Remote and Robotic Surgery - Essay Example

Section # Remote/Robotic Surgery A. Is this legal At this juncture, remote surgery is legal in all fifty United States; however, the commonality of its usage is restricted to a few special cases. This restriction is due to the fact of its overall rarity and expense rather than current laws restricting its use and or application. It is the very issue of legality and liability that has likely discouraged the practice from gaining more widespread acceptance. With ever increasing medical malpractice insurance costs to practitioners and doctors alike, it is unlikely that many medical professionals will be eager to pursue greater development of the remote surgical field, due primarily to the fact that they will likely be reticent to accept any form of operational procedure that has the likelihood of placing them at even greater liability (Gamble, 2006). Not only will medical professionals be responsible for any mistakes that are made while a remote surgery is in process, they could also face the specter of being liable for any malfunction of any given part of the apparatus; whereas before they were solely responsible for their own malpractice and the potential malpractice of their attending staff. This brings us to the second question with regards to legality - responsibility for errors that might occur. B. Who is responsible for errors? Although liability costs have already been discussed, this is a far cry from ascribing responsibility to who and what for any mishaps that may occur during a remote surgery. The fact of the matter is, at this point, no one truly knows what entity might be held responsible for any malpractice lawsuits that may occur as a result of a botched operation. The actors to consider include to name a few: the surgeon, the team of helpers on location, the hospital, the anesthetist, the manufacturer of the remote surgical hardware, or the communications provider that provides the remote link between doctor and patient (Cisco, 1992). At this point of technological development of remote/robotic surgery, it remains unclear as to what entity or individual is ultimately responsible for any mishaps that might occur during the process and cause harm or distress to the patient. This is doubtless partly the case because of the diversified nature of current remote/robotic surgical procedures. Although the surgeon should be liable at any one step of the process, his responsibilities are housed under an umbrella of different responsible entities and actors. It stands to reason therefore that the surgeon himself cannot be responsible for a power outage at his location which interrupts the operation of the remote surgical interface. Likewise, the surgeon cannot be wholly responsible for any malfunctions in the communications link that relays information from the surgeon to the remote device and the patient who is being treated (Telecommunications Union, 1999). Similarly, the surgeon cannot be responsible for any faulty or erroneous programming that is encoded to the remote surgical device software which operates the system. Furthermore, there is a decided breakdown in communication that exists when the surgeon is performing remote and robotic surgery from a distance. Lastly, it is worth noting the other pitfalls of remote surgical procedures that have not been noted up until this point. Firstly, without a surgeon present, the nursing and technical staff will have difficulty, if not find it impossible, to read the surgeons motives and interpret his movements. Anyone that has spent time in an operating room will notice that the team of people responsible for sustaining the patient during the process uses both verbal and nonverbal communication to express their needs. Accordingly with nonverbal communication not a possibility during remote surgical procedures, the staff is left without a firm handle on the needs of the surgeon or attending physician. Although this is not a massive impediment to the administration of successful medical care, it is enough to disrupt normal operating room procedures and place an aura of confusion around the staff as to what the next necessary move will be. These are but a few of the many responsible entities within the process and doubtless one reason that the practice of remote/robotic surgery has not caught on to a greater degree. As if liability concerns are not costly enough to medical practitioners, very few in the medical community are interested in multiplying these complexities by adding in all of the requisite players that remote/robotic surgery requires (Mello, 2006). Furthermore, in order for the field to advance and the practice of remote surgery to become more widespread, these issues of requisite responsibility must be determined. C. What politics are involved with implementation? Legislation governing such procedures is doubtless a step that would eventually be instituted to legitimize and legislate the use and application as well as rules and regulations related to remote/robotic surgery. As such, law making bodies will have to institute guidelines for the industry before it could conceivably catch on to a greater degree. As is always the case, especially in the medical field, liability becomes a massive issue. With more and more doctors choosing alternative specialties than surgery because of the high liability insurance they must pay, it is worth noting that each and every element of the remote surgical process could be