As new advances in engineering have occurred in the past quarter century, new ethical issues have arisen, as we frequently see in health care technology. The health care industry can now keep many people alive for a longer period of time, and people who would have died twenty‑five years ago can now be treated. Premature infants, heart attack victims, and other individuals can now be treated with new devices that prolong life. But new possibilities also raise ethical questions about who should receive benefits, who should pay for them, and when is it ethical to prolong life. Should a person who is being kept alive on by a machine and who has no chance of being returned to a state of health be permitted to die? At what birth weight should a premature infant be treated with unusually expensive equipment? Learning how to deal with ethical issues will be an important part of your engineering career. This summary can only touch the surface of the issues that lie ahead.
Based on a sample of 22 oncology encounters, this article presents a discourse analysis of positive, neutral, or negative valence in the presentation of three elements of informed consent—purpose, benefits, and risks—in offers to participate in clinical trials. It is found that physicians regularly present these key elements of consent with a positive valence, perhaps blurring the distinction between clinical care and clinical research in trial offers. The authors argue that the rhetoric of trial offers constructs and reflects the complex relationships of two competing ethical frameworks—contemporary bioethics and professional medical ethics—both aimed at governing the discourse of trial offers. The authors consider the status of ethical or unethical persuasion within each framework, proposing what is called the best-option principle as the ethical principle governing trial offers within professional medical ethics.