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After discussing the topic of the use of robotics in medical surgeries, we decided to look up a concrete example and dive deeper into how we can view this debate ethically.
With the improvement of robotic technology, robots has been serving as a substitution of human in many areas like heavy industry, logistics industry, which do us a great favor to save effort. However, there is a new application of robot arises a great argument recently, the robotic surgery.
Robotic surgery is designed to minimize the damage to the patient and allows surgeons to perform a more accurate operation by the robotic surgical system than using the traditional instruments.People would be happy to accept this new concept unless damage is made to patients by the robotic surgery system. It indeed also can increase the risk of the surgery, for there will be inevitable error caused by machine failure or human mistakes.
There are many stakeholders on this issue, obviously we have direct stakeholders, like surgeon who operate those robot, patients who are on the operating table, and their family. Yet the indirect stakeholders, like the company making robotic surgical system, hospitals, the insurance company etc.
A utilitarian test determines whether an action will produce the best outcome for everyone involved, ultimately maximizing good results and minimizing damage. This is an “end justifies the means” test in which right and wrong are determined by whether or not the best overall outcome occurs. Utilitarianism can be used to analyze whether the results of a more consistent, high-performing robot can outweigh the uncertainties in autonomous surgery.
First, we look at the alternative actions one can take, and who is affected by them. In autonomous robot surgery, the immediate parties involved are the surgeons and the patients. We may also study the manufacturers and programmers of the robot, who provide the necessary technology to overcome the unpredictability of surgery. Surgical robots can participate in varying levels, requiring different levels of supervision. From remote controlled devices to simple assistants to complete autonomy, we will look at a variety of robots capable of gauging the changes in living flesh and coordinating movements accordingly.
To start with, we look at the current status of robotic surgery, which is the use of remote-controlled devices. Probable outcomes of manned devices rely mostly on the surgeon and their skill level/dexterity. In the short run, patients may feel more at ease with a human hand and brain at work, but this sacrifices the impeccable accuracy and consistency that a fully autonomous robot might provide. Remote-controlled devices allow freedom of intervention and complete control by the surgeon, as well as the situational judgment often required when performing surgery. However, on the flip side, it also gives leeway for human error and a lower quality procedure.
In contrast, we compare a mostly autonomous procedure performed by the Smart Tissue Autonomous Robot (STAR). During a procedure to stitch up a pig’s intestine, the STAR proved to provide more watertight and consistent stitches, as well as the ability to maneuver around soft tissue unpredictability with the use of near-infrared fluorescent (NIRF) tags. In the long run, these more accurate and efficient procedures may offer better and longer-lasting effects, there is the overarching issue of trust and uncertainty. Autonomous surgery on soft tissue subjects relies on the algorithm to calculate changes in shape and consistency depending on the NIRF tags. Even in the successful trial run of the STAR, the tags were placed by hand inside the subject’s intestine and monitored closely by the professionals present. While autonomous surgery is valuable in that it saves time, energy, and reduces human error, it is also an uncharted territory with many uncertainties that requires high monetary investment.
The decision that produces the greatest benefits over the costs for all affected currently appears to be a balanced mixture between procedures done by hand and automated surgeries. As shown in the STAR trials, autonomous robots can lend a helping hand by performing the more monotonous, repetitive tasks that require precise calculations and consistency, while real surgeons continue to operate on the more risky, unpredictable portions of the procedure. From a stakeholder point of view, this minimizes doubt and uncertainty about the procedure because there will always be a surgeon to keep an eye on the robot, while the robot provides elevated accuracy to enhance the procedure as a whole.
Should there someday be a policy enacted about the use of autonomous surgical robots, it is very likely that the procedures will be outlined by a certain amount of professional supervision. While sensory technology and precision can be continuously improved, there still remains a level of doubt from both patients and surgeons alike. So, while programmers may design and code the robots to optimize the efficiency and uniformity of the procedure, the fact remains that the other stakeholders involved will decide on a set level of human participation.
Though there are many individuals affected by the ethical dilemma on autonomous surgery, one ought to prove its justification based on its equality. Though an equality test may seem subjective, there are objective means to measure the justification of autonomous surgery. In doing such, we will assess the the correctness of the validity based on evaluating the distribution. For autonomous surgery, the distribution that ought to be evaluated includes those benefited or burdened by the existence of robotic surgeons.
The “who” in this test will be all involved in the health care policy and potential candidates for surgery. Though all of these potential patients may not need surgery, their medical evaluation will be affected and altered due to this growing technology. Therefore when assessing the distribution for the justice test, we are narrowing the stakeholders to be the surgeons, patients, and all potential candidates in need for medical attention.
This distribution is subjected to be either burdened or benefited with these growing technologies. The distinction between those benefited and burdened is undefined as there are many cases in which those positively influenced by the integration of autonomous surgery will also be negatively impacted. For example, though the autonomous surgery may offer a greater degree of precision, the robotic surgeon may not be able to account for inevitable unexpected turns in surgery. As the MIT article referenced above mentioned, there will always be a need for human intervention and supervision in autonomous surgery due to this issue. Despite this detrimental effect for the patient, the doctors benefit greatly from less pressure and need for perfection. Though there is the negative effect of changing technology and a greater learning curve, their jobs seem objectively “easier” as there is less pressure for perfection. Though there are payoffs for all parties involved, these negative effects can have positive solutions and are less weighted than the benefits of the positive outcomes. Therefore, the distribution seems fair in terms of risk of life and career. Though we acknowledge there are other conditions that can be accounted for in calculating the justice, we will focus on the specific distribution to conclude that it is relatively fair for the potential patients and doctors involved in the treatment.
