Download Use of robots in healthcare

V Conference Franco-Japonaise de Bioethique
The impact of robotization on Japan's
healthcare/ L’impact de la robotisation
sur les soins de santé au
Japon
Yutaka Kato
Department of Medical Ethics,
Osaka University Graduate School of Medicine
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Abstract
•
Robots have been gradually put into use in healthcare. And Japan is often regarded
as an international hub of robotics research. Against this backdrop, this
presentation aims to provide an overview of potentially diverse and broad impact
of robotization on healthcare primarily in Japanese context, and to present several
fundamental countermeasures to tackle with the challenges arising from the
broadness of the issues. After briefly presenting a working definition of the term
“robot” in relation to “artificial intelligence” in order to frame the question, the
presentation will describe the issues classified in three categories: robotization in
medical setting, implications of the status quo of Japan’s robotics industry for
Japan itself as well as for other counties, and robotization indirectly affecting
healthcare. The first category deals with the use of robots in medical setting as
typified by diagnosis, surgery and nursing. The third includes such issues as use of
robots in medical research, labor/employment and occupational injury/disease.
The presentation is mainly based on literature research including journal articles
reporting the current development tendencies. I will conclude the presentation by
presenting a number of measures to be taken against potential negative impact of
robotization on healthcare. Within the scope of this presentation, I will limit my
inquiry to short- and medium-term possibilities.
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Overview
• Working definition
• In the following 3 categories
1. Robotics in medical setting
2. Japan’s robotics industry
3. Robotics indirectly affecting healthcare
• Short- and medium term
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Working definition
• we define “robot” as an engineered machine that senses, thinks,
and acts: “Thus a robot must have sensors, processing ability that
emulates some aspects of cognition, and actuators. Sensors are
needed to obtain information from the environment. Reactive
behaviors (like the stretch reflex in humans) do not require any
deep cognitive ability, but on-board intelligence is necessary if the
robot is to perform significant tasks autonomously, and actuation is
needed to enable the robot to exert forces upon the environment.
Generally, these forces will result in motion of the entire robot or
one of its elements (such as an arm, a leg, or a wheel)”. This
definition … leaves open the possibility of biological robots, as well
as virtual or software ones. But it does rule out as robots any fully
remote-controlled machines, since those devices do not “think”,
e.g., many animatronics and children’s toys. Rather, the generally
accepted idea of a robot depends critically on the notion that it
exhibits some degree of autonomy or can “think” for itself, making
its own decisions to act upon the environment. Thus, the US Air
Force’s Predator unmanned aerial vehicle (UAV), though mostly
tele-operated by humans, makes some navigational decisions on its
own and therefore would count as a robot. (Lin et al.)
• This presentation adopts the above definition.
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Working definition
Provisional justifications for the above definition:
• The relation between Robotics and AI (Artificial
intelligence)
• After the beginning of this millennium, new robots
intended for personal use appeared and
“implementation/embodiment of human intelligence
on machines,” which was originally the goal of AI,
became the immediate goal of robotics (Arimoto)
• View of robots as physical embodiment of AI
• Development tendencies in engineering toward
greater autonomy necessitates revisiting implications
of “autonomous” devices which are not completely
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controlled.
Working definition
The consequences of adopting this definition:
• AI is almost omnipresent: e.g. automobiles, airplanes, software, etc.
(continuity.)
• Albeit dubious, some argued that the development of AI could be
an exponential progress according to Moore’s law (The prediction
by Gordon Moore, cofounder of the Intel Corporation, that the
quantity of transistors that can be placed inexpensively on an
integrated circuit would double approximately every 18 months. ）
and reach critical point unexpectedly.
