Budny 10:00
R16
ETHICS AND NEURAL PROSTHETICS
Bradley Alderama (bpa14@pitt.edu)
cochlear implant model for clientele use. “A cochlear implant
is a neural prosthetic that provides a sense of sound to
profoundly deaf individuals” [5]. Cochlear implants are a
modern technology that Stryker, in this scenario, wants to
develop and put on the market. The implants are very
profitable because there are no other alternatives for
individuals with severe hearing loss. The Stryker corporate
office wants to have a prototype ready by the end of the month
and a marketable device by the end of the year. My team and
I have been working on this project for several months
conducting research and animal experimentation but believe
that the device is still not ready for human implantation. Our
supervisor goes ahead and approves of the device even though
he knows that there isn’t sufficient research and test are not
past animal experimentation. He also demands that our group
omit the fact that the cochlear implant is still not ready for
clientele use in our report. He reasons with our group saying
that by cooperating and finishing by the deadline, we would
not be in trouble with corporate and our jobs would not be in
jeopardy. He also reasons that by releasing the product
sooner, we would also help treat the profoundly deaf with the
technology sooner.
INTRODUCTION TO NEURAL
PROSTHESTIC ETHICS
What defines ethics and is there a certain code that we, as
engineers, have to go by? Why should engineers, the problem
solvers of the world, have to care about ethics? Even in our
everyday lives, we all have ethics or morals that we go by.
Engineers, then, should have ethical codes and morals to
influence the decisions they make. Whenever a dilemma
arises where someone feels conflicted about whether to do the
“right” thing or the practical thing, it is labeled as a grey area.
However, engineers are still people and struggle making
decisions that are in this grey area. For example, countless
deadlines need to be met and if those deadlines are not met by
the engineer, it could mean they are out of the job.
Alternatively, a product that needs to be done in a certain time
frame may be rushed and fallible because of complications
that arise during testing [1]. Newer technologies, such as
neural prosthetics, are not untouched by these ethical
dilemmas. A neural prosthetic is defined as a “device that
supplants or supplements the input and/or output of the neural
stimulus” [2]. In other words, neural prosthetics offer a way
to bypass neural deficits and restore motor, sensory or
cognitive disabilities. The technology of neural prosthetics
offer a plethora of ethical dilemmas. If the surgery for neural
prosthetics is done wrong or the technology is not up to code,
could make the patient’s disability even worse. The use of
these prosthetics could also be viewed as playing God and
modifying a human not helping it. Studies done by research
in Germany, showed that the biggest arguments against
prosthetics is that more research needs to be done before put
into use and the dilemma of informed consent [3]. All of these
situations, show why it is important to have a code of ethics
that could help guide engineers. Guidelines such as the
National Society of Professional Engineers Code of Ethics are
helpful for making decisions in the grey area. Ethical
dilemmas can be seen in both minimal and significant topics
and can have severe consequences if the wrong decision is
made.
ETHICAL DILEMMAS
“Engineers must be dedicated to the protection of public
health, safety and welfare”. According to the National Society
of Professional Engineers, engineers are tasked with
improving the world by making sure they aren’t worsening it
while striving to achieve that goal [6]. In the case of our
scenario, there are ethical dilemmas that the Stryker team
have to hope with and that violate this code. The first
questionable act viewed in the scenario is that my supervisor
approves of the device even though he knows that it is not
ready for implantation. The Biomedical Engineering Society
code of ethics is helpful to use as a barometer to decide
whether the action is ethical or not. “Biomedical engineers are
expected to use their knowledge, skills and abilities to
enhance the safety, health and welfare of the public” [7]. The
Biomedical Engineering Society wants their engineers to
improve society and not aim for the most efficient or the
easiest solution. The BMES also states that biomedical
engineers in the health field are responsible for the rights of
patients. To put it simply, my first priority, as an engineer, is
not to develop the most cutting edge technology but rather
make sure that patients are being examined and researched in
an ethical manner. In this case, both the NSPE and BMES
codes are applicable. The supervisor clearly has no regard for
the negative consequences for approving a potentially faulty
device. If the cochlear implant turns out to be faulty due to
insufficient testing, patients could potentially have their
SCENARIO
Imagine that I am a biomedical engineer working for
Stryker Corporation in Michigan. “Stryker is a company that
strives for advancement and is a global leader in medical
device industry” [4]. The company stresses on helping their
patients live healthy lives and speedy recovery through their
devices. Some of the company’s latest devices are neural
prosthetics that need to be surgically implanted. My
supervisor assigns me to a group tasked with developing a
University of Pittsburgh, Swanson School Engineering
2015-11-03
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Bradley Alderama
hearing worsen. This would violate the obligation of
engineers to use their knowledge to enhance the safety and
health of the public. A similar scenario involves a case study
with X-Med, a corporation that specializes in medical
devices. The current X-Med project was postponed
previously because of a complication with the device. The
project manager approves of the device even though there still
may be a technical issue. The lead product development
engineer is fearful that there could be negative consequences
because the project manager approved of it prematurely [1].
