This article provides a comparative analysis of the regulatory landscapes governing artificial intelligence (AI) in healthcare in the European Union (EU) and South Africa (SA). It critically examines the approaches, frameworks and mechanisms each jurisdiction employs to balance innovation with ethical considerations, patient safety, data privacy and accountability. The EU’s proactive stance, embodied by the AI Act, offers a structured and risk-based categorisation for AI applications, emphasising stringent guidelines for risk management, data governance and human oversight. In contrast, (...) SA’s regulatory environment is characterised by its infancy and lack of specificity, with existing legislation such as the National Health Act and the Medicines and Related Substances Act providing a foundational but limited framework for addressing the unique challenges posed by AI in healthcare. The article delves into the dynamic nature of AI technologies, highlighting the need for continuous risk assessment, the importance of transparent and responsible data governance and the critical role of human oversight in ensuring patient safety and autonomy. It discusses the obligation of clear liability frameworks to address potential malfunctions and security breaches in AI applications. Through this comparative lens, the manuscript identifies regulatory gaps and proposes that the South African Law Reform Commission (SALRC) should play a predominant role in developing draft legislation for AI prior to the evolution of challenges related to these technologies. (shrink)

Artificial intelligence is set to transform healthcare. Key ethical issues to emerge with this transformation encompass the accountability and transparency of the decisions made by AI-based systems, the potential for group harms arising from algorithmic bias and the professional roles and integrity of clinicians. These concerns must be balanced against the imperatives of generating public benefit with more efficient healthcare systems from the vastly higher and accurate computational power of AI. In weighing up these issues, this paper applies (...) the deliberative balancing approach of the Ethics Framework for Big Data in Health and Research. The analysis applies relevant values identified from the framework to demonstrate how decision-makers can draw on them to develop and implement AI-assisted support systems into healthcare and clinical practice ethically and responsibly. Please refer to Xafis et al. in this special issue of the Asian Bioethics Review for more information on how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end of this paper. (shrink)

Healthcare applications of AI have the potential to produce great benefit, but also come with significant ethical risks. This has brought ethics to the forefront of academic, policy and public debates about AI in healthcare. To help navigate these debates, we distinguish three general modes of ethical theorizing in contemporary secular AI ethics: (1) idealism, which seeks to articulate moral ideals that can be applied to concrete problems; (2) realism, which focuses on understanding complex social realities that (...) underpin ethical problems; and (3) pragmatism, which promotes deliberate methods that allow joint action in the present but also enable to future moral growth and progress. We discuss the strengths and weaknesses of each of these modes and illustrate their relevance to salient ethical problems arising from AI in healthcare. Finally, we argue that, while all three have merits, pragmatist approaches deserve more attention they have received thus far. (shrink)

Public-private partnerships are established to specifically harness the potential of Big Data in healthcare and can include partners working across the data chain—producing health data, analysing data, using research results or creating value from data. This domain paper will illustrate the challenges that arise when partners from the public and private sector collaborate to share, analyse and use biomedical Big Data. We discuss three specific challenges for PPPs: working within the social licence, public antipathy to the commercialisation of public (...) sector health data, and questions of ownership, both of the data and any resulting intellectual property or products. As a specific example we consider the case of the UK National Health Service providing patient data to Google’s DeepMind AI program to develop a diagnostic app for kidney disease. This article is an application of the framework presented in this issue of ABR. Please refer to that article for more information on how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. We use four specific values to help analysis these issues: public benefit, stewardship, transparency and engagement. We demonstrate how the Deliberative Framework can support ethical governance of PPPs involving biomedical big data. (shrink)

This groundbreaking proceedings volume explores the integration of Artificial Intelligence (AI) across key domains—healthcare, finance, education, robotics, industrial and other engineering applications —unveiling its transformative potential and practical implications. With a multidisciplinary lens, it transcends technical aspects, fostering a comprehensive understanding while bridging theory and practice. Approaching the subject matter with depth, the book combines theoretical foundations with real-world case studies, empowering researchers, professionals, and enthusiasts with the knowledge and tools to effectively harness AI. Encompassing diverse AI topics—machine (...) learning, natural language processing, computer vision, data analytics and supervisory control — the volume showcases state-of-the-art techniques propelling AI advancements. Structured into four parts: Part 1: Artificial Intelligence (AI), explores evolving deep neural networks, reinforcement learning, and explainable AI, providing a deep dive into the technical foundations of AI advancements. Part 2: Robotics and Control Systems, delves into the integration of AI in robotics and automatic control, addressing supervisory control, automated robotic movement coordination, anomaly detection, dynamic programming, and fault tolerance, offering insights into the evolving landscape of intelligent automation. Part 3: AI and Society, examines the societal impact of AI through chapters on ethical considerations, economic growth, environmental engagements, and hazard management, providing a holistic perspective on AI's role in shaping society. Part 4: PhD Symposium, presents the future of AI through cutting-edge research, covering legal and ethical dimensions, privacy considerations, and computationally efficient solutions, offering a glimpse into the next generation of AI advancements. Catering to a diverse audience—from industry leaders to students—the volume consolidates the expertise of renowned professionals, serving as a comprehensive resource for navigating the ever-evolving AI landscape. An essential reference for those staying at the forefront of AI developments. (shrink)

