Beverly L. Smith-Keiling- 1Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School and College of Biological Sciences, Minneapolis, MN, United States
- 2Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States
With modernization of safety standards for microbiology outreach teaching laboratories, ethical challenges arise in teaching microbiology for the public good without short-changing students in under-resourced situations, or when institutional support is subpar. Still, educators want students to engage using applied skills for inquiry, research-based microbial learning activities – safely. Following several United States microbial outbreaks, federal investigation traced sources back to teaching laboratories. Policy discussions ensued. The American Society for Microbiology (ASM) Task Force provides recommended but not mandated guidelines; however, guidelines are not amenable by all. Here, a real-world, ethical scenario of a university-level outreach microbiology laboratory course hosted at several locations provides context for under-resourced challenges in safety compliance. In this example of biomedical and public health ethical considerations, upper administration puts the onus on instructors to assure safe labs for their students and the general public. Temporarily hired instructors without curriculum or sufficient institutional support are put in precarious positions with often egregious practices to get the job done. This scenario is examined with different public health ethical frameworks and principles: non-maleficence, beneficence, health maximization, efficiency of policy regulations, respect for institutional and instructor autonomy, justice, and proportionality balancing stakeholder concerns. Sample curricular strategies are employed to mitigate these challenges. Taking a utilitarianism framework of the greatest good for the most benefit, this paper advocates for social justice supporting access to education as a moral duty. Administrations should ensure instructors are supported sufficiently to provide safe, authentic learning experiences. Solutions for under-resourced outreach teaching are needed for public trust.
Introduction
Teaching microbiology laboratory courses safely has new meaning and ethical challenges. Even before modern life-altering pandemics begin changing worldviews, raised awareness is needed of ethical safety challenges faced in under-resourced science teaching laboratories. Change away from “normal science” practice creates tensions. Reasoning helps “puzzle-solve” through crisis (Kuhn, 1962). Exploring ethical dilemmas helps balance competing needs such as increasing stringency of safety in resource-limited settings without limiting learning, sustaining equitable educational opportunities, and negotiating administrative priorities. Every accident or near miss, whether biological or chemical, teaches lessons reminding that safety is integral to science. Worst-case scenario emerging pathogen pandemic planning is attentive to history, changing paradigms in biosafety, social justice, and ethical lenses to mitigate disease. All are trademarks applying public health perspectives (Mack et al., 2007) also necessary in the small-scale educational setting.
Comprehensive, updated biosafety sources (Wooley and Byers, 2017) include specific recommendations addressing the special environment of the college-level teaching laboratory and recognizing burdens and liabilities of instructors from under-resourced settings (Woolverton and Woolverton, 2017). Additional resources and CDC biosafety training modules1 (Table 1) can assist institutional decision-making capabilities to maintain safe standards, even when staff may lack legal protection when some institutions avoid compliance. Generally, biosafety officers assist instructors to assure safe student instruction environments. Without institutional support and oversight, sometimes the instructor alone makes the decision to use practices beyond biosafety level (BSL)1 criteria, conducted on a standard laboratory table with minimal personal protective equipment (PPE), e.g., optional gloves and eye protection. Some practices, e.g., discouraged isolation from environmental sources, could isolate BSL2 organisms and pose infectious risk. Even well-equipped laboratories working within established laboratory safety practices have risk (Hayden, 2011) as seen in several multi-state outbreaks234 of a pathogenic strain of Salmonella Typhimurium originating in clinical and teaching laboratories.
Table 1. Sample University X under-resourced teaching laboratory scenario.
In response, an American Society for Microbiology (ASM) task force drafted and revised guidelines (Emmert, 2013; Woolverton, 2013; Byrd et al., 2019). An updated addendum,5 clarifies use of risk group RG1 organisms, and better accounts for the range of emergent issues in teaching facilities and laboratory practices. Guidelines are recommended, but not mandated. However, as enhanced safety guidelines evolve, they do not fully account for additional burdens that arise in under-resourced institutions. Assumptions of how microbiology is supposed to function often fail to include alternate viewpoints and practices in under-resourced settings.
