Biomedical Engineering Reference
In-Depth Information
Amy also reminds us that engineers need to keep
thinking. We must analyze each possible outcome from
a number of perspectives, including those that are not so
easy for technical types to grasp, such as the sociological
and psychological risks and benefits. From there, the
engineer can follow a critical path to an acceptable solution.
Questions
1. Consider a case of bioethical importance. The case
can be a negative or a positive paradigm.
2. What are the strengths and weaknesses of this case
(as per Whitbeck)?
3. How might you be more of an ethical agent than
a judge in answering these questions?
4. Identity a current bioethical issue that is being
approached as an abstract math problem with
human beings. What are the shortcomings of this
approach?
The first thought experiment introduces us to an im-
portant consideration in bioethics, the so-called principle
of double effect. Think of this as an equation with two
constraints. The first constraint stems from Socrates'
moral challenge to ''first do no harm.'' The second con-
straint was fully first articulated by the thirteenth-
century Italian theologian, Saint Thomas Aquinas:
as is the negative (bad) effect. In particular, the bad must
not cause the good effect. Also, the benefit of the bad
must not outweigh the benefit of the good. Finally, an-
other ethically acceptable approach without the side ef-
fects must not be available.
A bioethical example of the double effect is that of the
vaccine. A government and any manufacturer normally
know the population risk of administering a vaccine to
the public. Most are expected to benefit, with a small
Good is to be done and promoted and evil is to be
avoided.
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In its most simple form, the doctrine says that an act that
leads to negative side effects is permitted, but deliberate
harm (even for good causes) is wrong. This seems similar
in both scenarios, but the second thought experiment
involves actively harming one person, whereas the first
thought experiment involves harm as a side effect. In the
trolley case, you are just redirecting the harm. However,
in the second case you have to do something to the
homeless man to save the four. In the first case, no person
has more rights than anyone else not to be crushed, but in
the second case, the homeless man has a right not to be
killed, even though his organs would be put to good use.
These distinctions among professional decisions point
to the fact that engineers will face risk trade-offs and
double effects to some degree during their careers. For
example, in designing a device, some persons (e.g., im-
munocompromised) may be harmed by its use. If all of
a certain group are harmed at the expense of another
group's benefit, this could be conceived as intentional
harm. The way to mitigate this harm is to disclose fully
the shortcomings of the device and to work on im-
provements that will decrease the likelihood of harm.
The device must do inherent good (e.g., provide insulin
to diabetics or deliver drugs to ill patients). In other
words, the designer must not actually intend to accom-
plish the bad effect (harming immunocompromised
people). The ill effect is simply unavoidable in the effort
to do good. If another approach would avoid the bad and
still accomplish the good, then such an option is the
preferred and obligatory act.
Another provision of the double effect is that the good
effect must be at least as directly an effect of the action
Teachable moment: Who was Van Rensselaer
Potter?
The word ''bioethics'' was coined by Van Rensselaer
Potter (1911-2001), an American biochemist. He wrote
two important topics. The first,
Bioethics: A Bridge to the
Future
(Prentice-Hall), wherein he coined the term, was
written in 1970 as a call to integrate many scientific and
engineering disciplines to provide for an environment that
was both livable and sustainable (that term as applied to
the environment did not yet exist either). Bioethics was
subsequently coopted by the medical community and
was redefined specifically to address the morality of
medical practice (including appropriateness of
treatments and technological advances). Meanwhile,
Potter grew more and more respectful of the ''land ethic''
espoused by Aldo Leopold, and attempted to recapture
his original meaning and coined another phrase, ''global
bioethics,'' in this 1988 topic,
Global Bioethics: Building
on the Leopold Legacy
(Michigan State University Press).
For our purposes, the term also harkened a new role for
biosystem engineering.
Questions
1. Consider the prefix ''bio'' and how it applies to both
terms: bioethics and global bioethics.
2. Contrast these terms from Potter and Leopold's
perspectives with those of the contemporary
definition of biomedical ethics.
3. Why has the term bioethics morphed in meaning so
much since Potter coined it?