Artificial intelligence (AI) has attracted an increasing amount of attention, both positive and negative. Its potential applications in healthcare are indeed manifold and revolutionary, and within the realm of medical imaging and radiology (which will be the focus of this paper), significant increases in accuracy and speed, as well as significant savings in cost, stand to be gained through the adoption of this technology. Because of its novelty, a norm of keeping humans “in the loop” wherever AI mechanisms (...) are deployed has become synonymous with good ethical practice in some circles. It has been argued that keeping humans “in the loop” is important for reasons of safety, accountability, and the maintenance of institutional trust. However, as the application of machine learning for the detection of lumbar spinal stenosis (LSS) in this paper’s case study reveals, there are some scenarios where an insistence on keeping humans in the loop (or in other words, the resistance to automation) seems unwarranted and could possibly lead us to miss out on very real and important opportunities in healthcare—particularly in low-resource settings. It is important to acknowledge these opportunity costs of resisting automation in such contexts, where better options may be unavailable. Using an AI model based on convolutional neural networks developed by a team of researchers at NUH/NUS medical school in Singapore for automated detection and classification of the lumbar spinal canal, lateral recess, and neural foraminal narrowing in an MRI scan of the spine to diagnose LSS, we will aim to demonstrate that where certain criteria hold (e.g., the AI is as accurate or better than human experts, risks are low in the event of an error, the gain in wellbeing is significant, and the task being automated is not essentially or importantly human), it is both morally permissible and even desirable to kick the humans out of the loop. (shrink)

Artificial intelligence (AI), represented by machine learning, artificial neural networks and deep learning, is impacting all areas of medicine, including translational research (from bench to bedside to health policy), clinical medicine (including diagnosis, treatment, prognosis and healthcare resource allocation) and public health. At a time when almost everyone is focused on how to better realise the promise of AI to transform the entire healthcare system, Dr Appel calls for public attention to the AI in medicine and the negative (...) outcome penalty paradox. Proposing this topic has deepened our thinking about the application of AI in clinical diagnostics, and also prompted us to find more effective ways to integrate AI more effectively into future clinical practice. In addition to Dr Appel’s insightful advice, I hope to offer three other possible perspectives, including changing public perceptions, re-engineering clinical practice processes and introducing more stakeholders, to further the discussion on this topic. (shrink)

What does Artificial Intelligence (AI) have to contribute to health care? And what should we be looking out for if we are worried about its risks? In this paper we offer a survey, and initial evaluation, of hopes and fears about the applications of artificial intelligence in medicine. AI clearly has enormous potential as a research tool, in genomics and public health especially, as well as a diagnostic aid. It’s also highly likely to impact on the organisational and business (...) practices of healthcare systems in ways that are perhaps under-appreciated. Enthusiasts for AI have held out the prospect that it will free physicians up to spend more time attending to what really matters to them and their patients. We will argue that this claim depends upon implausible assumptions about the institutional and economic imperatives operating in contemporary healthcare settings. We will also highlight important concerns about privacy, surveillance, and bias in big data, as well as the risks of over trust in machines, the challenges of transparency, the deskilling of healthcare practitioners, the way AI reframes healthcare, and the implications of AI for the distribution of power in healthcare institutions. We will suggest that two questions, in particular, are deserving of further attention from philosophers and bioethicists. What does care look like when one is dealing with data as much as people? And, what weight should we give to the advice of machines in our own deliberations about medical decisions? (shrink)

A number of Artificial Intelligence (AI) ethics frameworks have been published in the last 6 years in response to the growing concerns posed by the adoption of AI in different sectors, including healthcare. While there is a strong culture of medical ethics in healthcare applications, AI-based Healthcare Applications (AIHA) are challenging the existing ethics and regulatory frameworks. This scoping review explores how ethics frameworks have been implemented in AIHA, how these implementations have been evaluated and (...) whether they have been successful. AI specific ethics frameworks in healthcare appear to have a limited adoption and they are mostly used in conjunction with other ethics frameworks. The operationalisation of ethics frameworks is a complex endeavour with challenges at different levels: ethics principles, design, technology, organisational, and regulatory. Strategies identified in this review are proactive, contextual, technological, checklist, organisational and/or evidence-based approaches. While interdisciplinary approaches show promises, how an ethics framework is implemented in an AI-based Healthcare Application is not widely reported, and there is a need for transparency for trustworthy AI. (shrink)

Bioethics, Volume 35, Issue 7, Page 623-633, September 2021.