Guidelines are assumed to be beneficial. Beneficence promotes a safety-ethics culture to prevent hazards, near-misses, or unreported incidents regardless of the science, size of laboratory or setting (Hill, 2016). Even small hazards in a teaching laboratory with untrained, introductory-level students may pose risk for undocumented laboratory-acquired infection (LAIs) (Carlberg and Yeaman, 2006). Harding and Byers (2006) review the epidemiological approach of distribution in populations and LAIs from research, clinical, and teaching. Outbreaks from teaching laboratories are low, but not systematically monitored or reported. Impacts include host susceptibility, behavioral factors, and the environment. Despite benefits, guidelines can also cause harm. Maleficence can occur when they are misunderstood, ill-fitting for the environment, or mandates produce unintended consequences.
Real-world biomedical challenges and public health ethical dilemmas are not new for under-resourced institutions with faculty struggling to provide microbiology laboratory courses safely. What appears non-standard for the mainstream is standard in another, termed “under-resourced” or “outreach” for the purpose of this article includes formal learning in different modalities: distance education, online and hybrid courses using do-it-yourself (DIY) at-home kits, citizen science, and laboratory courses hosted at different sites via a traveling lab bus. Assumptions begin with faculty having solid foundational understanding and respect for microorganisms and safety. Recognizing “one-size-fits-all” standards are not feasible, faculty and institutions adhere to a “good-faith effort” (Woolverton and Woolverton, 2017). However, what happens if these assumptions are not met, when a sole safety-trained scientist is alone pushing for reform, or when the upper administration is more concerned about the financial bottom line and appearance of effort without the true fidelity and commitment? These questions of safety and social justice in education are best addressed applying a public health ethics equity approach.
Under-resourced outreach teaching example University X provides a real-world scenario (Table 1). Challenges and failure to meet laboratory safety guidelines and other dilemmas are examined using a novel approach applying public health ethical analysis. Social justice issues surrounding the development and implementation of guidelines raises potential harm if mandated too harshly or when under-resourced institutions fail to respond well. Public health policymaking applies several frameworks. Schröder-Bäck et al. (2014) outlines seven principles to explore cases such as under-resourced University X: non-maleficence, beneficence, health maximization, efficiency, respect for autonomy, justice, and proportionality. Here, to assure that biosafety restrictions do not limit learning science in an unjust manner, this analysis raises awareness of the minority voice of under-resourced institutions.
Non-Maleficence in Biosafety Guideline Compliance and Acceptable Risk in Changing Paradigms
Changing paradigms increase conflict by altering what constitutes acceptable risk, biosafety measures, and abilities to comply. The basis of bioethics and public health ethics is the Hippocratic oath “primum nil nocere,” taken as the first principle of non-maleficence and “do not harm.” There is a duty to educate as well as protect health. Lack of compliance to safety policy guidelines can harm, as can mandating too harshly. The framework of Kass (2001) asks the overall public health goals, program (guidelines) effectiveness, and potential burdens. If the goals, such as safety, cannot be implemented fairly to mitigate burdens, then we as a society collectively decide procedurally what should and should not be done to protect the health and maintain the education of communities. Bernheim et al. (2009) promotes procedural justice through ethical reflection of all affected groups being part of the decision-making process. The ASM community endeavors to duly discuss biosafety in educational teaching laboratories. Publication in journals requires explanation of adherence to safety guidelines; however, even this rigor can exclude. Burdens faculty face creates tensions when facing the moral code that they “ought” to meet guidelines – particularly when the institution fails them. When more voices are heard, then a balance for the under-resourced can procedurally be sought.
The framework of Baum et al. (2007, 2009) helps manage tensions in daily work by asking how the program guidelines advance wellbeing and respond to the needs of the community. Resolution of conflicts is determined by how burdens created by mandates (or even recommended guidelines) can be minimized through improved alternative approaches for fairness in equity and wellbeing. Rather than theoretically assuming safe practices, feasibility is considered in the daily practice.
The safety guidelines suggest risk assessment to prevent harm, e.g., student mishap, exposure, or a bigger contagion. The principle of non-maleficence is balanced with degrees of harm that would give the greater benefits. Guidelines are acceptable when other harms they create are limited. This utility by Bentham’s measure of wellbeing evokes the doctrine of utilitarianism of providing the greatest good for the greatest number (Bentham, 1781, 1996). However, utilitarianism is flawed since consequences are not predictable. In applying consequentialist theory, the actions of utility deemed most correct is one that provides the most benefit gain for the majority (Roberts and Reich, 2002). Utilitarianism is challenged by social justice and the needs of the minority if utility is only increased for the majority.
