Ethical Approaches to Informed Consent for Autonomous Robotic Assisted Surgery

PROJECT ABSTRACT This project is specific to bioethics research and focuses on the ethical use of surgical robot-enabled data recording. Surgery is on the verge of a paradigm shift towards autonomous robot-assisted surgeries (RAS). Increasingly, RAS is incorporating artificial intelligence (AI) algorithms to automate parts of surgery, allowing computer algorithms to make critical decisions during surgery and directly affecting patient care. AI has the potential to improve patient care but vast amounts of surgical data are required to develop AI algorithms. While video and audio recordings have long been used for sharing surgical skills and education, RAS increases the invasiveness of recordings by also capturing the surgeon’s handling of surgical instruments. The more invasive nature of the recording, combined with the increased need for surgical data driven by AI developments in healthcare, necessitates further consideration of the ethics of surgical data use. The potential for AI-enabled RAS to improve patient care through learning from surgical data recordings raises potential ethical issues in privacy, ownership, and liability. Through recording surgeon’s handling of instruments, companies are starting to automatically evaluate the surgeon’s performance and make comparisons to other surgeons. This increased level of scrutiny potentially invades surgeons’ privacy and affects their willingness to undertake difficult procedures. Additionally, recordings of surgeries may be used to develop autonomous robots that can one day directly compete with surgeons. Companies may make money off the surgical technology developed through recordings of surgeons’ skills. Currently, surgical skills are not generally protectable by patents, leaving surgeons vulnerable to imitation by AI. Lastly, the pervasive use of surgical recordings may increase liability for hospitals. The objective of this study is to examine ethical issues in RAS-enabled surgical recordings. We will examine stakeholders’ perceptions of ethical issues involved in recording and using recorded surgical data, particularly with regard to privacy, ownership, and liability. We will run conference workshops to engage with the community and brainstorm ways technology and guidelines can support the ethical use of recorded surgical data. The specific aims are to: 1) Assess stakeholders’ ethical concerns about privacy, ownership, and liability of recorded surgical data. 2) Engage engineers and surgeons to identify technology designs for the ethical use of surgical data. The impact of the proposed study will be an improved understanding of the ethical concerns regarding privacy, ownership, and liability of recorded surgical data. While conducting our parent R21, we discovered novel ethical concerns about data recording. This bioethics supplement will complement our parent R21 (which focuses on ethical issues concerning informed consent for surgical robots) by addressing broader concerns about surgical data. Our findings will inform guidelines to support the ethical use of recorded surgical data.