Biomedical Engineering Reference
In-Depth Information
laws, and regulations within the milieu of profitability for
the organization. This benefits the engineer and the or-
ganization, but is only a step toward full professionalism,
the kind needed to confront bioethical challenges. We
who teach engineering ethics must stay focused on the
engineer's principal client, ''the public.'' One in-
terpretation of the ''hold paramount'' provision of this
ethical canon is that it has primacy over all the others. So,
anything the professional engineer does cannot violate
this canon. No matter how competent, objective, honest,
and faithful, the engineer must not jeopardize public
safety, health, or welfare. This is a challenge for such
a results-oriented profession.
Bioethics Question: How can medical and
engineering ethics coalesce?
This requires that the engineer think about the life cycle
not only during use but when the use is complete. Such
programs as ''design for recycling'' (DFR) and ''design for
disassembly'' (DFD) allow the engineer to consider the
consequences of various design options in space and time.
They also help designers to pilot new systems and to
consider scale effects when ramping up to full production
of devices.
Like virtually everything else in engineering, best
serving the public is a matter of optimization. The vari-
ables that we choose to give large weights will often drive
the design. Treating cancer, providing devices to aid
cardiovascular functioning, and delivery of efficacious
drug therapies are noble and necessary ends. The engi-
neer must continue to advance the state of the science in
these high-priority areas. But, the public is a complicated
entity and the human body is uniquely exquisite. Thus,
any possible adverse effects must be recognized. These
should be incorporated and properly weighted when we
optimize benefits. We must weigh these benefits against
possible hazards and societal costs.
In our zeal to provide the best technologies, devices,
services, and plans, we cannot treat the general public as
a means to such noble ends. Here is where the primary
focus of the physician and that of the engineer begin to
diverge. The medical practitioner's principal client is the
patient, whereas the primary client of the engineer is the
public. Nothing is more important to the engineer than
the health and safety of the public.
The engineer, especially the biomedical engineer,
must navigate both professional codes. As evidence, the
Biomedical Engineering Society recently recognized this
with its approval of a new code of ethics in 2004. The
code recognizes that the biomedical engineer practices
at the confluence of ''expertise and responsibilities in
engineering, science, technology, and medicine.''
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Mirroring the NSPE code, the biomedical engineering
community reminds its members that ''public health and
welfare are paramount considerations.''
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Public safety and health considerations affect the
design process directly. Almost every design now requires
at least some attention to sustainability and environ-
mental impacts. Biomedical designs are not excluded.
For example, there is a recent requirement for changes in
drug delivery to decrease the use of greenhouse gas
propellants like chlorofluorocarbons (CFCs) and instead
using pressure differential systems (such as physical
pumps) to deliver medicines. This may seem like a small
thing or even a nuisance to those who have to use them,
but it reflects an appreciation of the importance of in-
cremental effects. It also combines two views, that of the
patient (drug therapy) and the public (environmental
quality).
One inhaler does little to affect the ozone layer or
threaten the global climate, but millions of inhalers can
produce enough halogenated and other compounds that
the threat must be considered in designing medical de-
vices. Environmental quality and sustainability are public
virtues. To the best of our abilities, we must ensure that
what we design is sustainable over its useful lifetime.
Engineering competence
Engineering is a technical profession. It depends on
scientific breakthroughs. Science and technologies are
drastically and irrevocably changing. The engineer must
stay abreast of new developments. This is particularly
challenging for biomedical science and biosystem tech-
nology, where the scale of interest continues to decrease.
It was not that long ago when organs were the most re-
fined scale of interest, giving way to the organelles and
cells. Now, the ''nanoscale'' is receiving the most atten-
tion, with structures and systems having design units of
but a few angstroms.
Engineering: both integrated
and specialized
Professional specialization has both advantages and
disadvantages. The principal advantage is that the
practicing engineer can focus on a specific discipline
more sharply when compared to a generalist. The
principal disadvantage is that integrating the different
parts can be challenging. For example, in a very complex
design only a few people can see the overall goals. Thus,
those working in specific areas may not readily see du-
plication or gaps that they assume are being addressed
by others.
A classic example of the shortcomings of over-
specialization can be found in the video
Professional
Ethics and Engineering
produced by Duke's Center for