When all voices are not heard equally, policy guidelines can result in harmful unintended consequences. Harm results if fear or administrative ignorance results in course cancellations. Without alternative approaches, under-resourced educators face burdens of teaching laboratory courses with inadequate safety vs. offering no course at all.
University X (Table 1), dedicated to low tuition for lower socioeconomic (SES) students, limits funding resources, temporarily hires faculty, lacks lab manual curricula, and lacks institutional safety officers. Overwhelmed by deficient support, faculty rely on piecemeal lab kits “on hand” and think outside the box to teach authentic science, often putting faculty in precarious positions with egregious practices to get the job done. The slippery slope begins when faculty trying to encourage greater student engagement use “let’s give it a shot” attitude and “let’s try it and see” to justify their choices (Tippins et al., 1993). Educators knowledgeable of the risks advocate for support, sometimes as the lone voice seeking institutional change. The unguided administration can balk and retaliate resulting in microbiology laboratory course cancellations and in doing so, denying access to education and science literacy. Ethical frameworks applied by the scientific community can help address the underlying moral conflict of stringent biosafety guidelines causing harm.
Beneficence, Health Maximization, and Efficiency
The crux lies in balancing acceptable “tradeoffs” between non-maleficence degrees of harm and the second principle of beneficence, the obligation to produce benefit. To weigh the beneficence of guidelines, risks are ascertained with the broader view of the third principle, health maximization including the greater population. Risk assessment of small-scale threats are similar to the larger scale National Response Framework emergency management cycle: prevention of hazards, risk identified, and fairness imposing mandates to protect (Gostin, 2000a,b,c, 2010; Gostin and Powers, 2006; Gostin and Wiley, 2016). Public health law ties mandates to different degrees of enforceable governmental regulation and even non-mandated, non-enforced guidelines imply obligation through semantics (Harmon, 2016). The moral burden put upon an instructor, whether sufficiently supported or not, and the guilt and culpability that would be incurred if an accident occurred increases the ethical dilemma.
Guidelines elicit a public health benefit to student populations. If pressure from restrictive measures threatens the course loss, then a counter benefit is for the greater public good with an obligation to provide laboratory education supporting science literacy and the welfare of others. Science literacy and microbial appreciation are increasingly important at every level of our global society to understand how scientific understanding changes through evidence. We need laboratory courses for a full science curriculum for our future scientists and health care workers, as well as policy makers, agencies, and general population (Timmis et al., 2019). In sustaining more science courses, then the fourth principle, efficiency, promotes greater impacts. By assuring evidence-based, cost-effective, safe practices for under-resourced education, then science literacy is maintained without short-changing learning even with subpar institutional support.
These trade-offs are exemplified as University X struggles with more stringent guidelines when applying skills of the standard “isolation of unknown” as one form of discovery meeting ASM curricular learning outcomes.6 Outside of the standard of practice, instructors still resort to isolation practices not consistent with guidelines. Lacking stock cultures, students swab different environmental, their own human body, or other animal sources to isolate unknown microorganisms. Microbes grow, students streak to isolate pure culture colonies, and stain to identify. Risk increases working with environmental cultures if a pathogen is propagated in pure culture; yet, reliance on these traditional practices provides ease of source materials and low cost when it is difficult to order and maintain stock cultures. Alternate methods are sought within guideline recommendations (Table 1). Course-based undergraduate research experiences (CURES) for institutions that desire applications of real-world, authentic research experiences but may lack research infrastructure have additional needs (Alkaher and Dolan, 2014; Auchincloss et al., 2014; Davis et al., 2017). Some have expanded Tiny Earth soil projects for broader educational applications with adapted protocols for genomic identification and pivot to online with the pandemic7 (Basalla et al., 2020).
