ENGR 0011, Bursic, 2:00 PM
R07
SHARING UMBILICAL CORD TISSUE UNITS FOR COMPENSATION: A
CASE STUDY IN THE ETHICAL ENGINEERING DECISION MAKING
PROCESS
Taylor Jones (tgj7@pitt.edu)
THE SITUATION: HOW I ENDED UP WITH
AN ETHICAL DILEMMA
I was doing research with the University of Kansas
Medical Center on umbilical cord tissue mesenchymal stem
cells and working part time for the National Institute of
Health in the summer of 2012. The institute was
knowledgeable of my research position at the university as it
occasionally affected my work, especially if I had to travel
or attend conferences. At the University, we were making
great strides towards the “isolation of the Wharton's jelly
matrix to be used as a scaffold for tissue regenerative
applications” [1]. We were specifically looking at the use of
the stem cells in this matrix as a way to treat avascular
necrosis, a bone disease that causes eventual deterioration of
the bone tissue [2]. The study solicited umbilical cord
donations from the general public with the conditions that
the participants must be pregnant females over the age of 18
who are willing to donate [1].
When donating umbilical cord tissue for stem cell
research, the tissue must be collected at the time of birth and
stored properly soon after [3]. The stem cells in the tissue
have the potential to treat and cure a wide variety of diseases
including those of the cartilage, bone, heart, and spinal cord
[3] and are therefore highly sought after in research.
The University of Kansas received an influx of
participants, far more than it could use for the study due to
limited resources, so we ended up with an excess of
umbilical cord units.
At the same time, the National Institute of Health was
researching in the same field, but with more varied
applications in the treatment of diseases. The institute has a
highly specific process of obtaining and processing
umbilical cord units for research, which does not allow for
donations from the general public [4]. Due to this process,
there was a lack of cells to perform research with, and the
NIH was falling behind in publishing its findings. For this
reason, the chair of stem cell research at the Institute
approached me about obtaining ten units of umbilical cord
donations from the University of Kansas. He offered a large
stipend for my efforts as well.
INTRODUCTION: THE ETHICAL
CONCERNS AND DECISION MAKING
RESOURCES
University of Pittsburgh, Swanson School of Engineering
2013-10-29
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I was now faced with several dilemmas. By not giving
the Institute more units, I could be limiting the field of
research and halting any new findings that could save
hundreds of lives. In the same breath, if I gave the Institute
the units, I would be going against its policy of not accepting
donations from the general public, which could negatively
affect the research process. And lastly, I debated whether it
would be okay to take from one of my employers and give to
another, with a monetary benefit to myself.
When deciding how to deal with these ethically charged
questions, I spent a lot of time consulting engineering codes
of ethics including those of the National Society of
Professional Engineers and the Biomedical Engineering
Society. I also consulted several resources on morals and
social impact in engineering situations. I made a list of all
the pros and cons to any possible decision and consulted
with family and friends to obtain their opinions.
AN APPLICATION OF THE BMES CODE
OF ETHICS
Upon consultation with the Biomedical Engineering
Society’s Code of Ethics, a highly regarded document
among biomedical engineers, I was able to determine some
potential deciding factors in my decision making process.
The first section, Biomedical Engineering Professional
Obligations, highlighted the idea of helping others, but at the
same time, respecting and upholding the honor of all
biomedical engineers [5]. I found that giving the excess units
of umbilical cord tissue would be helpful to the general
public because it would increase the speed at which new
discoveries could be made and brought into medical
practice. But then, by secretly giving these units to the NIH I
am not only putting my reputation at risk, but also an entire
society of biomedical engineers, negatively impacting the
way the public looks upon us and possibly halting any
further recognition or willingness of others to participate in
biomedical engineering studies.
Giving the units to the NIH without the permission of the
University of Kansas also violates the standards set forth in
the Research Obligations of Biomedical Engineers. These
standards clearly state the need to give proper credit to all
involved in the research [5], so if the university put forth the
effort to obtain these units, they should be cited as doing so,
bringing up another issue. The National Institute on Health
has a guideline that limits the participant pool for umbilical
cord donations; it cannot use units from the general public.
By giving the institute the excess units from the university, I
Taylor Jones
am allowing those involved to go against company policy. It
is my responsibility to step in and protect the institute, the
larger society of biomedical engineers, and any potential
patients to whom the research is applied.
There is also an issue with donor rights, which is stated
to be a primary concern in the Health Care Obligations
Code [5]. The donors have a right to know where their
umbilical cord units will be used and what they will be used
for. If they only signed consent for use at the University of
Kansas with certain parameters, then that’s the only way
their donations can be used.
