Budny 10:00
L16
ETHICS APPLIED TO INTRACAVITARY BALLOON CATHETER
BRACHYTHERAPY
Anna Dzuricky (atd21@pitt.edu)
barrier, accurately emits radiation to a specific area of the
brain to minimize excessive/ harmful radiation, and is easily
implanted post surgery. This brachytherapy system is
marketed exclusively by GliaSite, in the United States [4].
The success and public availability of this type of
brachytherapy could lead to increased life spans and possible
elimination of the cancer from the body. Plus, this device
could lead to other advancements in cancer radiation
treatments for numerous other organs, reducing the influence
of one of the leading causes of disease and death in our
world. My team was assessing the effectiveness of not
specifically the GliaSite balloon catheter, but rather the
radioactive isotope injected into the balloon as part of the
chemotherapy process.
Previously, IsoRay had used the liquid radioisotope
known as Lotrex (Iodine-125) [5]. Our team found that
another radioisotope was far superior to the existing Lotrex
in terms of effectiveness of radiation as applied to the
GliaSite intracavitary balloon catheterization. This new
isotope was liquid Cesium-131, named Cesitrex [6]. We
concluded that Cesitrex eliminated the need for a thyroid
block as required with Lotrex, was safer with patients and
staff, and easier to clean up than other isotopes [6]. Cesitrex
has very similar energy to Lotrex, thereby not compromising
the strength of radiation. Cesitrex had a far shorter half-life,
consequentially making patients with Cesitrex treatment,
radioactive for only 30 days, as opposed to the 180 days
experienced by patients with the Lotrex treatment [7].
These results were so exciting that IsoRay had promptly
filed for a FDA approval of the radioisotope. Because the
project involved significant intellectual property, everyone
on the team was required to sign a confidentiality agreement.
Nearing the end of the summer, I overheard one member of
my team speaking to a former colleague working for a
different corporation about our new technology. My team
member explained our entire summers-worth of research to
his friend. I was concerned about the legal repercussion
bound for my team member for breaking the confidentiality
contract, as well as for the credibility of the research done by
my entire team, including myself.
INTRODUCTION
Ethics in the field of engineering focuses mainly on one
specific form of ethics known as normative ethics.
Metaethics (how our ethical standards arise) and Applied
ethics (focused on specific issues) both are important forms
of ethics, but they are only subsequently analyzed in
engineering, as they relate to normative ethics [1]. As
defined by George D. Catalano in his 2006 publication
Engineering Ethics: Peace, Justice, and the Earth,
“Normative ethics seek to provide standards that can govern
right and wrong behavior” [1]. The Golden Rule is an
example of a moral standard such as this [2]. The most
significant assumption made in normative ethics is that there
is only one ultimate criterion of moral conduct, whether it is
a single rule or a set of principles.
There are three variations in normative ethics. These
variations include virtue, duty, and consequentialist theories.
Virtue ethics place less emphasis on learning rules, but
rather stress the significance of developing good habits of
character [3]. Duty ethics base morality on specific, basic
principles of obligation. They are often associated with
ideologies such as fidelity, reparation, gratitude, justice,
etc… [1]. Lastly, Consequential ethics involve the weighing
of the pros and cons in an ethical situation in order to
determine whether the total good consequences outweigh the
total bad consequences [3].
One form of Consequential ethics, Utilitarianism, is
especially influential in the engineering world. Utilitarianism
is based on the assumption that, “an action is morally right if
the consequences of the action are more favorable than
unfavorable to everyone” [1]. In a broad sense,
Utilitarianism defines the unspoken yet largely significant
mission of working as an engineer – to perform an action
where the consequences are favorable to all. In simpler
words, utilitarianism means working for the improvement of
all peoples’ lives. Therefore, the importance of ethics in
engineering cannot be understated due to the overwhelming
fact that engineering ethics are integrated and help define
essentially the work of all engineers.