The integration of artificial intelligence (AI) into healthcare and research introduces sophisticated diagnostic and treatment capabilities but also raises significant ethical challenges from development to deployment and evaluation, requiring comprehensive ethical training and interdisciplinary collaboration to ensure the responsible use of AI technologies. The “CONNECT with AI”- Collaborative Opportunity to Navigate and Negotiate Ethical Challenges and Trials with Artificial Intelligence) workshop was a three-day event, engaging multi-institutional interdisciplinary and interprofessional participants (both industry professionals and academicians) from diverse fields such (...) as Medicine, Dentistry, Nursing, Engineering, Law, and Allied Health Sciences from India. There was equal distribution of participants from diverse fields. A mixed-method approach utilizing pre- and post-workshop assessments, confidence level surveys and thematic analyses of small group discussions and open-ended questions to evaluate the impact of the workshop on participants’ ethical understanding and decision-making skills regarding AI. Post-workshop evaluations indicated a significant improvement in both theoretical knowledge and practical application of AI ethics, with assessment scores rising markedly from pre-workshop levels (p < 0.0001). Confidence in handling ethical dilemmas related to AI saw substantial increases across all domains, particularly in ensuring patient privacy and data security (p < 0.0001). Qualitative feedback highlighted diverse perceptions and sector-specific concerns about AI, emphasizing the importance of customized ethical guidelines and the integration of AI into healthcare practices. The workshop effectively enhanced participants’ competence and confidence in addressing AI-related ethical issues, demonstrating the critical role of interprofessional education in fostering an ethical AI implementation framework. Continuous, interdisciplinary and interprofessional training is essential to navigate the evolving ethical landscape of AI in healthcare, ensuring safe, effective, and responsible technology use. (shrink)

The application of AI in healthcare has dramatically changed the practice of medicine. In particular, AI has been implemented in a variety of roles that previously required human physicians. Due to AI's ability to outperform humans in these roles, the concern has been raised that AI will completely replace human physicians in the future. In this paper, it is argued that human physician's ability to embellish the truth is necessary to prevent injury or grief to patients, or to protect (...) patients’ feelings. Such embellishments are usually defined as “white lies,” which not only include intentionally providing false, incomplete, or misleading information to patients, but also withholding information. White lies are not uncommon in medical practice, especially in some particular cultures, such as Asia; and to some particular patients, such as children. Here, white lies are defended based on the position of weak paternalism. And although medical AI may surpass human physicians in diagnostic accuracy, efficiency, and treatment, they cannot intentionally lie to patients, which is necessary to prevent injury or grief or to protect patients’ feelings in some cases. From this perspective, it is further argued that AI cannot completely replace human physicians. (shrink)

Peer commentary on Char, Abràmoff & Feudtner (2020) target article: "Identifying Ethical Considerations for Machine Learning Healthcare Applications" .

The field of artificial intelligence (AI) ethics has exploded in recent years, with countless academics, organizations, and influencers rushing to consider how AI technology can be developed and im...

This paper motivates institutional epistemic trust as an important ethical consideration informing the responsible development and implementation of artificial intelligence (AI) technologies (or AI-inclusivity) in healthcare. Drawing on recent literature on epistemic trust and public trust in science, we start by examining the conditions under which we can have institutional epistemic trust in AI-inclusive healthcare systems and their members as providers of medical information and advice. In particular, we discuss that institutional epistemic trust in AI-inclusive healthcare depends, (...) in part, on the reliability of AI-inclusive medical practices and programs, its knowledge and understanding among different stakeholders involved, its effect on epistemic and communicative duties and burdens on medical professionals and, finally, its interaction and alignment with the public’s ethical values and interests as well as background sociopolitical conditions against which AI-inclusive healthcare systems are embedded. To assess the applicability of these conditions, we explore a recent proposal for AI-inclusivity within the Dutch Newborn Screening Program. In doing so, we illustrate the importance, scope, and potential challenges of fostering and maintaining institutional epistemic trust in a context where generating, assessing, and providing reliable and timely screening results for genetic risk is of high priority. Finally, to motivate the general relevance of our discussion and case study, we end with suggestions for strategies, interventions, and measures for AI-inclusivity in healthcare more widely. (shrink)

Background: Artificial intelligence (AI) is transforming healthcare systems by improving operational efficiency, simplifying patient care procedures, and improving diagnostic accuracy. Artificial intelligence (AI) technologies, like machine learning and natural language processing, present previously unheard-of chances to quickly and accurately evaluate enormous volumes of healthcare data, assisting with clinical decision-making and enhancing patient outcomes. Aim thorough examination and analysis of artificial intelligence's impact on healthcare leadership, with a particular emphasis on present nursing trends and their implications for the (...) future. The study tries to uncover the advantages, difficulties, and consequences of AI integration by looking at how AI technologies including clinical decision support systems, predictive analytics, robots, natural language processing, and telehealth are being used in nursing practice. Method: A comprehensive analysis including research articles published between 2015 and 2024 was carried out. To give a thorough overview of AI's present and future uses in healthcare, major themes and trends were found and summarized. Results: By stressing AI's role in improving diagnostic accuracy and patient outcomes, the study highlights the technology's major contributions to drug discovery, virtual patient care, and medical imaging. Human-centered design concerns, the necessity of educational changes, and ethical challenges surrounding the application of AI surfaced as crucial topics needing attention. Conclusion: AI has enormous potential to transform healthcare by enhancing operational effectiveness, optimizing the delivery of care, and increasing diagnostic precision. Still, ethical issues must be resolved, interdisciplinary cooperation must be promoted, and educational frameworks must be improved in order to provide healthcare workers with the necessary AI skills. (shrink)

