Introduction
With the rapid growth of modern society and the wide range of technological advancements, people have more opportunities to access challenging procedures, especially in the field of medicine. Technological progress in robotics and artificial intelligence provides countless future prospects for addressing current healthcare issues. Some of these challenges include population aging, an increase in chronic diseases, financial constraints, and the lack of a skilled workforce. According to Dolic, Castron & Moarcas (2019), the application of robotics in healthcare might lead to improvements in “medical diagnosis, surgical interventions, prevention and treatment of diseases, and support for rehabilitation and long-term care” (p. 7). In addition, the new digital solutions might facilitate more efficient and computerized management of work and provide continuous training for clinicians.
Considering the many benefits of AI in medicine, there is also a number of potential risks for care providers, such as the argument that technologies contribute either to solve inequalities or to aggravate them. With that said, the current research on the practical application of robotics in healthcare needs to focus on the potential risks and ethical considerations to develop further innovations and advance medical practice. The central research question driving this study is, “Does the application of the robotics technologies in the healthcare settings pose any risks to patients in terms of the ethical framework?” More specifically, the research will investigate whether implementing the robotics approach into the clinical practice is the solution for the physicians or risk towards safe and adequate patient-care delivery.
Primary Focus of the Research
This research is built upon the previously conducted studies about the successful application of robotics in various medical procedures and related risks. The research’s primary focus is the article in the Journal of Medical Internet Research by Simshaw, Terry, Hauser & Cummings (2016). It analyzes the advent of robotics in transforming industries and identifies the issues of patient safety, security, and privacy, and the effect of regulation of medical equipment and data protection legislation on robots in healthcare. It is crucial to understand the changing role of robotics in health care and identify current and future challenges to enhance related benefits and, therefore, identify vital ethical concerns of AI applications in medicine.
It is generally believed that robots have immense potential to positively change the healthcare system and its organizational structure, including hospital and home settings. A regulatory framework is crucial to understand the ways in which robots might transform. These include “highly autonomous robotic functions of medical supplies and enhanced healthcare functions performed by general personal robots” (Simshaw et al., 2016, p. 34). Current regulation of medical equipment and data protection legislation provides legal challenges for the advent of healthcare robots that have to be addressed in terms of future innovations. There is an evident need for incorporating safety measures in the evaluation of emerging medical robots because current regulations’ focus is limited to devise functionality and security. In addition, robotics in healthcare might present an exceptional growth and centralization of patient data. Therefore, the dynamic development of robotic technologies underlines the importance of regular revision of policies and practices by medical institutions. This research about the fundamental regulatory framework for medical devices and data protection is crucial for ensuring the beneficial potential of healthcare robotics and further developing core ethical considerations for their practical application.
Analysis of the Current Literature
Based on the future anticipations regarding robotics in medicine, ethical issues are highly relevant when examining the prospect of intelligent, autonomous, and human-like computerized robots that provide care for patients. However, such an innovative approach addresses the main concern about the quality of robotics healthcare and the ambiguous potential to replace the nurses and other care providers. Most importantly, the existing literature doubts whether robotics in healthcare can adequately perform the caregiver role and can be left alone with the patient. Stahl & Coeckelbergh (2016) highlight the critical ethical concerns regarding healthcare technologies, including replacement and its implication for labor and quality of care, moral agency, trust, data protection, and other safety issues. Under this study, the application of robotics in the healthcare system is analyzed within the concept of Responsible Research and Innovation (RRI) in ICT (Information and Communication Technology) in correlation with the traditional approaches. The core issues identified were the lack of cross-disciplinary education and funding structures to support the conceptual framework and technical research, which are two critical aspects to analyze ethics regarding healthcare robotics.
Another critical research is based upon the semi-structured interviews with both the clinicians and patients who were exposed to the robotics technologies treatment. Cresswell, Cunningham-Burley & Sheikh (2018) provide critical deductive components to assist in designing the research structure and remain close to the research question. They include the technological dimension, social/human dimension, organizational dimension, and macro-environmental dimension. First, one should define the increased demand for robotics in healthcare and evaluate its benefits in a variety of sectors. Dolic et al. (2019) identified the following applications of robotics for the medical areas, including “robotic surgery, care, and socially assistive robots, rehabilitation systems, and training for health and care workers” (p. 8). Accordingly, computerized technologies allow more precise, less invasive, and remote treatment and help to address the increased demands for long-term care of the aging population. Robotics also supports the patient recovery process and offers support for continuous training and lifetime education initiatives for doctors.
