Mahboobin 10:00
R-03
GENE THERAPY: A STUDY OF ETHICS IN ENGINEERING
Chris Cardiello (cgc26@pitt.edu)
ENGINEERING AND ETHICS
Engineering in Modern Society
It may be easy to take for granted the role engineers
play in society. In reality, engineers play a part in nearly every
aspect of modern life. Take, for example, transportation.
Highways, bridges, tunnels, and ordinary roads are designed
by civil engineers. Without careful planning and precise
execution, the roads that make modern society integrated and
whole would fall apart. Transportation by air owes itself to the
work of aerospace engineers, who must ensure that air vehicles
are completely safe and fit for duty; finding out about a fatal
design flaw while 30,000 feet in the air is less than ideal.
Aerospace engineers also make satellite communications
possible. Cell phones, GPS locators, television, and many
other luxuries that define modern civilization would not be
possible if it weren’t for aerospace engineers. Plastics and
other polymers are used extensively in almost every consumer
product, but very few people take the time to consider where
these materials come from. Without chemical and material
engineers, the most trivial objects such as plastic bags would
be nonexistent. Engineers across all fields are responsible for
the essential structures that differentiate the developed world
from developing countries. In short, engineers keep modern
society from collapsing. Considering wide variety and
importance of the products and services that engineers are
responsible for, it is understandable that engineers are
expected to perform with precision and consideration for the
public. As a result, organizations such as the National Society
of Professional Engineers have drafted codes of ethics that
engineers are expected to follow.
What is Ethics?
In 1928, a group of researchers set out to treat syphilis
in African American communities in the southern United
States. However, due to changes in funding, the researchers
opted instead to examine the long-term effects syphilis has on
African Americans. While research already existed on the
effects of syphilis in white males, the researchers decided to
go ahead with the study anyway, believing that African
Americans were inferior to whites and therefore would be
affected differently by the infection. During this experiment,
researchers withheld the true purpose of the research from the
participants. Vague phrasing and medical jargon allowed
researchers to trick the uneducated participants into thinking
that they were receiving syphilis treatment, where in reality
syphilis treatments were being withheld from the subjects.
When the news came out that patients were intentionally being
University of Pittsburgh, Swanson School of Engineering
Date of submission 2014-10-28
denied treatment and lied to, the public was outraged [1].
Nowadays, there are codes and regulations to prevent immoral
methods of research. These codes are called ethics codes.
Ethics codes ensure public safety and fairness. In the syphilis
study, information was obtained by denying participants
treatment. Today, this is considered ethically wrong.
Engineers, too, are held to various codes of ethics. It is vital
that all those who pursue a career in engineering study these
ethical codes so that they may perform their duties skillfully
and professionally.
ETHICAL DILEMMAS IN ENGINEERING
Conflicts of Interest
Ethical codes clearly spell out right from wrong in
plain text. On paper, they’re simple and functional. However,
engineering in the field is much less black and white.
Engineers work for a variety of employers and clients in a
multitude of situations, potentially under hundreds of different
conditions. What course of action should be taken if one
section of an ethics code conflicts with another section or
code? Should an engineer’s personal values play a role in
deciding their actions? What happens when the wishes of an
employer or client conflict with a code of ethics? It may be
easy to assume all engineers have the welfare of the public in
mind; however, recall that the efficient human extermination
processes and mechanisms used in Nazi concentration camps
were devised and implemented by engineers [2]. To give an
example, consider the ethics of my current scenario.
My Work
My name is Chris Cardiello and I have been working
as a biomedical engineer for Medical Solutions Inc. for 5 years.
During my time with the company my area of research has
been the application of gene therapy to treat and cure complex
and deadly conditions. In recent months, I have made
promising advancements in the fight against HIV using gene
therapy, which have the potential to catch the attention of
medicinal companies and health organizations alike. To fully
comprehend the situation, an appreciation of the science of
gene therapy is necessary.
What is Gene Therapy?
Gene therapy is a method of treating disorders,
diseases, and conditions through the manipulation of genes.
Gene therapy can be used to target a specific gene or to
randomly insert a functioning gene to take the place of a
malfunctioning one. The simplest application of gene therapy
Chris Cardiello
is to treat monogenetic disorders – disorders caused by a single
malfunctioning gene. To treat these disorders, a functioning
gene is inserted randomly into the genome of the patient. Even
with the malfunctioning gene still in place, the new gene takes
on its role and corrects the disorder [3]. Gene therapy has
shown promising success over the years. For example, gene
therapy has been used to successfully treat sickle cell disease
in mice. Sickle cell disease is caused by a defective gene that
causes “abnormal β-globin molecules [to] adhere to each other
and form long fibers that deform red blood cells into the sickle
shape” [4]. To treat the disease, researchers developed a gene
that encodes for proper β-globin molecule production. This
gene is inserted into a retrovirus, which has the capability to
modify the DNA of its host. The virus transfers the therapeutic
gene into hematopoietic stem cells, cells that eventually
become red blood cells. By introducing this gene at the source
of the sickle cells, the treatment lasts permanently instead of
being limited by the lifespan of the red blood cells. Treated
mice saw anywhere from eight times fewer sickle cells to a
disappearance of sickle cells completely [4].
