Complications happen in surgery, no matter how good you are. Who takes the blame when a patient has a bile leak or dies from a cholecystectomy? This brings up new legal questions that must be answered.
Technology and the bureaucracy that is spawned from it destroys accountability. Who gets the blame when a giant corporation with thousands of employees cuts corners to re-design an old plane to keep up with the competition and two of those planes crash killing hundreds of people?
No one. Because you can't point the finger at any one or two individuals; decision making has been de-centralized and accountability with it.
When AI robots come to do surgery, it will be the same thing. They'll get personal rights and bear no responsibility.
I mean, the accountability lies with the company. To take your example, Boeing has paid billions of dollars in settlements and court ordered payments to recompense victims, airlines, and to cover criminal penalties from their negligence in designing the 737 Max.
This isn't really that different from malpractice insurance in a major hospital system. Doctors only pay for personal malpractice insurance if they run a private practice and doctors generally can't be pursued directly for damages. I would expect the situation with medical robots would be directly analogous to your 737 Max example actually, with the hospitals acting as the airlines and the robot software development company acting as Boeing. There might be an initial investigation of the operators (as there is in an plane crash) but if they were found to have operated the robot as expected, the robotics company would likely be held liable.
These kinds of financial liabilities aren't incapable of driving reform by the way. The introduction of workmen's compensation in the US resulted in drastic declines in workplace injuries by creating a simple financial liability company's owed workers (or their families if they died) any time a worker was involved in an accident. The number of injuries dropped by over 90%[1] in some industries.
If you structure liability correctly, you can create a very strong incentive for companies to improve the safety and quality of their products. I don't doubt we'll find a way to do that with autonomous robots, from medicine to taxi services.
The FDA released guidance in March 2025 requiring "human-in-the-loop" oversight for all autonomous surgical systems, with mandatory attribution of decision-making responsibility in the surgical record. This creates a shared liability model between the surgeon, manufacturer, and hospital system.
See, the more time goes by, the more I prefer robot surgeons and assisted surgeons. The skill of these only improves and will reach a level where the most common robots exceed the 90th, and eventually 95th percentiles.
Do we really want to be in a world where surgeon scarcity is a thing?
Well, it depends on your definition of 'surgery'. One could well imagine that transplanting your conscience into a new body might well be feasible before we get to live on Mars.
I used to think this myself in the past, but my opinion has shifted over time.
If a surgeon needs to do X number of cases to become independently competent in a certain type of surgery and we want to graduate Y surgeons per year, then we need at least X * Y patients who require that kind of surgery every year.
At a certain point increasing Y requires you to decrease X and that's going to cut into surgeon quality.
Over time, I've come to appreciate that X * Y is often lower than I thought. There was a thread on reddit earlier this week about how open surgeries for things like gall bladder removal are increasingly rare nowadays, and most general surgeons who trained in the past 15 years don't feel comfortable doing them. So in the rare cases where an open approach is required they rely on their senior partners to step in. What happens when those senior partners retire?
Now some surgeries are important but not urgent, so you can maintain a low double digit number of hyperspecialists serving the entire country and fly patients over to them when needed. But for urgent surgeries where turnaround has to be in a matter of hours to days, you need a certain density of surgeons with the proper expertise across the country and that brings you back to the X * Y problem.
To summarise your view, more surgeons means not enough experience in a given surgery to maintain base levels of skill.
I think this is wrong; you would need a significant increase, and the issue I was responding to was “shortage”. There’s no prospect of shortages when the pipeline has many more capable people than positions. Here in Australia, a quota system is used, which granted, can forecast wrong (we have a deficit of anaesthetists currently due to the younger generation working fewer hours on average). We don’t need robots from this perspective.
To your second point, “rare surgery”; I can see the point. Even in this case, however, I’d much rather see the robot as a “tool” that a surgeon employs on those occasions, rather than some replacement for an expert.
"Rare" is an overloaded word, so let me clarify: I asked one of my friends who's a general surgeon, and he estimates he does 1 to 2 open cholecystectomies or appendectomies per year. It falls in an unfortunate gray zone where the cases aren't frequent enough for you to build up skills, but they are frequent enough that you can't just forward all the cases on to one or two experienced surgeons in the area. (They would get incredibly backed up.) And sometimes a case starts laparoscopic and has to be converted to open partway through, so you can't always anticipate in advance that a senior surgeon will need to be available.
I agree that robotic surgery is not a solution for this. We haven't even got L5 long haul trucking yet, so full auto robotic surgery in the real world, as opposed to controlled environments, is probably decades away.
Have human surgeons cross-train as veterinary surgeons. Instant increase to the maximum X×Y (depending which parts of the practice contribute to competence).
We should always have human experts, things can and will go wrong, as they do with humans.
When thinking about everything one goes through to become a surgeon it certainly looks artificial, and the barrier of entry is enormous due to cost of even getting accepted, let alone the studies themselves.
I don’t expect the above to change. So I find that cost to be acceptable and minuscule compared to the cost of losing human lives.
Technology should be an amplifier and extension of our capabilities as humans.
> Excellent question! Would you like to eliminate surgeon scarcity through declining birth rates, or leaving surgical maladies untreated? Those falling within the rubric will be treated much more rapidly in the latter case, while if we maintain a constant supply of surgeons and a diminishing population, eventually surgeon scarcity will cease without recourse to technological solutions!
Most technological capabilities improve relatively monotonically, albeit at highly varying paces. I believe it's a reasonable position to take as the default condition, and burden of proof to the contrary lies on the challenger.
Humans can keep improving, we take that as granted, so there is at least one solution to the problem of general intelligence.
Now, robots can be far more precise than humans, in fact, assisted surgeries are becoming far more common, where robots accept large movements and scale them down to far smaller ones, improving the surgeon’s precision.
My axiom is that there is nothing inherently special about humans that can’t be replicated.
It follows then that something that can bypass our own mechanical limitations and can keep improving will exceed us.
You can't comment like this on HN and we have to ban accounts that do it repeatedly. This style of commenting is not what HN is for and it destroys what it is for. HN is only a place where people want to participate because other people make an effort to keep the standards up. If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.
No one. Because you can't point the finger at any one or two individuals; decision making has been de-centralized and accountability with it.
When AI robots come to do surgery, it will be the same thing. They'll get personal rights and bear no responsibility.