This case is very similar to our scenario because a superior
chooses to accelerate a project so that they do not get in
trouble. According to Canon 1A of the NSPE code, “if an
engineer’s judgement is overruled under circumstances that
endanger life or property, they shall notify their employer or
client and such other authority as may be appropriate” [6]. My
primarily belief is that even though my supervisor could
potentially save our jobs or even boost my reputation by
releasing the latest technological project, it still violates the
NSPE code of ethics. The Stryker Company may still believe
that innovation is the utmost priority but, in the case of an
engineer, it is the safety and welfare of the public. In addition,
the code of ethics help instruct me with what action to proceed
with. Because the supervisor is approving a medical device
that could potentially endanger someone’s life, the
appropriate action would be to report my supervisor to a
higher up.
In addition to the danger to public safety, the falsification
of records is an apparent ethical dilemma for the Stryker
workers. Falsification can be used to garner reputation or to
shortcut publication pieces as in the case of the undergraduate
student, Lisa. In this specific case study, a student is reading
through a research article in the current issue of Cell and
believes that the data may have been edited or fabricated. She
is faced with the dilemma to report it to her mentor or keep it
to herself. Cell is a very well respected scientific journal and
she has doubts that an organization of that stature could
fabricate their information [8]. Deceitful tactics are also used
to cut corners and save money and time on projects. For
example, Rashid, an engineer from City Technical Institute
works at a construction firm called Rome Builders
Incorporated. Rashid is new at the job so he gets tasked with
making sure that all the workers at the projects are accounted
for. However, he notices that there is a flaw in the building
plans. Some of the steel beams that need to be coated cannot
be coated because they are covered by the walls. Rashid then
sees that the coating supervisor lies and says that all the beams
have been accounted for. Rashid is facing an ethical dilemma
because of the deceitfulness by the coating supervisor [9]. In
both Lisa’s and Rashid’s case, the information that a
supervisor should be accountable for is withheld or modified.
Engineers are responsible for issuing public statements only
in an objective and truthful manner [6]. In our scenario, the
supervisor wants me to fabricate and falsify the research and
results that our team has done on cochlear implants. This
however is unethical according to the NSPE code. More
specifically, it violates the professional obligation of
engineers to avoid the use of statements containing material
that is a misrepresentation of fact or omits a fact. Our
supervisor wants me to omit the fact that the cochlear implant
device has only been tested on animals. By demanding that
our group send out a uniform report on the technology, he is
asking us to endorse this deceitful information. This violates
the NSPE canon that states “An engineer shall not permit the
use of name with any person they believe is engaged in
fraudulent or dishonest enterprise”. The supervisors at Stryker
care only for their reputation or making a quick buck so it
would be unethical to endorse the cochlear implants
according to NSPE [6]. Biomedical engineers involved with
research must comply with all legal and ethical guidelines and
respect the rights of human and animal subjects [7]. By
modifying the information, it would mean that I would be
withholding information from human subjects about their
cochlear implant surgery which would be immoral. There are
many problems that can arise from being an engineer, but by
following code of ethics I am able to determine what is right
and wrong.
ETHICAL DEBATE OVER NEURAL
PROSTHETICS
Not only do ethical dilemmas arise from situations but
they can also arise from the technology itself. Neural
prosthetics are used to help repair sensory, cognitive and
motor disabilities but they cannot completely treat them.
Many ethical questions came about because of neural
prosthetics. Neural prosthetics are still relatively new field so
many people are hesitant over this “miracle technology”. A
study was conducted in Germany to gauge the current view of
neural prosthetics and if there was any negative stigma
towards the technology. Two hundred and eighty six articles
dating from 1999 to 2009 were analyzed in the study. It was
shown that the majority of articles were uncritical and focused
on positive aspects. Out of the 286 articles, 146 shed a
positive light on neural prosthetics. The remaining articles
were predominantly neutral with negative view points being
in the minority. The main things to pull from the studies were
the ethical dilemmas with using neural prosthetics. Informed
consent was a hot topic throughout the various articles [3].
Informed consent is when someone such as an engineer or a
doctor decides to use the technology/treatment on an
individual who cannot decide from themselves. Many times
these individuals are in a coma and are mentally ill so other
people make the decisions for them.
