Meaningful human control of increasingly autonomous robots for surgery

This chapter addresses Meaningful Human Control (MHC) and related ethical issues raised by increasing levels of autonomy for surgery robots. First, achieved levels of autonomy are illustrated using state-of-the-art exemplary cases. Second, for each autonomy level, MHC duties of human surgeons are described. In particular, the problem of modulating MHC is addressed, in the light of what action a surgical robot performs autonomously, the operational environment where the action takes place, and how the action is performed, that is, which robotic skills and technologies are employed. Third, drivers for extending robotic autonomy beyond the current state of the art are explored in connection with microsurgery and emergency surgery. These drivers point to possible tensions between the goal of preserving MHC and medical beneficence goals. Finally, MHC of surgical robots is discussed in a broader bioethical context, including its impact on informed consent and trust relationships between surgeons and patients.