Treatment of more complex diseases such as HIV can
be approached in a similar fashion, even though HIV is not an
inherited trait passed down through reproduction. Once in the
body, the virus binds to CD4 lymphocyte cells, also known as
T-cells. The virus then modifies the DNA of the T-cell,
rendering it unable to perform its regular duties of fighting
infection. Before dying, the T-cells are used by the virus to
reproduce, further spreading the infection [5]. In this example,
the hematopoietic stem cells that produce T-cells are the target
of the gene therapy. HIV resistance traits are inserted into the
stem cells, which reproduce and spread the resistance. When
these stem cells turn into T-cells, they are immune to HIV and
thus cannot be killed by the virus [3].
Gene therapy is not without risks, however. In 2002,
doctors in a Parisian hospital attempted to use gene therapy to
treat severe combined immune deficiency (SCID) in a group
of children. While the treatment was successful in at least nine
of the children, one child developed a form of cancer in
response to it. Christof von Kalle, a molecular biologist at the
Cincinnati Children’s Hospital, studied the effects of the gene
therapy using a technique known as linear amplificationmedicated polymerase chain reaction (LAM-PCR) and found
that the cancer was caused by the therapeutic gene being
inserted into the LMO-2 gene. Mutations in the LMO-2 gene
can be responsible for cancers in children. Additionally, the
sequence intended to increase the expression of the therapeutic
gene instead promoted the mutated LMO-2 gene, causing the
cancer to spread. Why, then, were nine of the other children
cured of their condition without side-effects while this
particular child developed cancer? The answer lies in the
nature of gene therapy. Retroviruses can be used to insert genes
into a genome, however doctors have no control over where
the retrovirus inserts itself. If the virus inserts itself into certain
genes, such as the LMO-2 gene, complications can arise [6].
As part of my research into preventing and curing
HIV, I have been experimenting with gene therapy as a means
of inserting HIV-resistant genes into the hematopoietic stem
cells of mice with HIV. After many trials, nearly all mice that
received the gene therapy expressed HIV resistance in their Tcells. These results, once released, have the potential to
generate considerable attention in the field of medicine, and
many scientists and health organizations would be eager to
hear of the future applications of the research. However, news
is not all positive, as some mice in the test groups have
developed cases of leukemia from the treatment. I have not yet
been able to isolate the cause of the cancer, and have concluded
that more experimental trials with mice are necessary.
Successfully curing HIV would be a major medical
phenomenon. As a result, doing so would garner large sums of
grant money for my company; knowledge of which my
supervisor is well aware. To promote the company and
increase funding, my supervisor has asked me to release a
report of the findings; however he has explicitly directed me
to not include any information about the occurrences of
leukemia in the test subjects. Additionally, he has ordered that
I move on to experimental trials in human test subjects in an
attempt to accelerate the process of finding and implementing
a cure for HIV in humans on a large scale. The conflict arises
between the decision to follow my employer’s orders and lie
about the test results or to make known the current problems
with gene therapy.
Code of Ethics
The best place to look in faced with an ethical
dilemma is the National Society of Professional Engineers
(NSPE)’s Code of Ethics for Engineers. This code is in place
to set a standard of ethical practices for all professional
engineers, as well as provide guidance in certain situations. For
example, the code immediately applies to the current scenario.
The first doctrine of the code states that, “Engineers, in
fulfillment of their professional duties, shall: 1. Hold
paramount the safety, health, and welfare of the public” [7]. In
the case of gene therapy, to advance experimental trials onto
human subjects without fully understanding the processes and
risks of the procedure poses an immediate threat to those
receiving the treatment. An engineer should trust his or her
judgments when considering the safety of a project. To
proceed with a project with the knowledge that it poses a threat
to public safety is unethical. The supervisor’s request to omit
vital information from the formal report of the experiments
raises a conflict as well. Referring to the code of ethics results
in a conflict of interests. Subsection 3 of Article I explicitly
states that public statements are to be issued only “in an
objective and truthful manner”. The code expands on this,
stating that statements “shall include all relevant and pertinent
information” [7]. The Biomedical Engineering Society Code
of Ethics supports this notion, adding that biomedical
engineers shall “publish and/or present properly credited
My Scenario
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Chris Cardiello
results of research accurately and clearly” [8]. Omitting the
results concerning cancer growth in treated individuals
constitutes withholding “relevant and pertinent information,”
and to do so would be dishonest and unethical. However, the
code also states that engineers are to “act for each employer or
client as faithful agents or trustees” [7]. What should an
engineer do when confronted with a choice between unsafe,
dishonest behavior and loyalty to a client or superior? A
similar situation faced review from the NSPE Board of Ethical
Review. An unnamed client contracted an engineer to examine
the structural integrity of a building that the client intended to
sell, without performing any renovations. The report the
engineer was contracted to write was to be strictly confidential
with the client. While the building was fine structurally, it
harbored electrical and mechanical violations that could pose
a threat to possible occupants. The engineer, keeping with the
agreement of confidentiality, told the client of the hazards but
revealed the information to no third parties. The NSPE Board
of Ethical Review ruled that the engineer’s actions were
unethical, noting that there was a conflict between ethical
values, but asserting that “matters of public health and safety
must take precedence” [9]. In this scenario, the engineer
should have alerted the proper authorities of the buildings
problems, as they pose a risk to any future occupants. In
another scenario, an engineer was contracted by a firm to
design the foundation of a set of buildings in an area with
unstable ground. The engineer suggested to use piles to support
the buildings, which would ensure the buildings’ long term
safety. The build team’s contractor, when given this
suggestion, inquired why they could not just use shallow
spread footings as support, which abide by the local safety
codes and cost much less. The engineer advised against this as
the shallow spread footings would not last in the long term,
eventually causing structural damage to the buildings.
