Abstract
My technical capstone project and STS research are related through the framework of care ethics, specifically how its application, or absence, affects medical device design and patient outcomes. My capstone project was to develop a pressure-sensing system that improves the prosthetists’ ability to provide care for patients receiving below-the-knee prostheses by quantitating the traditionally qualitative fitting process. In contrast, my STS research examines the failure of the DePuy Articulating Surface Replacement (ASR) hip implant, a case in which care ethics was not prioritized in its design and marketing. Together, these projects show the benefits of adopting a care ethics framework in engineering practice and the consequences when care is neglected.
My technical work focuses on developing a pressure-sensing system that enables prosthetists to improve upon the current qualitative fitting process by incorporating quantitative measurements. Designed for below-the-knee amputations, this device measures the pressure distribution on the residual limb at the socket interface. The surface of the limb has load-tolerant regions that can withstand higher pressures and separate pressure-sensitive areas that cannot. Sensors attached to key areas on the limb measure these pressure variations and the device presents normalized data to the prosthetist in real time. This allows for precise data-driven adjustments to be immediately applied during the fitting process, ensuring pressure is appropriately distributed. By improving the accuracy of socket fitting, this system aims to reduce complications from socket misfit, while also decreasing material use, time, and overall cost of individualized prostheses.
My STS research examines a case in which a medical device company failed to act ethically under a care ethics framework. DePuy Synthes, a subsidiary of Johnson & Johnson, released the ASR hip implant in 2003. It was recalled in 2011 due to high revision (failure) rates (Cohen, 2011). Care ethics emphasizes attentiveness, responsibility, competence, and responsiveness to patient needs and respect to asymmetric power dynamics (Tronto, 1998). I argue that while DePuy was attentive to the accumulating data regarding ASR complications, the company failed to take responsibility by acknowledging the clear harm done to patients. In addition, DePuy provided false information, thereby exploiting the power imbalance between the company and its physician and patient clients. As a result, for years DePuy continued marketing the implant in spite of being aware of the complications that lead to tens of thousands of patients receiving implants that required surgical removal and reimplantation.
Working on both projects simultaneously provided valuable insight into the relationship between ethical frameworks and engineering practice. Studying the failures of DePuy showed the consequences of neglecting patient-centered care. This motivated me to prioritize safety, effectiveness, and accountability in my own design process. This included creating designs that would avoid limb injury during device use and would minimize inaccurate sensing data. At the same time, my technical work offered practical insight into the challenges prosthetists face, deepening my understanding of clinical care. Together these experiences helped me better understand that thoughtful, data-driven tools can support clinicians and ultimately enable higher-quality, more ethical patient care.