subject to liability litigation. As such, the full legal ramifications of to what extent the internet service provider is liable for damage should the connection be lost during surgery, to what extent the hardware developer of the surgical hands at the patient’s location is liable for any mishap, and if the surgeon himself is liable to a lesser degree due to his lack of proximity to the patient is all something that would need to be absolutely defined prior to the technology having a chance of gaining greater popularity. This issue alone could be one of the relevant causes that this technology has not caught on to a greater degree than it has currently. Likewise, the issue is further politically charged by the fact that patients will likely be reticent to accept such a vast deviation from standard medical practices that they have grown accustomed to. Not surprisingly, if the technology continues to advance and become more and more popular, there will likely be a great deal of political posturing as to legislating the legality of remote surgery and the constraints that govern it as well as the degree of freedom that machines will have within the medical profession. Depending upon the feelings of the general electorate at that given time, as well as news stories in the mainstream press concerning the overall safety of the operations, the procedure could conceivably by outlawed altogether. Although such a reaction would be a heavy-handed response – it is not out of the realm of reason to consider. Moral and ethical implications A. Is it moral to use a robot to save a human life? Comparative to the psychological implications of remote surgery discussed earlier, the most noteworthy moral and ethical implications that this type of procedure bears is the fact that instead of a doctor and a team of technicians performing the surgery, the patient must now rely on a combination of man and machine to adequately address their needs. This type of man and machine combination hearkens back to some of Isaac Asimov’s writings. The moral and ethical dilemma for the patient is coming to grips with the fact that they are now allowing both man and machine equal access to their health, their body, and most importantly their life. Although this may seem a bit preposterous at first, it is a very real consideration and one that people will need to analyze and reject or accept more and more in the coming years and technological advancements mean a greater and great integration of both machines and technology to the tasks we had previously expected of doctors and nurses. B. Is it ethical to leave a human life in the hands of a robot? This question directly depends on the level to which robotic instrumentation is making decisions. Accordingly, are the decisions being made out the hands of human oversight (in the form of a surgeon) and to what degree is the programming regimented or to what degree do perceived inputs determine how the robot responds external stimuli. Although these questions may appear laborious and just a matter of syntax, the degree of autonomy that the robot/surgical device has and the degree to which it is capable of drawing inference from data (both actual information and perceived data) are key to answering the question of morality with regards to remote/robotic surgery. It would be unfair to answer a question regarding morality with relation to robotic surgery without hearkening back to the father of robotics: Isaac Asimov. Asimov, a famous science fiction writer and philosopher that wrote prolifically on subjects relating to science fiction and robotics, is perhaps best known for penning the three laws of robotics. These simple yet profound laws were intended to govern robots operating within the constructs of a human world are as follows: 1. “A robot may not injure a human being or, through inaction, allow a human being to come to harm.” 2. “A robot must obey the orders given to it by human beings, except where such orders would conflict with the First Law.” 3. “A robot must protect its own existence as long as such protection does not conflict with the First or Second Law” (Asimov, 2008) Although primarily a science fiction writer, Asimov understood the increasing role that robotics and automatons would play in our future world. As such, he sought to create a series of codes and rules under which their programming would be forced to operate. The conflict that occurred in his books and short stories always hinged upon the breaking of one or more of the aforementioned rules. Simply stated, with harmony that these rules implied, no plot line could be derived. As humans, we have an inherent difficulty completely and wholly trusting a machine to make a moral and/or ethical decisions for itself or on our behalf. As such, as long as technology continues to increase, and humans will become more and more dependent on the services of machines/robotics for things as diverse as healthcare services, it will become incumbent upon any and all developers to adhere to the basic premises of Asimov in order to assuage the fear of those that may not be ready to fully accept the use of remote or robotic operations. Accordingly, if robotic/remote surgery becomes increasingly popular and the degree of autonomy that robots will have comes to exceed human purview, then it would only be rational to constrain the programming in some way to ensure that Asimov’s three laws of robotics be included at the fundamental level. The issue therein is