Vidic 2:00
L12
ETHICS IN ENGINEERING
Emma Hundertmark (ejh45@pitt.edu)
INTRODUCTION
The first trial of a new surgery aimed at curing
Alzheimer’s disease is underway. Being the resident expert
on the diffusion tensor model, DTM, technology at the
hospital, I am present to run the machinery and monitor the
results. Thing are proceeding well in that the procedure is
following the predicted course of action. Hours later the
potential curing portion of the surgery is over and cleaning,
suturing, and double checking is all that remains. Because no
more alterations to the brain are to be made, the DTM
machine, and as a result, me are no longer need. Suddenly,
however, the assisting surgeon is called from the table to deal
with an emergency with another patient. He asks me to take
over his tasks now include suturing tissue after it no longer
served the patient well to be open, securing retractors to hold
back tissues that need to remain open for tying loose ends, and
using sponges to remove blood from the work site. I, being
only privy to understanding the DTM technology, am not
qualified to complete these tasks but if I do not, the person
being operated on could suffer due to lack of hands working
on him/her. There is also the possibility that the assistant
surgeon will stay if I choose not to take responsibility of his
tasks and the patient with the emergency will not get the help
he or she needs. My dilemma starts here and my thought
process goes as follows.
BACKGROUND
Imagine the progress engineering has made in the
medical field. When this country was founded, life
expectancy was 35 years. Now, a child born in the year 2000
is expected to live to be 120 years old. That estimation is does
not consider the scientific advancements we have yet to
develop. One such advancement, new enough that the first
trial was last year in 2020, is the use of DTM technology to
monitor brain activity during the procedure. MRI technology
has been used in the mid-surgery setting for some time but the
resolution, for one, is not accurate enough for precise and
meaningful readings. Water molecules travel the same speed
as the machine is able to take a reading and there are simply
too many signals to make any sense in one pixel offered by
normal MRI technology. Similarly, one full MRI scan on one
human brain produces too much information to process the
meaning of it all. The mass of information would be found is
meaningless because of data storage needed to draw a
conclusion from it is too large. MRI also suffers from an
inability to contrast between anything but chemical
University of Pittsburgh, Swanson School of Engineering 1
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properties. Fortunately, DTM technology has been improved
to the point where the image resolution and quality are refined
enough that accurate and meaningful readings are
gathered[1]. Also new to the medical community is this
potential surgical cure for Alzheimer’s disease. With bated
breath people wait for news on the outcome of this procedure
and it is with great honor that I am chosen to work the DTM
machine during this telling moment in medical history. This
honor turns to terror when I have to weigh my options against
possible life and death, the careers of my fellow medical
professionals, the law, and my own morals.
CODES OF ETHICS
Presented with this dilemma, my thought process
brings me back to freshman year of college. I recalled
working on an ethics paper so my initial reaction is to debate
which sources I used on that project that would have
information pertaining to my current predicament. The first
two sources that came to mind were the code of ethics for
engineering through the National Society of Professional
Engineers and the Biomedical Engineering Society Code of
Ethics. These seemed relevant since, by definition, they
outline the standards engineers should hold their behavior to.
The cannons that specifically stuck out in my mind from the
code of ethics for engineers that argued in favor of my option
to take part in the surgery stated that “Engineers shall hold
paramount the safety, health, and welfare of the public,” and
“Engineers are encouraged to… work for the advancement of
the safety, health, and well-being of their community” as well
as a similar ethic from the Biomedical Engineering Society
Code of Ethics stating, “Biomedical engineers in the
fulfillment of their professional engineering duties shall…use
their knowledge, skills, and abilities to enhance the safety,
health, and welfare of the public” [2][3]. The way I applied
these moral guidelines to my situation was by considering the
fate of the man or woman on the table if I refused to get
involved. With one less set of hands operating on his open
skull, more and or worse complications could arise than those
caused by my lack of experience. On the other hand, if my
refusal to take part in the surgery causes the assistant surgeon
to stay, the other patient with the emergency will not get the
care he or she needs. This could result in permanent damage,
death, or at least temporary discomfort that would be on my
hands. With two people needing the attention of one doctor,
it is my engineering duty to offer my assistance since my job
entail keeping the health and safety of people at the forefront
of my mind.