SUMMARY AND EVALUATION OF
AVAILABLE SOURCES
ETHICAL DILEMMA
This past summer, I was working in a lab with a team
on a research project involving various radioactive isotopes
for the application of chemotherapy via intracavitary balloon
catheters for IsoRay Inc. Intracavitary balloon catheter
brachytherapy is currently the most suitable choice for
radiation therapy after resection of a brain tumor. This type
of drug delivery has the ability to bypass the blood brain
University of Pittsburgh, Swanson School of Engineering
2014-10-28
In my assessment of the sources available to me as I
was dealing with this ethical decision, I found multiple
sources that were both helpful, and likewise inadequate.
These sources included engineering codes of ethics, various
case studies, and two additional sources.
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Anna Dzuricky
Violations [10]. This case dealt with financial constraints,
and fire safety and public health. In the case, a client lost
funding for renovations that would result in the building
passing local fire codes [10]. The main connections I saw
between my case and this fire safety case revolved around
the issues of revealing information without prior consent of
the client or employer, and the disclosure, without consent,
of confidential information concerning the business affairs
or technical processes of a client or employer. In the case,
the engineer working with the client would be forced to
break his confidentiality agreement if safety was being
questioned.
Reading the case study was very useful because it
clarified that the only condition under which an engineer
would break confidentiality would be for the sake of safety.
The case study did concern safety of people, and the
engineering authority was notified. The case study utilized
the points under the National Society of Professional
Engineers, but further explained them and presented them in
relation to actual examples of where the points were
applicable. From the case study, I could conclude that
because there was no question of safety in my ethical
dilemma, that my team member had been ethically wrong in
breaking confidentiality. The proposed action by this case
study would be to notify the leader of the team so that they
could take appropriate measures.
The next case study that I researched was Case 7 – A
Problem of Understanding from Stanford Biodesign [11].
This case dealt with the possibility of using others’ work to
publish/ patent something of your own. Specifically in this
case, a young inventor was refusing to take suggestions from
a fellow engineer who had better resources in order to ensure
that the significant discovery was widely and more readily
made available [11]. Connections between this case study
and my own situation could be seen in taking others’ work
and presenting it as your own. Under any circumstances, this
action would be considered plagiarism or theft, and is highly
prohibited, as was seen in both codes of ethics that I
researched.
I found fewer benefits from this case study, simply
because I was previously aware of the fact that plagiarism is
not tolerated in engineering (and practically in any other
discipline). The case clarified that point. Therefore, I
concluded that my team member’s breach of confidentiality
that quite probably could have led to plagiarism (on the
behalf of his friend) was unethical.
The last case study I studied was Case 7 – Sometimes
Silence is Golden from WebGURU [12]. This case outlined
a situation where a man working on a team researching a
new technology witnessed another member of his team who
had signed a waiver of confidentially; speak about the
technology to another man from another research group [12].
Essentially, this case study aligns perfectly with the ethical
dilemma presented to me in the IsoRay lab. In this case
study, I learned that because everyone in the group signed a
confidentiality agreement, there were laws that applied to the
Engineering Code of Ethics
The first source I explored in pursuit of some advice
was the National Society of Professional Engineers Code of
Ethics for Engineers [8]. The parts of the code that
concerned my ethical debate were specifically sections I,
II.1.c., III.4., and III.9.. Section I: Fundamental Canons
explained the basic ethical code for professional engineers.
The most significant points made here were, “3. Issue public
statements only in an objective and truthful manner. 4. Act
for each employer or client as faithful agents or trustees. 5.
Avoid deceptive acts. 6. Conduct themselves honorably,
responsibly, ethically, and lawfully so as to enhance the
honor, reputation, and usefulness of the profession” [8].
Despite these key points being presented in a way that was
easily understood, they were very little help because of their
vagueness. Section II.1.c stated, “Engineers shall not reveal
facts, data, or information without the prior consent of the
client or employer except as authorized or required by law or
this Code” [8]. This point was more specific, yet still did not
assist me in my ethical dilemma. Section III.4 deals with not
disclosing information to anyone who an employer has not
approved. Section III.9 deals with giving credit to whom
credit is due, and recognizing the proprietary interests of
others.
In general, the National Society of Professional
Engineers Code of Ethics was not a very useful resource for
my situation because the document was aimed at informing
engineers on how to conduct themselves ethically, but not on
how to deal with specific situations such as mine.
