Glenda Hannibal is a junior assistant at the department of sociology where she is exploring and addressing some of the hidden assumptions and enabling conditions driving the development of social robotics. For our campaign “semester question” (Semesterfrage) Glenda gives some examples of how robots are currently developed and used to improve the health of people and how the work in laboratories of robot engineers is going to play a significant role in the healthcare of tomorrow.
Robotics might not be the first thing that comes to mind when we ponder upon the semester question: “health from the laboratory – what is possible?”. First of all, when we look at society today it might seem like it is still far from being invaded by robots as it is so often showed in various pop-cultural narratives of big Hollywood productions, like Blade Runner (1982), The Matrix (1999) or I, Robot (2004). But perhaps we are simply not looking at the right places. Healthcare is in fact one of the areas where research and technological innovation have been looking towards robotics as a promising solution to the various challenges posed by serious illnesses and accidents, demographical changes, and lifestyle problems. Judging by recent developments, the use and growing potential of robotics in medicine and for therapeutic purposes is something that has the potential to radically transform current understanding of health, and as such has attracted attention of many philosophers and sociologists.
Where robots are made
To understand the relationship between the semester question and robots we might begin with the place where robots are made. When we think about laboratories in context of health the images that first come to mind are those of chemists, biologists, and geneticists in white coats setting up scientific experiments and recording carefully the results in protocols. What we tend to forget is that places where robots are constructed are also laboratories. With the advancements in robotics over the last 40 years the laboratories where robots are being developed are becoming increasingly important for reflections on modern society as much of the knowledge and technical solutions developed for robots are increasingly being integrated into different areas of life. Medicine and therapy are among the areas that have recently found much inspiration in robotics.
The robots developed and used for healthcare that will be motioned as examples can be understood and grouped by use of two different metaphors. The metaphor of the cyborg – the human and machine merged together to such a degree that it is no longer possible to make a clear distinction – covers the robotic additions that are used inside or on the body. The metaphor of the artificial assistant – a robot that has build-in capacities to navigate autonomously and interact with people by projecting agency – covers the kind of robots that are used alongside the healthcare professionals.
So-called nanobots are robots that are capable of working on a cellular level as they swim around the body delivering drugs, helping fight foreigner objects, fixing damages, and generally keeping people healthy. Recently, a research team at Bar-Ilan University developed a DNA–based nanorobots, which they inserted into a living cockroach and which they were later on able to control by ordering it to, for example, release a molecule it was carrying. The design of this nanorobot is inspired by origami and designed in such a way that once the robot arrives at a designated location inside a body it can unfold in order to release drugs with an amazing accuracy. The long-term goal of the research team is that the robot will eventually be able to help in human diagnoses or treatment.
Robotic prosthetics aims to provide amputees with impressive new levels of control as these mechanical limbs are controlled by microprocessors and nerve impulses through a brain-computer interface. For example, engineers at the Johns Hopkins University have developed a robotic arm prosthesis that has up to 20 degrees of independent motion and can be controlled solely by mind. The participants in the experiments, they believe, should even be able to feel some sensation with their prostheses when the remapped nerves grow deeper. The field of prosthetics is now evolving towards powered exoskeletons, which are wearable AI bionic devices placed on the body. One example is a motorized, lower-body exoskeleton developed by PHOENIX, a start-up company from the University of Berkeley, which is designed to provide people with severe mobility issues to help and support to rise up from their wheelchairs and walk independently.
Surgeons already use surgical robots to perform complex operations as these allow for minimal invasiveness and therefore reduce the recovery time for the patients. Already used widely in hospitals worldwide is the DA VINCI surgical system developed by the Silicon Valley based company, Intuitive Surgical. It is used for soft-tissue procedures as for example hysterectomies, gall bladder and kidney removals, prostate cancer treatment and heart valve operations. Though the robotic system relies on a human operator to carry out the operations it also makes use of weak AI software that is constantly being improved in order to advance the robotic system. The ultimate goal is to advance the technology so it can be used for highly complicated brain operations.
The artificial assistant
Hospital robots can be found in hospitals driving around to deliver food, medicine and supplies. Robots like TUG, which is manufactured by the Pittsburgh-based company Aethon, is today gracing the hospital halls in the US and Japan. This robot makes use of lasers to navigate in the environment and is able to open doors or call for elevators by means of wireless connection and can deliver fresh bed sheets to the staff when needed. The robot is therefore part of a larger infrastructure running the everyday life of the hospital and often staff members end up naming and decorating the robots as they come to adapt their automated co-worker. Another example is the robot PEPPER developed by SoftBank Robotics, which has been helping out as a receptionist in a Belgian hospital. By use of face-recognition the robot is able to detect the emotions of humans it encounters and provides information verbally to patients and visitors.