Hundertmark, Emma
On the other hand, the code of engineers also states
“Engineers shall undertake assignments only when qualified
by education or experience in the specific technical fields
involved” [2]. This canon can be applied to this situation
easily in that I do not have the education and training
necessary to participate in the surgery in the manner that I am
being asked. My inexperience could cause me to do
something wrong and I could further harm the patient more
than if I had let the surgeon proceed alone. The next
prominent points come from the rules, “Engineers shall
conform with state registration laws in the practice of
engineering” from the engineering code and “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” from
the biomedical code [2][3]. These principles enforce that I
am not protected by the law for being an engineer. Since
touching the patient in the medical manner I was being asked
to do was considered battery which is against the law, both
codes of ethics advised against it. I would also be
disrespecting the rights of the subject by putting him or her in
conditions that he or she did not consent to.
The next example from the respective source
involved a situation almost identical to mine. Another factor
is added as the case study causes me to consider, not just the
patient’s reaction to defying the surgeon’s request, but the
surgeon’s reaction as well. The question is asked “will the
student create a situation of unhappiness or anger in the CV
surgeon by refusing to help that might negatively affect the
other students or the program sponsoring the
student?[sic]”[5]. Creating a negative environment for an
operation could be detrimental to the safety of the patient and
endanger relationships between professionals whose jobs
depend on effective interactions and communication.
The last source supplied a case study which shared a
similar backbone to mine. Authorities were asking an
employee to carry out a task that put the safety of people at
risk due to lack of training. His options were to finish the job
with his employees, putting them at risk but allowing them to
keep the jobs that fed their families, or protect their safety
while taking away their source of income [6]. Although these
circumstances mirrored mine in that both sides of the
argument have ethical pros and cons, it only sympathizes with
me rather than helping me come to a conclusion. Therefore I
look to the articles I used for my project all those years ago.
CASE STUDIES
ETHICS ARTICLES
Still in the same questioning position as before, after
taking into consideration the codes of ethics, I move on to
other possible sources of moral help. Still evoking memories
from my freshman ethics paper, the next car on my train of
though was to access arguments based on similar ethical
dilemmas such as my own. I found these in the ethical cases
on the WebGuru website, the Stanford Biodesign website, and
the Texas Tech University’s Website. In the first example,
from WebGuru, I found an example involving a student who
was invited to participate in an experiment that she was not
educationally prepared for and would only be supervised by
adults with very little ability to speak English. She was ill
prepared for the experiment and as a result, when an accident
occurred, she suffered third degree burns over 40% of her
body and died 18 days after the incident. In addition to
arguments already covered by the codes of ethics, this case
study also brought up the responsibility of the university, or
in my case the hospital. UCLA was fined for “”serious”
violations of workplace safety laws finding that the university
had not properly addressed previous outstanding safety
violations in that research group, that student had not been
adequately trained” [4]. This entered my responsibility to the
hospital into the equation. If my lack of experience led to a
mistake that later led back to the hospital, it would be my
fault. The fate of the hospital’s reputation as well as financial
status could suffer if I chose to participate and then proceeded
to fail. Furthermore, I would not want my actions to reflect
poorly on either the surgeon or the assistant surgeon.
Article relevantly titled “Ethics in Surgery” and
“Brains, Ethics, and Elective Surgeries,” provide several
aspects of the issue that I had not thought about. The first
brings into question what it would mean overall if I assist with
the surgery. The magnitude of dishonoring what the patient
has consented to was not something I looked at as a problem
unless I made a mistake. The article made me understand that
by trying to justify breaking the covenant could be the tool
others in the future use to rationalize far less moral counts of
disregard of consent. It could also be devastating if patients
were to find out that their wishes were ignored. It would
begin a tailspin of trust usually placed in doctors that was the
basis of patient-doctor relationships.
Surgeries are
complicated and dangerous enough with a reliable doctor but
when that faith is gone from society, the logistics of how
surgery is viewed would be completely skewed. Patients
would forgo getting lifesaving surgeries for fear of what will
happen to them while they are under the knife [7].
Conversely, the article offers the points that before a
surgery, the patient should be well versed on the possible
complications that may occur. These warnings come before
consent is given, so theoretically they have agreed to a
procedure that could take unexpected turns [7].
