Ex Vivo Model of Biopsy Clip Migration in Breast Cancer; Surgeons, Not Butchers: Medical Ethics in the Evolution of Breast Cancer Treatment

My technical project and STS research project both focus on the standard of care in treating breast cancer surgically. In the STS research paper, I look at how a particular surgeon acted ethically by moving away from the radical mastectomy and towards a more conservative operation. This analysis leverages duty ethics with principles of medical ethics as the ideological guidelines (Beauchamp and Childress, 2019), which are essential for biomedical engineers to keep in mind in introducing new technologies to a clinical setting. My technical project aimed to develop a one-step breast biopsy clip that does not migrate and is visible intraoperatively, which has an overarching goal of improving the patient experience by eliminating an uncomfortable procedure. Thus, this project emphasizes the medical principle of nonmaleficence that is also a primary component of my ethical analysis in the historical evolution of breast cancer treatment.
In my technical report, I discuss the development of a novel one-step breast biopsy clip to mitigate migration. We base this on a predicate device, the HydroMARKTM clip (Mammotome), which is a one-step intraoperatively visible hydrogel clip. However, this clip is known to migrate (Klein et al., 2012), so improvement upon its design is necessary to ensure physicians can rely on its efficacy. The first step towards designing a clip that mitigates migration by altering its adhesive and expansive properties was developing an effective method of tracking migration of traditional metal biopsy clips within a model system. This was the ultimate focus of our project due to time and material constraints; we did not reach our ultimate goal of prototype development. However, successfully establishing a negative control is an important first step towards solving this clinical issue.
In my STS research paper, I consider surgeon Dr. George Crile Jr., who was known for resisting the surgical standard of care for breast cancer due to issues with patient outcome and autonomy (Lerner, 2001). I argue that by eliminating a mutilating procedure in his clinical practice, Dr. Crile emphasized the ethical principle of nonmaleficence, which is the obligation to “do no harm.” Additionally, by allowing his patients the opportunity to choose a less extensive procedure where other surgeons would unilaterally prescribe the radical surgery, Dr. Crile respected his patients’ autonomy. I argue that Dr. Crile acted ethically according to duty ethics because he appropriately obeyed moral rules that all physicians have a duty to follow (van de Poel & Royakkers, 2011).
Working on these two projects simultaneously allowed me to reflect further on how my classroom study of biomedical engineering can be contextualized in the real world. Initial brainstorming for the technical project emphasized improvement of patient experience, which is an easy goal to justify. However, studying historical trailblazers who shifted the standard of care in breast cancer treatment from an ethical perspective allowed me to consider the moral concepts that were underlying our technical project. Our project aimed to change the standard of care less drastically than Dr. Crile did, but the goal of minimizing patient discomfort is present in both cases, emphasizing the ethical importance of pursuing nonmaleficence in breast cancer treatment.

School of Engineering and Applied Science

Bachelor of Science in Biomedical Engineering

Technical Advisor: Timothy Allen, William Guilford, Lynn Dengel

STS Advisor: Benjamin Laugelli

Technical Team Members: Alysha Akhtar, Lucy Brown