Biomedical Ethics for Engineers: Ethics and Decision Making in Biomedical and Biosystem Engineering (Biomedical Engineering Series) PDF
Preview Biomedical Ethics for Engineers: Ethics and Decision Making in Biomedical and Biosystem Engineering (Biomedical Engineering Series)
Biomedical Ethics for Engineers This page intentionally left blank Biomedical Ethics for Engineers: Ethics and Decision Making in Biomedical and Biosystem Engineering Daniel A. Vallero, Ph.D. AMSTERDAM • BOSTON • HEIDELBERG • LONDON • NEW YORK • OXFORD PARIS • SAN DIEGO • SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO Academic Press is an imprint of Elsevier Academic Press is an imprint of Elsevier 30 Corporate Drive, Suite 400, Burlington, MA 01803, USA 525 B Street, Suite 1900, San Diego, California 92101-4495, USA 84 Theobald’s Road, London WC1X 8RR, UK This book is printed on acid-free paper. Copyright © 2007, Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Science & Technology Rights Department in Oxford, UK: phone: (+44) 1865 843830, fax: (+44) 1865 853333, E-mail: Contents Preface xi Done Is Good xiv Structure and Pedagogy xvi Notes and Commentary xix Acknowledgments xxi Bioethics Questions Posed in Text xxiii Prologue: Bioethics – Discovery through Design A Different Approach to Bioethics 3 Arguments for and Against Case Analysis 4 Driver’s Education Analogy 5 Example Case: Priming the Pump 6 Case Analysis 7 Notes and Commentary 8 Chapter 1 Bioethics: A Creative Approach Thought Experiments 10 Teachable Moment: Trust 12 The Principle of Double Effect 12 Teachable Moment: The Engineer as Agent versus Judge 12 Amy the Engineer 15 Teachable Moment: Who Was Van Rensselaer Potter? 18 Credat Emptor 18 TeachableMoment:Capital Punishment, Abortion, and theDefinition of Human Life 20 The Good Engineer 21 Feedback and Enhancement of Design 22 Teachable Moment: The Good Engineer 24 The Profession of Engineering 25 Engineering Bioethics and Morality 26 Discussion Box: Ethics and the Butterfly Effect 27 “Small” Error and Devastating Outcomes 28 Technology, Engineering, and Economics 28 Teachable Moment: The Dismal Scientist versus the Technological Optimist 31 Engineering Competence 39 v vi Contents Engineering: Both Integrated and Specialized 39 Who Is a Professional? 40 What Is Technical? 41 Systematics: Incorporating Ethics into the Design Process 42 Notes and Commentary 43 Chapter 2 Bioethics and the Engineer Major Bioethical Areas 51 Cloning and Stem Cell Research 52 Teachable Moment: Nanog 56 Human Enhancement 57 Patenting Life 57 Teachable Moment: Patenting Germplasm 58 Neuroethics 59 Organ Transplantation 60 Responsible Conduct of Human Research 60 Animal Testing 61 Is the Research Worth It? 63 Systematic Reality Check 66 Genetically Modified Organisms 67 Transgenic Species 68 Food 68 Environmental Health: The Ethics of Scale and the Scale of Ethics 70 Temporal Aspects of Bioethical Decisions: Environmental Case Studies 70 Agent Orange 71 Japanese Metal Industries 74 Minamata Mercury Case 74 Cadmium and Itai Itai Disease 75 Scale Is More than Size 77 Love Canal 78 Times Beach 79 Teachable Moment: The Whole Is Greater than the Sum of Its Parts 80 Active Engineering 81 Ethical Theories: A Primer 83 Truth 84 Psychological Aspects of Ethics 86 Teachable Moment: The Physiome Project: The Macroethics of Engineering toward Health 89 Fairness 94 Value as a Bioethical and Engineering Concept 95 Technical Optimism versus Dismal Science 96 Notes and Commentary 98 Contents vii Chapter 3 An Engineered Future: Human Enhancement Professional Zeitgeist: How Engineers Think 106 Improvement versus Enhancement 109 Engineering Intuition 111 Engineers versus Economists 112 Intuiting Value 113 Deductive and