The article entitled “Brains, Ethics, and Elective
Surgeries,” goes deeper into the process in which a patient
decides to undergo a surgery. Usually, a bioethicist or an
individual ethics consultant will help the patient understand
that in extreme cases, brain surgeries may cause paralysis,
change in behavior, or death. They go over in detail the
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possibilities and the uncertainty of these procedures. This
consultation is usually requested by the physician so to relieve
some of the responsibility he or she feels for the patient’s
response to the procedure [8]. It still does not legally expunge
me of any actions but it works in my favor morally as it does
for the physicians. Also on a personal-debate level, the paper
touches upon the subject of surrogate decision making. This
occurs when the patient is unable to make known their
preference as is the case in the operating room. When this
scenario occurs, the patient’s best interests “as defined by
quality of life, relief of suffering, etc.” are used to decide what
actions should be taken [7]. As an expert on DTM
technology, I have witnessed many of these surgeries and feel
capable of assuming the duties of the assistant surgeon. This
point argues for accepting the offer to help because in my
opinion, it would hold the patient’s best interests in
consideration.
enough to handle the position, my main reasons for refusing
the offer is to keep appearances; protect the reputation of the
surgeons and the hospital, keep my name clean, not to
besmudge the name of doctors everywhere, and to uphold the
name of biomedical engineers. I would put a living human
being’s life in danger to save face. Lastly Banksy brings up
the fact that following this code of ethics could be a sign of
blind obedience; the same compliance that led to the
holocaust and the sort. His quotes, “A lot of people never use
their initiative because no-one told them to” and “My main
problem with cops is that they do what they're told. They say
'Sorry mate, I'm just doing my job' all the fucking time” speak
volumes in my circumstances [10]. I have the ability of
independent thought and so far, most of my instincts have told
me to offer my assistance, but mostly laws and principles
stand in my way. The thought that I could be losing my
personal beliefs because of the rules of higher-ups scares me.
NON-SCIENTIFIC SOURCES
CONCLUSION
Still with more arguments for both sides of the issue,
I look to less scientific/legal/procedural sources. First I
reference the bible; specifically the parable of the Good
Samaritan. In a society in which it was common for Jews to
be hated by Samaritans, one man defied the preconceived
stereotype because it was his moral obligation to help the
Jewish man in distress. It is important to the parable to
acknowledge that a passing priest and Levite avoided the man
before the Good Samaritan went to his aid[9]. From this
record, I take away that even though most people expected the
Samaritan to hate the Jew more than any other person who
passed him, he defied social formalities because of his moral
duty. Granted, status quos are much different than laws but
with someone’s life is at stake, I would still prioritize their life
over my legal status.
My last point of reference for my moral dilemma
comes from a personal hero of mine, the graffiti artist from
Bristol, Banksy. As someone who defies laws on a very
regular basis, he makes several decent arguments for using
your own morals as a guide rather than those made by
organizations or governments. One that is rather relevant to
the matter is “The greatest crimes in the world are not
committed by people breaking the rules but by people
following the rules. It's people who follow orders that drop
bombs and massacre villages” [10]. This was just an effective
matter that if I listened to the rules, I could potentially let
someone die. With less attention paid to the operation than
has been delegated as necessary, the likelihood of an issue
occurring is much larger. Morally, I do not know how
comfortable I would be with knowing I was responsible for
that. Banksy hits some sensitive spots when he says “Some
people become cops because they want to make the world a
better place. Some people become vandals because they want
to make the world a better looking place”[10]. I was able to
apply this to my situation because, assuming I feel capable
Luckily all of these sources and all of this
information was ground into my head freshman year so I am
now able to recall it all and make a snap decision after
considering all of this. The law makes the argument that
participating would be wrong and ethics agrees, adding that
my inexperience could put people in danger. Case studies
make me consider that I could be endangering the reputations
of the hospital and the surgeons. Codes of ethics contradict
themselves when they set for the principals that as an engineer
I should keep the patient’s safety as my priority and case
studies add that I could anger the surgeon by refusing his
request to help. Articles and personal references seem to
universally argue on the side of intervening in the surgery
when they provide the point of view that the patient was
warned of the possibility of complications and that occasions
do occur in which surrogate decision making involves another
party taking into consideration the patient’s best interest when
they are unable to do so themselves. Finally morals speak to
the human part of me when they bring to light that I have a
moral obligation to help the person whose head lies before me
open and vulnerable. I refuse to let society’s opinion on my
actions keep me from helping someone who needs it, and I
will not become a blind follower who sacrifices my personal
ethics for the rules and regulations of big brother. While there
is no right answer here because no one knows how things will
turn out, my mental process debating the pros and cons of the
situation has me leaning towards intervening in the surgery.
