Analyzing the Ethics Behind Biomedical Engineering

One of the assignments in Cameron Kim’s bioethics course is to watch the 1997 film Gattaca.

The movie takes place in an unspecified future where children are ‘made’ through a eugenics-based genome engineering program that removes or limits the risk of diseases and ensures that children develop the best possible traits from their parents. The main character, a man named Vincent, played by Ethan Hawke, was conceived naturally, and is viewed as possessing ‘undesirable’ genetic traits, limiting his career possibilities.

While the movie itself is a work of science fiction, the ethical ideas and problems it introduces pertain directly to the lessons Kim teaches regarding CRISPR and the ever-evolving field of genome engineering.

Kim, a professor of the practice in Duke University’s Department of Biomedical Engineering, launched the class in 2022 as part of a wider push by the Pratt School of Engineering to promote an ethics-forward engineering education for their students. While many courses included lectures that covered the role of ethics in engineering, BME290: Ethics in Biomedical Engineering marked the first time a faculty member created a dedicated course for the topic in the department.

“It felt like this class unlocked a new way of thinking for me that I haven’t experienced in any other class I’ve taken at Duke,” says Morgan Sindle, a junior in Duke BME who took the class this semester. “Being able to look at problems with the perspectives I’ve gained from this class feels like a skill that’s just as necessary as the engineering skills that I’ve learned at Duke.”

While it’s impossible to cover the entirety of the field’s ethical and philosophical conundrums over a single semester, Kim does his best to ensure that the students have a strong foundational understanding of the different ethical guidelines that have shaped the biomedical engineering and medical fields. Namely, the principles of beneficence, which is acting in the best interest of the patient; justice, which is broadly ensuring that there is equitable access to care; nonmaleficence, which is the obligation of a physician not to harm a patient; and autonomy, which gives everyone the right to decide whether they want to participate in biomedical research experiments.

After the students have developed an understanding of these principles, Kim tasks them to explore how they can be applied to emerging technologies in biomedical engineering to ensure that the work remains ethical.

“We could always discuss challenges from 30 years ago and learn from them, but I want these students to be forward thinking,” says Kim. “So many of these technologies are evolving and changing in ways that necessitates us talking about them now. For example, what CRISPR can achieve today is different than what was possible even three years ago.”

Over the course of the semester, Kim and his students cover topics including brain-computer interfaces, human genome editing, the use of AI and machine learning in medicine, the ever-evolving use of stem cells and organoids, and the decision-making process in clinical care. Through a combination of readings, videos, case studies and in-class discussions, students learn about the ethical problems plaguing each topic, like bias in healthcare data or the ownership and commercialization of organoids used in basic research. At the end of each week, they submit written assignments sharing their thoughts and the ethical basis behind them.

“There’s not always a stark ‘bad’ versus ‘good’ answer, but this class gave me a better way to articulate my thoughts, concerns and decisions about different practices and technologies going forward, and I think that makes it easier for me to uphold ethical principles in my own work,” says Skyler Campbell, a junior in Duke BME. “Learning about these technologies was great, but what’s more applicable for me was thinking about how we can make sure we’re using them as equitably and efficiently as possible.”

Kim is already planning how he’d like to expand the class for next year. Ideally, he says, this would include guest speakers, like Duke BME’s own Charles Gersbach or Samira Musah, who can better discuss the evolving ethical challenges they’d faced in their respective fields. But for now, he’s thrilled the class can provide the foundational knowledge the students need to become well-rounded, ethical engineers.

“I’ve taught a lot of classes and helped launch a few others, but I think this is the class I’m most proud of right now,” says Kim. “When I was a student at Duke, our professors wanted us to become leaders and innovators who could think broadly and critically about the problems we face as engineers. To come back to the university 10 years later to launch this course that not only helps us acknowledge problems but discuss how we can make things better––make things more equitable and ethical––feels like a full-circle moment.”