Robotic Systems in Operating Theaters: New Forms of Team–Machine Interaction in Health Care

Abstract

Background Health information systems have developed rapidly and considerably during the last decades, taking advantage of many new technologies. Robots used in operating theaters represent an exceptional example of this trend. Yet, the more these systems are designed to act autonomously and intelligently, the more complex and ethical questions arise about serious implications of how future hybrid clinical team–machine interactions ought to be envisioned, in situations where actions and their decision-making are continuously shared between humans and machines. Objectives To discuss the many different viewpoints—from surgery, robotics, medical informatics, law, and ethics—that the challenges of novel team–machine interactions raise, together with potential consequences for health information systems, in particular on how to adequately consider what hybrid actions can be specified, and in which sense these do imply a sharing of autonomous decisions between (teams of) humans and machines, with robotic systems in operating theaters as an example. Results Team–machine interaction and hybrid action of humans and intelligent machines, as is now becoming feasible, will lead to fundamental changes in a wide range of applications, not only in the context of robotic systems in surgical operating theaters. Collaboration of surgical teams in operating theaters as well as the roles, competencies, and responsibilities of humans (health care professionals) and machines (robotic systems) need to be reconsidered. Hospital information systems will in future not only have humans as users, but also provide the ground for actions of intelligent machines. Conclusions The expected significant changes in the relationship of humans and machines can only be appropriately analyzed and considered by inter- and multidisciplinary collaboration. Fundamentally new approaches are needed to construct the reasonable concepts surrounding hybrid action that will take into account the ascription of responsibility to the radically different types of human versus nonhuman intelligent agents involved.

Artificial Intelligence and Surgery: Ethical Dilemmas and Open Issues

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“…Moreover, AI may change the role of other professionals working with surgeons, e.g., anesthesiologists. New paradigms in education also involve other clinicians 27 .…”

Is it alright to use artificial intelligence in digital health? A systematic literature review on ethical considerations

“…Occasionally, new categories or names for ethical constructs are created, for example, "trustworthiness," 36,59 but without really differing from the four core principles commonly used in bioethics (or the additional fifth category that we also used to categorize our results). Furthermore, ethical aspects in the context of AI in healthcare are being studied in a wide range of research areas, for example, technical implementations, 96 the use of robotic systems in operating theaters, 95 care robots fort the elderly 93 or in the area of caregivers and geriatric patients. 69…”

Societal and Ethical Issues in HRI

“…Not less ethically sensitive is the issue of robotic assistance in the medical field and carebot use to assist vulnerable end users, such as people with cognitive impairments, children, or seniors. Steil et al [96] provide valuable insights into the ethical challenges associated with robot deployment in medical settings. In the field of robotic care, robots are employed for the care of elderly people, people with disabilities, and children.…”