Roboethics - Ethical Engineering for International Development and Environmental Sustainability - page 84

5.1 Robotic Systems for Health Care

Medical robots (Li and Xu 2007 ; Mavroidis et al. 1997 ) are being used in health
care, including in operating theatres (Mettler et al. 1998 ; Ruurda et al. 2002 ). This
includes very small-scale systems down to subatomic particle size, and systems an
order of magnitude smaller are being developed. Applications can be divided into
the following three groups: (1) robotics for medical procedures, (2) systems to sup-
port training and (3) robotic body part replacement or strengthening. They include
the following:

1. Robotics for medical procedures.

(a) Robotic telesurgical workstations.
(b) Robotic devices for endoluminal surgery.
(c) Robotic diagnosis systems, including computerised axial tomography (CAT)
scan, nuclear magnetic resonance (NMR) and positron emission tomogra-
phy (PET).
(d) Robots for therapy, including laser eye treatment, targeted nuclear therapy
and ultrasonic surgery.

2. Robotic systems to support training.

(a) Virtual environments for surgical training.
(b) Haptic (tactile) interfaces for surgery and physiotherapy training.

3. Robotic body part replacement or strengthening.

(a) Artifi cial limbs (legs, arms).
(b) Artifi cial hearts, kidneys and other organs.
(c) Artifi cial sensory organs (or parts of sensory organs), including the eyes and
ears.
(d) Exoskeleton to strengthen limbs and/or the spine.

Medical robotics raises a number of challenging ethical, social and technical
questions. From the technical perspective, many medical applications and, in par-
ticular, surgery have very low tolerance of error. In addition, robotic surgery gener-
ally involves a small workspace and reduced sensory input. Issues of safety,
reliability and control are of fundamental importance and back-up systems may be
required. Size, costs and functionality are also important. The use of robotic surgery
may require surgeons to develop additional skills while maintaining existing skills.
There are also ethical issues relating to the role of the robot. In the case of robotic
surgery involving very small-scale robots, e.g. nano- and femtorobots, on the scale
of or able to manipulate items of size from 10 −9 to 10 −15 m, it is probably natural to
consider the robot a tool, even if it has some degree of intelligence. There may also
be issues of the degree of autonomy which it is appropriate to grant this robot. This
raises the question of the overall ethical responsibility of the surgeon, particularly in
the case of very-high-performance and high-reliability robots which can carry out
tasks more safely and effectively than the surgeon. However, there will still be a