The advancement in robotic technology has made it possible to introduce robotic support systems in a surgical theatre in the aim to increase patient’s well being. The boundaries of professional responsibility and liability blurred with regards to patient safety, public opinion, obstacles associated with novel technologies and removal of human decision making with increased involvement of robots. This has resulted in an ethical problem: what level of involvement of robotic technology should be approved when undertaking medical surgery?
The main stakeholders involved in this issue are the government, surgeons, patients and engineers.
No involvement of robots should be allowed in medical surgery at all
Robotics has adversely affected some surgeries as it was discovered that they have caused injuries to patients. These injuries would not have occurred without the robots involvement. In these instances it would be better to exclude robots as they do not fulfil their function of improving patient well being, indeed robot assisted surgery (RAS) was linked to over 100 deaths and more than 1000 injuries in the US alone.
The American College of Obstetricians and Gynecologists states that: “there is no good data proving that robotic hysterectomy is even as good as – let alone better – than existing, and far less costly, minimally invasive alternatives” highlighting that a skilled surgeon could to perform the surgery without the associated risks of RAS. RAS failed in its implementation into cardiovascular and gynecological surgeries and was only successful in urological surgeries as it reduced bleeding from patients. Despite this success, on the basis of impotence and incontinence which are better indicators for success, RAS is no better than traditional surgery.
Surgeons through extensive training are capable of making intraoperative decisions which enables them to adapt to a changing scenario, a necessary skill that robotics in surgery do not yet possess. This presents the notion that this technology should be subjected to further investigation and testing by independent bodies without a vested interest in order to produce a safe product which will not negatively impact a patient’s well being. This would require government legislation to enforce predecided standards. Introducing further legislation would also prevent over enthusiasm, which sometimes occurs with technology causing a rush on a novel product which is unproven and thus possibly dangerous. These robots are vulnerable to hacking which clearly a surgeon would not be, as such RAS would potentially compromise patient safety where remote connection was involved.
Robotics of assistive nature and the prospect of fully autonomous medical robots should be allowed
Robotic technology is an integral part of modern medical practice. Bio-imaging processing and nanoscale robots in the bloodstream are a few examples where robotics assist medical personnel in making a judgement on the required treatment. This prompts engineers to push the boundaries in which robotics can contribute to medical care. This is an example of paternalism in which engineers are determined to advance RAS as far as possible for the usage of surgeons. There is evidence which shows that RAS has been successfully employed by Guy’s Hospital and is actively being used to treat cancer. The benefit here is clear, improved treatment for those with life threatening illness reducing surgery time, recovery time and increased survival rates. Considering the life saving ability should the cost be factored into decisions on adopting the technology, would this not be akin to assigning a monetary value to a life?
There is future prospect for the implementation of RAS, but as with any novel technology, certain challenges will have to be overcome at the early stages. In this instance, there are two main issues to be addressed; the first being the learning curve in using these surgicals robots and the second which involves software and hardware problems with the robots.These issues have resulted in accidents and injuries, however it would be wrong to presume that surgery would be better off without RAS, the next building block in the future of surgical medicine. For example, laparoscopic surgery is considered a successful surgical method today experienced many patient complications in its infancy. Reports have shown that the proportion of accidents have reduced over time with increasing implementation of RAS which implies progress as surgeons are becoming more experienced with RAS. In addition, with the release of every new model of robot, it comes with several progressive improvements: less malfunctions with components parts, tightened security protocols against hacking and generally the hardware and software for the surgical robot have been optimised. Instead of focusing on the few negatives of RAS, we would serve ourselves better if we build on its many more merits. The focus should be on setting up proficient training schemes for surgeons and regulating the standard quality and requirements of these robots.
By taking advantage of the robotic advancement to full automatisation, we can take the stand of a utilitarian viewpoint to bring the greatest happiness to the greatest amount of people. In our context, this can be done by deploying autonomous robotic surgeon to hazardous environment where access to trained surgeons is not available such as the battlefield. In this way, personnel can have valuable medical access without worrying about the surgeon’s safety. Medical assets such as trained surgeons can be put to better use such as medical research. Autonomous robotic surgeons can also be stationed in rural areas where medical access is limited. This way, more people can have access to proper medicine care albeit by robot rather than having those access limited only to first-world country. Governments can then provide better medical coverage to the populace without regards to geographical obstacles. With availability to medical care, the waiting time of these essential services can also be reduced with robotics technology. Robots can be productive for a long period of time only subjected to maintenance compared to surgeons who are susceptible to fatigue which can subsequently result in error in judgement which is often fatal. Patients can be reassured that emergency care is always available at its best regardless of the demand.Undeniably, the medical robotic application hasn’t been perfected yet and accidents do occur. However, compared to the inevitable benefits that the global community can reap from this, the sacrifices along the way is all well worth it.
54: Jeffrey Bong, Obi Ossai, James Browne, Matthew King