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ETHICS IN BIOMEDICAL ENGINEERING
Daniel Fulmer ([email protected])
INTRODUCTION
The occupation of engineering is one of, if not the most,
difficult professions to remain completely ethical. Some of
the reasons are that “engineering is an important and learned
profession. As members of this profession, engineers are
expected to exhibit the highest standards of honesty and
integrity. Engineering has a direct and vital impact on the
quality of life for all people. Accordingly, the services
provided by engineers require honesty, impartiality, fairness,
and equity, and must be dedicated to the protection of the
public health, safety, and welfare. Engineers must perform
under a standard of professional behavior that requires
adherence to the highest principles of ethical conduct” [1]. I
am focusing more specifically on the ethics in biomedical
engineering which has its own set of canons and obligations
to follow. “Biomedical engineering is a learned profession
that combines the expertise and responsibilities in
engineering, science, technology, and medicine” [2], so you
must not only follow the code of ethics as described by the
National Society of Professional Engineers (NSPE), but also
an extra, more detailed set of guidelines that need to be
followed by biomedical engineers at all times. “The rapidly
advancing field of synthetic biology seeks novel solutions to
old problems in environment, energy, and health through the
integration of biology and engineering knowledge and
know-how. The goal is to engineer biological machines—
biological systems that do not occur in nature—to perform
human-directed functions” [3]. In the case of engineering
sensation in artificial limbs with the use of electrodes and
electrical pulses, many ethical dilemmas can arise. It is the
duty of a biomedical engineer to overcome these obstacles
and make the ethical decision, which may not always be the
“right” decision in some people’s eyes.
.
that “the potential range of applications for these systems is
vast, and the potential value of these applications—in
effectively and efficiently addressing environmental
problems, energy needs, and therapeutic goals in health—is
enormous” [3]. This same information about synthetic
biology is also “well known to policymakers and
governmental agencies, including the National Science
Foundation (NSF), which is funding research in the field.
These policymakers and governmental agencies are also
concerned about the ethical and policy problems that may be
associated with the development and application of these
machines—and about our capacity to identify, understand,
and address them” [3]. This comes into effect when dealing
with the restoration of senses to patients with artificial limbs.
The electrode/electrical pulse system that was created to
mimic sensation is seen as a great invention, but because it is
a man-made machine replacing a naturally occurring
process, an ethical dilemma is sure to arise. Biotech faced a
major ethical controversy dealing with this. A large
corporation confronted them about buying their technology
and turning it into a human enhancement tool instead of an
aid to injured patients. They began to realize that “with
continuing advances in science and technology, some of the
basic parameters of the human condition might be changed
in the future. One important way in which the human
condition could be changed is through the enhancement of
basic human capacities” [4]. While they would make a
sizable increase in income if they decided to partner with the
corporation, it would stray from the original reason they
were working with the technology.
Dangerous Procedure
Biotech is a company that focuses on major dilemmas in
the biological field. It uses some of the brightest engineers in
the world to come up with solutions to these seemingly
impossible problems. Recently they have been working on
bringing back sensation to patients who have prosthetic
limbs. Specifically, they use electrodes connected to three
major nerves in the arm that send electrical pulses to the
brain, mimicking senses.
In order to get this technology to work, the doctors and
engineers must surgically implant an electrode cuff on three
of the major nerves of the arm. This procedure is unique to
the technology, so it is difficult and can only be done by a
clinical specialist. They are the only individuals with the
expertise and experience necessary to successfully complete
this task [5]. It turns out the day of one of the surgeries to
insert the electrodes, the specialist isn’t there, but my
colleagues feel confident that I can perform the operation
just from watching the main doctor multiple times. I
however believe that this is a poor decision because it is a
dangerous procedure and if done incorrectly could cause
further injury or even death to the patient.
Man-Made
Confidentiality
Biomedical engineers, like the ones at Biotech, focus
much of their effort on the invention and advancement of
technologies that improve life for people. Engineers know
After the successful surgery and implantation of the three
electrodes in a patient’s arm connected to his prosthetic
limb, and careful adjustments to the electrical pulses that
CASE STUDY
University of Pittsburgh, Swanson School of Engineering 1
2015-11-03
Daniel Fulmer
create the sensation, the team of biomedical engineers at
Biotech were ready to share their accomplishment to the
world. They entered their patient in various medical expos,
wrote extensive case reports, and even used him in real life
demonstrations. In biomedical engineering it is very
important for engineers to get their work out to the rest of
the scientific community, but that occasionally brings up
ethical dilemmas. In this case the patient with the
technologically advanced prosthetic started to feel
uncomfortable with all the press and observation he was
receiving. It was not only the fact that he was being shown
off as an object, but also that a lot of his personal
information was being given out as part of the research. The
patient was under the assumption that all his information
would be protected under doctor patient confidentiality,
which is based off ethics not law [6]. Although in some
cases it can be “called upon in legal matters to establish the
extent by which ethical duties of confidentiality apply to
legal privilege” [6] It is this legal privilege which “involves
the right to withhold evidence from discovery and/or the
right to refrain from disclosing or divulging information
gained within the context of a special relationship,” [6] in
this case the bond between the patient and the biomedical
engineers that performed the procedure on him. By breaking
this pact, an an ethical problem arises for the engineers. Do
they share their work with the world, or respect the wishes
of the patient that helped them get to this point?
