Virtual Reality or Virtual Mortality? Should VR (Virtual Reality) be used to aid medical and surgical procedures?

Group 18

Virtual Reality (VR) has revolutionised the manner in which humans visualise, adapt and interact with simulated environments and its applications within the field of healthcare has extended from student medical training to pseudo surgical collaborations. Medicine can be envisaged as a balance of trade-offs, where the benefits associated with implementing this pioneering technology to drive improvements in patient welfare are offset by the risks of physical desensitisation, patient data privacy and the excessive costs. Is it ethically acceptable to employ standard VR practices throughout the NHS that is intrinsically grounded upon providing the great of good and welfare to patients, with the avoidance of misapplication and ill health?

Virtually the next medical marvel…

Current VR technology is generating benefits that could transform the way medical professionals and patients experience healthcare. The use of Microsoft HaloLens is advancing the field of VR by overlaying CT scans of the patient over their body. Surgeons can “see” patient’s unique anatomy and can navigate away from important structures when making incisions. In other areas, an emerging technique at Alder Hey Children’s Hospital incorporates CT and MRI scans, creating a virtual image of an infant’s heart in which doctors can explore, enabling a more accurate diagnosis of the problem prior to surgery. This will reduce the need for exploratory surgeries, in aim of increasing the diagnosis success rate and reducing the need for subsequent corrective operations.

The foremost practicality behind employing simulated operations is the availability for the surgeons to train within safe and controlled environments at no harm to the ‘patient’ or surgeon, improving dormant and acquiring new transferable skills, whilst building confidence due to the repetitive nature. The advantage of a systematic training platform such as ‘OssoVR’ ensures all doctors can perform independently, as the lack of training in current graduates means that 30% of junior doctors cannot perform individually. In addition, this universal platform regulates medical training to the same standard at an accelerated educational progression. The ability to record and map surgical procedures from multiple standpoints into a platform allows students to envisage all roles within the operating team, without posing risks from being present.

The emerging use of VR can bring together surgeons from around the world to operate on patients, as proven when surgeons from Mumbai and London simultaneously wore headsets appearing live in the same operating theatre at The Royal London Hospital; each pointing to 3D scans appearing as holograms and engaging in discussion. The use of VR in this manner is arguably democratising surgical practices, as it does not limit insight only to those present in theatre. Of more importance to global development, its use in this sense could be used to improve accessibility and equality in healthcare globally.

Based on the theory of Utilitarianism, when various methods of treatment are available, the patients’ welfare and wellbeing should be paramount as actions should always be taken to consequently result in ‘the highest quality of happiness’ and it is morally eudemonistic to consider the welfarism of all. Utilising this technology should not be limited as it produces the greatest good for the greatest number, with the avoidance of misapplication. 

Kant’s theory argues that moral decisions should be made based upon universal principles. If the action in question here is allowing VR to be used in surgical procedures and enhancing medial training, this action ultimately improves patient welfare and may result in better global equality. It would be hard to argue against improving standards of living and improving healthcare globally as being morally correct, therefore it is our moral duty to allow VR to be introduced into relevant surgical procedures.

Beyond a surgical reality?

Based of virtue ethics, it can be argued that the use of VR in medical/surgical procedures is unethical. The modern theologian James F Keenan suggests that an important virtue is justice and that ‘justice requires us all to treat human beings equally and impartially’. The problem with VR is that ‘technical difficulties mean some physical findings such as skin colour cannot be taught in simulators’. This may lead to the unequal availability of treatment for different patients. For example, someone with white skin may have access to state-of-the-art VR technology treatments whereas people of other races would have no choice but to be treated by traditional methods.  

The increasing use of VR in the assistance of the practice of assisting medical students is increasing the likelihood of defective learning. As the systems are manufactured, the programme could miss out vital signs in the simulation. This could lead to students potentially neglecting potential life-threatening signs of an illness/disease within the body. Also, the use of VR may encourage shortcuts when dealing with an ill patient. Based on the theory of care ethics, doctors/surgeons should understand the importance of building a relationship with the patient. However, with the use of VR, the development of understanding how to build a patient-medic relationship may be omitted; instead VR may encourage the development of an artificial relationship rather than one that is genuine. Defective learning may also encourage shortcuts, such an omitting patient consent and abiding by safety procedures.

