Tag Archives: Health care provider

Medbots, Autodocs & Telemedicine


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In science fiction stories, movies and games automated medical services are quite common. Some take the form of autodocs—essentially an autonomous robotic pod that treats the patient within its confines. Medbots, as distinct from the autodoc, are robots that do not enclose the patient, but do their work in a way similar to a traditional doctor or medic. There are also non-robotic options using remote-controlled machines—this would be an advanced form of telemedicine in which the patient can actually be treated remotely. Naturally, robots can be built that can be switched from robotic (autonomous) to remote controlled mode. For example, a medbot might gather data about the patient and then a human doctor might take control to diagnose and treat the patient.

One of the main and morally commendable reasons to create medical robots and telemedicine capabilities is to provide treatment to people in areas that do not have enough human medical professionals. For example, a medical specialist who lives in the United States could diagnose and treat patients in a remote part of the world using a suitable machine. With such machines, a patient could (in theory) have access to any medical professional in the world and this would certainly change medicine. True medical robots would obviously change medicine—after all, a medical robot would never get tired and such robots could, in theory, be sent all over the world to provide medical care. There is, of course, the usual concern about the impact of technology on jobs—if a robot can replace medical personnel and do so in a way that increases profits, that will certainly happen. While robots would certainly excel at programmable surgery and similar tasks, it will certainly be quite some time before robots are advanced enough to replace human medical professionals on a large scale

Another excellent reason to create medical robots and telemedicine capabilities has been made clear by the Ebola outbreak: medical personnel, paramedics and body handlers can be infected. While protective gear and protocols do exist, the gear is cumbersome, flawed and hot and people often fail to properly follow the protocols. While many people are moral heroes and put themselves at risk to treat the ill and bury the dead, there are no doubt people who are deterred by the very real possibility of a horrible death. Medical robots and telemedicine seem ideal for handling such cases.

First, human diseases cannot infect machines: a robot cannot get Ebola. So, a doctor using telemedicine to treat Ebola patients would be at not risk. This lack of risk would presumably increase the number of people willing to treat such diseases and also lower the impact of such diseases on medical professionals. That is, far fewer would die trying to treat people.

Second, while a machine can be contaminated, decontaminating a properly designed medical robot or telemedicine machine would be much easier than disinfecting a human being. After all, a sealed machine could be completely hosed down by another machine without concerns about it being poisoned, etc. While numerous patients might be exposed to a machine, machines do not go home—so a contaminated machine would not spread a disease like an infected or contaminated human would.

Third, medical machines could be sent, even air-dropped, into remote and isolated areas that lack doctors yet are often the starting points of diseases. This would allow a rapid response that would help the people there and also help stop a disease before it makes its way into heavily populated areas. While some doctors and medical professionals are willing to be dropped into isolated areas, there are no doubt many more who would be willing to remotely operate a medical machine that has been dropped into a remote area suffering from a deadly disease.

There are, of course, some concerns about the medical machines, be they medbots, autodocs or telemedicine devices.

One is that such medical machines might be so expensive that it would be cost prohibitive to use them in situations in which they would be ideal (namely in isolated or impoverished areas). While politicians and pundits often talk about human life being priceless, human life is rather often given a price and one that is quite low. So, the challenge would be to develop medical machines that are effective yet inexpensive enough that they would be deployed where they would be needed.

Another is that there might be a psychological impact on the patient. When patients who have been treated by medical personal in hazard suits speak about their experiences, they often remark on the lack of human contact. If a machine is treating the patient, even one remotely operated by a person, there will be a lack of human contact. But, the harm done to the patient would presumably be outweighed by the vastly lowered risk of the disease spreading. Also, machines could be designed to provide more in the way of human interaction—for example, a telemedicine machine could have a screen that allows the patient to see the doctor’s face and talk to her.

A third concern is that such machines could malfunction or be intentionally interfered with. For example, someone might “hack” into a telemedicine device as an act of terrorism. While it might be wondered why someone would do this, it seems to be a general rule that if someone can do something evil, then someone will do something evil. As such, these devices would need to be safeguarded. While no device will be perfect, it would certainly be wise to consider possible problems ahead of time—although the usual process is to have something horrible occur and then fix it. Or at least talk about fixing it.

In sum, the recent Ebola outbreak has shown the importance of developing effective medical machines that can enable treatment while taking medical and other personnel out of harm’s way.

 

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Protect Life Act

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Abortion is a matter of seemingly endless moral and political debate. In the latest round, the Republican controlled House has passed the Protect Life Act. Two of the main aspects of the act include preventing federal money from being used in health care plans that cover abortion and to allow health care workers to refuse to perform abortions. This includes cases in which an abortion is medically necessary to save a woman’s life.

The first aspect of the act seems to be at least partially a solution in search of a problem. The Affordable Care Act (known by the dysphemism “Obamacare”) already prevents public money separate from private insurance payments covering abortion. However, the is a common misconception (intentionally fueled) that “Obamacare” pays for abortions.