Inductive Reasoning: Precursors to Intuition 114 Creativity 116 Moral Coherence 120 Creativity and Bioethics 122 The Ethical Quandary of Enhancement 124 Scientific Dissent 126 Notes and Commentary 134 Chapter 4 The Bioethical Engineer Professional Trust 139 Codes of Ethics: Words to Live By 142 Discussion Box: The Code of Hammurabi 143 Limitations of Codes of Ethics 147 Risk Shifting: Organochlorine Pesticides 147 Right of Professional Conscience 152 Groupthink and the Right of Conscience 156 Animals and Engineers 158 Teachable Moment: Confined Animal Feeding Operations and the Moral Standing of Animals 159 Making Ethical Decisions in Engineering 160 Discussion Box: Four Persons Who Changed the Way We Think about Nature 162 John Muir 162 Rachel Carson 162 Christopher Stone 163 Gaylord Nelson 164 Notes and Commentary 164 Chapter 5 Bioethical Research and Technological Development Beyond Regulation 169 Integrity 169 Teachable Moment: The Therapeutic Misconception 173 viii Contents The Experiment 173 The Hypothetico-Deductive Method 174 Research Conflict of Interest 175 Teachable Moment: Truth and Turtles 176 Professionalism 178 Technology: Friend and Foe 178 Teachable Moment: Medical Device Risk 179 Risk Homeostasis and the Theory of Offsetting Behavior 180 Artifacts 182 Automation and Mechanization of Medicine 183 Professional Consideration: Do Engineers Have Patients? 184 Technological Reliability 185 Low Tech Engineering 189 Information Technology 190 The Ethics of Nanotechnology 193 Notes and Commentary 195 Chapter 6 Bioethical Success and Failure Teachable Moment: Engineering Measurement 201 Measurements of Success and Failure 203 Technological Success and Failure 203 Risk as a Bioethical Concept 205 Safety, Risk, and Reliability in Design 206 Probability: The Mathematics of Risk and Reliability 206 Discussion Box: Choose Your Risk 210 Reliability: An Ethics Metric 214 Reducing Risks 217 Risk as an Ethical Concept 220 Risk-Based Ethics: The Syllogism Revisited 223 Causation 225 Biographical Box: Sir Bradford Hill 226 Notes and Commentary 228 Chapter 7 Analyzing Bioethical Success and Failure Medical Device Failure: Human Factors Engineering 232 Teachable Moment: How to Analyse a Medical Device 233 Utility as a Measure of Success 234 Failure Type 1: Mistakes and Miscalculations 236 Failure Type 2: Extraordinary Natural Circumstances 236 Failure Type 3: Critical Path 237 Contents ix Failure Type 4: Negligence 243 Failure Type 5: Lack of Imagination 244 Bioterrorism: The Engineer’s Response 244 Dual Use and Primacy of Science 246 Social Response of Engineering to Terrorism 248 Success Paradigms 248 Characterizing Success and Failure 249 Accountability 249 Value 250 Case Analysis 250 Notes and Commentary 258 Chapter 8 Justice and Fairness as Biomedical and Biosystem Engineering Concepts Fairness and Distributive Justice 263 Discussion Box: Harm and the Hippocratic Oath 271 Teachable Moment: Disposal of a Slightly Hazardous Waste 272 Solution and Discussion 272 Though Experiment: Who Is More Ethical? 274 Professional Virtue and Empathy 277 Teachable Moment: Albert Schweitzer and the Reverence for Life 277 Reason 279 Teachable Moment: Abortion, Fairness, and Justice 280 Utility 281 Teachable Moment: Utility and Futility 283 Precaution as a Bioethical Concept 285 Discussion Box: The Tragedy of the Commons 286 Notes and Commentary 287 Chapter 9 Sustainable Bioethics Green Is Good 291 Sustainability 292 Teachable Moment: Rational Ethics and Thermodynamics 293 Life Cycles and Concurrent Engineering 300 Case Study Box: SIDS, A Concurrent Engineering Failure 301 Discussion Box: The Coffee Cup Debate 305 The Bioethics of Combustion 307
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