One of the sectors for which Artificial Intelligence applications have been considered as exceptionally promising is the healthcare sector. As a public-facing sector, the introduction of AI applications has been subject to extended news coverage. This article conducts a quantitative and qualitative data analysis of English news media articles covering AI systems that allow the automation of tasks that so far needed to be done by a medical expert such as a doctor or a nurse thereby redistributing (...) their agency. We investigated in this article one particular framing of AI systems and their agency: the framing that positions AI systems as replacing and outperforming the human medical expert, and in which AI systems are personified and/or addressed as a person. The analysis of our data set consisting of 365 articles written between the years 1980 and 2019 will show that there is a tendency to present AI systems as outperforming human expertise. These findings are important given the central role of news coverage in explaining AI and given the fact that the popular frame of ‘outperforming’ might place AI systems above critique and concern including the Hippocratic oath. Our data also showed that the addressing of an AI system as a person is a trend that has been advanced only recently and is a new development in the public discourse about AI. (shrink)

Nurses have traditionally been regarded as clinicians that deliver compassionate, safe, and empathetic health care (Nurses again outpace other professions for honesty & ethics, 2018). Caring is a fundamental characteristic, expectation, and moral obligation of the nursing and caregiving professions (Nursing: Scope and standards of practice, American Nurses Association, Silver Spring, MD, 2015). Along with caring, nurses are expected to undertake ever‐expanding duties and complex tasks. In part because of the growing physical, intellectual and emotional demandingness, of nursing as well (...) as technological advances, artificial intelligence (AI) and AI care robots are rapidly changing the healthcare landscape. As technology becomes more advanced, efficient, and economical, opportunities and pressure to introduce AI into nursing care will only increase. In the first part of the article, we review recent and existing applications of AI in nursing and speculate on future use. Second, situate our project within the recent literature on the ethics of nursing and AI. Third, we explore three dominant theories of caring and the two paradigmatic expressions of caring (touch and presence) and conclude that AI—at least for the foreseeable future—is incapable of caring in the sense central to nursing and caregiving ethics. We conclude that for AI to be implemented ethically, it cannot transgress the core values of nursing, usurp aspects of caring that can only meaningfully be carried out by human beings, and it must support, open, or improve opportunities for nurses to provide the uniquely human aspects of care. (shrink)

This study examines the expanding field of medical tourism with an emphasis on strategies for marketing and entrepreneurship. The literature on the entrepreneurial components of medical tourism and the contribution of artificial intelligence (AI) to enhancing healthcare services and attracting medical tourists from across the world will be examined. Through the Web of Science database, a thorough literature analysis was carried out using keywords associated with marketing, entrepreneurship, medical tourism, and AI. In order to provide more comprehensive conclusions about (...) the sector, the research combines the results of many regional studies. The study identifies key elements that impact medical tourism, such as strategies for marketing, cultural aspects, and infrastructure. In order to improve healthcare services and bring in foreign patients, it points out successful case studies from nations like Malaysia, China, and Iran, highlighting the need for encouraging entrepreneurial ecosystems and productive government cooperation. The research comes to the conclusion that increasing healthcare access and quality requires the medical tourism business. In order to maximize patient experiences and eventually promote development in the medical tourism industry, it emphasizes the significance of customized marketing techniques and the use of AI technology. (shrink)

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depend on patient preferences. In this paper, we focus on the ethical questions arising from the design, development and deployment of AI systems to support (...) decision-making around cardiopulmonary resuscitation and the determination of a patient’s Do Not Attempt to Resuscitate status (also known as code status). The COVID-19 pandemic has made us keenly aware of the difficulties physicians encounter when they have to act quickly in stressful situations without knowing what their patient would have wanted. We discuss the results of an interview study conducted with healthcare professionals in a university hospital aimed at understanding the status quo of resuscitation decision processes while exploring a potential role for AI systems in decision-making around code status. Our data suggest that (1) current practices are fraught with challenges such as insufficient knowledge regarding patient preferences, time pressure and personal bias guiding care considerations and (2) there is considerable openness among clinicians to consider the use of AI-based decision support. We suggest a model for how AI can contribute to improve decision-making around resuscitation and propose a set of ethically relevant preconditions—conceptual, methodological and procedural—that need to be considered in further development and implementation efforts. (shrink)

