The ethics of robotic surgery is a multi-faceted topic of debate with many different viewpoints all worthy of deeper exploration and consideration. Medicine is ever-changing due to major technological innovations and government regulations. With all these changing factors in medicine, the focus should always be to provide the best possible care for the end user, or the patients. Is robotic surgery the best way to provide for the end user? There are many concerns and questions that may arise from robotics in medicine.
Here is a short list of some hot-button topics in the current environment of healthcare. Thesis The use of robotics in surgery has had profound impacts on the way we have done medicine in today’s world. We will explore five of the issues that robotic surgery has had specific impacts on: 1) Social 2) Technical 3) Moral 4) Cultural 5) Ethical Robotic Surgery I. History 1st non-laparoscopic case was in 1985 1st laparoscopic case was in 1987 1993 AESOP 1st robot approved for surgery by FDA daVinci approved for laparoscopic surgery in 2000.
SOCRATES 1st telecollaboration surgery in 2001 II. Technology Robotic and Computer guided are used interchangeably The surgeries are less invasive than open surgeries daVinci system has three components Surgeons Console Robotic Cart with arms that hold the instruments 3D Vision system Surgeons movements are scaled down into micro-movements Used in: prostate cancer surgery hysterectomy Mitral heart valve surgery III. Pros Smaller Incisions – smaller scars Shorter hospital stay – Quicker recovery Less blood loss IV. Cons Longer training for surgeons.
Cases are longer during training Costs per procedure are higher V. Moral and Ethical Implications of Robotic Surgery Addressing moral (human rights) and ethical issues raised by robots in surgery VI. The moral and ethical implications for clinicians, patients and society at large on the Four evolving health telematics: a. electronic health records b. transmission of visual media in disciplines such as teleradiology, teledermatology, telepathology and teleophthalmology c. telesurgery and robotics and d. the use of call centers and decision-support software VII.
Concerns about the dazzling speed at which technology is developing aRobots being empowered to make moral and ethical decisions bOvercoming legal and licensing barriers before telesurgery becomes clinically practicable VIII. Reasonable Human Concerns of facing the consequences of an uncontrolled and unprepared future of intellectual robots at work in the following fields: aGenetic engineering bhuman cloning ctissue engineering dintelligent robotics enanotechnology fsuspended animation gregeneration hspecies prolongation IX.
Concerns that robots will soon outsmart humans; while humans compute at 4 ? 10 computations per second (cps), robots compute at 3. 5 x 10 cps. Thus the following looming questions aWill computer/robots/machines soon be more intelligent than humans? And if so, can humans communicate with them? bWill they remember that humans made them? cWill they even need us humans anymore dIf they are intelligent, will we be able to pull the plug X. Concerns of robots making life-or-death decisions in unpredictable situations, thus assuming—or at least appearing to assume—moral agency * XI.
The urgency of providing answers to questions regarding moral and ethical issues to clarify human doubts so that they will enjoy the benefits that robots in surgery supposedly will bring. XIISocial Issues of Robitics in Surgery * ANew medical technology changes things socially for patient and doctor * The need to fully disclose all aspects to the patient to obtain informed consent * Doctor self-improvement through life-long learning to ensure the highest quality of service for the patient * Evaluating the best approach.
* BImplementation of new robotic procedures could be more for the prestige of the practice, not necessarily because they are skilled in the area * More patients are apt to come to them wanting the new, minimally invasive procedures * Doctors have a choice to either provide the desired procedure or lose the patients and their money * Surgeons may/may not accept the technology * Surgeons may be socially influenced to use technology they would otherwise balk at * Cost of robotics * Availability of the robots.
* CRobotics in surgery is changing from ‘knowledge’ work to ‘manual’ work * Less ‘talented’ surgeons as they aren’t fully trained in evasive surgery * Experienced surgeons are worried that newer surgeons are not as trained as them, thus not believing in their co-workers ability to actually perform evasive surgery (using a scalpel) * Surgeons are replaced by robots in surgery * More robots could equal less surgeons * DSurgeries * Robotic surgeries are tedious work of the surgeon * Surgeon fatigue.
* Surgeries that use robots also increase the amount of time of the actual procedure. The longer the surgery, the risk of complication increases * Takes away from the human aspect. Surgeon is not physically engaged with the patient * Implementing unproven technology could cause secondary surgeries * patient overall dissatisfaction * Relying too much on the technology may push surgeons to consider a robotic surgery even for a minor health problem * EPeople may think robots will eventually take over our entire lives.
* Using medical robots may/may not help the public accept robotic technology as a whole * This new technology is not popular among some part of the society and it is hard for some people to know what kind of problems are going to occur by using this technology * Many patients’ aren’t educated with regard to robotics in surgery and may be hesitant when faced with having it done * * XIIIExplore accountability concerns of robotic surgery. * AWho is responsible if something goes awry? * Are the manufactures at fault?
* Are the surgeons operating the robot, assuming said robots are not fully autonomous, at fault? * BHow to provide ethical healthcare while keeping cost down. * Is it cheaper to operate these robots than not to? * If not cheaper, are they better? CThe extent of how much is automated. Are the robots capable of AI(artificial intelligence) or are they guided by a human surgeon? * How much input is required by the operator? * Is the machine capable of calculating risk in a given decision making process?
DWill robotic surgeries be less invasive? Create shorter hospital stays or shorter recoveries? * If a patient can recover faster due to robot surgery, it is a step forward. A less invasive surgery can make for a much faster recovery, less down time for the end user resulting to less lost wages etc.. EWhat will robotics cost the end user in the long run? Is the use of robotics going to cost more to patients and insurance companies with no real benefit? Will end users have a choice between robotics and a human surgeon?
XIV. Technology in its cultural context, media influence AIs the media helping to influence this technology? BAre there cultures that do not believe in this technology CWhat cultures are using robotic surgeries? DWhat government agencies are using robots? EIs the government helping out with grants or tax deductions FHow can we convince other cultures to utilize this technology GWhy are so many people having these surgeries performed by robots? HWhy are robotic surgeries so popular among the media? References Dasgupta, P., Jones, A. , & Gill, I. S. (2004, December 20).
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Surgeon responsibility in the era of change. Retrieved from http://www. ncbi. nlm. nih. gov/pmc/articles/PMC3021345/ Satava, R.M. (2003, September). Biomedical, ethical, and moral issues being forced by advanced medical technologies.. Retrieved from http://www. ncbi. nlm. nih. gov/pubmed/14606491 Stanberry, B. (2001, December 25).
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