knowledge I know for selfish ends; I shall treat any information I acquired about individuals in the course
of my work as strictly confidential, and may be divulged only to authorized persons or entities or with
consent of the individual when necessary;
I shall report any infractions of these principles of professional conduct to the authorities responsible for
the enforcement of applicable laws or ulations, or to the Ethics Committee of the Philippine Association
of Medical Technologists as may be appropriate.

To these principles, I hereby subscribe and pledge to conduct myself at all times in a manner befitting
the dignity of my profession.

Roles and Responsibilities of Medical Technology Professionals

Medical Technology is indeed a rapidly advancing discipline and profession. The role of medical
technology professionals in the diagnosis and treatment of diseases is very crucial in health care
practice. In the Philippines, R.A. 5527 or the Medical Technology Act of 1969, defines the scope of work
of the different medical technology professionals. There is no doubt that the role of the medical
technologist is to collaborate with other health care practitioners to provide humane and dignified
health service. The following are the tasks of medical technology professionals in the practice of
laboratory science.

Perform Clinical Laboratory Testing

A medical technologist must be capable of performing the most basic to the most advanced laboratory
tests. A graduate of Bachelor of Science in Medical Technology/Medical Laboratory Science is expected
to show competency in performing routine laboratory tests including urinalysis and stool examination.
He or she should be capable of performing hematologic, microbiologic, serologic, chemical, and other
procedures in the different areas of laboratory science. In turn, it is expected that the clinical laboratory
will be equipped with the resources necessary for performing such procedures or any kind of laboratory
testing.

Perform Special Procedures

Medical technologists are also expected to perform special procedures in diagnosing diseases. These
may include the operation of advanced diagnostic equipment. Special procedures can also include
molecular and nuclear diagnostics.

Ensure Accuracy and Precision of Results

In performing different procedures to diagnose diseases, a medical technologist should always be
conscious of the accuracy and precision of both the testing process and its results. Accuracy and
precision impacts the interpretation of results by the physician to provide proper medication in the
treatment of diseases.

Be Honest in Practice

A practicing medical technologist, like any other professional, is expected to be honest in the practice of
his or her work. It is important that a medical technologist values honesty, particularly in conveying or
reporting the results of any laboratory procedure. He or she should act according to the Medical
Technology profession's Code of Ethics and his or her pledged oath of practice. A medical technologist
must be honest at all times in the conduct of test procedures to come up with accurate and precise
results.

Ensure Timely Delivery of Results

In collaborating with other health care practitioners, a medical technologist must be aware of the
urgency of delivering results on time especially in cases that require urgen treatment. There are times
when physicians will request laboratory tests which require immediate action. One should take
notations on "STAT" or even observe the source of the requests (eg, from the emergency room [ER] or
operating room [OR]). It is important for a medical technologist to be alert to fully address the needs of
the patient. Since some laboratory procedures are time bound, it is important that a medical
technologist is able to perform the duties required of him or her, as soon as possible.

Demonstrate Professionalism

A medical technologist must be able to perform his or her functions according to the professional Code
of Ethics for medical technology professionals. He or she should be aware of the laws and regulations
governing the practice of medical technology and should not exploit its function beyond its boundaries.
In the Philippines, the practice of medical technology profession is governed by R.A. 5527 or the
Philippine Medical Technology Act of 1969. Other governing regulations are supplemented by the
Clinical Laboratory Act of 1966 (R.A. 4688) and the Blood Banking Acts of 1956 (R.A. 1517) and 1995
(R.A. 7719). National organizations as the Philippine Association of Medical Technologists, Inc. (PAMET)
and the Philippine Association of Schools of Medical Technology and Public Health, Inc. (PASMETH) also
have their own constitutions and by-laws in accordance with the governing laws and code of ethics

Uphold Confidentiality
Ensuring confidentiality of patient's information is one of the core duties within the medical practice (De
Bord et al.). Confidentiality requires health care providers to keep a patient's personal health
information private unless the patient consents to release the information. Patient records are expected
to be kept in confidence by the medical technologist. It is expected that these records containing very
important information are protected and made available only when necessary. A medical technologist
must be aware at all times of the value of confidentiality and the entirety of the ethical codes of their
profession.

Collaborate with Other Health Care Professionals

A medical technology professional is required to collaborate with other health care practitioners in
order to build a well-functioning team. Most often, projects fail because people fail to cooperate with
others. Collaboration is the act of working together in order to achieve a desired outcome. Success in
the health care setting is achieved not because of the availability of highly sophisticated hospital or
laboratory equipment, but because of teamwork. A highly-trained physician will only be able to
efficiently treat his or her patient if laboratory

testing, monitoring, drug prescription and dosage, and more are properly rendered and administered by
other health care professionals. These protocols cannot be done by the physician alone. Having one
non-collaborative and incompetent member in the team alone can result in potentially dire
repercussions.