I determined that all of the ethical standards presented in
the Biomedical Engineering Society’s code applied to my
scenario, with the exception of those about training
obligations. My situation did not involve any student
training, so there was no need to worry whether special
interests would be involved. Although the code did give me
a lot to think about, it provided a more conflicting view than
I would have liked, so I had to weigh out which codes were
more important and relevant to my situation than others.
entire society of people at risk of scrutiny and could limit
future funding and participation in engineering research.
This possibility not only violates this code, but would also
limit the ability of engineers to help the public, a
fundamental principle of our existence. In addition, the
secretive nature of the process would not allow for proper
credit to be given to the University of Kansas for their effort
in soliciting participants and obtaining the umbilical cord
units.
Because of the scope of my scenario, I was able to
disregard quite a few irrelevant cannons and principles, but
the majority could be applied and evaluated in this context.
Most of the disregarded ideas were about special interest,
which did not play a key role in my situation. Overall this
source was very useful it pointing out which of the
Biomedical Engineering standards I should hold with the
highest regard. It also gave me an idea of how many codes I
could potentially violate by giving the units to the NIH.
CORD BLOOD BANKING ARTICLE:
MAINTAINING INFORMED CONSENT
AN APPLICATION OF THE NSPE CODE OF
ETHICS
Upon further research, I discovered an article by Cathy
A. Cooper and Mariesa R. Severson entitled Cord blood and
tissue banking: supporting expectant parent's decision
making. This article emerged from the International Journal
if Childbirth Education and discussed the need for doctors
and medical professional to provide the facts about umbilical
cord banking so that parents were able to make informed
decisions [7]. I deemed the facts presented in this article
important due to their international recognition and
specificity to my situation. The authors were concerned that
families were not being properly notified of all components
of the donation/banking process.
Although this article was presented based on public and
private cord blood banking, the premise of informed consent
was important to my situation. I learned from another
source, that informed consent should include a section on the
disclosure of information [8] about the participant and their
donation. Reading this article made me think further about
how donating excess umbilical cord units would affect the
study participants. I realized that some parents might be
okay with donating to the research at the University of
Kansas, but not to the research at the NIH. For example,
maybe they did not agree with some of the NIH’s research
practices and would not want to contribute to such a cause.
The participants also have a right to privacy that is being
violated through the sharing of these units. The units that
people so graciously donate are what allow further research
in engineering; disrespecting or possibly upsetting patients
will limit the number of people who want to participate in
future studies.
Several of the cannons in the National Society of
Professional Engineers Code of Ethics underlined the same
ideas that the BMES code underlined, allowing me to
determine which codes I should hold with higher
importance. This source also applies to the entire
engineering field and states the minimum expected of one
who works in such a field.
I was also able to gather some new ideas of what should
influence my decision. For example, rules of practice,
cannon one, subsection d, e, and f, states that engineers
should not become involved with businesses that are
conducting dishonest practices [6]. Instead of simply, not
giving the umbilical cord units, this standard requires that I
completely dissociate from the NIH and then report them to
the proper authorities. This standard will rank higher in my
decision making process because of the severity it suggests.
Cannon four of the same code of ethics relates to
compensation for work in a study or research program.
Engineers cannot accept compensation from an outside
source for the work they are doing at a university, hospital,
or any other research institution [6]. It is deemed unethical
for me to accept payment at the University of Kansas and
them provide services to the NIH that stem from my
research at the University for any type of payment.
The decision to give the excess umbilical cord units
would also violate several professional obligations outlined
in the NSPE code of ethics. Section e of the first subheading
related to acting with honesty and integrity states “engineers
should not promote their own interest at the expense of the
dignity and integrity of the profession” [6]. Accepting
money form the NIH would benefit me, but could put an
ENGINEERING ETHICS OPINION:
EVERYONE’S RESPONSIBLE
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Taylor Jones
faced with an ethically charged decision. For this reason I
find it very helpful to sit down and write out a pro and con
chart for each outcome and then weigh each pro/con in order
to find the overall benefit or detriment of that decision. This
strategy also helps me to compile all the research I have
completed and organize it such a way that is clear and that I
can return to several times to think about.
From the ethical codes alone, I accumulated several
reasons to accept or deny the request for umbilical cord units
from the National Institute of Health and a chart helps me to
find where the codes overlap and reveals reoccurring
themes, which can then be valued with greater significance.
Then, I am also able to add new information to it. For
example, when I talked to my mom about what she thought
was best, I was writing notes on my pro/con chart. The
visual representation helps me to ultimately make my
decision.
The professional journal article by Josep M. Basart and
Montse Serra entitled Engineering Ethics Beyond Engineers’
Ethics presented in the Science and Engineering Ethics
Journal expanded the way I was thinking about engineering
ethics. I was able to accept the authors’ ideas because many
of the engineers’ ethics that they discussed connected to the
NSPE and BMES codes of ethics.