took the deal from the corporation, I would be promoting my
own interest and having my work influenced by those
conflicting interests. In terms of the impact on me, I would
likely be fired from my job at Biotech and ostracized by the
engineering community for taking my own goals ahead of
the goals of the organization. All the individuals involved
with this technology, mostly the patients with prosthetics,
would be majorly affected by this decision. Selling the idea
of this technology that was made specifically to help them
get back sensation in their prosthetic limb would cause them
to either not get the treatment at all, or have to fight with all
the other normal people who just want the technology to
enhance themselves. It is not fair that people who actually
need the technology just to function on a daily basis would
be subject to inconvenience because of one selfish
engineer’s decision. Biotech and all of its workers would be
impacted from this decision also. They would lose all of
their patents and holds on this technology along with losing
any money that could have been made of of it. They also
would be letting all of their patients down. These people
with artificial limbs looked to Biotech for a solution to their
problem. With that gone they could not get the help they
rightfully deserve.
The second case contains and even larger, more
important ethical dilemma. It deals with performing a
dangerous procedure without the person most qualified to
carry it out. This breaks the National Society of Professional
Engineers’ code of ethics by “not being guided in all their
relations by the highest standards of honesty and integrity”
and “not advising their employers or clients when the
believe a project will not be successful or come with
complications” [1]. When I (as the engineer) did not believe
that I was able to perform the electrode implantation surgery
successfully, I was obligated to tell my superiors and the
patient that fact. Not doing so could get me fired for
negligence. It might also cause Biotech to be liable to
lawsuits brought forth by the patient who was operated on.
In terms of the individual patient himself, he could have
been injured more seriously or even lost his life due to me
performing the surgery instead of the most qualified
engineer on staff. This example also goes against the
Biomedical Engineering Society code of ethics. If I chose to
perform the surgery anyway, this decision would not
“comply fully with legal, ethical, institutional,
governmental, and other applicable research guidelines,
respecting the rights of and exercising the responsibilities to
colleagues, human and animal subjects, and the scientific
and general public” [2]. I would not have respected the
rights of the patients that underwent the surgery, making me
responsible for anything that happened to him. This also
meant I did not “consider the larger consequences of their
work in regard to cost, availability, and delivery of health
care” [2]. It is very unethical to not take into account all the
outcomes, positive or negative, that come out of the decision
an engineer made. Choosing to do the surgery would be an
example of a poor decision.
CODES OF ETHICS
The field of biomedical engineering has not been around
very long, so the codes of ethics made specifically for this
concentration is limited. This is even more relevant for
synthetic biology, which the electrode and electrical pulse
technology is an example of. It may be considered “the most
daring step taken in scientific and, indeed, human history,
but it has received relatively little attention from the
bioethics community” [7]. This is surprising because “the
field offers the potential for unimaginable advances in
human development, yet also has potentially great
destructive power” [7].
Decisions
Biotech had to deal with three different ethical
dilemmas, each of which brought up a different problem. In
the first case it was the idea of taking a man-made
technology meant solely for medical purposes and turning it
into a commercial upgrade for human enhancement. If I was
the engineer in this situation, I would decide against selling
the technology. Although it would be a very profitable way
to go, it goes against the National Society of Professional
Engineers’ code of ethics. It states that “engineers shall not
promote their own interest at the expense of the dignity and
integrity of the profession” and also “shall not be influenced
in their professional duties by conflicting interests” [1]. If I
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Daniel Fulmer
The third case includes ethics that are very important to
how the biomedical engineers handled the patients case and
how they presented it to the engineering community and
public. According to the National Society of Professional
Engineers’ code of ethics, “engineers shall not disclose,
without consent, confidential information concerning the
business affairs or technical processes of any present or
former client or employer, or public body on which they
serve” [1]. The biomedical engineers of Biotech broke this
rule by giving out the patient’s personal information without
his okay. This can bring about many consequences for all
parties involved, starting with the engineers getting fired
from Biotech and leaving both them and the organization
open for lawsuits. The patient may be continuously bothered
and harassed by the engineering community about the
technology he was equipped with. Additionally, much of his
personal information is out in the public, which can cause
negative effects on his life. In most cases, consequences are
so bad that the ethical dilemmas are easily overcome, but in
this instance there are some positives. For the engineering
community, sharing this information would enable the idea
of this technology to become more widespread and
eventually used on more people who would benefit from
regaining sensation in their prosthetic limbs. That is what
makes the ethics in this case more difficult than the others.