Conduct Research

Practicing medical technologists must also be engaged in research activities to update their skills.
Research work, whether experimental or descriptive can contribute significantly to the discovery of new
knowledge in the field of medical technology and in assessing and revisiting already known ones. It can
greatly help in the further development of the field and may be used as future reference for patient
care.

Involvement in Health Promotion Programs

Medical technologists should not be confined only to the four corners of their clinical laboratories.
Medical technology is a multi-disciplinary field which consistently ventures into other areas of health
care including health promotion. A medical technology professional must be actively involved in
reaching out to the community. There are many ways by which the medical technology profession can
help improve the lives of people. Other health care professionals such as nurses and physicians are
easily seen in community outreach programs because of the nature of their professions. Medical
technologists, as valuable health care professionals, are also expected to do the same. The following are
some ways that medical technology professionals can help the community:

1. Cooperate with other health care professionals in health promotion campaigns such as promoting the
ideal attitudes on hygiene, community sanitation, waste segregation, and disease prevention.

2. Implement pre-planned programs of health promotion campaigns.

3. Offer free laboratory testing such as blood typing, urinalysis, fecalysis, blood sugar testing, cholesterol
testing, and other tests beneficial to the entire community.

4. Collaborate with other health care professionals once diagnoses are done.

Defining the Practice of Other Laboratory Personnel

The following is a list of other valuable laboratory personnel with various roles in the health care
delivery system, specifically in the area of laboratory medicine. It is important to note that medical
technologists work closely with these laboratory personnel in order to provide accurate and precise
laboratory results. The different roles of different laboratory personnel are interconnected. It is
important that all should work in harmony in order to provide the best patient care.

Pathologist

As defined in R.A. 5527:

A pathologist is a duly registered physician who is specially trained in methods o laboratory medicine, or
the gross and microscopic study and interpretation of tissues, secretions and excretions of the human
body and its functions in order to diagnose disease, follow its course, determine the effectivity of
treatment, ascertain cause of death, and advance medicine by means of research (Section 2, b.).
A pathologist is always considered to head a clinical laboratory and monitor all laboratory results. A
laboratory result without the signature of a pathologist may not be considered valid.

Medical Laboratory Technicians

As defined in R.A. 5527:

A medical laboratory technician is a person certified by and registered with the Board of Medical
Technology and qualified to assist a medical technologist and/or qualified pathologist in the practice of
medical technology as defined in the aforementioned act (Section 2, d.).

There are certain qualifications other than what is stated above to become a medical technician
provided that he or she satisfies the qualifications such that he or she:

a. Failed to pass the medical technology licensure examination given by the Board of Medical
Technology but obtained a general rating of at least 70% and provided finally

that a registered medical laboratory technician when employed in the government

shall have the equivalent civil service eligibility not lower than the second grade;

b. Passed the civil service examination for medical technicians given on March 21, 1969; or

c. Finished a two-year college course and has at least one (1) year experience of working as a medical
laboratory technician; provided that for every year of experience in college, two (2) years of work
experience may be substituted; and provided further, that the applicant has at least ten (10) years of
experience as medical laboratory technician as of the date of approval of this decree.

Phlebotomist

A phlebotomist is an individual trained to draw blood either for laboratory tests or for blood donations.
When only small quantities of blood are needed, a phlebotomist can draw blood by simply puncturing
the skin but when larger volumes of blood are needed, venipuncture or even arterial puncture is done.
Arterial collection can only be performed by a specially trained phlebotomist. Nowadays, phlebotomy is
a skill confined not only to medical technologists but to other health care practitioners as well, provided
that they were given certification by a reputed certifying or training body.

In the Philippines, a medical technologist is required to be skilled in phlebotomy.

Although, in other countries, phlebotomists need not get a degree (Cardona et al., 2015).

They are trained on the job and go through phlebotomy programs sponsored by community

colleges which take as little time as two months. After completing the program, they may take

an examination for them to be recognized as a certified phlebotomist by the American Society

for Clinical Pathology (ASCP), American Medical Technologist (AMT), and the National

Healthcareer Association (NHA).

Cytotechnologist

A cytotechnologist is a laboratory personnel who works with the pathologist to detect changes in body
cells which may be important in the early diagnosis of diseases. This is primarily done by examining
microscopic slides of body cells for abnormalities or anomalies in structures, indicating either benign or
malignant conditions. A cytotechnologist selects and sections minute particles of human tissue for
microscopic study, using microtomes and other equipment and employs stain techniques to make cell
structures visible or to differentiate its parts. The Papanicolaou (Pap) test and the H&E are the most
commonly employed staining techniques.

Histotechnologist
A histotechnologist, also referred to as histotechnican, is a laboratory personnel responsible for the
routine preparation, processing, and staining of biopsies and tissue specimens for microscopic
examination by a pathologist (Cardona, 2015). Although there is no formal training for
histotechnologists in the Philippines, being a histotechnologist is perceived to be a decent paramedical
profession abroad. In the United States, one can complete a histotechnician program accredited by the
National Accrediting Agency for Clinical Laboratory Science (NAACLS). This program usually takes a year
to complete and covers. courses in chemistry, histology, immunology, biochemistry, and medical ethics.
Aspiring histotechnologists can also complete an associate degree program in a reputable health facility
that includes supervised histology training to gain an associate degree in Applied Science (AAS) major in
Histology.