Mainly designed to assist people with various kinds of tasks socially assistive robots are currently considered a new addition to existing healthcare practices. For example, the robot NAO developed by SoftBank Robotics helps children with diabetes by educating them about the symptoms of hypo- or hyper-glycaemia and by guiding them in regulating their own blood sugar on a daily basis. AUTOM is a robot developed by the personal robots lab at MIT, which supports people in losing weight by keeping track of their eating and exercise habits. A socially assistive robot was also used for motor-task rehabilitation of stroke patients via demonstrations of gestures, explains a team working at University of Southern California who developed the robot BANDIT. In order to maintain bodily and emotional health among elderly with dementia or Alzheimer the robot MARIO, a result of a EU funded research project, can verbally interact with patients via voice-activated software in order to support their memory and cognitive skills. The robot can also make a comprehensive assessment of a patient’s medical state and mental capacities, which can supplement the work done by the care professionals.
Therapeutic robots have recently been developed to help elderly with dementia or children with autism spectrum disorder by providing mental and behavioral support, companionship, and facilitating communication skills tutoring. The best known robot for cognitive therapy among elderly with dementia is the robot PARO developed by the Japanese National Institute of Advanced Industrial Science and Technology. This robot has a zoomorphic design of a pup harp seal and can respond to its owner via five different kinds of sensors (i.e. tactile, light, audition, temperature and posture) in a way that stimulates patients. It also has a software program for reinforcement learning that encourages the dementia patients to stroke the robot, and to recognize, as well as respond, to its owner as it is repeatedly exposed to their voice. The robot KEEPON developed by a research team at Miyagi University with its minimalistic design, and the ability to tilt, bounce and turn, invites children with autism to engage in simple communication. Even though these robots are designed for multiple users, the elderly and children often establish a personal relation to the robots and consequently these therapeutic robots also provide a kind of companionship for the patients.
Social and ethical reflections
Robot-supported health enables a lot of interesting and promising solutions to the various health problems people are facing today by improving health and well-being, filling care gaps, and aiding health care workers. However, finding a way in which robots can support health for everyone while also taking into account the many social and ethical challenges that follow from such technologies is not easy. Some of the social issues concerning the use of robots in medicine and healthcare relate to questions of justice and fairness. As it might already be clear, robot-technology is expensive not only to develop but also to use.
This might result in un-equal treatment of patients or special-need groups, as they might not be able to get access to such resources due to their cost, or their local hospital does not have this technology. So unless the robots become cheaper than the technologies already in use today, the treatment and maintenance of health might become a social issue that relies on social circumstances or geographic setting. Moreover, introduction of nanobots enables not only the treatment of diseases but also the enhancement of the human body potentially making people in the future very resistant to diseases and illnesses. This might give rise to ethical questions about how far we can go in the treatment of health without risking creating a society where some people are left behind.
Concerning the use of robots as assistants in healthcare practices, several ethical challenges can be pointed out. One of the most discussed issues is the risk of limited or reduced human contact as people using this technology are now interacting with robots on a daily basis sometime more than with care professionals. Another concern revolves around the ethical issue of privacy as the robots not only collect data about the users but also store it for use later on. Moreover, there is also much discussion about whether the use of robots among elderly with dementia and children with autism leads to deception or degrading treatment as they might not be able to make a distinction themselves.
Given these few examples of some of the social and ethical issues one should carefully balance the benefits against the social or ethical costs of using robots in medicine and healthcare. The discussions about the disadvantages of robots for health are very important not only for the individual but for the society as a whole, which means that such discussions should happen not only among researchers and developers but should also include the future users of robot-technologies. Asking and addressing these kinds of questions is precisely at the heart of philosophical and sociological perspectives on these topics.
Sometimes these social and ethical issues resulting from robot-supported health can be anticipated but very often they only become visible when these robots are already in use. Sensitivity to the way in which robots are altering our notion of health and current health practices, whether in our private homes or in public institutions, is one of the things that needs to be researched very closely on both a theoretical and empirical level, which is also the main focus of the recent work under the label of “healthcare robotics”.
Considering this short overview of some of the robots being developed by engineers in their laboratories it is possible to see how these robots already are, and will most likely become even more, an integral element in health care. For this reason, when we ask questions regarding health-related research in laboratories we must also take into consideration the developments in robotics.