In an era of “hi-tech” medicine, efficiency, technical sophistication and innovation draw recognition from a wide audience of colleagues, patients and society. The UK government's acknowledgment that up to 70% of medical diagnoses now rely on pathology laboratory analyses1 emphasises the crucial role that laboratory physicians play in patient care.

Although sustaining high ethical standards remains crucial in both clinical and laboratory practice, and ethical dilemmas are faced daily by laboratory physicians, ethics does not receive the attention it deserves. The Canadian Association of Pathologists emphasises the prominent role ethics plays in laboratory medicine in its mission statement “…providing national leadership through the promotion of excellence in practice, education and research, and through the fostering of integrity and high standards of ethical behaviour”.2

Although there is usually no direct contact with patients, the “faceless” laboratory physician's first and foremost duty is to act in the best interests of the “faceless” patient who is often “just a number”.3 4 Although personal knowledge of the patient is often lacking, the laboratory physician does have intimate knowledge of at least a part of the patient—the specimen5—and an unusual three-way contract is made between clinician, laboratory physician and patient. This is the case in particular where a life-altering event may occur on the basis of the definitive decision of a laboratory physician and the act of faith with which this is accepted by the patient.5 6

Consider the following example. Dr Z heads the microbiological department of a large clinical laboratory. After a busy shift and as she is about to leave, it is brought to her attention that an abnormal cerebrospinal fluid report written by a junior resident has not been reviewed by a senior colleague before being sent out to the clinician. She decides to …