Nuclear Medical Technologist

A nuclear medical technologist is a health care professional who works alongside nuclear physicians.
Nuclear medical technologists apply their knowledge of radiation physics and safety regulations to limit
radiation exposure, prepare and administer radiopharmaceuticals, and use radiation detection devices
and other kinds of laboratory equipment that measure the quantity and distribution of radionuclides
deposited in the patient or in the patient's specimen.

Toxicologist

A toxicologist studies the effects of toxic substances on the physiological functions of human beings,
animals, and plants to develop data for use in consumer protection and industrial safety programs. He or
she also designs and conducts studies to determine physiological effects of various substances on
laboratory animals, plants, and human tissue, using biological and biochemical techniques.

KEY POINTS

Medical laboratory science is one of the most important fields in the health care delivery system. It plays
an important role in the diagnosis, treatment, and management of disease.

Medical technology is designed to improve the detection, diagnosis, treatment, and monitoring of
diseases.

R.A. 5527 or the Medical Technology Act of 1969 defines the nature and scope of the Medical
Technology profession in the Philippines.
Human Existence and Ethics

Ethics is the moral code that guides how an individual should behave. As a branch of knowledge, it deals
with moral principles. Ethics is also about the individual's search for meaning while dealing with human
problems which may be logical (problems of reasoning), epistemological (problems of the truth),
cosmological (problems of universe), ethical (problems of morality), aesthetical (problems of art and
beauty), or scientific problems (problems of science) (Timbreza, 1993). With the various definitions of
ethics every individual should be open in dealing with ethical problems.

Human beings are logical beings but human existence is inexplicable. At the moment a person is born,
he or she begins to suffer and will continue to suffer until death (Timbreza, 1993). Indeed, to have been
born human is tragic because life is a perpetual process of making sense of the absurdity of one's
existence. Making sense of the meaning of human existence throughout history has brought about
many developments in the study of ethics.

Schools of Ethics

Ethics deals with a diverse prescription of universal concepts and principles that serve as foundation of
moral beliefs. Some may agree that there is no such universal or absolute ethical principle that would
apply to all, as elaborated on by ethical relativism. Some may say that the standards of right or wrong
are always relative depending on cultural and social factors.

In many cases ethics can be connected to morality. For Donal Harrington, morality can be viewed in
different perspectives-as a law, as an inner conviction, as love, as personal growth, and as social
transformation. However, there are also nuances between ethics and morality as illustrated by James
Gustafson (1974).

Ethics

Theoretical prescriptions/critiques

The nature of the good

• The nature of human person • Criteria of judgment

Ethical Relativism

Morality

Based on principles practiced by a particular community

Fundamental convictions of human agent . Character of moral agent

• Use of norms

Situational analysis

Ethical relativism, also known as moral relativism, is a school of ethics anchored on the principle that
morality is relative to the norms of a particular culture. It is a theory based on norms relative to a
particular culture or society. For example, some cultures may accept certain acts and behaviors that are
unacceptable to other cultures.

Ethical relativism acknowledges societal diversity, that every society has a unique moral design and
culture; and people's beliefs are greatly influenced by culture. The challenge to each society is the
preservation of its cultural uniqueness and acknowledgment of cultural differences.

Ethical Pragmatism

Pragmatism is a philosophical approach or movement that began in the 1870s. The term was coined by
Charles Sanders Peirce and further developed by William James. It is considered as America's most
distinctive and major contribution to the field of philosophy, It is more of a theory on knowledge, truth,
and meaning rather than morality. Although the language of moral interest may appear in many of the
writings of Peirce and James, it is interesting that a pragmatic conception of good and truth can be
applied in the medical context especially in terms of decision making and moral reasoning.n
Ethical Utilitarianism

Founded by two English Philosophers Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873),
this school of ethics states that the rightness or wrongness of actions is determined by their
consequences. The principle of utility formulated by Mill states that "actions are good insofar as they
tend to promote happiness, bad as they tend to produce unhappiness. The utility or usefulness of an
action is determined by the extent to which it promotes happiness rather than its reverse."

Moral Issues

There are numerous ethical issues in the field of medicine that are perceived to be controversial.
Diversity, decision making, compliance, and governance are some of the concerns that need to be
considered when doing an ethical review in the context of the health care profession. Various views
formulated by many philosophers, theologians, and moralists provide people with difficult decisions as
to whether an action is acceptable or not. The following ethical issues are those that continue to be
talked about and debated on because of their controversial nature.

Abortion

Abortion is considered illegal in the Philippines. Article II, Section 12 of the 1987 Philippine Constitution
states that:

The state recognizes the sanctity of life and shall protect and strengthen the family as a basic
autonomous social institution. It shall equally protect the life of the mother and the life of the unborn
from conception (Article II, Section 12).