The second source I researched was the Biomedical
Engineering Society Code of Ethics [9]. This code of ethics
was even more general than the National Society of
Professional Engineers Code of Ethics. For example, the
BME Code expresses verbal integrity by, “Publish and/or
present properly credited results of research accurately and
clearly” [9]. Similar to the previous studied code, this code
of ethics states general key points on engineering ethics.
However, these points are presented in an informative
manner rather than a way in which engineers like myself can
interpret them to real-life situations.
Overall, the codes of ethics that were researched were
not very helpful because of their vagueness and simplicity,
as well as their presentation. If I were an amateur engineer
who wanted to be made aware of universal codes of ethics
for all engineers, these two sources would be very effective.
However, the key points were not given in an applicable
manner to current engineering ethical dilemmas such as the
one I was presented with in the IsoRay lab, working on
radioisotopes for the intracavitary balloon catheter.
Case Studies
The first case study that was researched was from the
National Society of Professional Engineers, Case No. 13-11
– Public Health and Safety – Delay in Addressing Fire Code
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Anna Dzuricky
breaking of that contract due to its legal nature [12].
Breaking that legal contract would result in legal prosecution
by the funder (in my case, IsoRay), should they choose to
take legal action.
This case study was very useful because of how directly
it related to my specific situation. I discovered the legal
implications that were referred to briefly in my research of
the code of ethics. Therefore, it was suggested that our
employer, IsoRay, would legally prosecute my team member
for his breaking of the confidentiality agreement, if
authorities were notified of my team member’s actions.
other engineers faced with ethical dilemmas, I would suggest
looking at both the codes of ethics for engineers as well as
multiple case studies. Consulting additional sources and
evaluating personal ethics also are useful in coming to a
final decision about an ethical dilemma.
In my ethical engineering dilemma, I witnessed a team
member break a confidentiality agreement that all team
members signed, and possibly aid another colleague in the
stealing of original ideas regarding the more-effective
Cesitrex treatment for a GliaSite intracavitary balloon
catheter, while working for IsoRay. The codes of
engineering ethics were very basic in nature, and sometimes
were too vague to apply to realistic situations. However,
their application in conjunction with multiple case studies
provided much insight into what others had done in similar
situations. Lastly, the additional sources of my brother and
ethics teacher, gave me an extra sense of what other people
(sometimes not engineers) would do in my situation, while
reminding me to include some of my own personal ethics in
my decision.
In general, I found that the codes of ethics, case studies,
and additional sources all suggested notifying a higher
authority so that they could take further action regarding
legal prosecution and punishment for possible plagiarism.
Therefore, in a utilitarianistic frame of mind, I concluded
that I would notify my supervisor of exactly what I had
overheard/ witnessed because I believed, and was supported
by the National Society of Professional Engineers and BME
Codes of Ethics, as well as the case studies and additional
sources that what I had witnessed was ethically wrong.
Additional Sources
In addition to my research done in both the National
Society of Professional Engineers and BME Code of Ethics,
and well as the three case studies, I also employed the use of
two resources I have utilized before in ethical decisionmaking.
The first additional source I consulted was my brother,
Michael Dzuricky [13]. Not only is he a trusted, truthful
friend, but he also is a biomedical engineering graduate
student at Duke University. Upon asking him what action I
should take, as a witness to an ethical dilemma with multiple
consequences, he told me that if I felt that there was an
ethical code broken, that I should notify the supervisor of the
lab team and let him handle the rest [13]. I thought this was
useful advice, especially because it had been what he had
done in a similar situation with his lab in undergraduate
college.
The second additional source that I utilized was my high
school ethics teacher, Matthew Ochalek [14]. When asked
the same question that I had related to my brother, Mr.
Ochalek stated that because I was fully, consciously aware
of the situation in which my team member knowingly broke
his confidentiality agreement, I had a moral obligation to
myself to do what I believed was right [14]. This
information was new, considering that in the profession of
engineering, my decisions affect not only me, but also large
numbers of people. Personal morals play a role in my
particular situation, as they would with any ethical decision,
however because the context of the ethical dilemma is
engineering, ethical decisions must be based on some sort of
engineering-ethical basis, and not solely on personal ethics.
