Considering the Ebola Epidemic and the Biomedical Engineering Ethical Mandate

Dr. Bernard Cohen, Chair of the IEEE EMBS Ethics and Professional Responsibility Committee, joins IEEE Pulse this month with his column “It’s a Question of Ethics.” We’ve asked Dr. Cohen to share with us some of his goals for the column as well as his thoughts on ethical considerations for biomedical engineers associated with the Ebola outbreak.

IEEE Pulse: Welcome to IEEE Pulse! Tell us a little about yourself and your motivation for writing a column on ethics.

BC: My research and teaching have concentrated on neuroelectrodiagnostic data acquisition and analysis aimed at patients suffering from neurological disorders. Specific emphasis has been placed on acquisition, analysis, and monitoring of the electroencephalogram, evoked potentials, electromyograms, and topographic brain mapping. My focus is on new techniques for intraoperative monitoring of high-risk surgical procedures.

I also teach and lecture on biomedical ethics as well as philosophy and implementation of patient-centered care procedures. It seems to me that, within the engineering profession, we tend to sidestep the important ethical issues that may specifically affect us or that affect our profession. My hope is to bring these to an open forum to enhance better understanding and recognition of ethical issues.

IEEE Pulse: Can you elaborate on these ethical imperatives?

BC: On a daily basis, we each encounter situations that may have ethical (and possibly legal) undertones. Our jobs are intimately connected with careful analyses as well as pressures from all levels. Things such as ignition locks, device safety, impact on culture and humanity in general, pressures to produce a product or release it before it is fully proven, etc., all enter our sphere. One of the best ways to deal with these issues is an open and honest discussion of how other folks have handled similar circumstances.

IEEE Pulse: What then is your vision for this column on ethics?

BC: Open discussions of ethical dilemmas need to be handled in a sensitive fashion without identifying any of the parties involved. That can be done in a large publication such as IEEE Pulse by keeping specific names anonymous. My goal is to have the column serve as a sort of clearing house for these matters.

IEEE Pulse: What would you like the audience to gain through these types of discussions?

BC: Greater awareness of the importance of dealing with ethical issues. Action will always beat reaction at every level.

IEEE Pulse: Speaking of greater awareness and action, while the World Health Organization (WHO) has been working vigorously with the challenge of getting the Ebola outbreak under control, what should the response be from the biomedical engineering community internationally in furthering these efforts?

BC: We have now seen the Ebola virus come on to our shores here in the United States and burying our heads will not make us immune from either the issues or the disease. As big as our world may seem, it is actually very small and we are a part of it.

If we take a brief look at the IEEE EMBS code of ethics we find the following mandates:

1. Respect human dignity and privacy of patients and human subjects
4. Support the preservation of a healthy environment
7. Observe the rights of human research subjects and strive for a balance between benefits and potential harm

I picked these three because the connections to this situation were obvious but I’m convinced that if we read the 12 points of the code of ethics in greater depth, we would find more items that have an impact on how our response as biomedical engineers should be to the Ebola epidemic.

For example, with the cases of Ebola diagnosed in the United States, there seemed to be a lot information and misinformation circulating rapidly across the media. In this arena, perhaps the most significant responsibility that we have is that, as biomedical engineers, we are looked to for solid, no nonsense definitive advice and council on a wide variety of issues. We therefore need to be informed and aware of the specific details related to the Ebola virus. We need to be able to dispel rumors and inaccurate information and speak definitively about known details. We need to be prepared to voice an opinion that strongly supports the appropriate and ethical treatment of Ebola patients as well as the ethical development of cures. We also should be aware of our responsibilities in our employment relative to those areas that our companies may be involved that might impact the Ebola virus.

While it is clear that the physician population will be the first to bear the responsibilities noted above, nevertheless biomedical engineers, in their mandate and ethical requirements, are not “immune” from being a reliable source of information and perhaps even the focal point for action within their professional community.

In addition, people and organizations may naturally turn to us for advice as healthcare professionals and we need to be prepared in this area as well. We need to know the impact of personal protective equipment (PPE) and how to obtain such PPE as may be necessary. We need to know the signs and symptoms of the virus so that if, in our jobs, or in our daily lives, there is an issue that needs to be addressed, we can make appropriate accommodations. We need to recognize the importance of partnering with our colleagues for the purpose of education. We need to be aware of what facilities are available in our communities to assist in the care and treatment if necessary.

Whether you work in a hospital, manufacturing facility, university, or are even in private practice, all of the above become our ethical mandated responsibility as part of the biomedical engineering community.

IEEE Pulse: As a community, how should we view this situation in conjunction with other ethical situations that we may encounter?

BC: There is no issue that is totally independent of any other issue. Regardless of the nature or source of the circumstances, our little universe just keeps bringing us many of the same issues but with a different skin.

IEEE Pulse: Thank you for joining us and we look forward to hearing more in the future. Any final thoughts?

BC: I urge readers to submit for consideration ethical issues or dilemmas that you are or have been faced with. ALL specific names and any identifying details will be “neutralized” before publication. Also, I’m eager to hear your thoughts on these matters in general. Please send your thoughts and comments to me at: Ethics@Pulse.EMBS.org.

  • Barbara Oakley

    Very thoughtful article that helps frame bioengineering work on a larger, more thought-provoking, scale. Thank you!