Does the promotion of remote surgery actually benefit us?

Group 9

Introduction

Nowadays, robotic arms have been widely developed in the field of medicine. And with the development of telecommunication technology such as optical fibre, it is possible to perform remote surgery, surgeons can control robotic arms that allow patients to be treated far away without spending a lot of time travelling. Although the field of remote surgery is mature and has had several successful attempts, there are still many limitations, for example, some people may not be able to afford the expensive fees. This article will discuss the feasibility of remote surgery and whether it should be widely used.

Remote surgery enables more people to benefit

The exploration of remote surgery is a topic that is being explored by physicians worldwide. The journal EClinicalMedicine reports that on 3 September 2019, at the Apex Heart Institute in Ahmedabad, India, physicians relying on an interventional robotic platform performed successful percutaneous coronary intervention (PCI) procedures on five patients diagnosed with coronary artery disease (CAD) at a research centre 20 miles from the catheterization laboratory. All five patients met the primary study endpoint of whom all achieved the primary study endpoint of a successful surgery and no major adverse cardiac events (MACE) prior to discharge. The success of this study has been described as a milestone for the future of remote interventional medicine. On 13 January 2021, the R-One robot developed by the French company Robocath performed Europe’s first remote robotic-assisted coronary angioplasty, spanning 75 miles between two sites. Professor Rémi Sabatier said that the original intention of the remote surgery was to address the differences in the level of care for cardiovascular disease due to differences in place of residence.  This way reflects an ethic of care for patients in poorer areas and can help patients to get better access to treatment. At the same time, it is a virtue ethical way of promoting remote surgery that focuses on the patients themselves. In Europe, even though it is clear that coronary angioplasty is a better option for patients than fibrinolytic therapy, 40% of heart patients are still not treated with coronary angioplasty because of the length of time it takes to get to an interventional cardiology centre. With a range of geographical, structural and economic factors that make it difficult to improve access to treatment contributing to the cardiovascular disease being the number one cause of death worldwide, the exploration of remote surgery is a subject that is being explored by doctors worldwide.

Universal access to remote surgery satisfies the utilitarian view of the greatest happiness of the greatest number. The current uneven distribution of medical resources across regions includes the developed world and is particularly acute in developing countries. Universal access to remote surgery can help the greatest number of patients to receive the best possible treatment.

All patients should have the best possible healthcare,  supported by Kant’s theory. The central tenet of Kant’s theory is good will, and the premise that remote surgery can be a universal treatment option is that it is already safe and feasible. Mahmud et al. have demonstrated through clinical trials that PCI and Robotic-assisted PCI have comparable clinical success rates (100% and 98.8% respectively), demonstrating that robotic-assisted PCI is feasible and safe in the treatment of more complex conditions. Thus, being able to ensure that it is safe and feasible, remote surgery could be a treatment option for all, helping all to overcome the limitations of geography and other factors.

The limitation of remote surgery

According to a US study, the number of robotic surgical errors increased by 103 cases between 2006 and 2012, in the simplest hysterectomies, 26% of people suffered injuries and 8.45% died. When robotic surgery goes awry, it is often difficult to identify who is responsible for the error. The circumstances of every medical incident can be different. Some accidents are caused by machine failure, others by doctor’s operation. Because of this, medical errors caused by robots can become quite complex and involve too many organizations. As a result, some people can escape their responsibilities more easily through legal loopholes.

This action is clearly against good will and does not conform to the definition of Kantian theory. According to Kantian principles, everyone should follow certain moral and legal rules. For an action to be allowed, it must be possible to apply to all without a contradiction occurring. Different from traditional surgery, the process of remote surgery involves a large number of mechanical devices such as robotic arms. Although these mechanical devices sometimes enable doctors to better fulfil their duties, once a medical accident occurs, it often takes a lot of effort to find out the cause of the medical accident, Doctors can use this factor to place some of their own responsibility on mechanical devices, which in turn makes them less responsible for their own responsibilities, this is a clear contradiction to what these robotic arms are designed for. Another problem is that a set of remote surgery robots would cost around $2 million and some of the robotic arms are disposable which means it would cost more on replacing the components. On the other hand, the teaching cost of how to operate machines and the annual maintenance cost cannot be ignored as well. This made the remote surgery cost $3000–$6000 more than the traditional surgery. However, the average median class salary in the US in 2021 was about 62000$ per year, this is only the paper data, considering the US social problems such as losing jobs and the crime rate the actual salary would be much less than the theoretical data. As a result, the majority of the population would not have the chance to do such expensive and difficult surgery in their lifetime.  If remote surgery is promoted, only the rich would benefit from it, whereas most people such as the median class cannot benefit from remote surgery due to the high cost. This is the opposite of utilitarianism, where the decisions made must benefit the majority of people.