The practicality of using VR must also be addressed; a common reason for using VR within surgery is for real-time broadcasting, allowing the global medical community to observe. However, most operations can take anywhere up to 18 hours each time, so battery life of VR systems becomes very problematic; Google Glass’s battery life is limited to around 30 minutes when videoing and Microsoft HoLolens has a battery life of just 2.5 hours. The additional pressure of changing a VR system mid-operation could become very problematic and potentially life threatening.

Introducing VR into hospitals and operations will require the implementation of specialised consent forms and new laws and regulations. These forms with new patients that had yet received treatment and with the addition of VR, this would take a substantial amount of time ensuring that the patients understand how the technology is utilised. Introducing VR will eventually lead to lengthy ethical discussions with a multitude of people including: physicians, developers and patients.

Initial Decision

As described in the preceding article, it can be argued ethically that the benefits of improving surgical training and success rates outweigh the reasons against VR implementation of defective learning and manufacturing flaws. This topic is contentious and targets the traditionalist outlook, however our verdict lies upon the Utilitarianism theory which ensures the great of good to a large number of people. We therefore ask for your opinion, should VR be employed throughout NHS surgical and medical procedures?

55 thoughts on “Virtual Reality or Virtual Mortality? Should VR (Virtual Reality) be used to aid medical and surgical procedures?

  1. Although I think VR may play an important role in the future, my worry would be when we use more machines we start to treat humans as such, and problems may arise

    1. Hello b5013387,

      VR is set to revolutionise the healthcare industry and I see your point about treating humans like ‘virtual’ robots without any compassion or empathy for the outcome. I can add to this by saying that when students practice in VR on virtual humans without any physical harm, this could in fact replicate to real life situations, a huge ethical dilemma. Thank you for your comment!

  2. An interesting topic. While I can see the benefits, it seems like the worries about technical difficulties and the breakdown of the personal relationships between healthcare professionals and patients is an ethically important issue. Therefore I think there are serious concerns in its use in procedures.

    1. Hello Natasha,

      Which benefits would you think seem the most viable for implementation into the VR market? Although the technical breakdown aspect is foremost worrying, I believe with substantial R&D into this technology over the next few years would eradicate the risk to as low as possible. Risk is never completely avoided so the risk is to be taken, but this is inherent to everything anyway. Thank you for your reply.

  3. Interesting article. I think using VR to train surgeons who are new to the field could be extremely useful, however it is important to note that it will never perfectly replicate reality which could be a shock to some when they perform real operations and possibly have an adverse affect on quality.

    Also it is important to realise the high monetary cost associated with VR. With the constantly reducing NHS budget, would this be diverting funds from other areas of the service? This could cause an ethical dilemma if so.

    1. Hello Jim,

      The replication of reality is the comment on this industry which is most prevalent and a reasoning I have ground my arguments upon heavily for physical desensitisation. The lack of physical training and feeling when operating on cadavers I believe is paramount and should not be avoided at any costs, where VR can be at use during surgery when the patient agrees. Resources would inevitably have to be diverted also, something a cost benefit analysis could improve. Thank you for your comment!

  4. Problems stated about the uses of VR seem to be mainly centred on technological issues, ethical issues such as VR not being as effective on patients who aren’t white skinned, or not fully reproducing a “real life” surgery go away with improvements to the technology. I would therefore suggest using those arguments as justification to not use VR in surgeries and surgery training are actually counterproductive since it is only by adopting and improving the technology that the issues can be addressed.

    It is also important when considering tools for training surgeons that there is no way to replicate a live surgery without actually making the student perform real surgery on real patients which given the risks associated seems highly unfavourable compared to the low risk of using VR. Perfect is the enemy of the good, etc etc

    1. Hello RJN,

      The technology aspect is something which is being developed by R&D in the NHS and this can only possibly be brought about by diverting resources or external investment/subsidy. The technology should be proven to be advantageous before this is available, therefore I agree with your comments. Thank you for your comment.

