The biomedical engineer’s pledge: overview and context

TL;DR

This paper introduces a new ethical pledge for biomedical engineers to foster a sense of professional duty, similar to the Hippocratic Oath for doctors.

Contribution

The paper proposes a novel 'Biomedical Engineer’s Pledge' to address the lack of a symbolic ethical commitment in the field.

Findings

Biomedical engineering lacks a symbolic ethical oath comparable to the Hippocratic Oath in medicine.

A new 'Biomedical Engineer’s Pledge' has been developed to inspire ethical awareness and serve as a graduation tradition.

The pledge includes a preamble, ten promises, and a concluding statement tailored to biomedical engineering.

Abstract

Although biomedical engineering (BME) is a profession with ethical responsibilities comparable to those in medicine, it has, until now, lacked a counterpart to the Hippocratic Oath. While professional societies have established codes of ethics for biomedical engineers, these documents lack the symbolic and ceremonial significance of an oath or pledge. By contrast, the recitation of the Hippocratic Oath, or its modern version, the “Physician’s Pledge,” serves as a powerful rite of passage for medical students, fostering a strong sense of ethical duty at the start of their professional journey. However, the content of the Hippocratic Oath includes elements specific to clinical practice and is not directly applicable to biomedical engineering. To fill this gap, we have created a “Biomedical Engineer’s Pledge,” comprising a preamble, ten promises, and a concluding statement, to inspire ethical awareness and establish a meaningful graduation tradition.

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Full text

Introduction

Biomedical engineers operate at the intersection of healthcare and technology, where ethical dilemmas frequently arise. In medicine, a symbolic yet essential element in shaping ethical awareness is the Hippocratic Oath, whose origins can be traced back to ancient Greece [1]. Its modern adaptation, the World Medical Association’s “Physician's Pledge” or Declaration of Geneva, continues this tradition as a brief, non-binding declaration taken at graduation [2]. Pledges and oaths offer a compelling way to cultivate ethical awareness through a memorable symbolic act that requires little academic effort. Regrettably, the content of the “Physician's Pledge” includes elements specific to clinical practice and is not directly applicable to biomedical engineering. To fill this gap, we created the “Biomedical Engineer’s Pledge,” modeled after the “Physician’s Pledge” but adapted to the unique ethical landscape of the discipline, while explicitly introducing some additional aspects (e.g., the avoidance of fraud against patients and the minimization of animal experimentation). This effort involved students, academics, industry professionals, physicians, and ethicists.

In the past, calls have been made for the implementation of a “Hippocratic Oath” for biomedical engineering [3], and several initiatives in this direction have been undertaken. These include dissertations proposing ethical guidelines for biomedical engineers [4], ethical codes by biomedical engineering societies [5–9], and solemn declarations such as the Order of the Engineer taken by graduating students “to serve as ethical engineers” [10] or “pledges to professionalism” [11], even including the performance of very ceremonial acts involving tokens such as rings [12]. Remarkably, France has recently introduced a mandatory research integrity oath as a requirement for obtaining a PhD [13]. However, to the best of our knowledge, nothing resembling an oath or pledge specifically aimed at biomedical engineering students has ever been published.

The process used to collaboratively draft the pledge, along with a detailed explanation of its wording and principles, is documented in a manuscript available in the public repository Zenodo [14]. More interestingly, the manuscript also includes several case studies or ethical dilemmas, outlined to illustrate how the pledge can be applied in practice.

We believe the pledge will not only reinforce ethical values among students but also strengthen public understanding of biomedical engineering, foster interprofessional solidarity, and serve as a source of pride for students and their families.