Initial Decision:

Remote surgery is worthy to be promoted.

7 thoughts on “Does the promotion of remote surgery actually benefit us?

  1. I agree with your idea that remote surgery is worthy of being promoted. Today’s healthcare resources are inequitably distributed, a problem that the epidemic has amplified. Telemedicine, including telesurgery, may be an effective way to address this issue. Your discussion makes reasonable use of the ethical perspective. Additionally, the entire argument is rigorous. Support!

  2. Remote surgery is indeed a promising technology, and overcoming its low success rate compared with other operation modes is key at this stage. As I concerned, the cost problem will be improved with the development of materials and communication technology in the future.

  3. Remote surgery is indeed a very interesting topic. At present, there is an uneven distribution of medical resources and the level of medical care varies from region to region, so using this technology could alleviate or even solve this problem to a certain extent, and in the future it may also reduce the cost of surgery to a great extent and thus reduce the cost of surgery for patients. Even though there is still the possibility of errors with the current technology, I believe that when the technology matures, remote surgery will have a very good future, just like the current L3 autonomous driving technology.

  4. Remote surgery is clearly effective for patients who are in a hurry to get to a more advanced hospital because of the lack of time. At the same time, the promotion of remote surgery is in line with utilitarinism, because areas with low-level medical care are the majority in a country, and the promotion of remote surgery has brought a lot of happiness to patients in these areas. Although the safety of patients is difficult to guarantee to a certain extent, as a medical method, telesurgery is worth promoting.

  5. Remote surgery is a very good topic as I believe it will become mainstream in the near future. This article does a very good job of presenting the pros and cons of remote surgery. The ethical view Tina uses is very correct. The remote surgery can bring hope to poor areas and areas where medical resources are scarce. I hope that we can analyse more of the advantages and disadvantages of remote surgery from other perspectives.

  6. The article clearly describes the advantages and disadvantages of tele-surgery as a therapeutic approach. Owing to the inequities in the level of medical care in today’s world and the uneven distribution of medical conditions, certain patients suffering from serious diseases who need urgent medical treatment cannot be effectively treated locally. The use of remote surgery offers the possibility of saving the patient. From the point of view of egoism and Kantian theory.
    But for the average person, remote surgery is not only expensive, but also far less likely to be successful than the surgeon himself. So I don’t think there’s much chance of the technology being accepted by the masses right now. However, as the target technology improves, the success rate and cost of surgery are bound to rise. The application of remote surgery is very promising.

  7. Feedback
    1. Clarity of problem/dilemma
    Clearly stated dilemma in the opening paragraph with an advantage and disadvantage given. I suggest that may be a bigger disadvantage is that remote surgery might be more error-prone?

    2. Use of ethical theories in the For Case
    Mentioning care ethics is interesting. The first issue is what relationship are you looking at. I’d suggest it’s the relationship between surgeon and patient – is that affected now that a robotic device, albeit controlled by the surgeon, is being used? Good use of the other theories.

    3. Use of Ethical theories in the Against case
    In the against argument, bring in care ethics as the use of robotic surgery could affect the relationship between surgeon/hospital and patient/patient’s family.

    4. Advice on Assignment Two
    a. Identifying stakeholders
    b. Courses of action
    Apart from the obvious stakeholders, the developers of the robotic technology are also stakeholders.
    For courses of action have a look at win-win as the technology is now being used.

    5. Personal remarks
    The key question for us all is this: “Are you happy to undergo robotic surgery?” The chance of success is 98.8%, which seems great, but as it’s you ‘under the knife’ do you focus on the 1.2% instead? If you answer ‘No’, then that tells you that Kant’s theory opposes it.

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