  5. Really interesting article. There are definitely some advantages to implementing this technology. I’d suggest that Utilitarianism isn’t the best ethical theory to follow because in the attempt to achieve the greatest good for the greatest number there is potential to lose the personal connection between Surgeons and patients due to an impersonal process. Also, Utilitarianism ignores the rights/ needs of minorities and it could lead to unethical decisions being made in order to satisfy the masses.

    1. Hi Sam

      Interesting thoughts about utilitarianism, if you don’t believe this is the best ethical theory to follow what theory do you believe is? In reference to your point about how it may be unethical to pursue with VR if it doesn’t satisfy the needs of minorities, in reality, most technologies don’t necessarily suit everyone. So contradictory, it may be better to satisfy the needs of the majority where possible, over not imploying the technology at all.

      Thank you for your comment!

    2. Hello Sam,

      Utilitarianism may not be the best ethical theory on reflection, therefore a deeper understanding of medical ethics such as autonomy and principilism have been investigated. Your comments very much back up our initial judgement which we concur with to this date. Thank you for your comment!

  6. VR is taking us forward in construction, from allowing clients to walk through their buildings before they are built to practicing intricate construction techniques. Sounds like the medical profession has similar opportunities and I think the NHS should grasp them. Yes there are risks – there are risks with everything – but they can be managed and on the whole we will benefit.

    1. I agree that the NHS should grasp such opportunities as other industries are implementing such technology. Therefore, in order for health care procedures to remain technologically up to date it is important that VR technology is pushed within the NHS.

  7. From the introduction, I wasn’t clear on the benefits of using VR in surgery. However, these benefits were made clear in the next section.

    I wasn’t fully convinced of the ethical reasoning against using VR – something to develop in assignment two.

    1. Hello Patrick,

      Thank you for your comment. A summary of the main ethical concerns of VR technology usage involves the cost, discrimination and defective learning. Such high costs means a large amount taxpayers money most go towards the technology which would only be fair if it was a guaranteed benefit. Furthermore, the technology is only programmed to certain skin types meaning patients cannot all receive equal treatment. Finally, defective learning is a worry as any faults in the technology are going to be passed onto medical students meaning such problems are likely to re occur.

  8. A topic that has such relevance to so many industries in the current climate. Whilst I can see many benefits to the application of this technology, something I wish could have been pursued for some of my recent hospital visits, the disadvantages to the patient are significant and the emotional connection can be lost. In addition, the breakdown of VR could lead to potentially fatal applications of the headset and large law implications could be pursued by the victim if there are difficulties in the operation, a strong ethical foothold.

    1. Hello 0770Andrew

      Thank you for your comment. I agree that the use of VR would be useful within medical procedures and I also agree that VR has serious disadvantages due to the robotic like behaviour that medicinal professionals may adapt. However, I would like to acknowledge that the breakdown issues, although today that is problematic; after increasing research and development of VR within the medicinal field these issues could eventually be resolved. Thank you again for your comment.

  9. This is a really exciting prospect for medicine! It’s amazing that we are finding new uses for technology every day that will increase quality of life for so many people.

    I would argue that human life should be protected at almost any cost, but with the increasing pressure on the NHS budget for example, would the benefit of these new technologies be worth the cost of installing such high-tech new equipment? Is the the benefit widespread enough to justify the investment? Could it lead to potential cutbacks in other areas, potentially more generalised departments, or potentially lead to higher costs to patients to help subsidise?

    I hope not because it sounds really great!

    1. Hello mea15gf

      Thank you for your comment. I also believe that the costs, upon the current climate for the NHS may, at this point, be too much of a large investment. However, I believe as research and development progresses further and VR becomes produced on a wider scale, this will result in a price reduction. Therefore, with a reduced cost, VR within medicinal procedures may become more affordable. So I agree that, at the moment, it may not be economically viable but, in the future it could be easily implemented into the NHS.