And while this seems to be my answer, Banksy has another
quote that accurately sums up this situation and most of life;
“Nothing is black and white, and there is no purity and there
is no such thing has justice” [10]. As humans, all we can do
is try to be our best. As engineers, we have the tools to make
our best really fantastic, or our wrong, very detrimental. My
opinion is that the most important guide outlined in this entire
mental whirlwind of ethics, duties, and consequences, is that
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our first priority should always be to try and better the
situation we are in.
seph+P+DeMarco&rft.date=2007-0401&rft.pub=Bioethics+Press&rft.issn=0266688X&rft.eissn=21688230&rft.volume=23&rft.issue=1&rft.spage=39&rft.externa
lDocID=1262397901&paramdict=en-US pg. 39
[9] New King James Version. Nashville: Thomas Nelson
Publishers, 1984. Print.
[10] Banksy. (2005). Wall and Piece. Michigan: Century.
(Print Book) pgs. 8, 19, 51.
REFERENCES
[1] J. Tournier, S. Mori, et al. “Diffusion Tensor Imaging
and Beyond.” Magnetic Resonance in Medicine. (online
article).
http://onlinelibrary.wiley.com/doi/10.1002/mrm.22924/full
pg. 1532-1556. pg. 1532-1556.
[2] “Code of Ethics for Engineers.” (2007). National Society
for
Professional
Engineers.
(Online
article).
http://www.nspe.org/sites/default/files/resources/pdfs/Ethics/
CodeofEthics/Code-2007-July.pdf
Pg.1-2
[3] “Biomedical Engineering Code of Ethics.” (2004).
Biomedical Engineering Society. (Online Article).
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics(2).pdf
Pg. 1
[4]“Ethics Case Studies.” WebGuru. Np. (Web). 10/22/2014.
http://www.webguru.neu.edu/professionalism/researchintegrity/ethics-case-studies
[5]“Ethics Case Study in Biodesign.” (Nd). Stanford
Biodesign.
Np.
(web)
10/22/2014.
http://biodesign.stanford.edu/bdn/resources/ethicscases.jsp
[6] Palau-Salvador, Guillermo; Ana de Luis. (2014).
“Engineering Ethics in Spain: The Risky Tank.” Np. (web).
10/22/2014.
http://www.depts.ttu.edu/murdoughcenter/products/cases.ph
p
[7] Wall, Anji, et al. (2012). “Ethics in Surgery.” Current
Problems
in
Surgery.
(Online
article).
http://rt4rf9qn2y.search.serialssolutions.com/?ctx_ver=Z39.
88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fm
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&rft.au=Wall%2C+Anji&rft.au=Angelos%2C+Peter&rft.au
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o:pmid/23445722&rft.externalDocID=23445722&paramdict
=en-US pg. 99-134.
[8] Ford, Paul J.; Joseph P. DeMarco. (2007). “Brains, Ethics,
and Elective Surgeries: Emerging Ethics Consultation.”
Ethics & Medicine: an International Journal of Bioethics
(Online
Article).
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88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fm
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ADDITIONAL SOURCES
New King James Version. Nashville: Thomas Nelson
Publishers, 1984. Print.
Banksy. (2005). Wall and Piece. Michigan: Century. (Print
Book) pgs. 8, 19, 51.
ACKNOWLEDGMENTS
I would like to thank my Writing Instructor, Libby Ferda,
for her support and guidance while this paper was a work in
progress.
Harry Volek deserves recognition for consulting with me
about the content of this paper as well.
Sara Thompson was a great aid in the technicalities of
this paper.
The doctors and nurses who worked on my grandfather
during his struggle against Alzheimer’s Disease played the
role of informing me on the specifics of his condition and the
treatment of such. The knowledge I gained from them was
referenced often during this paper’s completion.
My grandfather was the inspiration of this paper and will
always serve as the source of my passion for fighting this
disease.
My great aunt is a current victim of dementia with a large
possibility of Alzheimer’s disease. She provides constant
motivation for a breakthrough in this field.
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