However, Mr. Ochalek’s insight was still useful in
reminding myself to factor in my own personal ethics, in
addition to the engineering ethics that I had researched.
REFERENCES
[1] G. Catalano. (2006). Engineering Ethics: Peace, Justice,
and the Earth. New York: Morgan & Claypool. (print book).
pp. 13-17
[2] J. Wattles. (December 1996). The Golden Rule. Oxford:
Oxford University Press. (print book). pp. 167
[3] T. Holt. (2009). “Normative Ethics.” Moral Philosophy.
(website). http://moralphilosophy.info/normative-ethics/
[4] (8 July 2014). “Intracavitary Balloon Catheter Brain
Brachytherapy for Malignant Gliomas of Metastasis to the
Brain.” BlueCross BlueShield of Mississippi. (website).
http://www.bcbsms.com/index.php?q=medical-policysearchpage.html&action=viewPolicy&path=%2Fpolicy%2Femed
%2FIntracavitary+Balloon+Catheter+Brain+Brachytherapy+
for+Malignant+Gliomas+or+Metastasis+to+the+Brain.html
[5] W. Stomp. (13 September 2011). “IsoRay Receives FDA
Clearance for GliaSite Brachytherapy Balloon Catheter for
Brain Cancer.” MedGadget. (online article).
http://www.medgadget.com/2011/09/isoray-receives-fdaclearance-for-gliasite-brachytherapy-balloon-catheter-forbrain-cancer.html
CONCLUSION
Utilitarianism can be classified as the foundation for all
engineering ethical concepts. Consequences that result in
what is best for all, is truly what I believe engineering to be,
at its most basic function. Therefore, combining ethical
values as a community of engineers and personal morals is
essential to all decisions made in the engineering world. For
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Anna Dzuricky
[6] (12 May 2014). “IsoRay’s Liquid Cesium-131 (Cesitrex)
Receives Final Regulatory Approval for Use in GliaSite
Brain Cancer Treatment System.” IsoRay. (online article).
http://www.isoray.com/custom_type/isorays-liquid-cesium131-cesitrex-receives-final-regulatory-approval-use-gliasitebrain-cancer-treatment-system/
[7] (17 October 2013). “Cesium-131 Seed Brachytherapy
Plus Subtotal Resection for Lung Cancer Patients.” National
Cancer Institute. (website).
http://www.cancer.gov/clinicaltrials/search/view?cdrid=744
482&version=HealthProfessional
[8] (July 2007). “Code of Ethics for Engineers.” National
Society of Professional Engineers. (online article).
http://www.nspe.org/sites/default/files/resources/pdfs/Ethics/
CodeofEthics/Code-2007-July.pdf
[9] (February 2004). “Biomedical Engineering Society Code
of Ethics.” Biomedical Engineering Society. (online article).
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics(2).pdf
[10] (30 April 2014). “Public Health and Safety-Delay in
Addressing Fire Code Violations.” National Society of
Professional Engineers. (online article).
http://www.nspe.org/sites/default/files/BER%20Case%20No
%2013-11-FINAL.pdf
[11] “Case 7-A Problem of Understanding.” Stanford
Biodesign. (website).
http://biodesign.stanford.edu/bdn/ethicscases/7problemofund
erstanding.jsp
[12] “Sometimes Silence is Golden.” webGURU. (website).
http://www.webguru.neu.edu/professionalism/casestudies/sometimes-silence-golden
[13] M. Dzuricky. (25 October 2014). Interview
[14] M. Ochalek. (25 October 2014). Interview
ACKNOWLEDGEMENTS
In the writing of this paper, I would like to acknowledge
my constant roles models (my grandma and papa) for
continuing to inspire me. In particular I would like to
acknowledge my brother and Matthew Ochalek for their
sagacity and help with this assignment. Plus, I would like to
thank my family and friends for all they have done and
continue to do for me as I continue my education in
engineering.
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