For new educators, even well trained from R1 research institutions, temporary visiting professor, or adjuncts, the shift to low-resourced education can be daunting with subpar institutional support, proving difficult to navigate and ensure safe, meaningful curricula. Institutions of any type might struggle when modalities change due to life-altering pandemics. When courses globally shift online, many instructors face new challenges teaching laboratory courses authentically and safely, but more so if institutional resources and instructor preparedness are limited (Hodges et al., 2020; Procko et al., 2020; Rapanta et al., 2020). Even providing critical thinking curricula can be a challenge when resources are limited (Aparna et al., 2020, this issue; Song et al., 2016). Hierarchy designates safety officers bear the burden of liability, but places a higher burden of culpability on the instructor. Frustration mounts when the institution lacks a safety officer and inability to publish with embarrassing institutional breaches.
When instructor practices are noncompliant with guidelines, they may need deeper investigation to determine risks of students potentially isolating a pathogenic microorganism from environmental sources (Table 1). Even the easily adapted “handwashing” or “disinfectant” labs with resistant bacteria found in soil and paper towels are not without risk since any immunocompromised situation, even pregnancy, increases risks. Although most human infectious disease pandemics originate from cross-species transmission, these are rare in a teaching laboratory (Hughes et al., 2010). However, several dramatic and timely examples provide a valid warning (Table 1). Any anomaly away from “normal science” pushes the paradigm change.
Respect for Autonomy vs. Top-Down “Paternalistic” Mandates
Within public health frameworks, paternalistic guidelines mandated from the top-down are contrasted with the fifth principle of respect for autonomy as a moral consideration (Childress et al., 2002). Academic decision-making by institutions and instructors to comply with guidelines, or not, is a moral choice if guidelines limit individual liberties, or academic freedom. A disadvantage to autonomy is the ethical burden of poor compliance: the student choosing not to comply, the instructor desiring autonomy in teaching strategies, or the administration failing to adequately provide support.
Some educators find themselves advocating for policy changes at their own institutions but in precarious positions of power dynamics. If educators advocate too firmly or take a whistleblowing approach, then courses could be canceled and jobs lost. University X with an inability to comply (or administrative choice not to allocate funds) may result in a knee jerk reaction to cancel microbiology courses putting future generations at risk with the increasing fear of science and lack of knowledge that protects us all and limits justice.
Justice for Equitable Access
Baylis et al. (2008) highlight frameworks that focus on a social justice approach for the common good. This calls upon relational autonomy, solidarity of common interests rather than “us and them,” and justice in the fairness of how decisions are made. With the consequentialist approach, respect for individual stakeholder interests is unbalanced. Taking the deontological, duty-based approach, policies holding social justice take priority for the most good. Supporting faculty in being able to adhere to a duty-based approach applies normative ethical theory; a moral code determines if an action is right or wrong under a set of rules (Bellefleur and Keeling, 2016). However, if the rules only assume adequate resources, then this adds burden to the duty under-resourced educator’s bear.
When the need to follow updated safety guidelines poses threats to course cancellations, then the under-resourced institutions are at further risk. To increase social justice, education needs to reach beyond those in college who cannot afford education by expanding the greater good through promoting science literacy. A hidden part of the unintended consequences of this dilemma is that more of those who come from lower SES attend these under-resourced colleges (Engberg and Allen, 2011). Engaged learning such as laboratory courses offered at community colleges, minority-serving institutions, and from educational opportunities provided through the United States military contracts at home and abroad along with other outreach settings is valuable. Engagement matters in student retention and success (Kuh and Pascarella, 2004; Pike, 2004; Kuh et al., 2006), so this potential cancellation of courses presents a social justice dilemma by limiting science courses that keep low SES students on the trajectory toward graduation, further degree completion, and next steps. Despite increasing college enrollments for underrepresented ethnic minorities, the trends for educational attainment of science, technology, engineering, and mathematics (STEM) degrees and overall graduation within 6 years show disparities (de Brey et al., 2019; McFarland et al., 2019; Cahalan et al., 2020). It is fundamental that resources are attainable, guidelines are equitable, and stigma is limited.
Microbiology fluency, laboratory practices, and equitable access to these skills must be met for mastery of concepts through equitable opportunities and completion (National Academies Science Engineering Medicine, 2018). The vision that all students who desire access to learning, should obtain it is addressed through the Partnership for Undergraduate Life Sciences Education (PULSE) with rubrics to measure and promote Vision and Change (Brancaccio-Taras et al., 2016). Although this is useful to achieve goals of modern competencies (Woodin et al., 2010) across different institution types, some under-resourced institutions such as University X are missed in this revolution and feel the gap.