  10. I regrettably find myself concurring with ‘RJN’ above. Technology only improves with increased usage, ‘ironing out the kinks’ so to speak. While the ‘ethics problem’ is intertwined with advances in medicine – and in this case, medical technology, I believe it lacks sufficient weight here; surgeons aren’t entering the matrix, and we’re not altering genetics to create the perfect human. At most, using VR in surgery is supplementary.

    My only issue, as mentioned above, would be using VR as a crutch, relying on it to the extent that doctors and surgeons become complacent and forgetful of their own knowledge. However, as this is unlike to be the case, ‘to infinity, and VR!’

    1. Hello SDC,

      Its nice to see that people do agree upon most of the topics surrounding this area of the NHS regarding high monetary investments. The ‘crutch’ idea is useful as it allows the patient to have some autonomy about its use on them during surgery, although what would could be done in undergraduate training? Thank you for your comment.

  11. VR is set to inevitably create a completely new future in engineering and many frames of industry for our youth, with the integration of AI. Despite the significant impact such technology could create, the treatment of patients who may have life-threatening illnesses would be potentially favoured for the ‘improved’ surgical environments, probably providing inequality to patients who could benefit from such technology too and may miss out if VR is not laid out across the whole industry. In addition, the problem of patient mistreatment due to the software interface may lead to loss of emotion and connection between surgeons and patients.

    1. Hi Jeff

      Although there may be inequality as the technology is initially rolled out, it is hoped that as we move into the future, VR will be available across the whole industry. A care ethics approach on this issue, as you mention the problem with loss of emotion and connection, is used as one of the greatest ethical arguments against the implementation of the technology. If the profession is aware of this prior to implementing the technology, I would hope to see a drive to ensure that professionals maintain personal relationships with their patients, in the aim of avoiding this issue.

      Thanks for you comment!

  12. Really good read with lots of interesting points! I think that in the everlasting search for medical improvement it is a must to develop this technology. If VR can help to improve just one person’s life then it is has been worthwhile.
    In the current crisis that the NHS faces with understaffing, VR offers an opportunity to cut teaching costs and give junior doctors and students access to technical training that is just not possible in the current climate.

    1. Hi Andy

      Thanks for your comment. There is a definite opportunity for the NHS to revolutionise its training practices by employing virtual reality. An in-depth cost analysis would be able to verify if teaching costs could be cut, despite current high implementation costs. Prices should fall over time as the technology is developed, therefore, we can be hopeful to see this in training practices in the future.

  13. On initial judgement, I disagree with the initial decision. Before ethics can even be considered, as mentioned above, the NHS is not in its best of forms currently with money being very tight. I doubt the public would approve of such funding into a concept. Maybe it could take off in the private sector where the money isn’t so tight?

    1. Hello sg_academy,

      I completely agree with the resource allocation aspect of this argument. The NHS isn’t in the best of situations currently and trying to implement such a high monetary investment to such VR technology can have bad public perceptions. Considering the private sector, this is a valid point although outside the scope of this report. Thank you for your time!

  14. An excellent article with some very interesting points. The article does explain how ethical issues with VR are complex in this current climate. However, overall if it’s going to improve the well-being and lives of medical patients then it’s worth pursuing. Other benefits which include helping to train junior doctors also makes the prospect and exciting one.

    1. Hello ERS

      I very much agree that using VR to train junior doctors is hugely beneficial; less money will be spent on training with medicinal professionals. However, this cost reduction may be overseen as the price of implementing VR may be too expensive for the NHS to afford giving the current financial circumstances.

  15. An interesting article that nicely lays out both sides of the debate.
    The healthcare community is a global one that drives innovation and continuous improvement – as such we must accept that technology such as VR is here to stay.
    Whilst it’s role in doctor training has obvious advantages I don’t think that we have yet reached a place where it can replace the human interaction – patients want a dialogue with their physician and respond better when they do. However if VR can reduce mistakes, enhance training then coupled with good people skills health outcomes should improve.

    1. Hi paul,

      Thank you for your comment. I very much agree that patients still want a dialogue with their physician and respond better when they do. However I believe you are correct in saying we must accept VR technology as it may lead to better health care outcomes. For this reason it is important that VR technology is developed and improved to over come the ethical problems it may cause rather than dismissing the technology all together.

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