We are living in the digital world where artificial intelligent (AI) is increasingly prevalent in our daily life. By feeding in huge amount of data, AI enables machine or computer programs to “learn”, analyze and perform complicated task independently. Healthcare is one of the sectors where AI can be fully utilized on various platforms such as administration and medical diagnosis. Current applications of AI in healthcare include detecting cancerous tumors, neural abnormalities and cardiovascular abnormalities in patients as well as distinguishing high-risk leukemia patients. Now, researchers are looking into implementing AI in the surgical field, but at the same time many ethical questions and concerns were raised.
Positive ethical arguments for autonomous AI surgeons
Currently, there are already many cases of successful AI implementation in surgical procedure including the robotic eye surgery by PRECEYES and robot-assisted super-microsurgery by MICROSURE. From these positive outcomes, it is suggested that aid of AI improve surgeons’ performances, where technical difficulties (small, precise hand movements) and physical limits (performing difficult operations for long hours) could be overcome. These not only benefit the surgeons, patients could enjoy a faster recovery and shorter hospitalization – minimizing the crisis of bed shortage in hospitals. AI robotic surgeons were also proved to outperform human professional in both diagnosing disease and performing surgical procedures in a more accurate and precise manner – which is crucial when it concerns life and death. Utilitarianism argues that we should follow the act which will result in greatest net increase in happiness. So, although massive data is required for successful implementation of AI, this could be offset by the great increase in efficiency of surgical performance – which is definitely the desirable outcome for the majority stakeholders including patients, surgeons and hospitals.
Various emergencies may occur during surgery and any possible outcomes highly depends on the critical immediate decision of the surgeon. However, a human’s moral compass is influenced by the seven emotions. From the virtue ethical perspective, it is difficult for a human to act rightfully virtuous consistently in their life compared to an AI robot, which can be programmed to “learn” the “ideal ethical principle” to effectively become more virtuous than humans themselves. It is especially difficult for a surgeon to control their emotions when facing some ‘exceptional’ patients. According to Surgeon Paul A. Ruggieri, he was once asked to operate someone who just killed his wife .Inthis case, he appeared to be devoid of any feelings, but he said ‘I wanted him to die’. Surgeons work in a VUCA (volatile, uncertain, complex and ambiguous) environment, so it is difficult to ensure that every surgeon can handle the conflict between personal emotions and the scalpel well. AI surgery robots however, without personal bias can treat patients as equals completely, which block out any outside interferences.
Negative ethical arguments for autonomous AI surgeons
Implementation of AI in surgical procedure may provide many benefits to the surgeons. However, how about the patient’s right to privacy who require to share their data? Data is the oxygen of AI. AI works as you must initially feed in massive data for it to “learn” and perform optimally. They require data to train algorithms so that the surgeries can be performed accurately, as any programming errors could harm the patient’s life. Kant argues that we should respect the autonomy of others, treating them as ends in themselves and not as means to an end. The use of AI has neglected the Kant’s ethical theory, as it could violate the patient’s data privacy and protection. Are you sure that the data are stored securely? Who has the access to them? AI does not respect the autonomy of others when patient’s privacy is compromised as their personal data collected are used in means to an end to further the organization’s self-interest. According to a consumer survey performed by Accenture in 2018, 23% of patients indicated that they would not use AI tools since they are not willing to share their data. AI technology has been a nightmare among patients who are concerned about their privacy and security due to the higher risk of cybercrime and loss of data.
Besides, cost of implementing AI in autonomous robotic surgery is very high. Although the price is currently unspecified, it is estimated that medically approving a partially autonomous medical robot with the Food and Drug Administration (FDA) will take around $94 million and 54 months to process. The overall cost to develop an autonomous medical robot will definitely be much higher, and this price will reflect on a patient’s surgical costs. Not many people will be able to enjoy this privilege, especially when it is reported that 83% of the world population in 2017 has low and middle-income range and may not be able to afford it. This would contradict the original intentions of the development of AI for medical surgeries in terms of utilitarianism, as only a small part of the world population will benefit from it and not all hospitals can purchase and use AI robots for medical surgeries due to limited funding.
From the virtue ethical point of view, it is unknown whether the intentions of the programmer of the AI is rightfully virtuous. Regardless of whether medical doctors are involved during the process, the risk of the AI being programmed to be biased towards monetary gains for hospitals will lead in negative implications, such as death of patients. Aside from putting medical surgeons out of jobs, the use of AI in autonomous robotic surgeries may also lead to skills decay among surgeons due to lack of practice, resulting in dangerous situations in cases where the AI robot failed and had to be taken over by a human surgeon.
The use of AI in medical surgeries is deemed practical, especially from a technical perspective. As engineers who strive to apply scientific knowledge to meet social needs, we would recommend the development of AI use for medical surgeries. If moral values and ethics can be defined, it is possible that one day ethically aligned AI system can be developed to counterpoise existing ethical concerns.