• Highly-developed AI is expected by some to be enormously
profitable (e.g. through pharmaceutical development (Bostrom))。
• Affected by development status of nanotechnology etc.（terminals
small enough to tap into neurons, the development of nano-bots,
indispensable for the improvement of performance). The relation
between nanotech and AI is chicken-and-egg? (Highly-developed AI
can overcome hurdles in nanotechnology)
• Issues involved in rights and responsibilities of autonomous robots
will come into sight in medicine in the long run
ex. Responsible for medical accidents (caused by autonomous
decision by a robot)
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1. Robotics in medical setting
•
Use of robots in healthcare
ex. Robots designed to help daily activities (Exact Dynamics: MANUS(iArm), Secom:
MySpoon)
ex. Hospi (Panasonic)
ex. Paro
ex. Power suit
ex. AURORA Project (University of Reading, treatment of autism through interaction
with robots, which is supposed to be easier than interaction with other people)
• Robots used in surgery
Zeus, Da Vinci, ROBODOC (very limited autonomy), reduction of hand tremor
• Use in education
ex. Robots for practical training
• Medical diagnosis system
ex. MYCIN：developed in 1970s (rule-based expert system)
• Use in research and development
ex. Robot model of Parkinson disease
ex. Virtual human
ex. Robo Scientist
• Treatment by cyborgization
↓
Improvement in patients’ QOL
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Treatments formerly impossible may be possible (concern for swelling medical
1. Robotics in medical setting
• The term “robot” appears only once in “Basic
welfare engineering” (“Robotics series”)
• Most of healthcare robots are useless … the
majority of the practically used healthcare
devices, including wheelchairs, is low-tech
（Tejima）
• The term “robotics” appears only in 4 lines in
the 181-page annual report by Medical
Center for Translational Research at Osaka
Univ. Hospital.
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1. Robotics in medical setting
• “Frame problem” exists in healthcare. ex. Necrosis is caused by
diabetes, Buerger's disease, gum disease, or spider or? Difficulty in
depending entirely on diagnostic system and simultaneously
demand for more advanced AI.
• The way a society perceives to have patients or elderly citizens left
to robots (possibly cultural differences) (Lin et al.)
• Difficulty in developing a relationship with robots used in
healthcare?（A thousand-fold processing ability is necessary for
robots to pass the Turing test and to be an “intelligent thinker”?
Weather human qualities that cannot be replaced by robot-human
relationship exist in human-human relationship?)
• Increased importance of engineering knowledge
• The more complex and intricate, the more breakable and difficult to
repair.
• The greater dependence on robots equipped with computers
necessitates countermeasures against cracking.
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1. Robotics in medical setting
• As many have noted on other industries, also in healthcare simple
tasks can be performed by robots (ex. mere assistance, doublecheck function), in Japan, labor shortage in the future is anticipated.
• Inhibiting/prohibiting factors for robotization of healthcare include:
opposition or approval by professional associations (possibly split
within), expenses for medical institutions and the entire society
(Robots can be cheaper in the future? Software can be low-budget
than robots?）
• Human beings may be liberated from simple tasks (characterized by
3Ds: dull, dirty, dangerous) or deprived of rights for simples tasks as
occupation. Less intelligent people may be marginalized (from
occupations in healthcare) more intensely than they are today.
• Job loss needs to be compensated.
• Not only negative effects but also positive effects which can
mitigate personnel turnover problem: reduction in manpower
shortage, prolonged work.
• The possibility that surgeons and physicians can be replaced by
robots constitutes another problem? （Lin et al.）。And possibly,
scientists (robo scientists).
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1. Robotics in medical setting
• Technological means can be available prior to
regenerative medicine, despite the arrival of iPS cells
(ex. treatment for vision loss). Also, the former can
be preferred, due to their relative ease of
maintenance or the possibility of adverse events.
• Implications and issues pointed out for technological
enhancement are also applicable.
• If the standards of performance changes,
enhancement may be closer to treatment?
• Problems with body or devices?
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1. Robotics in medical setting
• Treatment by cyborgization
e.g. If the properties of an object grabbed at are autonomously
judged, the definition of robot may be met (autonomous
decision based on information from the environment)
e.g. Artificial vision system (can be categorized into robot if
equipped with (autonomous) information processing)
• Nothing more than minor adjustment?
Or in terms of autonomy, autonomy
merely in information processing should
be distinguished from higher levels of autonomy
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1. Robotics in medical setting
• Electronic (on screen )（ ex. World Highest Resolution
Virtual Human
http://www.cuhk.edu.hk/cpr/pressrelease/031028e.htm ）
• Electronic (on screen )
Researchers at Univ. of Oxford and Univ. of Auckland
working on models of the whole heart say,“If we get
some good milestones from the heart, we can start
adding other systems such as the lung. The big mission
is the virtual human – that’s where this project is going,
even though it could take 20 years.
http://www.wellcome.ac.uk/News/2004/Features/WTX023668.htm
• Possibility of “virtual human” using real tissues and organs but
without the brain. （Greenfield: re-translated from
the Japanese translation. The translation may be wrong, but still
this possibility cannot be entirely dimissed.
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1. Robotics in medical setting
• Possible distinctions between electronic and
biological virtual human systems.
The latter may eventually have nervous system
for monitoring neurological diseases, effects of
brain hormones, discomforts (in the distant
future, fusion with humanoid robots). Dignity of
human body and nervous system?
