Wednesday, December 17, 2014

Are we ready for bionic patients

Hugh Herr, a roboticist at MIT, has boldly asserted that disability will be largely eradicated in the 21st century through bionic limbs. Herr may have been accurate about the medical side, but important legal and ethical issues will have to be resolved before this new technology becomes commonplace.

Are we ready for bionic patients

Hugh Herr, a roboticist (yes, that’s a real job title) at the Massachusetts Institute of Technology, boldly asserted at a conference organized by The Economist that disability will be largely eradicated in the 21st century. Upon revealing his bionic legs, Herr suggested that patients may soon decide to replace painful arthritic limbs with fully functional robotic ones.

Herr may have been accurate about the medical side, but important legal and ethical issues will have to be resolved before this new technology becomes commonplace. When should we allow people to amputate their limbs? How should improved medical technology change our definition of a disability? And who will pay the cost? 

Patients rarely opt for voluntary amputation. Historically, prostheses were never as good as a natural limb. Herr asserts, however, that improved prosthetic technology may cause patients to consider amputation at a lower pain threshold. Philippa Oldham, head of manufacturing at the Institute of Mechanical Engineers, suggests that in the future, prostheses may be made of nanotube technology, have the same structure as a biological leg, and provide the same amount of energy.

Oscar Pistorius, a South African sprinter, gained fame when he became the first double amputee to compete in the Olympics. Pistorius, also known as “Blade Runner,” ran in the 2012 Summer Olympic Games on Flex-Foot Cheetah legs

Despite significant controversy, Pistorius was allowed to run. It was determined that he was "physiologically similar but mechanically dissimilar" to runners with natural legs. Olympic officials held that Pistorius was on equal footing (quite literally) with his competitors, despite being a double amputee.

Technology is changing the limitations on individuals with disabilities, which may also change legal definitions and rights. The European RoboLaw project is attempting to research issues such as the legal rights of a person with locked in syndrome who communicates with a brain-computer interface, and the potential need to change the definition of disability with changes in bionic and neural interface technology.

Additionally, we must consider ethical issues regarding when individuals should be allowed to opt for voluntary amputation. How severe must the condition be? If technology advances as Herr and Oldham predict, we may see individuals treating limb amputation as cosmetic surgery. Are we prepared to allow limb amputation the same way we allow nose jobs? And how does this possibility affect doctors’ requirement to “do no harm?”

Another issue to consider is cost. We will have to decide when insurance companies must cover these treatments and equipment, which will be extremely expensive. Maintaining and replacing prostheses can cost millions of dollars over the course of a lifetime. Under what circumstances should these technologies be considered medically necessary?

Although this type of medical advance is tremendous and can improve the lives of many, we must remember that no human being is immortal and mixing man with machine can lead to a variety of unexpected results. Before we allow arthritic patients to replace their legs with prostheses, we must carefully consider the consequences.

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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