Artificial intelligence (AI) is being tightly integrated into healthcare today. Even though AI is being utilized in healthcare, its application in clinical settings and health professions education is still controversial. The study described the perceptions of AI and its integration into health professions education and healthcare among health professions students. This descriptive phenomenological study analyzed the data from a purposive sample of 33 health professions students at a university in Kazakhstan using the thematic approach. Data collection was (...) conducted from March 30 to May 5, 2023, using an online questionnaire with four open-ended questions. Four significant themes describing the perceptions of the health professions students on AI and its integration into health profession education and healthcare was derived: enhanced interactive learning experiences, integrating artificial intelligence-powered diagnostic and decision-support tools into health professions education, AI technologies assist students in preparing for future roles in healthcare and integrating AI technologies presents several challenges. Health professions students perceived that integrating AI into health professions education and healthcare enhances their interactive learning experiences, increases knowledge and application of complicated medical topics, and prepares them for future healthcare roles. (shrink)

Xenophobia is one of the key drivers of marginalisation, discrimination, and conflict, yet many prominent machine learning fairness frameworks fail to comprehensively measure or mitigate the resulting xenophobic harms. Here we aim to bridge this conceptual gap and help facilitate safe and ethical design of artificial intelligence (AI) solutions. We ground our analysis of the impact of xenophobia by first identifying distinct types of xenophobic harms, and then applying this framework across a number of prominent AI application domains, reviewing the (...) potential interplay between AI and xenophobia on social media and recommendation systems, healthcare, immigration, employment, as well as biases in large pre-trained models. These help inform our recommendations towards an inclusive, xenophilic design of future AI systems. (shrink)

The two-volume set LNCS 10350 and 10351 constitutes the thoroughly refereed proceedings of the 30th International Conference on Industrial, Engineering and Other Applications of Applied Intelligent Systems, IEA/AIE 2017, held in Arras, France, in June 2017. The 70 revised full papers presented together with 45 short papers and 3 invited talks were carefully reviewed and selected from 180 submissions. They are organized in topical sections: constraints, planning, and optimization; data mining and machine learning; sensors, signal processing, and data fusion; (...) recommender systems; decision support systems; knowledge representation and reasoning; navigation, control, and autonome agents; sentiment analysis and social media; games, computer vision; and animation; uncertainty management; graphical models: from theory to applications; anomaly detection; agronomy and artificial intelligence; applications of argumentation; intelligent systems in healthcare and mhealth for health outcomes; and innovative applications of textual analysis based on AI. (shrink)

The prospect of including artificial intelligence (AI) in clinical decision-making is an exciting next step for some areas of healthcare. This article provides an analysis of the available kinds of AI systems, focusing on macro-level characteristics. This includes examining the strengths and weaknesses of opaque systems and fully explainable systems. Ultimately, the article argues that “grey box” systems, which include some combination of opacity and transparency, ought to be used in healthcare settings.

Self-tracking-technologies can serve as a prominent example of how digital technologies put to test established practices, institutions, and structures of medicine and healthcare. While proponents emphasize the potentials, e.g., for individualized healthcare and new research data, opponents stress the risk that these technologies will reinforce gender-related inequalities. -/- While this has been made clear from—often intersectional—feminist perspectives since the introduction of such technologies, we aim to provide a queer-feminist perspective on self-tracking applications in healthcare by analyzing (...) three concrete cases. In this way, we want to show why such a perspective is helpful in assessing self-tracking technologies and how such a perspective might contribute to a queering of healthcare. -/- After a short introduction to self-tracking in healthcare and the corresponding risks of reproducing gender-related inequalities, we introduce queer bioethics as a methodology to examine structural discrimination and marginalization in bioethical research. We apply this framework in the analysis of three exemplary self-tracking applications from the areas of nutrition/fitness, reproductive health, and mental health. In the subsequent discussion of these results against the backdrop of already existing queer-sensitive technologies, we identify an equal access, a subversive design, an inclusive database, and a diversity-sensitive and discriminatory-critical definition of purposes as well as individualized usage possibilities as first possible starting points for a queering of self-tracking applications. Finally, we draw conclusions, how such a critical perspective on self-tracking applications might also contribute to a queering of the healthcare system at a structural level. (shrink)

The scientific relationship between neuroscience and artificial intelligence is generally acknowledged, and the role that their long history of collaboration has played in advancing both fields is often emphasized. Beyond the important scientific insights provided by their collaborative development, both neuroscience and AI raise a number of ethical issues that are generally explored by neuroethics and AI ethics. Neuroethics and AI ethics have been gaining prominence in the last few decades, and they are typically carried out by different research communities. (...) However, considering the evolving landscape of AI-assisted neurotechnologies and the various conceptual and practical intersections between AI and neuroscience—such as the increasing application of AI in neuroscientific research, the healthcare of neurological and mental diseases, and the use of neuroscientific knowledge as inspiration for AI—some scholars are now calling for a collaborative relationship between these two domains. This article seeks to explore how a collaborative relationship between neuroethics and AI ethics can stimulate theoretical and, ideally, governance efforts. First, we offer some reasons for calling for the collaboration of the ethical reflection on neuroscientific innovations and AI. Next, we explore some dimensions that we think could be enhanced by the cross-fertilization between these two subfields of ethics. We believe that considering the pace and increasing fusion of neuroscience and AI in the development of innovations, broad and underspecified calls for responsibility that do not consider insights from different ethics subfields will only be partially successful in promoting meaningful changes in both research and applications. (shrink)

