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Cross Post: Machine Learning and Medical Education: Impending Conflicts in Robotic Surgery

Guest Post by Nathan Hodson 

* Please note that this article is being cross-posted from the Journal of Medical Ethics Blog 

Research in robotics promises to revolutionize surgery. The Da Vinci system has already brought the first fruits of the revolution into the operating theater through remote controlled laparoscopic (or “keyhole”) surgery. New developments are going further, augmenting the human surgeon and moving toward a future with fully autonomous robotic surgeons. Through machine learning, these robotic surgeons will likely one day supersede their makers and ultimately squeeze human surgical trainees out of operating room.

This possibility raises new questions for those building and programming healthcare robots. In their recent essay entitled “Robot Autonomy for Surgery,” Michael Yip and Nikhil Das echoed a common assumption in health robotics research: “human surgeons [will] still play a large role in ensuring the safety of the patient.” If human surgical training is impaired by robotic surgery, however—as I argue it likely will be—then this safety net would not necessarily hold.

Imagine an operating theater. The autonomous robot surgeon makes an unorthodox move. The human surgeon observer is alarmed. As the surgeon reaches to take control, the robot issues an instruction: “Step away. Based on data from every single operation performed this year, by all automated robots around the world, the approach I am taking is the best.”

Should we trust the robot? Should we doubt the human expert? Shouldn’t we play it safe—but what would that mean in this scenario? Could such a future really materialize?

Read More »Cross Post: Machine Learning and Medical Education: Impending Conflicts in Robotic Surgery

Judges Are Paid To Express Opinions

Introduction

In a series of five harrowing judgments, the President of the Family Division, Sir James Munby, expressed his frustration with the system that endangered the life of a child who was the subject of care proceedings. He was forthright. Some of his words were quoted in the press. A headline in the Guardian read: ‘Judge warns of ‘blood on our hands’ if suicidal girl is forced out of secure care.’ ‘Why won’t NHS help?’ asked the Sun. ‘State will have ‘blood on its hands’ if suicidal teen doesn’t get hospital bed soon, top judge warns.’

While the judge’s comments seemed generally to be applauded by the media, not all were happy. Here is a typical example of a commentator who was not:

‘To use a rhetorical outburst in one case to make broader political points about the state of public services jeopardises the principle of judicial separation. In saying that there are occasions when doing right “includes speaking truth to power”, and openly condemning the lack of adequate public resources, is to leave the respected realm of judicial neutrality and to enter the political fray. Language and tone matter. Even if the diagnosis is fair, for a judge to use this tactic is, well, pretty ill-judged.’Read More »Judges Are Paid To Express Opinions

Press Release – “Vale Charlie” Prof Julian Savulescu

Vale Charlie

At some point in all of our lives, we have to let go. One can only admire Connie Yates and Chris Gard who fought so hard for Charlie.

 

However, we should continue to question the original decision, and the way in which these decisions are made. Even if it is too late for Charlie now, we should improve how we make these decisions for the future.

Read More »Press Release – “Vale Charlie” Prof Julian Savulescu

The sad case of Charlie Gard and the rights *and wrongs* of experimental treatment

By Dominic Wilkinson @Neonatalethics

 

In a blog post published yesterday, Julian Savulescu argues that Charlie Gard should have received the experimental treatment requested by his parents 6 months ago. He further argues that “we should be more aggressive about trials of therapy where there are no other good options”.

I have previously argued (in a blog and in an editorial in the Lancet) that the requested treatment is not in Charlie’s best interests. In a forthcoming paper (co-authored with John Paris, Jag Ahluwahlia, Brian Cummings and Michael Moreland), we compare the US and UK legal approaches to cases like this, and argue that the US approach is deeply flawed.

Here are four areas where I agree with Julian

  1. In retrospect, it would have been better for Charlie to have received the requested treatment 6 months ago than to have a protracted legal dispute (with continued treatment in intensive care anyway)
  2. We should generally allow patients who are dying or severely ill, without other available treatment, to try experimental treatment if that is something that they (or their family) strongly desire
  3. If experimental treatments are unaffordable in public health systems but patients are able to pay for them privately, or have crowd-sourced funding for them, they should be made available
  4. Experimental treatments should not be provided where the side effects make that treatment highly likely not to be in the patient’s interests.