Ethical Issues caused by AI in Medical Practice
During the past few years, the role of AI significantly increased in diagnosing illnesses and arranging treatment patterns. As such, more sophisticated systems are well-received by many patients. In his IEEE Pulse article, Banks (2018) examines both practical and ethical implications of implementing AI and robotics in healthcare. The research states that AI technologies will be highly beneficial for patients suffering from neurodegenerative diseases, such as macular degeneration, dementia, and Parkinson’s disease” (Banks, 2018, p. 16). Moreover, healthcare robotics will significantly contribute to remote surgical assistance systems. The study also considers the issue of the great aging of the Western population, where assistive robotics is seen as the opportunity to enhance the mobility and autonomy of senior people. Banks (2018) also defines the healthcare areas in which robotics are currently used concerning elderly care:
- “mobile robotics (robotic wheelchairs),
- smart walkers to assist in patient mobility,
- personal assistant robots to help with medications and other everyday tasks,
- robotic manipulation systems for grasping objects,
- rehabilitation robotics,
- social robotics” (p. 17).
Banks’ (2018) study is a valuable source as it also considers the ethical issues within healthcare robotics practice. From an ethical perspective, people tend to be more anxious about the processes that robots perform that initially require human feelings, such as empathy and compassion. Even though humans are currently more aware of the ethical implications within the medical field, they still need to be supported with technological advancements. Furthermore, this study serves as the second central focus of this literature review because it highlights the concept of RRI, which establishes ethical reflection as a key element of the technology design process. Nevertheless, this study’s main idea is that clinicians will always remain responsible for any medical intervention since computerized systems only support doctors’ decisions. Therefore, the core ethical question is how technology developers and medical professionals will interact to develop robotic systems in a human context and facilitate ethics-oriented technological treatment.
Mental Healthcare Experience
By investigating more literature on the practical application of robotics in healthcare, one may discover more in-depth medical research regarding mental healthcare. The critical challenge the mental health sector currently faces is the attempt to address the shortcomings concerning those who require services and those who receive them. Rabbitt, Kazdin & Scassellati (2015) examine how technological innovations play a fundamental role in this conflict. To be more specific, the study is focused on socially assistive robotics (SAR) as a “particularly promising area,” which developed into several interesting mental healthcare applications (p. 35). It is important to note that, in this case of robotics research, SAR is not considered as a replacement for fully trained and skilled healthcare professionals. Alternatively, robotics are perceived as clinical tools and assistants in a broad range of medical settings. Moreover, the special challenges discussed by Rabbitt et al. (2015) involve ethical and related clinical concerns.
While it is generally perceived that mental healthcare has a considerably lower demand for robotics interventions, the current literature provides valuable insights into the crucial role that robots play in this field to promote further innovations. However, even in this relevantly narrow medical sector, robotics applications might enhance a wide spectrum of special ethical issues. Following the ideas of Rabbitt et al. (2015), potentially, one of the primary ethical concerns is “deception” despite the complete transparency of the process regarding the robot and its functions (p. 42). Those who interact with computerized technology, whether it is a doctor or a patient, might not be fully aware that a robot is a machine. Some users, including children and the elderly population, reported critical concerns by falsely considering a robot as a technological tool that has capabilities, such as emotional understanding. Consequently, patients may develop a relationship with the robot under such an incorrect belief, which is explained by ethical concern.
In practice, some robot manufacturers aim at producing highly skilled and realistic robots to enhance the likelihood. Thus, their goal is to make the robot-human interaction seem as animate and qualified as possible and closely related to reality. With that said, robots are attributed to having competencies that they lack. From another point of view, the research conducted by Rabbitt et al. (2015) states that robots are involved in the increased variations of social behaviors and properties that are realistic. As a result, this undoubtedly leads to attributions that surpass what the robots are and can actually perform. This can be seen when a child is offered to play with a robotic dog and perceives it as providing social companionship and having mental states, which makes the interaction similar to real life. The core idea implemented throughout the research implies that transparency alone is not capable of removing attributions of hypothetical qualities and characteristics of the robots. However, all the robotics-related concerns are solvable issues to address with the help of further research to deliver better quality care and intervention or provide some form of interaction.
