Proposal of a Novel Gastrostomy Button for Sensing Overfeeding, A Comparative Analysis of Sociotechnical Perspectives on Gene Editing Technologies

Sociotechnical Synthesis
Introduction
While each of my projects, both technical and STS research, focus on different aspects of healthcare and biomedical innovation, they are interlinked through a shared concern about the impact that new technologies may have on human health and bioethics. My technical project focuses on developing a novel and improved method of enteral nutrition, otherwise known as tube feeding, that reduces the main risks associated with this method of feeding. My STS research analyzes the ethical debate that follows in the wake of gene editing innovation, with a focus on the works of two well known philosophers. Each of these projects focuses on an emerging medical technology with great promise for improving patient care and quality of life for some but also, with each project there are profound ethical and social considerations. Working on these projects simultaneously has allowed me to reflect on how engineering solutions must take into account both these social and ethical considerations, on top of the technical performance, in order to make a technology that is truly safe and equitable for all.
Technical Capstone Project
My technical capstone project team set out to determine a solution to the most common risk associated with gastrostomy buttons (G-buttons) which is overfeeding and subsequent aspiration of stomach contents. Enteral feeding delivers nutrients directly to the gastrointestinal tract in patients who cannot meet their nutritional needs orally (Gramlich et al, 2018). One common complication from gastrostomy buttons is aspiration, during which gastric contents can get into the airways and put the patient at risk for pneumonia (Opilla, 2003). Aspiration is associated with overfeeding, and there are currently no mechanisms to detect stomach fullness during g-button feeding. The most affected populations include, but are not limited to, the elderly, people with neurological disorders, ICU patients, developmentally disabled children, infants, and people with GI structural abnormalities. In a study done across 109 nursing homes, it was found that 22.9% of G-tube patients aspirated (Cogen & Weinryb, 1989). The statistics are a bit unclear, but it is likely that these numbers are much larger, speaking to the importance of our work on this Capstone. During the early stages of this project, after doing extensive research, we determined a parameter that we believed to be best fit to indicate stomach fullness. Our project presents a proof-of-concept study of our novel device that senses stomach fullness and informs the user when to stop enteral feeding to prevent stomach overfilling. Our results suggest that the parameter we selected at the beginning of our project is indeed a viable parameter for monitoring stomach fullness and our device is sensitive to changes in this parameter.
STS Research Paper
My STS research paper focuses on the ethical debate that surrounds gene editing by performing a comparative analysis of the two philosophers: Peter Singer and Michael Sandel. Singer assumes a utilitarian point of view, arguing that rapid advances in gene editing technology can be ethically justified as long as the technology reduces suffering and improves quality of life for the vast majority of people (Singer, 1993). On the contrary, Sandel assumes a virtue ethicist point of view, warning that gene editing technology has dangerous potential to erode away our humanity by making human life a commodity rather than something that should be celebrated regardless (Sandel, 2010). Through this comparative analysis, I argue that the debate between Singer and Sandel uncovers a deeper tension between the push for rapid technological advancement and the need for ethical limitations. My research highlights that while it is true that emerging technologies often show great promise, the use of this technology must be regulated to avoid reducing our appreciation for the individuality of human life.
Conclusion
Working on each of these projects has forced me to recognize the tense balance between innovation and ethicality. Developing a novel medical device, like the one my team and I have developed in our capstone project, seemed to me like solely technical work. My STS research opened my eyes to the fact that even smaller innovations like our device can carry large social and ethical implications. This research led me to think more about the impacts our device may have, beyond just improving the quality of life for G-button patients. I have now considered questions such as: How affordable/accessible will this device be? Will this device deepen the socioeconomic rift if only some patients can afford it? How can we be sure that our device supports patient autonomy? Likewise, while gene editing is a much more controversial and risky therapeutic than our sensor embedded G-button, both of these projects have emphasized just how important it is that biomedical innovations be carefully tested, reviewed, and considered to ensure that we have minimized any unintentional complications, including social and ethical ones. I believe that if I had not gotten the opportunity to work on these projects simultaneously, I would not have developed such a strong appreciation for the many connections between technology and ethics that shape the way we as a society develop healthcare solutions.

References
Cogen, R., & Weinryb, J. (1989). Aspiration pneumonia in nursing home patients fed via gastrostomy tubes. The American Journal of Gastroenterology, 84(12), 1509–1512.
Gramlich, L., Hurt, R. T., Jin, J., & Mundi, M. S. (2018). Home Enteral Nutrition: Towards a standard of care. Nutrients, 10(8), 1020. https://doi.org/10.3390/nu10081020
Opilla, M. (2003a). Aspiration Risk and Enteral Feeding: A Clinical Approach. https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2015/11/opillaarticle-April-03.pdf
Sandel, M. (2010, May 10). Enhancement and Genetics [Interview]. https://www.youtube.com/watch?v=HXaP4Y88POE

Singer, P. (1993). Practical ethics (2nd ed). Cambridge University Press.

School of Engineering and Applied Science

Bachelor of Science in Biomedical Engineering

Technical Advisor: Timothy Allen

STS Advisor: MC Forelle

Technical Team Members: Olivia Gubbay, Natalie Kester, Evan Stewart