Biomedical Engineering Reference
In-Depth Information
problems are ill-posed. For example, an ill-posed problem
may be solved by what are known as ''inverse methods,''
such as restricting the class of admissible solutions using
a priori
knowledge.
A priori
methods include variational
regularization using a quadratic stabilizer. Usually, this
requires stochastic approaches, i.e., assumptions that the
processes and systems will behave in a random fashion.
By extension, small changes for good or bad can
produce unexpectedly large effects in an ethical decision.
A seemingly small mistake, mishap, or ethical breech
can lead to some dramatic, even devastating, results.
Engineers are constantly warned to pay attention to the
specific details of a design. The same admonition holds for
ethical issues. In fact, the famous engineer, Norman
Augustine has told us that ''engineers who make bad
decisions often don't realize they are confronting ethical
issues.''
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The design problem model of ethical problems
represents problems as characteristically possessing more
than one good (i.e., wise and responsible) solution. This
allows the engineer to avoid the trap of situational ethics,
where perpetrators are allowed to excuse their poor ethical
choices since there are no right or wrong answers. This
contradicts common sense and common morality. People
know that there are indeed wrong answers. We also know
that in most decisions, certain answers are more ethical
than others, with some clearly wrong (the worst is known as
the negative paradigm). Whitbeck's approach also
obviates the over-simplistic and often flawed attempt to
make an ethical decision into a multiple-choice question,
selecting the best among two or more choices (this is often
done in professional surveys, asking that as a practicing
engineer ''you be the judge''). This attempt at standardizing
and modularizing professional ethics flies in the face of one
of engineering's most important assets, creativity. The
design problem model clarifies the character of what
Whitbeck calls the agent's ''synthetic'' or constructive task
of devising and improving responses, a much-preferred
approach to the ''analytic'' approach of the judge.
An overarching advantage of the design approach is
that it places the engineer squarely within the situation.
From this vantage point, we can build solutions, rather than
select them. Whitbeck has argued that moral problems are
frequently mischaracterized as dilemmas; the roots of this
misrepresentation and its relation to the failure of applied
ethics are used to illuminate how to construct responses to
moral problems. She argues that in many cases, there is
a tendency to examine problems retrospectively, based on
the medical case method approach, as opposed to placing
the engineer in his or her most comfortable position of
designer. The academic approach of the philosophers
seldom matches what professionals and students need.
The medical case model tends to address acts, such as
whether to participate in a specific medical action (e.g., use
of genetic testing, withholding treatment, performing an
abortion, or removing a feeding tube). Within enumerated
constraints, society has granted the physician much
latitude in treating a patient. The moral decision-making
process in a medical situation depends on the general
circumstances that may justify or fail to corroborate such
acts. In other words, the attending physician in a hospital
has inherited the patient's entire history and must make
specific decisions about the act of patient care at that
precise moment. Conversely, engineers are more adept at
looking at problems from a life cycle perspective. Indeed,
like the physician, part of our fact finding should include
similar instances where a design has succeeded or failed,
for instance, by using event and fault tree scenarios to
understand the situation. However, the engineer goes well
beyond the ''act'' to consider how the system can be better
designed not only for damage control, but to prevent
similar situations in the future. Whereas an attending
physician may be limited to a decision of whether to
remove a feeding tube for a specific patient, the design
approach of the engineer is to look at the entire situation
that led to the potentially tragic consequences of this
decision. What could have been done to prevent the
situation from occurring, such as concrete steps toward
better technologies for health care and monitoring, and
even better-designed roads and vehicles so that the
accident that led to the coma and brain damage could have
been wholly prevented? The life cycle design perspective
calls for attention to all of the functions leading to an
outcome, not simply the goodness or shortcomings of
products.
One of the best examples of the life cycle viewpoint
has been articulated by a nonengineer. Theologian
Ronald Rolheiser
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shares a parable of a community that
dutifully, carefully, and honorably pulls a continuous
stream of dead bodies from the town's river. Each day the
moral people of the community give a proper burial to
each deceased person represented by the body, as
dictated by some type of social contract. In fact, these
efforts led to a well-organized system to deal with the
bodies, even providing jobs sorely needed by their
citizenry. However, the community never makes the effort
to travel upstream to find the source of the dead bodies!
The case-based approach would look at the act of each
person. Many of them are behaving quite morally by
providing the burials and paying their respect to the dead.
The agent-based design approach, however, requires
a trip upstream. What is it about our systems in
contemporary society that brings us to these bioethical
dilemmas? Why does the ''bottom-up'' approach, with
each person seemingly behaving morally, not lead to an
overall ethical system? Stepping back and taking the
comprehensive viewpoint clearly shows an overall
societal ethical transgression. So long as we have
a piecemeal, myopic view, no progress can be made in
eliminating the core problem.