not the fact that a machine will be used in operations: indeed we currently have ventilators, defibrillators, and a host of other bio-medical devices currently. Rather, the issue is the degree of choice that will be built into the programming that governs such a machine. The crux of the matter is that currently we answer questions relating to remote and robotic surgery; however, it is very likely that in the future the question will not hinge upon the morality or ethical nature of a surgeon using tools from a distance to operate on a patient. Instead, it is likely that the question will morph into the ethics and morality of robotic entities performing the entirety of surgeries with little to no human oversight. It is for this very reason that it is exceptionally important to know and understand how we as a society will interact and accept the presence of robotics in the medical field and at varying levels of our lives. Interesting, these three rules of robotics offered by Isaac Asimov bear a striking resemblance to another written code of ethics that has existed within the medical community for nearly two thousand five hundred years. The oath is of course known as the Hippocratic oath. Penned by a Greek physician in the 5th century BCE, the Hippocratic oath lays out what can be viewed as the very fundamentals of a physicians responsibility to his patient and thos within the house of the patient he/she is going to treat. As a way of comparison to Asimov’s “no harm” rules laid out previously, consider some of the dictums of the Hippocratic oath laid out below: “I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement: To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others. I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not give a woman a pessary to cause an abortion. But I will preserve the purity of my life and my arts. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with boys, be they free or slaves. All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life” (Hippocratic Oath circa 300 BCE). Even without a great deal of analysis, it is not difficult to see the major similarities between Asimov’s rules of robotics and the “no harm” principles championed by the Hippocratic oath intended for surgeons and physicians alike. Accordingly, the driving principle for governing the ethical and moral issues that arise from the introduction of robotic surgery, if carried out appropriately, will closely mirror (if not directly reflect) those outlined by Hippocrates in the past. At its core, humanity is distrustful of that which it cannot identify and/or empathize with. Machines scare us because we assume that they operate in such a dissimilar way that we oftentimes assume that they do not have our best interests in mind. Maintaining a doctor/patient relationship, or at the very least, maintaining the trust in ethics and morality between patient and various incarnations of man/machine/remote surgery/robotics will be an integral and important step to take before such a practice can be adopted. There are many impediments to the further adoption of remote and robotic surgery. These include technological concerns, liability issues, legal concerns, ethical and moral constraints, and lastly acceptance by the general population based upon all of these aforementioned metrics. Accordingly, for patient adoption to stand even a chance of gaining popularity, it will be incumbent upon medical professionals, programmers, data service providers, communications providers, remote surgical device designers, and everyone involved in the process to work fervently and prove to the consumer that the process is safe, ethical, constrained by the same rules that bind traditional medical practice, and cost beneficial to the end customer (Barry, 2005). The steps outlined in this analysis as well as the points and issues raised will help to guide the debate and point medical professionals and consumers alike in the correct direction as far as what standards they should expect and what questions they should seek answers to. Change of itself is an inevitable part of our life. However, sacrifice in quality does not have to go hand in hand with such a change. Bibliography Asimov, I. (2008). I, Robot. Halmstad: Spectra. Barry, T. Halam, K. 07/11/2005. Bloomberg. “Surgery Costs 69% More in U.S. Than in Canada, Study Says” Available at: http://www.bloomberg.com/apps/news?pid=newsarchive&sid=a4J.ER8r4CrM Accessed: 07/29/2012 Cisco. 1992. “Guide to ATM Technology - ATM Technology Fundamentals [Cisco Catalyst 8500 Series Multiservice Switch Routers] - Cisco Systems.” Available at: http://www.cisco.com/en/US/products/hw/switches/ps718/products_technical_reference_chapter09186a00800eb6fb.html#wp1019851. Accessed: 07/27/2012 Gamble, Kate. 2008. “No Sponge Left Behind.” Health Care Informatics. Available at: http://www.sciencedaily.com/releases/2010/09/100930112158.htm Accessed: 07/29/2012. Hippocratic oath. (n.d.). Online Etymology Dictionary. Retrieved August 21, 2012, from Dictionary.com website: http://dictionary.reference.com/browse/Hippocratic oath International Telecommunications Union. 1999. “Integrated Services Digital Network.” Available at: http://www.itu.int/rec/T-REC-I.150-199104-S/en Accessed: 07/28/2012 Mello, Michelle. 2006. “Understanding Medical Malpractice Insurance: A Primer”. Harvard School of Public Health. Available at: http://www.rwjf.org/pr/synthesis/reports_and_briefs/pdf/no8_primer.pdf Accessed: 07/27/2012 Read More