Nursing Experience
The predominant part of the existing literature about healthcare robotics is primarily focused on its correlation with clinicians, surgeons, and patients. However, the missing point is the fundamental care delivered by nurses, which is examined by Archibald & Barnard (2017). Nowadays, nurses face some challenges in comprehending, prioritizing, and providing essential care for patients regardless of their medical condition. At the same time, the healthcare system is challenged by lacking the care caused by the shortfalls in skilled medical personnel and lack of their mobilization. Therefore, healthcare institutions incorporate technology to alleviate and solve such challenges and get the most benefit. The research highlights the crucial role of technological competency as an integral part of caring competency, where robotics serve as a necessary element of technological progress.
The vision provided by the International College of Nurses incorporates that scientific and technological advancements remain the “servant of compassionate and ethical caring” based on spiritual and emotional needs (Archibald & Barnard, 2017, p. 2480). The central focus of this study is the relevance of a broader understanding of influence integrating patient involvement and empathetic care. These are critical aspects to assure that the practical application of robotic technology coordinates with nurses’ values and forward-thinking. To sum up, it is of the utmost importance for the nurses’ professional approach to conceptualizing personal position on rapidly increasing technological innovations and fundamental care delivery.
Related Research
Other topics the research examines include the study of existing types of robots used in current healthcare, prediction of future innovations, and identification of the key robotics features that pose regulatory issues. As such, the proposed purpose of this study is to examine the current regulatory and ethical framework within which the robotics technologies function and emphasize medical device regulation and data protection laws. However, there is another significant aspect to address in terms of robotics in healthcare since they challenge our understanding of equality (Fosch-Villaronga, 2019). The intended audience engages clinicians, nurses, and patients who want to educate themselves on the current innovative approaches in the medical field and future opportunities and threats they might provide. It is also a helpful literary source for medical facilities aiming to rearrange their working strategy and improve healthcare delivery and patient satisfaction.
Conclusion
The studies conducted by Stahl & Coeckelbergh (2016), Banks (2018), and Rabbitt et al. (2015) are undoubtedly the most related to the main research question of this study. Altogether, they raise the discussion about critical concerns regarding ethical framework within the practical application of robotics on healthcare. However, understanding the issue of robotics use in healthcare settings is incomplete without learning about regulatory frameworks, mental health, nursing experiences, key challenges, potential risks, and future directions. They are the most critical aspects of integrating the use of robotics in medical practice and organizing a coherent, safe, and beneficial environment of such a technological approach to medical treatment. This literature review outlined the most relevant studies based on existing medical experience in healthcare robotics usage and internal and external dialogues with clinicians and patients. Each of the research highlighted different topics but they are all associated with addressing the existing risks in terms of an ethical framework to deliver adequate and safe patient therapy by implementing computerized robots.
References
Archibald, M. M., & Barnard, A. (2017). Futurism in nursing: Technology, robotics and the fundamentals of care. Journal of Clinical Nursing, 27(11-12), 2473–2480.
Banks, J. (2018). The human touch: Practical and ethical implications of putting AI and robotics to work for patients. IEEE Pulse, 9(3), 15–18.
Cresswell, K., Cunningham-Burley, S., & Sheikh, A. (2018). Healthcare robotics: A qualitative exploration of key challenges and future directions. Journal of Medical Internet Research, 20(7), 1–11.
Dolic, Z., Castro, R., & Moarcas, A. (2019). Robots in healthcare: A solution or a problem? Workshop proceedings. European Parliament’s Committee on Environment, Public Health, and Food Safety.
Fosch-Villaronga, E. (2019). Robots, healthcare, and the law: Regulating automation in personal care. Routledge.
Rabbitt, S. M., Kazdin, A. E., & Scassellati, B. (2015). Integrating socially assistive robotics into mental healthcare interventions: Applications and recommendations for expanded use. Clinical Psychology Review, 35, 35–46.
Simshaw, D., Terry, N. P., Hauser, K., & Cummings, M. (2016). Regulating healthcare robots: Maximizing opportunities while minimizing risks. Richmond Journal of Law and Technology, 22(3), 1–38.
Stahl, B. C., & Coeckelbergh, M. (2016). Ethics of healthcare robotics: Towards responsible research and innovation. Robotics and Autonomous Systems, 86, 152–161.