The act goes beyond this in an attempt to restrict coverage of abortion. The bill, if made into a law, would forbid women from buying private insurance plans including abortion coverage. This is, of course, limited to purchases made through a state health care exchange.

The main justification for this aspect of the bill is that the Republican backers claim that taxpayer dollars should not go to abortions. Of course, the bill goes beyond that and attempts to restrict women’s choices.

On the face of it, the justification has a certain appeal. After all, in a democratic (or republican) system, the taxpayers have a right to decide where their tax dollars are spent (and also to have a role in decisions in general-if only via representatives). As such, if the majority of Americans are opposed to having tax dollars go to abortion, then it would be presumably correct to not provide such funding. Majority rule and all that would serve as the moral justification. This would, of course, entail that the same principle should apply uniformly. So, for example, if the citizens did not want subsidies going to corporations or did not want to fun capital punishment, then such things should not be allowed.

In the case of abortion, most Americans hold that it should be legal. While this does not entail that they want to fund abortions, it would seem to indicate that abortion rights are accepted by the majority of Americans. As such, attempting to restrict these rights under the guise of keeping taxpayer money from funding abortion would seem to be somewhat deceptive. After all, it is one thing to prevent public money from being used and it is quite another to forbid women from buying private insurance with their own money. It is especially ironic given the Republican mantras about the free market and individual choice.

Also, if most Americans favor the legality of abortion and the Republican backers of the bill are claiming that they are right to impose restrictions based on the fact that some people are morally opposed to abortion, then it would seem to follow that anything that is morally opposed should not be funded. This would include capital punishment, war, the drug war and so on. In fact, it seems likely that very little would be left with public funding. Naturally, it could be argued that the moral opposition would need to be significant, but even under that condition capital punishment and many other things could no longer be funded with public money. Perhaps this would be a good thing-but I am reasonable sure that neither the Democrats nor the Republicans would be willing to accept this a general principle.

Perhaps the most controversial component of the bill is that health care workers who morally oppose abortion will have the legal right to refuse to perform abortions-even when doing so is medically necessary to prevent the death of the woman. Currently hospitals are legally required to perform abortions when doing so is medically necessary to saving the life of the woman.  Some Catholic hospitals have been breaking the existing law for years.

On the one hand, a strong case can be made for allowing health care workers to decline performing an abortion on moral grounds. After all, a law that compels people to perform what they regard as an immoral action (such as fighting in war or paying taxes to support a war or what they regard as an unjust system) would seem to be well worth both moral and legal scrutiny. This matter has, of course, been addressed in regards to civil disobedience and the question of what a person should do when his/her conscience conflicts with the laws of the state.

In the case of non-emergency procedures, I am certainly sympathetic to the view that health care workers with strong moral beliefs should not be forced to engage in what they regard as an immoral action (most likely murder). Likewise, I am sympathetic to people who refuse to fight in war or support the state on the grounds that they regard the killing  (or murder) of human beings as immoral.

On the other hand, a strong case can be made that professionals are obligated to perform their jobs even when doing so goes against their conscience. For example, a nurse who is opposed to drug use would not seem to have the right to refuse to treat a victim of a self-inflicted drug overdose of illegal drugs. As another example, a police officer who thinks that homosexuality is an abomination would not seem to have the right to refuse to protect a homosexual who is being beaten to death.

In the case of emergency procedures, a very strong case can be made that such procedures should be performed. On utilitarian grounds, performing such procedures would seem to be right. After all, the most likely result of not performing the procedure is that the woman and the fetus both die. The procedure would at least save the life of one person, which would presumably be a good action. To use an analogy, imagine that a child has been rigged with a terrorist bomb and is running at a woman. The bomb cannot be removed in time and will detonate in seconds. A soldier or police officer is nearby and can stop the child-but only by shooting her. The woman can, of course, scream to the soldier/officer that she would rather die with her child. However, it would not seem wicked of the soldier or officer to take the shot if the woman did not forbid it.

It can, of course, be argued that this is not a utilitarian matter but a matter of the action itself being right or wrong. If it is assumed that abortion is wrong because it is killing, it would seem to follow that not helping the woman would also be wrong-after all, this would cause her death.

At this point it is natural to bring up the stock distinction between killing and letting die. In the case of the woman, the medical care provider would be letting her die rather than killing the other being (which may or may not be a person). In general, our moral intuitions tend to indicate that killing is worse than letting die, which could be taken as a point in favor of allowing health care providers to let women die rather than perform an abortion. However, since the being will also die anyway (in most cases) it would seem that refusing to save the woman would (as noted above) merely double the number of deaths rather than do something that would be morally commendable. This could even be argued on the same moral basis as triage. In this case, the act could be seen not as killing the being, but saving the mother rather than allowing two patients to die. To use an analogy, if a mother and child were brought to a hospital and both were dying and the doctor knew that her choice was between saving the mother or letting both die while she worked to futilely save the child, then the right thing to do would seem to be to save the mother. Expending pointless effort on a child that could not be saved while letting the mother die would not be noble or good. Rather it would be a wrongful decision that would kill the mother.  As such, this provision is clearly immoral.

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