The pledge

I solemnly declare that as a biomedical engineer:

1. I will hold paramount the safety, health, and well-being of patients, research participants, coworkers, healthcare workers, and the public.
2. Upholding the above, I will exercise my profession with integrity and responsibility.
3. I will do my best to ensure the autonomy and dignity of patients and research participants.
4. I will ensure the proper safeguarding of patient and research participant data.
5. I will not discriminate on the grounds of age, sex, sexual orientation, gender identity or expression, disease, functional diversity, origin, racial status, religious beliefs, political affiliation, social class, or any other identity factor.
6. I will not participate in patient deception or fraud against them.
7. I will share my scientific and technical knowledge, and I will not use it to violate human rights.
8. I will promote the replacement, reduction, and refinement of the use of animals in research.
9. I will contribute to the environmental and economic sustainability of healthcare and to universal health coverage.
10. I will demonstrate to my teachers, colleagues of any discipline, students, and society at large, the respect and gratitude that is their due.

I understand and commit myself freely and publicly to these principles.

Ethical foundations of the pledge

The pledge is structured around ten commitments, or promises, with the first commitment prioritizing the safety, health, and well-being of patients, research participants, coworkers, healthcare workers, and the public. As in the case of the “Physician’s Pledge”, the “Biomedical Engineer’s Pledge” can be fitted to the general bioethics framework of the Four Principles devised by Beauchamp and Childress: beneficence, justice, non-maleficence, and respect for autonomy [15]. However, the four general principles are not considered equally important in the pledge: non-maleficence and beneficence are given top priority in the first commitment. This same combination of the fundamental principles of beneficence and non-maleficence is captured in the classical formulation by Thomas Aquinas, “bonum est faciendum et malum vitandum,” meaning “good is to be done and evil is to be avoided” [16].

The specification of beneficiaries (i.e., “patients, research participants, coworkers, healthcare workers, and the public”) serves to prevent oversights, and equally important is the clear identification of the purposes (“safety, health, and well-being”). Although no explicit hierarchy is stated, it is by no coincidence that safety comes first. This aligns with the Latin phrase “Primum non nocere” (“Above all, do no harm”), which underscores the principle of non-maleficence. Widely taught in medical schools, this aphorism has uncertain origins and is often mistakenly attributed to the Hippocratic Oath [17].

It is important to note that the explicit prioritization of the first promise implicitly demands an assessment of the potential consequences of actions or omissions. In other words, a careful analysis of risks and benefits is required. Actions must be evaluated by weighing their risks against their anticipated benefits. This benefit-risk consideration is a cornerstone of guidelines followed by ethics committees overseeing medical and human research. Notably, the “Nuremberg Code” for medical research, developed in response to Nazi atrocities, states: “The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment” [18].

The second commitment or promise—“Upholding the above, I will exercise my profession with integrity and responsibility”—emphasizes the moral obligations of biomedical engineers, though it holds secondary priority to the first promise. Given the potential life-altering impacts of biomedical engineering, practitioners must accept accountability for their actions and outcomes. Ethical responsibility extends beyond legal compliance, requiring awareness of consequences and a commitment to “doing the right thing.” Integrity involves consistently upholding high moral and professional standards, supported by good practices. The subsequent promises should be understood as specific expressions of what it means to act with integrity and responsibility. As a guiding principle, provided the first promise remains uncompromised, these later commitments should take precedence over other moral considerations.

Biomedical engineering is a rapidly advancing field where technological developments must be balanced with ethical considerations. The pledge explicitly acknowledges the risk of fraud, deception, and unethical manipulation of medical technology, reinforcing a standard of accountability. The Theranos case, in which misleading claims led to severe ethical violations, serves as a cautionary tale, illustrating the real-world implications of ethical lapses in biomedical engineering [19].