• Can lead to reduced adverse events and use of
experimental animals
• AI egg or chicken? Highly developed AI is
necessary for developing new drugs?
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2．Japan’s robotics industry
• Robotics and Japan
Robotics - national forte
Equipped with by far the most industrial robots
Need to compensate decrease in labor force possibly
by robots
Weak in medical devices
Robo-philia?
• (In relation to the above point： together with a
governmental plan to increase workers from overseas,
the majority of whom most likely undertake simpler
task, can be the first to be deprived of their work, if
imigratation precedes robotization)
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2．Japan’s robotics industry
89% of medical devices approved in
Japan (especially high-risk devices) are
from overseas (Yamaoka)
Approximately 80% of patent
applications for medical devices filed at
Japan Patent Office are from overseas.
International Federation of Robotics (IFR)
• Japan is equipped with by far the most industrial
robots (Industrial structures, employment in tertiary
industry)
• Despite its strength in engineering and robotics,
Japan is relatively weak in medical devices (Some
think it is because of overly strict regulations and
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(cultural) emphasis on safety).
2．Japan’s robotics industry
• variations in national development capability, ethics and law -> uneven trajectory internationally
• Implications of Japan’s strength
Taking lead and possibly site of pilot use
Plenty of room for robotization and the consequent impact for
other parts of the world
Without leading the debate on ELSI of robotics, Japan may
incur “policy vacuum” situations worldwide.
But the self-understanding of leading roboticists as robo-philic
may have negative effect on such debate.
• Need to formulate international guidelines at some future
time to avoid “policy vacuum.” Possibility or responsibility that
Japan can (or should) provide a model and springboard.
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2．Japan’s robotics industry
• In a position to influence other countries
ex. Japanese leaders of International robotics
societies
ex. International sales of ASIMO and others
ex. Media contents
(“Transformers” a Hollywood
film of Japanese origin)
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3．Robotization indirectly affecting
healthcare
• Reduction of occupational injury/disease
(asbestos/mines removal, tunnel, factory, miner,
hearing impairment, pneumoconiosis, amputation,
etc. ) as a indirect effect
• When robotics becomes a basic social infrastructure,
those who are less skillful using robots may be
marginalized by being unfit for newly emerging
society (e.g. senior citizens?) and also may be
(gradually) expelled from healthcare professions.
• Demand for a new (mental?) ability, (for which
humans are not biologically or evolutionarily
designed)
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3．Robotization indirectly affecting
healthcare
• Implications of closeness to humans may be worth
revisiting.
• On one hand, closeness to humans can be useful in
healthcare. e.g. A robot for bathing can be less
obtrusive, less horrifying by human-like appearance
(elimination of metallic surface, motor sound)
• On the other hand, (psychological) consequences to
be always surrounded by what gives the sense of
human qualities may be negative for people
withautism, social anxiety disorder (SAD),
agoraphobia, Taijin kyofusho symptoms (a culturebound syndrome, an expression of which is Shisen
kyofu (lit. sight fear), a fear to be looked at by others),
etc.
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Summary
• The current status is far away from the envisaged
goals, but the influences of robotization of
healthcare will be extensive (wide-ranging).
• Short-term advantages do exist in applications in
healthcare while medium- and long-term (and
unknown) risks are unclear.
• Safety, medical cost, and employment are among
anticipated problems.
• Japan, as an international leader in robotics, may be
able to contribute to dealing with ELSI of robotization
of healthcare.
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Measures to be taken 1
• Short-term advantages do exist. But we should not
let these advantages simply override medium- and
long-term (unknown) risks (a repeated pattern of
collapse of civilizations）
• Due to safety, medical cost, and employment
problems, meticulous and sufficiently strong
regulations may be necessary when introduced.
• Due to the interdisciplinary nature of the technology,
propensity toward secrecy (and possibly exponential
development), preemptive discussion is necessary to
avoid a repeat of the landmine problem.
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Measures to be taken 2
• When exporting the products from Japan, manufactures
should consider the situation in the destination for export.
• Japan is relatively weak in medical devices possibly due to
overly strict regulations. We should not choose to loosen
these regulations merely for financial/industrial reasons
without extensive discussion.
• Against the risks including cracking (cf. Y2K problem),
oligopoly or monopoly may need to be controlled (robot
diversity).
• Possible psychological,
cognitive consequences may
justify the control of robot use
in healthcare in terms of
quantity and the closeness to humans.
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References
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