What are the limits of the use of artificial intelligence (AI) in the relational aspects of medical and nursing care? There has been a lot of recent work and applications showing the promise and efficiency of AI in clinical medicine, both at the research and treatment levels. Many of the obstacles discussed in the literature are technical in character, regarding how to improve and optimize current practices in clinical medicine and also how to develop better data bases for optimal (...) parameter adjustments and predictive algorithms. This paper argues that there are also in principle obstacles to the application of AI in clinical medicine and care where empathy is important, and that these problems cannot be solved with any of the technical and theoretical approaches that shape the current application of AI in specific areas of clinical medicine in which care for patients is fundamental. This is important, because it generates specific risks that may be overlooked otherwise, and it justifies the necessity of human monitoring and emotional intervention in clinical medicine. Consequently, difficult issues concerning moral and legal responsibility may ensue if these in principle problems are ignored. (shrink)

Artificial intelligence (AI) technologies in medicine are gradually changing biomedical research and patient care. High expectations and promises from novel AI applications aiming to positively impact society raise new ethical considerations for patients and caregivers who use these technologies. Based on a qualitative content analysis of semi-structured interviews and focus groups with healthcare professionals (HCPs), patients, and family members of patients with Parkinson’s Disease (PD), the present study investigates participant views on the comparative benefits and problems of using (...) human versus AI predictive computer vision health monitoring, as well as participants’ ethical concerns regarding these technologies. Participants presumed that AI monitoring would enhance information sharing and treatment, but voiced concerns about data ownership, data protection, commercialization of patient data, and privacy at home. They highlighted that privacy issues at home and data security issues are often linked and should be investigated together. Findings may help technologists, HCPs, and policymakers determine how to incorporate stakeholders’ intersecting but divergent concerns into developing and implementing AI PD monitoring tools. (shrink)

Background In an effort to improve the quality of medical care, the philosophy of patient-centered care has become integrated into almost every aspect of the medical community. Despite its widespread acceptance, among patients and practitioners, there are concerns that rapid advancements in artificial intelligence may threaten elements of patient-centered care, such as personal relationships with care providers and patient-driven choices. This study explores the extent to which patients are confident in and comfortable with the use of these technologies when it (...) comes to their own individual care and identifies areas that may align with or threaten elements of patient-centered care. Methods An exploratory, mixed-method approach was used to analyze survey data from 600 US-based adults in the State of Florida. The survey was administered through a leading market research provider (August 10–21, 2023), and responses were collected to be representative of the state’s population based on age, gender, race/ethnicity, and political affiliation. Results Respondents were more comfortable with the use of AI in health-related tasks that were not associated with doctor-patient relationships, such as scheduling patient appointments or follow-ups (84.2%). Fear of losing the ‘human touch’ associated with doctors was a common theme within qualitative coding, suggesting a potential conflict between the implementation of AI and patient-centered care. In addition, decision self-efficacy was associated with higher levels of comfort with AI, but there were also concerns about losing decision-making control, workforce changes, and cost concerns. A small majority of participants mentioned that AI could be useful for doctors and lead to more equitable care but only when used within limits. Conclusion The application of AI in medical care is rapidly advancing, but oversight, regulation, and guidance addressing critical aspects of patient-centered care are lacking. While there is no evidence that AI will undermine patient-physician relationships at this time, there is concern on the part of patients regarding the application of AI within medical care and specifically as it relates to their interaction with physicians. Medical guidance on incorporating AI while adhering to the principles of patient-centered care is needed to clarify how AI will augment medical care. (shrink)

The application of machine learning and artificial intelligence in healthcare domains has received much attention in recent years, yet significant questions remain about how these new tools integrate into frontline user workflow, and how their design will impact implementation. Lack of acceptance among clinicians is a major barrier to the translation of healthcare innovations into clinical practice. In this systematic review, we examine when and how clinicians are consulted about their needs and desires for clinical AI tools. Forty-five (...) articles met criteria for inclusion, of which 24 were considered design studies. The design studies used a variety of methods to solicit and gather user feedback, with interviews, surveys, and user evaluations. Our findings show that tool designers consult clinicians at various but inconsistent points during the design process, and most typically at later stages in the design cycle. We also observed a smaller amount of studies adopting a human-centered approach and where clinician input was solicited throughout the design process. A third of all studies reported on clinician trust in clinical AI algorithms and tools. The surveyed articles did not universally report validation against the “gold standard” of clinical expertise or provide detailed descriptions of the algorithms or computational methods used in their work. To realize the full potential of AI tools within healthcare settings, our review suggests there are opportunities to more thoroughly integrate frontline users’ needs and feedback in the design process. (shrink)