Discussing new technology puts the effects of cost and accessibility into light. Surgery is not a viable option for many in our country and around the world. Similarly, autonomous surgery may make surgery less accessible. This forces us to meet a criterion that not only is the autonomous procedure proven to be successful, but also that the surgery is affordable and can be performed in isolated and remote areas. Though this does not occur in an ideal world, there could be many efforts made to transform the lack of trained professionalism in remote areas. Therefore with integrating criterion on the development of this technology, we can observe that the new technologies will vastly benefit the majority of distribution involved.
There are many cases in which success was measured differently between doctor and patient. For example, in a case study on a 66 year old man in need of a urologist, there was an instance in which the doctor believed the surgery was successful as the surgery was completed autonomously. However, for the patient, the surgery was a failure. He was subjected to more time in the hospital and needed additional surgery due to failures and complications during the autonomous surgery. However, there are ethical and health laws in place to prohibit malpractice. These laws will regulate the justice in autonomous surgery and in fact improve living conditions due to this improvement and progression in technology. It is observable through various moral tests that relative justification can be observed to continue progressing technology in this direction.
A person’s character and personality are extracted from his or her experiences and are always growing and changing. The situations that one encounters as well as the surrounding community and environment that one grows up in will alter and develop his or her attitude and character traits, which in return affects his or her virtues. A person’s virtues define what ideals they feel are important for themselves. Virtues are not only different from person to person, but can change within a person’s lifetime. The virtue test highlights whether a certain action or decision reflects the value and personality of the person or organization. The situation that we are focusing are the involvement of robots in surgeries.
The Smart Tissue Autonomous Robot (STAR) was developed at the Children’s National Health System in Washington, D.C. to assist surgeons in soft tissue surgeries. In order to determine the performance and capabilities of the robot, STAR was given the task of stitching a pig’s small intestines using its own sensory capabilities. The results were compared to how well a skilled surgeon can perform this task. The stitches needed to tight and evenly spaced to prevent leakage. STAR was more consistent with its stitches, even though it needed assistance 40% of the time. In another case, a surgeon performed a prostatectomy with assistance of a robotic arm. Although the robot arm had the capability to make fine and precise incisions, because of mechanical problems that caused the arm to malfunction the surgery was prolonged and the patent had to come back because of internal bleeding.
These two examples show oppose results of using robots in surgeries. In the second situation, the surgeon proceeded with the surgery, even though he noticed that the equipment was malfunctioning. If we were to judge the surgeon’s virtues base on his decisions knowing the outcome of the surgery, we would think that performing the surgery with the robotic arm was not the best idea. However, the STAR demonstrates that it has the potential to be beneficial and reliable in soft tissue surgery. If our virtues prioritized the success of the patients over the ease of the operation, it seems that being able to produce fine and precise incisions as well as reliable stitches will benefit the patient. However, doctors should be monitoring the robots at all times and be ready to take over if they see that the robot is not performing as expected. With the present technology, surgeon should treat robots as assisting tools, not their replacements and treat the need to robots on a case by case basis. This will ensure that patients health and wellbeing are prioritized.
The most prominent issue that constrain the development of robotic surgery is the social distrust people have on robotic surgery systems. Almost every new technology would face this kind of skepticism when people do not trust the reliability of its application, especially for robotic surgery system which has a strong and direct influence on people’s health.
In the case’s scenario, the main reason for the failure application of robot assisted surgery (RAS) system is because that the doctor did not have much experiences on the RAS and he could not make the correct judgement when the robotic system had a mechanical issue and control the operation situation from getting worse, and caused a great body damage to the patient. Such tragedy illustrates that RAS itself is not totally autonomous, it needs the supervision of expertise and hence a lot of training on doctors and nurses should be involved to apply RAS with much less accidents. Such training is both resource and time consuming, and an inadequate training would easily cause disaster and hamper the social trust people have on the RAS technology.
Besides the social constraint, the high economic expense of RAS is also an obstacle for its vast application. According to a study in Ireland in 2014, the incremental cost of robot-assisted hysterectomy is an estimated €3291 (95% confidence interval €2509–€4183) more than the existing mix of open and traditional laparoscopic surgery. The additional cost of robot-assisted surgery is primarily driven by the increased cost of surgical equipment, the robot, maintenance of the robot, and the cost of theatre staff due to longer operative times. The only significant factor reducing the cost of surgery is a shorter hospital stay relative to open surgery.
Hence, the RAS is a technology that faces both obstacles from social and economic sides. To help apply this technology in a larger scale, we still need to take time to train the medical experts to cooperate with it to enhance the technology’s reliability, and minimize its economic expense.
A creative solution to integrating robots into the operating room would be to view them as assistants, not surgeons. A human would still perform the surgery but the robot would provide a service to make it easier. An example of this is a robot projecting diagrams of the patient’s internal organs with stabilization to track the patient as they move. This could allow the surgery to be completed much faster which would reduce risk and strain on the patients and surgeons. Additionally, these benefits can initially be minimally invasive so that there is little risk induced from using them. This would make the robots more attractive and increase their sales and adoption which would benefit the manufactures. They can then use the profit to improve robotic systems so that one day safe, fully autonomous robotic surgery is the norm.