Embodied care, spatiality, and the ethics of robotic surgery

William Andrew Drust

doi:10.17918/etd-6566

The search for technological innovation is a hallmark of 20th century medicine in the United States. One of the latest products of this search is a technique called robotically-assisted minimally-invasive surgery. The da Vinci® Surgical System, manufactured by Intuitive Surgical Inc., is one of the most well-known robotic surgery interfaces. Yet, while it is often hailed as a great improvement over both open surgery and more traditional methods of minimally-invasive surgery, some argue that its benefits are exaggerated and that it poses additional risks. Intuitive Surgical's claim is that robotic surgery performed via the da Vinci® system provides a measure of improvement in patient outcomes. However, critiques of the system cite exaggerated claims and unique traits which amplify risks of bodily harm. To understand how these risks are negotiated, various factors involved in surgical decision-making must be taken into account, including the effectiveness of advertising, the financial risks and rewards for hospitals and doctors, and attitudes concerning the manipulation of patients' bodies during procedures. In order to address these topics, a qualitative study was undertaken. Relevant data were gathered using three methods: content analysis of Intuitive Surgical's marketing materials, interviews with surgical professionals who work at a single hospital that houses a da Vinci® machine, and participant-observation at a "dinner-lecture" given for prospective da Vinci® surgeons. The analysis of this data is presented as a narrative that interprets the attitudes and events surrounding the gradual inclusion of the technology at this hospital site. This work was done in relation to three main theoretical areas. It joins existing literature on body discipline that attempts to explicate how bodies are fashioned or modified by the technologies with which they interact. As with all of the sources cited regarding this topic, this study finds two general truths at work regarding the da Vinci® Surgical System. First, the forms and/or designs of human bodies and non-human, technoscientific artifacts define and constrain the actions and activities each are able to perform. Moreover, this does not apply merely to physical actions. Social actions are also technologically mediated and it is important to recognize that fact for its consequences. The da Vinci® system makes itself worthwhile to surgeons by enhancing their embodied surgical experience while lessening the discipline to which their bodies are subjected. Additionally, this work attempts to address issues of power in the operating-room-as-workplace. This issue is salient when examining how a workplace's social environment is mediated by the arrival of a new technology. Furthermore, it takes on a special importance when that workplace dictates medical outcomes for unconscious patients visiting that social environment for a short time. Finally, this study is situated in an exploration of healthcare ethics. This is mainly done in relation to the framework provided by biomedicalization theory and recent studies examining various facets of larger industry trends such as pharmaceuticalization. Marketing of the da Vinci® system highlights the increasing involvement of the medical technology industry in determining patterns of healthcare consumption through the cooptation of surgical authority, strategic marketing language, and appeals to robotics as a cultural trope. As an ethical matter, do the limited improvements provided by this machine justify the high costs of implementation? In a country where healthcare costs, and, in turn, health insurance premiums, are constantly rising, many people find it difficult to afford even basic care. Even in a for-profit setting, doctors should feel an obligation to limit those costs that are unnecessary.

Embodied care, spatiality, and the ethics of robotic surgery

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Embodied care, spatiality, and the ethics of robotic surgery

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