The advance in Internet of Things technology has increased the opportunities for a healthcare system design, which is an urgent need owing to the growth in population among the older adults in many countries. This requires giving thought to the kind of innovative technological design methods that can find suitable solutions for home care. The application of Health Smart Homes by means of the technologies of the Internet of Things, can be used to support rehabilitation treatment and help the (...) senior citizens to understand the importance of taking measures to maintain a healthy standard of living that can meet their needs. The aim of this article is to develop and assess a design method for the following purposes: to determine and map out the physical and emotional state of the home care users, such as senior citizens; to implement a participatory design that includes the user within its social, psychological and therapeutic context; to explore the flexible method when applied to older users; to provide a way for the users to be “personalized” through a wide range of solutions that involve analyzing the behavioral patterns of different individuals in a standardized manner and to define a set of smart technologies for each problem and senior citizen. This article sets out a collaborative method called FlexPersonas, which is employed for the flexible mapping of users and to improve decision-making with the support of Internet of Things technologies. In this context, computing systems can identify the behavior of the user and issue warnings to the Carers about any abnormal event. Studies with an interdisciplinary team point out the potential and drawbacks of the method. (shrink)

This paper provides a critical review of economic outcome metrics used in healthcare value assessment, emphasizing the evolving landscape of resource allocation, patient-centered approaches, and standardization efforts. With healthcare costs rising globally, the efficient allocation of limited resources is essential. Metrics like Quality-Adjusted Life Years (QALYs), Disability-Adjusted Life Years (DALYs), Incremental Cost-Effectiveness Ratios (ICERs), and Cost-Benefit Analysis (CBA) are central to guiding funding decisions, influencing insurance coverage, and shaping treatment prioritization. Emerging trends, such as the integration of artificial (...) intelligence (AI) and big data, are enhancing the precision of these assessments, while patient-centered metrics underscore the importance of patient satisfaction and quality of life. Additionally, there is a growing push for the standardization of these metrics to create consistent frameworks across diverse health systems. This paper explores case studies, practical applications, and future directions to provide insights into how healthcare systems can adopt more effective, globally aligned economic assessments. (shrink)

Aims To examine the understanding of the ethical dilemmas associated with Big Data and artificial intelligence (AI) among Jordanian medical students, physicians in training, and senior practitioners. Methods We implemented a literature-validated questionnaire to examine the knowledge, attitudes, and practices of the target population during the period between April and August 2023. Themes of ethical debate included privacy breaches, consent, ownership, augmented biases, epistemology, and accountability. Participants’ responses were showcased using descriptive statistics and compared between groups using t-test or ANOVA. (...) Results We included 466 participants. The greater majority of respondents were interns and residents (50.2%), followed by medical students (38.0%). Most participants were affiliated with university institutions (62.4%). In terms of privacy, participants acknowledged that Big Data and AI were susceptible to privacy breaches (39.3%); however, 59.0% found such breaches justifiable under certain conditions. For ethical debacles involving informed consent, 41.6% and 44.6% were aware that obtaining informed consent posed an ethical limitation in Big Data and AI applications and denounced the concept of “broad consent”, respectively. In terms of ownership, 49.6% acknowledged that data cannot be owned yet accepted that institutions could hold a quasi-control of such data (59.0%). Less than 50% of participants were aware of Big Data and AI’s abilities to augment or create new biases in healthcare. Furthermore, participants agreed that researchers, institutions, and legislative bodies were responsible for ensuring the ethical implementation of Big Data and AI. Finally, while demonstrating limited experience with using such technology, participants generally had positive views of the role of Big Data and AI in complementing healthcare. Conclusion Jordanian medical students, physicians in training and senior practitioners have limited awareness of the ethical risks associated with Big Data and AI. Institutions are responsible for raising awareness, especially with the upsurge of such technology. (shrink)

In their article,1 Jecker et al highlight a widespread and hotly debated issue in the current application of artificial intelligence (AI) in medicine: whether we should develop more powerful AI. There are many perspectives on this question. I would like to address it from the perspective of the fundamental purpose of medicine. Since its inception, medicine has been dedicated to alleviating human suffering and ensuring health equity. For thousands of years, we have made great efforts and conducted many investigations to (...) eliminate human suffering and have achieved remarkable results. However, the reality of achieving health equity falls far short of expectations. The WHO considers health equity to be a fundamental human right, meaning that there should be no unjustified, avoidable or remediable differences among the population as a whole, whether those differences result from social, economic, demographic or geographic factors, or from other forms of inequality such as gender, race, disability or sexual orientation.2 Health equity means reducing and ultimately eliminating disparities in health outcomes between vulnerable groups and others, caused by health risk factors and difficulties in accessing quality health services. This means that we must strive to reduce structural social bias. It is well known that the traditional healthcare system is riddled with various health inequities. …. (shrink)

