{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T11:28:05Z","timestamp":1793618885428,"version":"4.5.0"},"reference-count":37,"publisher":"Walter de Gruyter GmbH","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2026-0661_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The objective of this study is to evaluate the ethical dimensions of reflex and reflective testing (RRT) within the framework of value-based laboratory medicine and in alignment with ISO 15189:2022. The study aims to highlight the challenges in guiding and standardizing these practices in an era of value-based medicine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0661_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The ISO 15189:2022 requirements for quality and competence were examined alongside the IFCC Code of Ethics and relevant literature. The ethical evaluation was structured around the four core principles of bioethics: beneficence, non-maleficence, autonomy, and justice. Specific ethical issues related to RRT were identified through expert discussion and compared with the ISO standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0661_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The thorough examination reveals that although ISO 15189:2022 does not use the RRT terminology directly, its requirements provide a robust framework for these interventions. Based on beneficence, non-maleficence, autonomy, and justice, RRT interventions align with ISO 15189:2022 and promote value-based laboratory medicine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0661_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Laboratory specialists\/professionals must balance the four ethical principles to ensure that the \u201ctotal testing process\u201d serves the patient\u2019s best interest in conformity with ISO 15189:2022. By adopting a strong ethical culture, the profession can successfully transition from being a producer of test results to a key partner in personalized and value-based medicine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2026-0661","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T11:55:46Z","timestamp":1783079746000},"page":"2704-2712","source":"Crossref","is-referenced-by-count":0,"title":["Ethical evaluation of reflex and reflective testing in conformity with ISO 15189:2022\u202fat the value-based laboratory medicine era"],"prefix":"10.1515","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9630-3852","authenticated-orcid":false,"given":"Gulsen","family":"Yilmaz","sequence":"first","affiliation":[{"name":"Department of Medical Biochemistry , Ankara Yildirim Beyazit University, Faculty of Medicine , Ankara , T\u00fcrkiye"},{"name":"Department of Medical Biochemistry , Ankara Bilkent City Hospital , Ankara , T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa M.","family":"Budelier","sequence":"additional","affiliation":[{"name":"TriCore Reference Laboratories , Albuquerque , NM , USA"},{"name":"Department of Pathology , University of New Mexico , Albuquerque , NM , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudip K.","family":"Datta","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , All India Institute of Medical Sciences , New Delhi , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Zaninotto","sequence":"additional","affiliation":[{"name":"QI.LAB.MED, Spin-off of the University of Padova , Padova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3262-0349","authenticated-orcid":false,"given":"Julian","family":"Verona","sequence":"additional","affiliation":[{"name":"Servicio de Laboratorio, Hospital de Balcarce \u201cDr. Felipe A. Fossati\u201d , Buenos Aires , Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Amayo","sequence":"additional","affiliation":[{"name":"Department of Human Pathology , Faculty of Health Sciences, University of Nairobi , Nairobi , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilda","family":"Fink","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Bioqu\u00edmica Argentina, Programa PROES , La Plata , Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joesph R.","family":"Wiencek","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and Immunology , Vanderbilt University School of Medicine , Nashville , TN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"2026110211032901769_j_cclm-2026-0661_ref_001","doi-asserted-by":"crossref","unstructured":"Plebani, M, Coskun, A. 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