The authors made a good point that the ethics of
engineering are not just about how one person acts, but how
the entire engineering community and all involved should
act [9]. They recognized that everyone involved in an
engineering situation in responsible for the ethics of each
other and the process [9]. This idea made me think about all
of the ethical codes and standards that the chairman was
violating by offering me money for the umbilical cord units.
I realized that by accepting the offer, I would be going
against ethical engineering practices and I would be
allowing the chairman to do the same. I was just as
responsible as he was and I had to step in to stop the
progress of unethical events.
CONCLUSION: ACCEPTING THE OFFER
WOULD BE HIGHLY UNETHICAL
Upon evaluation of all the sources stated above, I would
decide not to give the excess umbilical cord units to the
National Institute of Health. Accepting the money and
giving away the umbilical cord units violated far too many
ethical principles presented by both the Biomedical
Engineering Society and the National Society of
Professional Engineers. I realized that ethical engineering is
not a personal endeavor. Everyone involved in the research
is responsible and everyone will suffer the consequences. I
had to step in and protect the greater engineering society. In
addition, any advancement in NIH research would have to
be revaluated or ignored, nullifying the one key benefit of
transferring the units. Weighing out all of the pros and cons
of my decisions and thinking about the research I had done
ultimately helped me to choose the more ethical option.
SPEAKING WITH FAMILY AND CLOSE
FRIENDS: GAINING AN UNBAISED
OPINION
Speaking to others when I am having trouble making a
decision not only provides me with new ideas and opinions
from others, but also helps me think through the situation. I
often find that when I talk to others about a topic or
question, I think about new aspects of the situation. A
conversation also provides an opportunity to offer an idea
and have it critiqued by someone outside of the immediate
situation. When choosing someone to talk to, it is important
to have a variety of people and a least one who will offer a
complete outside perspective. This unbiased opinion of a
past professor or current coworkers, for example, will be
very valuable because they do not have any emotional
connections. At the same time it is also important for me to
talk to someone I confide in. I will be more likely to share
information and internal conflicts I have if I talk to my mom,
dad, or sister.
In this scenario, while the conversations were occurring,
I took copious notes that way I could return to them later
with a clear mind and reflect. From these conversations, I
would be able to accumulate an idea of what others would
perceive as right and wrong, giving me a glimpse into how
outsiders would view my decision.
REFERENCES
[1] O. Aljitawi. (2010, July 19). “A Research Study Looking
at
Specific
Tissue
of
the
Umbilical
Cord.”
ClinicalTrials.gov.
(Online
Study
Record).
http://clinicaltrials.gov/show/NCT01166776
[2] “Avascular Necrosis.” (2013). Cleveland Clinic.
(Website).
http://my.clevelandclinic.org/orthopaedicsrheumatology/diseases-conditions/hic-avascularnecrosis.aspx
[3] “What is Cord Tissue?” (2013). Americord. (Website).
http://cordadvantage.com/cord-tissue-banking.html
[4] “Stem Cell Information.” (2013). National Intitues of
Health.
(Website).
http://stemcells.nih.gov/info/pages/faqs.aspx#umbilical
[5] “BMES Code of Ethics” (2004). Biomedical Engineering
Society.
(Online).
MAKING A LIST OF PROS AND CONS: A
VISUAL REPRESENTATION OF THE
DECISION MAKING PROCESS
I feel that it is very important to take a lot of time to
evaluate all possible outcomes and their implications when
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Taylor Jones
[9] J.M. Basart, M. Serra. (2011). “Engineering Ethics
Beyond Engineers’ Ethics.” Science and Engineering Ethics.
(Online Article). DOI: 10.1007/s11948-011-9293-z.
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics(2).pdf
[6] “NSPE Code of Ethics” (2007). National Society of
Professional
Engineers.
(Online).
http://www.nspe.org/Ethics/CodeofEthics/index.html
[7] C.A. Cooper, M.R. Severson. (2013). “Cord blood and
tissue banking: supporting expectant parent's decision
making.” International Journal of Childbirth Education.
(Online
Article).
http://go.galegroup.com/ps/i.do?id=GALE%7CA334177957
&v=2.1&u=upitt_main&it=r&p=AONE&sw=w&asid=27f4
bb1c08999f075eb3f8d66be146f9
[8] C. Petrini. (2010). “Umbilical cord blood collection,
storage and use: ethical issues.” Blood Transfusion. (Online
Article). DOI: 10.2450/2010.0152-09
ACKNOWLEDGEMENTS
I would first like to thank all of the engineering 11
writing instructors for their help throughout this writing
process. They were always there to answer questions and
sent several clarification emails with ideas on how to set up
the assignment. I would also like to thank Sam Pittman of
the writing center for going through my paper with me and
ensuring I aptly described how and why each of the
resources were useful.
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