The “Biomedical Engineer’s Pledge” draws inspiration from the “Physician’s Pledge” and from ethical codes developed by biomedical engineering societies such as the Code of Ethics of the Biomedical Engineering Society (BMES) [6], the Canadian Medical and Biological Engineering Society Code of Ethics [8], and the IEEE Engineering in Medicine and Biology Society (EMBS) Code of Ethics [9]. As a result, it shares important formal and conceptual similarities, particularly in relation to the fundamental ethical principles discussed above. However, the pledge also explicitly introduces certain ethical aspects that are overlooked or not fully addressed in some of these existing sources. For instance, the pledge also addresses issues such as patient autonomy, safeguarding of medical data, and non-discrimination. These aspects align with broader societal concerns, ensuring that biomedical engineering students understand the importance of ethical considerations in research and design. In a data-driven world, where neurotechnologies, medical records, and AI-based diagnostics are becoming prevalent, it is crucial for students to adopt strict ethical guidelines regarding data security and patient confidentiality from the very beginning of their careers.

Another notable and relatively overlooked aspect of the pledge is its emphasis on environmental and economic sustainability. Biomedical engineering, while transformative, also contributes to medical waste, carbon emissions, and economic disparities in healthcare accessibility. The pledge urges students to consider the long-term impact of medical innovations, ensuring that healthcare systems remain sustainable and inclusive.

Furthermore, as an additional novel element, the pledge promotes universal healthcare coverage, urging students to develop technologies that can bridge healthcare disparities rather than exacerbate them. This principle aligns with global health initiatives that seek to expand access to medical devices and treatments in underserved communities. The pledge, therefore, extends beyond individual responsibility to a collective ethical duty to advance global healthcare.

Use of the pledge and endorsements

Ethical training is often underemphasized in biomedical engineering curricula, with many programs offering only limited exposure to bioethics. The “Biomedical Engineer’s Pledge” provides an opportunity to institutionalize ethical awareness, similar to how the “Physician’s Pledge” has shaped medical professionals’ ethical standards. By incorporating the pledge into graduation ceremonies or professional milestones, institutions can foster a culture of ethical consciousness among biomedical engineering students. Although the pledge is primarily intended to be taken as a rite of passage by BSc students around their graduation, its preamble sentence is intentionally short and generic to allow the use of the pledge across various educational levels (BSc, MSc, and PhD) and contexts (e.g., before graduation, at the graduation ceremony, just after graduation, or many years after graduation, for instance, at alumni reunions).

Furthermore, adopting the pledge at an early stage in education helps students internalize ethical principles before they enter the workforce. It serves as a guiding framework for their decision-making, ideally through their entire careers. The public and voluntary nature of the pledge further enhances accountability, encouraging students to uphold their commitments beyond academic settings.

Many students who earn degrees in biomedical engineering go on to pursue careers in fields unrelated to biomedical engineering. However, even in such cases, the pledge can still serve as a valuable moral compass, guiding their professional conduct and ethical decision-making regardless of the specific discipline they ultimately follow.

The pledge has already been recited three times at the graduation ceremonies of biomedical engineering students at Universitat Pompeu Fabra in Barcelona, Spain, and once at the graduation ceremony at Universidad Politécnica de Cartagena in Cartagena, Spain.

Notably, the “Biomedical Engineer’s Pledge” has been officially endorsed by the Hippocratic Movement, a non-profit organization dedicated to promoting Hippocratic ideals among healthcare professionals, and it was also endorsed for recitation in July 2024 by the International Federation for Medical & Biological Engineering.

Conclusion

The “Biomedical Engineer’s Pledge” represents a significant step toward formalizing ethical responsibility within the biomedical engineering profession, with a particular emphasis on students. By outlining clear ethical commitments—ranging from patient safety to sustainability and global health equity—the pledge serves as a moral compass for both aspiring and experienced biomedical engineers. Unlike traditional regulatory frameworks, this pledge operates on a voluntary commitment, reinforcing the idea that ethical practice should be intrinsic rather than imposed. If widely adopted in educational institutions, the “Biomedical Engineer’s Pledge” has the potential to elevate the profession’s ethical standards, enhance public trust, and ensure that biomedical innovations continue to serve humanity responsibly.

The “Biomedical Engineer’s Pledge” can be accessed at https://www.upf.edu/web/biomedical-engineers-pledge and is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.