Who Trusts a Robot Surgeon? Spanish Survey Maps the Politics of Healthcare AI

Imagine waking up from anesthesia and learning that your operation was carried out, from first incision to final suture, by a robot. For most people that scenario still sounds like science fiction, yet robotic and AI-assisted surgery is advancing quickly, and the question of whether citizens would actually consent to such care is no longer hypothetical. A new study published in Frontiers in Political Science offers one of the most detailed portraits to date of how the public reacts to this high-stakes application of artificial intelligence. Drawing on a nationally representative survey of 4,004 adults in Spain, researchers from the University of Santiago de Compostela examined who feels comfortable with robot-performed surgery and why, uncovering a striking pattern in which age, ideology, gender, and general optimism about AI all leave measurable fingerprints on public attitudes.

The study rests on a large-scale telephone survey conducted by Spain’s Centro de Investigaciones Sociológicas between 6 and 15 February 2025, the first national survey the institute has devoted entirely to artificial intelligence. Interviews were completed in 1,131 municipalities across all 50 provinces, with stratified sampling by region and municipality size to ensure the sample mirrors the adult population. The crucial question asked respondents to rate, on a scale from 1 to 10, how comfortable they would personally feel undergoing a medical operation performed by a robot. Around that single outcome, the researchers assembled three clusters of explanatory variables: sociodemographic characteristics including sex, age, education, income and political ideology; attitudes toward and familiarity with AI; and perceptions of AI regulation, including awareness of the European Union’s AI Act.

The headline result is sobering for anyone expecting enthusiasm. Overall comfort with robot-performed surgery was moderate to low, averaging roughly 4 on the 10-point scale, and the differences between groups were substantial. Men reported a mean comfort score of 4.83, compared with just 3.77 for women, a statistically significant gap. Even more counterintuitive is the age pattern: comfort rose steadily across the life course, from 3.67 among respondents aged 18 to 34 to 4.79 among those 65 and older, inverting the familiar stereotype of tech-wary seniors and digital-native optimists. Income and education also mattered, with the highest earners, those bringing in more than 6,000 euros per month, recording the highest mean comfort of any income group at 5.23, while people with no formal education scored lowest.

To disentangle these overlapping factors, the researchers built hierarchical linear regression models, entering variables in three theoretical blocks and measuring how much explanatory power each block added. Sociodemographics alone explained 7.1 percent of the variance in comfort. Adding attitudes toward AI pushed the total to 15.8 percent, the single largest jump in the analysis. The regulation block contributed a further, more modest increment, bringing the final model to 16.8 percent of explained variance. The statistics themselves tell a story: what people believe and feel about artificial intelligence matters more for their comfort with robotic surgery than who they are, and governance perceptions, while real, play only a supporting role.

Within the final model, the strongest predictor by a clear margin was the perceived benefits of AI, measured as a count of the domains in which respondents thought AI would do more good than harm, with a standardized coefficient of 0.244. Age followed at 0.207, confirming that older Spaniards were markedly more at ease with the surgical scenario. Positive feelings toward AI, self-reported knowledge, household income, and education all contributed smaller positive effects. On the negative side, agreeing that implementing stricter ethical standards and legal safeguards for AI is one of humanity’s most significant challenges was the strongest reducer of comfort at minus 0.094, followed by being female at minus 0.093 and holding more right-wing ideological positions at minus 0.062.

The gender gap deserves particular attention because it echoes a growing international literature. Previous studies have found that women use generative AI tools less frequently, in large part because they are more sensitive to the social and ethical risks these technologies pose, and research on robotic surgery has repeatedly shown men expressing more favorable attitudes and greater willingness to undergo robot-assisted procedures. The Spanish data are consistent with that pattern, although the authors are careful about interpretation: they did not estimate interaction or mediation models, so they cannot say whether women prioritize harms while men emphasize benefits. Differential risk perception, unequal technological exposure, and differing healthcare experiences all remain plausible explanations to be tested directly in future work.

The age finding is equally puzzling and deliberately hedged. Much research links older age to lower acceptance of digital technologies, and studies of AI adoption among older adults emphasize that the real driver is the combination of age with digital literacy rather than age itself. Yet in this surgical scenario, older respondents were the most comfortable group. The authors suggest several non-exclusive explanations: greater perceived healthcare need, stronger expectations of clinical benefit, cohort effects, or even the way the survey question was worded. What they reject is the leap to a general claim that older citizens embrace healthcare AI more broadly; the result is a context-specific association that requires replication before it can be generalized.

Perhaps the most politically consequential finding concerns regulation. Awareness of the EU AI Act, adopted in 2024 to impose safeguards on high-risk AI applications, and general agreement with AI regulation showed no independent positive association with comfort in the adjusted models. The regulatory block added only about one percentage point to explained variance. In raw means, people who had heard of the AI Act did report slightly higher comfort, 4.65 versus 4.02, and supporters of the law scored 4.88 versus 3.99, but these unadjusted differences may simply reflect confounding by education, income, ideology or AI knowledge. The authors conclude that the formal existence and public visibility of regulation cannot be assumed to translate automatically into comfort with a specific application, a caution that cuts directly against the common assumption that passing laws is enough to win public trust.

The study is explicit about its limits. The outcome is a single hypothetical item about robot surgery, not actual patient behavior, and the survey captured no direct measures of trust in technology, clinicians, hospitals or regulators, leaving trust as a theoretically important but untested mechanism. Most individual variation, more than 83 percent, remains unexplained, and factors such as health status, prior experience with robotic procedures, and knowledge of human oversight were absent from the questionnaire. Spain’s predominantly public healthcare system and its specific regulatory context also shape the findings. Still, the message for policymakers is pointed: deploying the technology, enacting regulations, and issuing public information campaigns are not sufficient conditions for acceptance. Making the role of professionals, the degree of human oversight, accountability arrangements and expected clinical benefits genuinely intelligible to different social groups, the authors argue, is what responsible implementation of healthcare AI must now deliver.

Subject of Research: Public comfort with robot-performed surgery in Spain and its social, political, and regulatory correlates

Article Title: Public receptiveness to healthcare AI in Spain: social, political, and regulatory correlates in a surgical scenario

Article References: Loureiro-Álvarez, I., Savostsikava, A., & Bouzas-Lorenzo, R. (2026). Public receptiveness to healthcare AI in Spain: social, political, and regulatory correlates in a surgical scenario. Frontiers in Political Science, 8, Article 1947858. https://doi.org/10.3389/fpos.2026.1947858

Image Credits: AI Generated

DOI: 10.3389/fpos.2026.1947858

Keywords: artificial intelligence, robotic surgery, healthcare AI, public opinion, Spain, EU AI Act, political ideology, gender gap, technology acceptance, digital divide, survey research, health policy