The Ethics of Medical AI and the Physician-Patient Relationship.

This article considers recent ethical topics relating to medical AI. After a general discussion of recent medical AI innovations, and a more analytic look at related ethical issues such as data privacy, physician dependency on poorly understood AI helpware, bias in data used to create algorithms post-GDPR, and changes to the patient-physician relationship, the article examines the issue of so-called robot doctors. Whereas the so-called democratization of healthcare due to health wearables and increased access to medical information might suggest a positive shift in the patient-physician relationship, the physician's 'need to care' might be irreplaceable, and robot healthcare workers ('robot carers') might be seen as contributing to dehumanized healthcare practices.

Regulating Child Sex Robots: Restriction or Experimentation?

In July 2014, the roboticist Ronald Arkin suggested that child sex robots could be used to treat those with paedophilic predilections in the same way that methadone is used to treat heroin addicts. Taking this onboard, it would seem that there is reason to experiment with the regulation of this technology. But most people seem to disagree with this idea, with legal authorities in both the UK and US taking steps to outlaw such devices. In this article, I subject these different regulatory attitudes to critical scrutiny. In doing so, I make three main contributions to the debate. First, I present a framework for thinking about the regulatory options that we confront when dealing with child sex robots. Secondly, I argue that there is a prima facie case for restrictive regulation, but that this is contingent on whether Arkin's hypothesis has a reasonable prospect of being successfully tested. Thirdly, I argue that Arkin's hypothesis probably does not have a reasonable prospect of being successfully tested. Consequently, we should proceed with utmost caution when it comes to this technology.

Tumor diameter accurately predicts perioperative outcomes in T1 renal cancer treated with robot-assisted partial nephrectomy.

PURPOSE: To compare diameter as a continuous variable with categorical R.E.N.A.L. nephrometry score (RNS) in predicting surgical outcomes of robotic partial nephrectomy (RPN). METHODS: We retrospectively reviewed consecutive patients receiving RPN at our institution between July 2007 and June 2014 (n = 286). Three separate multivariate analyses were performed to assess the relationship between RNS components (R = radius, E = endophyticity, N = nearness to collecting system, L = location relative to polar lines), total RNS, and diameter as a continuous variable with operating time, warm ischemia time (WIT), and estimated blood loss (EBL). Each linear regression model's quality of fit to the data was assessed with coefficients of determination (R 2). RESULTS: Continuous tumor diameter and total RNS were each significantly correlated to operative time, EBL, and WIT (p < 0.001). Categorical R related to operative time (R = 2 vs. R = 1, p = 0.001; R = 3 vs. R = 1, p = 0.001) and WIT (R = 2 vs. R = 1, p = 0.003; R = 3 vs. R = 1, p = 0.016), but not to EBL. For each of these outcomes, diameter outperformed both R and total RNS, as assessed by R 2. Age, body mass index, Charlson Comorbidity Index, and anterior versus posterior location did not correlate with surgical outcomes. CONCLUSIONS: In this series of RPN from a high-volume center, surgical outcomes more closely related to tumor diameter than RNS. While RNS provides surgeons a standardized tool for preoperative planning of renal masses, tumor size may be employed as a more familiar measurement when counseling patients on potential outcomes.

Domesticating the Drone: The Demilitarisation of Unmanned Aircraft for Civil Markets.

Remotely piloted aviation systems (RPAS) or 'drones' are well known for their military applications, but could also be used for a range of non-military applications for state, industrial, commercial and recreational purposes. The technology is advanced and regulatory changes are underway which will allow their use in domestic airspace. As well as the functional and economic benefits of a strong civil RPAS sector, the potential benefits for the military RPAS sector are also widely recognised. Several actors have nurtured this dual-use aspect of civil RPAS development. However, concerns have been raised about the public rejecting the technology because of their association with military applications and potentially controversial applications, for example in policing and border control. In contrast with the enthusiasm for dual-use exhibited throughout the EC consultation process, the strategy for avoiding public rejection devised in its roadmap would downplay the connection between military and non-military RPAS and focus upon less controversial applications such as search and rescue. We reflect upon this contrast in the context of the European agenda of responsible research and innovation. In doing so, we do not rely upon critique of drones per se, in their neither their civil nor military guise, but explore the extent to which current strategies for managing their public acceptability are compatible with a responsible and socially beneficial development of RPAS for civil purposes.

A review on legal issues of medical robots.

This paper examines the legal challenges associated with medical robots, including their legal status, liability in cases of malpractice, and concerns over patient data privacy and security. And this paper scrutinizes China's nuanced response to these dilemmas. An analysis of Chinese judicial practices and legislative actions reveals that current denial of legal personality to AI at this stage is commendable. To effectively control the financial risks associated with medical robots, there is an urgent need for clear guidelines on responsibility allocation for medical accidents involving medical robots, the implementation of strict data protection laws, and the strengthening of industry standards and regulations.

[Do androids need a legal status?]. / Vers un statut juridique des androïdes?

The existence of the subject of law is not an automatic allocation when the will and the autonomy are awarded, but a tool conferred by the legal system in order to protect the humanity (based on the presupposition of a consciousness that the human being remains to be the only one to have and to suppose at the others). He cannot involve thus of reducing the question of the status of the android to the simple recognition of an intelligence, besides artificial, but of denying the reasoning by analogy any real impact for the existence of a legal status. If specific status there would be, it will be only because the human being will have decided on it for his own legally protected interest. The status of the android will be metonymical, by inclusion in that of the human person, or will not be.