Conclusion with Proportionality of Individual Freedom with Public Good
By applying public health frameworks, the primary goal is to mitigate harm in populations: harm from risk to health and from the unintended consequences of policies. The seventh and last principle of proportionality balances that the probable benefits of guidelines for the public good outweigh the infringement on the few. While considering non-maleficence, then compliance to guidelines could promote equitable safety, but harm could occur if equitable educational opportunity is lost. Guidelines with implied instructor culpability, or mandated with severe restrictions and without solutions, create inequitable gaps.
A solution of least infringement and equity to ensure stringent guidelines do not compromise student learning is to provide specifically written safe curricula to aid compliance. There are alternate methods to achieve learning outcomes and still promote compliance (Table 1). When advocating risk assessment, guidelines specifically recommend ideas to address the challenges under-resourced faculty face. This is attempted through contributions from diverse institutional types compiling creative ideas for non-traditional settings in open-source-shared curricula, i.e., ASM’s Microbe Library8 or Course Source.9 Broader dissemination to institutions is a proposed solution if educators themselves lack knowledge. This practice of under-resourced shared teaching ideas helps mitigate harm of excess burden placed on the instructor to meet guidelines when lacking institutional support. Reaching out through the community using an evaluated process with confidentiality assures all legitimate stakeholder voices are involved in providing equitable opportunities and protection for those from underserved populations most at risk of under-resourced courses. In this manner, justice would distribute an equitable, compliant, curriculum, while burdening all to comply.
Educators collectively assure healthy conditions in microbiology teaching laboratory courses philosophically through normative ethics: educators “ought” to be informed by updated guidelines, “ought” not to continue methods with higher risk, and institutions “ought” to provide faculty the curricular and biosafety officer support needed for optimal safety within constraints. Although utilitarianism allows protection and greater accessibility, we must still rely on morality as defined by social contract theorists to apply social justice frameworks for the underserved. Sometimes individual observation when seeing something amiss begs a moral duty to make the correction. Rather than waiting for adverse events, some try whistleblowing in the case of non-compliance or institutional protection. A notable voice, Dr. Li, first signaling the COVID-19 outbreak stated “I think a healthy society should not have just one voice” (Green, 2020). It is for this reason that the voices of the under-resourced must be heard in providing solutions.
Author Contributions
The author confirms being the sole contributor of this work and has approved it for publication.
Conflict of Interest
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Acknowledgments
Thanks to colleagues through the years who have shared challenges and knowledge of microbiology laboratory methods and safety, Lana Lamb for her dedication in supporting others in teaching microbiology safely, Andrew Sola and public health students Katrina Paleologos and Sarah Durkot for their eyes in reading this manuscript.
Footnotes
1. https://www.cdc.gov/training/QuickLearns/biosafety/
2. https://www.cdc.gov/salmonella/2011/lab-exposure-1-17-2012.html
3. https://www.cdc.gov/salmonella/typhimurium-labs-06-14/index.html
4. https://www.cdc.gov/salmonella/typhimurium-07-17/index.html
5. https://asm.org/Guideline/ASM-Guidelines-for-Biosafety-in-Teaching-Laborator
6. https://asm.org/Guideline/ASM-Curriculum-Guidelines-for-Undergraduate-Microb
7. https://tinyearth.wisc.edu/
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Keywords: ethics, laboratory, safety, policy, outbreak, risk, curriculum, equity
Citation: Smith-Keiling BL (2021) Real-World Ethical Dilemmas in Laboratory Safety for Microbiology Under-Resourced and Outreach Teaching. Front. Microbiol. 12:589569. doi: 10.3389/fmicb.2021.589569
Edited by:
Carlos Christopher Goller, North Carolina State University, United StatesReviewed by:
Nancy Boury, Iowa State University, United StatesCatherine Vrentas, The Engaged Scientist, United States
Copyright © 2021 Smith-Keiling. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Beverly L. Smith-Keiling, smithbev@umn.edu