However, as the firm held no responsibility for the buildings
once they are purchased, the contractor reasoned that long term
support was not necessary as they would not have any claim in
the buildings when damage occurs, and encouraged the
engineer to recommend shallow spread footings in his report.
In reviewing this case, almost all professional engineers and
engineering students opted against obeying the contractor,
citing risks to public safety [10].
In addition to potentially harming the public,
releasing misleading information damages the integrity and
reputation of not only the engineer at fault, but the profession
as a whole. The NSPE’s code of ethics includes a clause
prohibiting misrepresentation for self-gain, stating, “Engineers
shall not promote their own interest at the expense of the
dignity and integrity of the profession” [7]. Dishonesty can
ruin an engineer’s reputation and tarnish his or her chances at
finding employment. Marilee Jones, Director of
Undergraduate Admissions at MIT, was made to quit her job
in 2007 following news that she lied about her academic
history to boost her résumé. In a similar case, Pulitzer Prize
winner Dr. Joseph Ellis falsely claimed to his students to have
been a Vietnam War veteran. He, too, was fired [11]. These
two professionals lost their jobs and tarnished their reputations
through their dishonesty. Engineers must be mindful of what
they say and do to uphold their integrity and the integrity of
the profession.
TAKING ACTION
Resolution
After reviewing professional codes of ethics and
actual examples of ethical dilemmas, the right course of action
for my scenario becomes clear. The solution boils down to two
main obligations of any engineer: to always act with public
safety in mind and to uphold absolute honesty and integrity.
The NSPE’s code of ethics provides adequate guidance and
proves immensely valuable in determining questions of ethics.
In this scenario, I have decided to continue experiments using
mice as test subjects; the procedure is still not understood
enough to risk use on human patients. In addition, my official
report will include information about the cases of leukemia in
mice – to not include this information would threaten my
career, my reputation, and the reputation of engineers
everywhere.
Recommendation for Engineers
Engineers faced with ethical dilemmas must always
remember the most important rule: to “Hold paramount the
safety, health, and welfare of the public” [7]. Safety should
always be the number one concern of an engineer; this rule
reigns supreme over all others. One of an engineer’s most
valuable skills is judgment. An engineer should never do or
approve of anything that he or she does not feel comfortable
with. As an assurance of quality, an engineer may find it useful
to imagine being the one who will make use of his or her
services. When an engineer becomes stuck, codes of ethics
such as the one hosted by the NSPE are in place to help
determine the correct course of action, and he or she would be
wise to take advantage of them. The work of engineers
dominates nearly every aspect of society, meaning engineers
assume huge responsibility in their day to day work. Society is
upheld by the careful and precise work of engineers, so it is
imperative that they continue to practice their profession
ethically.
REFERENCES
[1] A. Scheidegger. (2009). “Tuskegee Syphilis Study.”
Encyclopedia of Race and Crime. (online encyclopedia).
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8-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt
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Syphilis+Study&rft.date=2009-013
Chris Cardiello
01&rft.pub=Sage+Publications%2C+Inc&rft.isbn=97814129
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[3]. J. Anderson, G. Bauer. (2014). “Gene Therapy for HIV
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[4] J. Stephenson. (2002). “Sickle Cell Gene Therapy.”
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[5]. (2009). “HIV Lifecycle.” AIDS.gov. (webpage).
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[6]. E. Check. (2002). “Gene therapy: A tragic setback.”
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n6912/full/420116a.html
[7]. (2007). “NSPE Code of Ethics for Engineers.” National
Society of Professional Engineers (online webpage).
http://www.nspe.org/resources/ethics/code-ethics
[8]. (2004). “Biomedical Engineering Society Code of Ethics.”
BMES.
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%20Ethics(2).pdf
[9]. C. Beck, J. Branch, D. O’Brien, L. Patterson. R. Andreoli,
M. Usmen, S. Sudler III. “Public Health and Safety – Delay in
Addressing Fire Code Violations.” National Society of
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%2013-11-FINAL.pdf
[10]. R. Bucknam. “Case 1015 – An Unsettling Situation.”
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[11]. “Honesty’s Always the Best Policy.” WebGURU: Guide
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ACKNOWLEDGEMENTS
Engineering Group R-03, including Connor Dudas
and Maggie Smith, for writing advice, motivation, and
company.
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