[Robots and intellectual property]. / La propriétê intellectuelle et les robots.

This topic is part of the global issue concerning the necessity to adapt intellectual property law to constant changes in technology. The relationship between robots and IP is dual. On one hand, the robots may be regarded as objects of intellectual property. A robot, like any new machine, could qualify for a protection by a patent. A copyright may protect its appearance if it is original. Its memory, like a database, could be covered by a sui generis right. On the other hand, the question of the protection of the outputs of the robot must be raised. The robots, as the physical embodiment of artificial intelligence, are becoming more and more autonomous. Robot-generated works include less and less human inputs. Are these objects created or invented by a robot copyrightable or patentable? To whom the ownership of these IP rights will be allocated? To the person who manufactured the machine ? To the user of the robot? To the robot itself? All these questions are worth discussing.

Liability exposure for surgical robotics instructors.

Surgical robotics instructors provide an essential service in improving the competency of novice gynecologic surgeons learning robotic surgery and advancing surgical skills on behalf of patients. However, despite best intentions, robotics instructors and the gynecologists who use their services expose themselves to liability. The fear of litigation in the event of a surgical complication may reduce the availability and utility of robotics instructors. A better understanding of the principles of duty of care and the physician-patient relationship, and their potential applicability in a court of law likely will help to dismantle some concerns and uncertainties about liability. This commentary is not meant to discourage current and future surgical instructors but to raise awareness of liability issues among robotics instructors and their students and to recommend certain preventive measures to curb potential liability risks.

Drones--ethical considerations and medical implications.

Drones enhance military capability and form a potent element of force protection, allowing humans to be removed from hazardous environments and tedious jobs. However, there are moral, legal, and political dangers associated with their use. Although a time may come when it is possible to develop a drone that is able to autonomously and ethically engage a legitimate target with greater reliability than a human, until then military drones demand a crawl-walk-run development methodology, consent by military personnel for weapon use, and continued debate about the complex issues surrounding their deployment.

Medicolegal review of liability risks for gynecologists stemming from lack of training in robot-assisted surgery.

The advances in robot-assisted surgery in gynecology evolved after most practicing gynecologists had already completed residency training. Postgraduate training in new technology for gynecologists in practice is limited. Therefore, gynecologists with insufficient training who perform robot-assisted surgery may potentially be at risk for liability. In addition to the traditional medical negligence claims, plaintiff attorneys are seeking causes of actions for lack of informed consent and negligent credentialing. Thus, it is essential that gynecologists be aware of these potential liability claims that arise in a robot-assisted malpractice suit. This commentary provides an overview of the current medicolegal liability risks originating from lack of training in robotic surgery and seeks to raise awareness of the implications involved in these claims. A better understanding of the doctrine of informed consent and seeking assistance of proctors or experienced co-surgeons early in robotics training are likely to reduce the liability risks for gynecologic surgeons.

Medical care issues in Japan highlighted by the regulatory approval of the da Vinci Surgical System.

Twelve years have passed since the emergence of the da Vinci Surgical System in the medical field, and highly advanced medical technology continues to develop rapidly. Surgeons are on a mission to provide better medical service every day. Yet, the Japanese Ministry of Health, Labour, and Welfare is taking a conservative stance against medical advancement. Two major issues that puzzle surgeons are the time-consuming process and delay in approval of medical devices, and limitations on health insurance coverage. The author of this article insists that now is the time to speak up for the reality that the more medical technology develops, the higher the costs that are necessary. He believes that all who are involved need to come together to share values for a better perspective.

Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons.

PURPOSE: With the exponential growth of robotic urological surgery, particularly with robot assisted radical prostatectomy, guidelines for safe initiation of this technology are a necessity. Currently no standardized credentialing system exists to our knowledge to evaluate surgeon competency and safety with robotic urological surgery performance. Although proctoring is a modality by which such competency can be evaluated, other training tools and guidelines are needed to ensure that the requisite knowledge and technical skills to perform this procedure have been acquired. We evaluated the current status of proctoring and credentialing in other surgical specialties to discuss and recommend its application and implementation specifically for robot assisted radical prostatectomy. MATERIALS AND METHODS: We reviewed the literature on safety and medicolegal implications of proctoring and the safe introduction of surgical procedures to develop recommendations for robot assisted radical prostatectomy proctoring and credentialing. RESULTS: Proctoring is an essential mechanism for robot assisted radical prostatectomy institutional credentialing and should be a prerequisite for granting unrestricted privileges on the robot. This should be differentiated from preceptoring, wherein the expert is directly involved in hands-on training. Advanced technology has opened new avenues for long-distance observation through teleproctoring. Although the medicolegal implications of an active surgical intervention by a proctor are not clearly defined, the role as an observer should grant immunity from malpractice liability. CONCLUSIONS: The implementation of guidelines and proctoring recommendations is necessary to protect surgeons, proctors, institutions and, above all, the patients who are associated with the institutional introduction of a robot assisted radical prostatectomy program. With no current guidelines we anticipate this article will serve as a catalyst of interorganizational discussion to initiate regulatory oversight of surgeon certification and proctorship.