Biomedical Engineering Reference
In-Depth Information
In recent years, therefore, the status of the patient in relation to the physician
or other health care professional has come to resemble that of the client in
relation to the engineer: a competent chooser.
1.3.3 At the Intersect of Medical and Engineering
Ethics
A first step for developing assistive technology ethics is to consider what
engineering and medical ethics might have in common. Both center on direc-
tives to avert the kinds of harm that professionals in the field have special
opportunity, occasion or opening to do. But engineering and medical ethics
presume very different notions of who or what must be protected from harm.
Engineering ethics aims to defend the general public welfare against harm
caused by inadequate engineers. But medical ethics is focused on protecting
individual patients from being harmed by feckless physicians.
Engineering ethics does not evidence similar worry about obligations to
dependent individuals. Rather, individuals to whom ethical obligation is owed
are cast mainly in the role of independent employers or clients. Clients are
presumed autonomous in the sense of their being suciently powerful to con-
trol or manage their own fates. They are owed the loyalty of the marketplace
- that is, compliance with their wishes by those whom they compensate for
doing so. Engineering ethics does conceive of the employers' good as poten-
tially in conflict with the public good, and ethical sensitivity and response to
such conflict is a central issue for engineering ethics.
Medical ethics does not usually conceive of, and thus is not centrally con-
cerned about, conflicts between the patients' good and the public good. The
main exceptions are (1) where medical resources are so scarce as to require
rationing and some kinds of patients are thought to seek or need more than
afairshare,soastodepriveotherequallydeservingrecipientsifthewants
of the most needy (who may also be the most ill) are satisfied or (2) where
an individual's health state poses a danger to others. If anything, in the lit-
erature of medical ethics individual recipients of services - that is, patients
- are much more likely to be portrayed as endangered by an indifferent or
hostile public that denies or delays treatment for them.
Thus, the characterization of recipients of medical services contrasts
markedly with the characterization of those who use engineering services.
To exercise their autonomy, patients control only the choice of whether to
consent or not to the decisions of professionals with knowledge and power of
a higher order than their own. Medical ethics even further discounts disabled
people's views about their own good, dismissing those who are not inclined to
risk whatever functionality they possess to pursue therapies to return them to
normality. It is well-known that surveys of people with disabilities find them
rating their quality of life higher than expected, but until recently bioethicists