Another ethical dilemma would be, as mentioned
previously, that the technology is still in its infant stage and
any surgeries done now could have long term effects and
consequences. For both of these dilemmas, a code of ethics
does not give an answer in black in white as before. The
decision on whether or not giving neural prosthetics to an
individual who is unable to give consent is ethical or not is
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Bradley Alderama
subjective. The NSPE and BMES code of ethics are also
unable to tell engineers whether or not a technology is suitable
for public use. Any variable could go wrong no matter how
much testing is done and so there needs to be a point where
we as engineers say that it is ready for the public. The NSPE
and BMES codes do not, however, give any specifications just
general moral guidelines to follow. For different companies
and individuals, they will have different codes and regulations
to follow.
I would like to delve in to the social ramifications of the
technology, more specifically, cochlear implants. Cochlear
implants cannot completely fix deafness and do not guarantee
improved language or cognitive development [10]. The
ethical debate is whether we should even insert implants into
the hearing impaired because they still remain partially deaf
whilst still requiring accommodation. Because of this, many
members of the deaf community oppose implants because
they threaten their language and culture without fixing
deafness. The ethical codes are also unhelpful in this case
because the idea of the protection of public health, safety and
wealthy can be viewed in two ways. As a reminder, engineers
are expected to “use their knowledge, skills and abilities to
enhance the safety, health and welfare of the public” [7].
Pertaining to the debate on whether implants are good for
society, the engineers could see cochlear implants and neural
prosthetics in general, as helping the overall population. The
deaf community, however, view the cochlear implants as
detrimental to society because it takes away from their own
identity and tries to acclimate them into society without fixing
the problem completely. In my opinion, the best course of
action would be to research the technology for several more
years and before then, only let individuals in dire need
undergo the implant surgery.
CONCLUSION
Engineers should employ both their own judgement and
several code of ethics when making a decision. For certain
scenarios, a code of ethics is able to give a concrete answer
on whether the scenario is ethical or not. Code of ethics like
those of the NSPE or BMES, also give instructions on how to
deal with an unethical project/decision. However, these codes
are not always applicable because many decisions/acts have
opposing sides like in the case with the deaf community and
engineers. As an engineer, ethical dilemmas will always be
prevalent because of our constant desire to constantly
improve and become more efficient. The best course of action
for the future, I believe, is to strive for advancement of society
while still keeping the safety of the public as the number one
priority.
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Bradley Alderama
REFERENCES
ACKNOWLEDGEMENTS
[1] “To Release or, Not to Release: An Engineer’s
Perspective.” (2015). Stanford Biodesign. (Website).
http://biodesign.stanford.edu/bdn/ethicscases/21releasequesti
on.jsp
[2] E. C. Leuthardt, J. L. Roland and R. Z. Wilson. (2014).
“Neuroprosthetics.” The Scientist. (Online article).
http://www.thescientist.com/?articles.view/article
No/41324/title/Neuroprosthetics/
[3] K. Laryionava, D. Gross. (2011). “Public Understanding
of Neural Prosthetics in Germany: Ethical, Social and
Cultural Challenges.” Cambridge Quarterly of Healthcare
Ethics.
(Online
article).
DOI:
10.1017/S0963180111000119 pp 434-439
[4] “Company History.” (2015). Stryker. (Website).
http://www.stryker.com/enus/corporate/AboutUs/History/ind
ex.htm
[5] “Cochlear Implants.” (2013). National Institutes of
Health.
(Online
article).
http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid
=83
[6] “NSPE Code of Ethics for Engineers.” (2015). National
Society
of
Professional
Engineers.
(Website).
http://www.nspe.org/resources/ethics/code-ethics
[7] “Biomedical Engineering Society Code of Ethics.” (2015).
Biomedical
Engineering
Society.
(Website).
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics(2).pdf
[8] J.R. Young. (2008) "Journals Find Fakery in Many Images
Submitted to Support Research." Chronicle of Higher
Education. http://chronicle.com/free/2008/05/3028n.htm
[9] “Roman Holiday.” (2015). National Institute for
Engineering
Ethics.
(Website).
http://www.depts.ttu.edu/murdoughcenter/products/cases.ph
p
[10] C. Lee. (2012). “Deafness and Cochlear Implants: A
Deaf Scholar’s Perspective.” Journal of Child Neurology.
(Online article). DOI: 10.1177/0883073812441248 pp. 821823.
A special thanks to those who helped me construct this
paper on the ethical dilemma of the use of neural prosthetics.
I would like to thank Nancy Koerbel and the instructors of the
O’Hara Writing Center. I would also like to thank Dr. Dan
Budny, Ms. Jill Harvey and the Swanson School of
Engineering staff and faculty.
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Bradley Alderama
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