The decision is a lot clearer once the Biomedical
Engineering Society code of ethics is referenced. It states
that biomedical engineers must “regard responsibility toward
and rights of patients, including those of confidentiality and
privacy, as their primary concern” [2]. Once the engineers at
Biotech disregarded the patient’s privacy, they put
themselves in a situation of poor ethics. If I were one of the
biomedical engineers in the instance, I would first ask the
patient for his consent on releasing this information and then
go about presenting the case to my engineering peers
without divulging any personal information about the
patient. This would be the most ethical thing to do.
you must either find an alternative or abandon the problem
entirely. It is better to remain ethical and not trigger any
consequences, than do something that may get you or
someone else get in trouble.
CONCLUSION
Ethics in engineering is extremely important. It is very
likely that all engineers will at some point during their career
be faced with an ethical dilemma that they must come to a
decision on. This is why they must not only be familiar with
the multiple codes of ethics, but also be able to understand
and follow the canons they represent. The case studies I
presented were specifically focused on biomedical
engineering and an electrode and electrical pulse technology
that returns the sense of touch back to patients with
prosthetic limbs. This dealt with many ethical dilemmas.
Engineers must work through these problems and come up
with the correct solution because there is a lot at stake, not
only for them, but the rest of the world.
REFERENCES
[1] National Society of Professional Engineers. (2007).
“Ethics.” Code of Ethics for Engineers. (online article).
http://www.nspe.org/resources/ethics/code-ethics
[2] Biomedical Engineering Society. (2004). “Ethics”
Biomedical Engineering Society Code of Ethics. (online
article).
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics(2).pdf
[3] R. M. Berry, K. Kinlaw. (2013). “Ethical and Policy
Problems in Synthetic Biology.” Online Ethics Center.
(online article).
http://www.onlineethics.org/Resources/Cases/27581.aspx
[4] N. Bostrom, R. Roache. (2007). “Ethical Issues in
Human Enhancement.” New Waves in Applied Ethics (online
article).
http://www.fhi.ox.ac.uk/ethical-issues-in-human
enhancement.pdf
[5] Stanford Biodesign. “Ethical Case Studies in Biodesign.”
The Clinical Specialist. (online article).
http://biodesign.stanford.edu/bdn/ethicscases/14clinicalspeci
alist.jsp
[6] USLegal. (2014). “Legal Healthcare.” Doctor Patient
Confidentiality. (online article).
http://healthcare.uslegal.com/doctor-patient-confidentiality/
[7] P. Heavy. (2013). “Bioethics.” Synthetic Biology Ethics:
A Deontological Assessment. (online article).
http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=
4400c960-bead-4143-9eea53cba3c37e9c%40sessionmgr110&vid=17&hid=109
Recommendations
After researching the ethics involved with biomedical
engineering, I have learned a lot that can help me as a future
engineer. I hope I can also use my knowledge to recommend
how others should approach ethical dilemmas. It is my duty
as set forth by the Biomedical Engineering Society code of
ethics to “honor the responsibility not only to train
biomedical engineering students in proper professional
conduct in performing research and publishing results, but
also to model such conduct before them” [2]. In my
professional opinion I would say when faced with a problem
dealing with ethics, first think about all the consequences
that may arise, positive or negative. Then compare all of
those to the codes of ethics that are relevant, including the
the National Society of Professional Engineers and whatever
engineering specializations are also involved. If even one
code is broken in the slightest it is an unethical decision and
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Daniel Fulmer
ADDITIONAL SOURCES
J. M. Basart. (2013). “Scientific Engineering Ethics.”
Engineering Ethics Beyond Engineers’ Ethics. (online
article) DOI 10.1007/s11948-011-9293-z
Web Guru. (2013). “Ethics Case Studies.” It Only Takes a
Second (online article)
http://www.webguru.neu.edu/professionalism/casestudies/it-only-takes-second
ACKNOWLEDGMENTS
I would like to thank my friends and family for making
this paper possible. They kept me from procrastinating and
giving up even when I really wanted. I would like to give a
special shout out to Maddie for helping me edit this paper
and make it not nearly as bad as it was before. I would also
like to thank Sam for motivating me to keep writing and
letting me wait until the last minute to finish this paper.
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