However, despite these areas of common ground, I reach starkly different conclusions from Julian. In my view, the doctors were right to oppose experimental treatment for Charlie in January, the judges were right to decline the family’s request for treatment in April, and it would be deeply ethically problematic to provide the treatment now, notwithstanding the recent intervention of the US president and the Pope.Read More »The sad case of Charlie Gard and the rights *and wrongs* of experimental treatment

Oxford Uehiro Prize in Practical Ethics: The Ethical Dilemma of Youth Politics, written by Andreas Masvie

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 This essay was the runner up in the undergraduate category of the Oxford Uehiro Prize in Practical Ethics 2017

Written by University of Oxford Student, Andreas Masvie

 

The West in general, and perhaps Europe in particular, tend to celebrate youth politics as a vital force of democracy. This is reflected in the current literature on youth politics, which appears to be almost exclusively descriptive (e.g. ‘What is the level of youth politics in country X?’) or positively normative (e.g. ‘How can country X heighten engagement in youth politics?’). Various youth councils and parliaments are encouraged and empowered by government as well as civil society, both at local and national level. This is also the case internationally. The UN, for instance, demands that youth politics be stimulated: “[Such] engagement and participation is central to achieving sustainable human development.”[1] I will approach the rationale of this collective celebration as a syllogism, defining ‘youth politics’ as organized political engagement of people aged 13–25:

P1        Youth politics increases the level of political engagement;

P2        Political engagement promotes democratic vitality and sustainability; thus

C1        Youth politics promotes democratic vitality and sustainability.

In this paper I am interested in challenging P2. Does the increased political engagement due to youth politics promote democratic vitality and sustainability? For the sake of argument, I will posit the trueness of P1. When it comes to P2: it would be difficult to argue that all forms of political engagement promote democratic vitality and sustainability (e.g. authoritarian neo-Nazism or revolutionary Communism). Hence, I shall take it for granted that P2 is constrained to activities and policies compatible with democracy.Read More »Oxford Uehiro Prize in Practical Ethics: The Ethical Dilemma of Youth Politics, written by Andreas Masvie

How do medical professionals decide on treatment options for children?

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Following widespread media coverage about the court case where baby Charlie Gard’s parents were told that his life support would be removed against their wishes, Dominic Wilkinson appeared on BBC’s Newsnight to discuss the factors that doctors take into account when making such difficult decisions. Short Video Full Programme

The bright side of Brexit

Let’s suppose, entirely hypothetically and for the sake of argument, that Brexit is a disaster for the UK. Let’s suppose that sterling crashes; that foreign travel is punishingly expensive and that, if you can afford to go abroad, you’re a laughing stock. Let’s suppose that the Treasury’s estimates of billions of pounds of losses each year are reasonably accurate; that unemployment rises; that credit ratings plummet. Let’s suppose Brexit creates a corrosive tide of racism; that things that should never be said, and can never be unsaid, are shouted at high volume. Let’s suppose that there’s a torrential brain drain; that UK universities fall down the international league tables; that the innovative treatments prescribed (to private patients only, unfortunately – no money left for the NHS) by the UK’s (predominantly white) doctors are all devised in New York, Paris and Rome rather than London and Leeds. Let’s suppose that the environment, unprotected by EU legislation, is trashed, and that Scotland leaves the UK.  Let’s suppose, too, that nervousness about all this creates an increasingly authoritarian style of government .

If all that happens, it’ll be great. At least if you’re a consistent utilitarian. The horror of the UK’s experience will strengthen the EU and prevent other countries from thinking that they should leave the Union – which would have similarly disastrous results for them and, if the EU itself dissolves, tectonic consequences for the stability of the world.Read More »The bright side of Brexit

Carissa Véliz on how our privacy is threatened when we use smartphones, computers, and the internet.

Smartphones are like spies in our pocket; we should cover the camera and microphone of our laptops; it is difficult to opt out of services like Facebook that track us on the internet; IMSI-catchers can ‘vacuum’ data from our smartphones; data brokers may  sell our internet profile to criminals and/or future employees; and yes, we… Read More »Carissa Véliz on how our privacy is threatened when we use smartphones, computers, and the internet.

Veterinarians and the best interests of animals

By Charles Foster

English law has traditionally, for most purposes, regarded animals as mere chattels. There is now animal welfare legislation which seeks to prevent or limit animal suffering, but provided that legislation is complied with, and that no other relevant laws (eg those related to public health) are broken, you are free to do what you want with your animal.

Veterinary surgeons are in an interesting position. The UK regulatory body for veterinarians, the Royal College of Veterinary Surgeons (‘RCVS’) publishes a Code of Professional Conduct. This provides, inter alia:

‘1.1  Veterinary surgeons must make animal health and welfare their first consideration when attending to animals.’

‘2.2  Veterinary surgeons must provide independent and impartial advice and inform a client of any conflict of interest.’ 

‘First consideration’ in 1.1 is a rather weasly formulation. Does it mean that it is the overriding consideration, trumping all others, however weighty those others might be? Or the one that veterinarians ought to consider first, before moving on to other criteria which might well prevail?Read More »Veterinarians and the best interests of animals