This paper elucidates and rationalizes the ethical governance system for healthcare AI research, as outlined in the ‘Research Ethics Guidelines for AI Researchers in Healthcare’ published by the South Korean government in August 2023. In developing the guidelines, a four-phase clinical trial process was expanded to six stages for healthcare AI research: preliminary ethics review (stage 1); creating datasets (stage 2); model development (stage 3); training, validation, and evaluation (stage 4); application (stage 5); and post-deployment monitoring (stage (...) 6). Researchers identified similarities between clinical trials and healthcare AI research, particularly in research subjects, management and regulations, and application of research results. In the step-by-step articulation of ethical requirements, this similarity benefits from a reliable and flexible use of existing research ethics governance resources, research management, and regulatory functions. In contrast to clinical trials, this procedural approach to healthcare AI research governance effectively highlights the distinct characteristics of healthcare AI research in research and development process, evaluation of results, and modifiability of findings. The model exhibits limitations, primarily in its reliance on self-regulation and lack of clear delineation of responsibilities. While formulated through multidisciplinary deliberations, its application in the research field remains untested. To overcome the limitations, the researchers’ ongoing efforts for educating AI researchers and public and the revision of the guidelines are expected to contribute to establish an ethical research governance framework for healthcare AI research in the South Korean context in the future. (shrink)

Like previous educational technologies, artificial intelligence in education threatens to disrupt the status quo, with proponents highlighting the potential for efficiency and democratization, and skeptics warning of industrialization and alienation. However, unlike frequently discussed applications of AI in autonomous vehicles, military and cybersecurity concerns, and healthcare, AI’s impacts on education policy and practice have not yet captured the public’s attention. This paper, therefore, evaluates the status of AIEd, with special attention to intelligent tutoring systems and anthropomorphized artificial educational (...) agents. I discuss AIEd’s purported capacities, including the abilities to simulate teachers, provide robust student differentiation, and even foster socio-emotional engagement. Next, to situate developmental pathways for AIEd going forward, I contrast sociotechnical possibilities and risks through two idealized futures. Finally, I consider a recent proposal to use peer review as a gatekeeping strategy to prevent harmful research. This proposal serves as a jumping off point for recommendations to AIEd stakeholders towards improving their engagement with socially responsible research and implementation of AI in educational systems. (shrink)

The increasing application of artificial intelligence (AI) to healthcare raises both hope and ethical concerns. Some advanced machine learning methods provide accurate clinical predictions at the expense of a significant lack of explainability. Alex John London has defended that accuracy is a more important value than explainability in AI medicine. In this article, we locate the trade-off between accurate performance and explainable algorithms in the context of distributive justice. We acknowledge that accuracy is cardinal from outcome-oriented justice because it (...) helps to maximize patients’ benefits and optimizes limited resources. However, we claim that the opaqueness of the algorithmic black box and its absence of explainability threatens core commitments of procedural fairness such as accountability, avoidance of bias, and transparency. To illustrate this, we discuss liver transplantation as a case of critical medical resources in which the lack of explainability in AI-based allocation algorithms is procedurally unfair. Finally, we provide a number of ethical recommendations for when considering the use of unexplainable algorithms in the distribution of health-related resources. (shrink)

The term ‘artificial intelligence’ has arguably come to function in political discourse as, what Laclau called, an ‘empty signifier’. This article traces the shifting political discourse on AI within three key institutions of global governance–OHCHR, WHO, and UNESCO–and, in so doing, highlights the role of ‘crisis’ moments in justifying a series of pivotal re-articulations. Most important has been the attachment of AI to the narrative around digital automation in human healthcare. Greatly enabled by the societal context of the pandemic, (...) all three institutions have moved from being critical of the unequal power relations in the economy of AI to, today, reframing themselves primarily as facilitators tasked with helping to ensure the application of AI technologies. The analysis identifies a shift in which human health and healthcare is framed as in a ‘crisis’ to which AI technology is presented as the remedy. The article argues the need to trace these discursive shifts as a means by which to understand, monitor, and where necessary also hold to account these changes in the governance of AI in society. (shrink)

The emergence of ethical concerns surrounding artificial intelligence (AI) has led to an explosion of high-level ethical principles being published by a wide range of public and private organizations. However, there is a need to consider how AI developers can be practically assisted to anticipate, identify and address ethical issues regarding AI technologies. This is particularly important in the development of AI intended for healthcare settings, where applications will often interact directly with patients in various states of vulnerability. (...) In this paper, we propose that an ‘embedded ethics’ approach, in which ethicists and developers together address ethical issues via an iterative and continuous process from the outset of development, could be an effective means of integrating robust ethical considerations into the practical development of medical AI. (shrink)

In their paper ‘Designing AI for mental health diagnosis: challenges from sub-Saharan African value-laden judgements on mental health disorders’, Ugar and Malele focused on the challenges and considerations surrounding the design and implementation of artificial intelligence (AI) and machine learning (ML) technologies for diagnosing mental health disorders in South Africa. Although the authors recognise the application of AI and ML in healthcare, they put forward the challenges, particularly in adopting Wakefield’s hybrid theory, where elements of naturalism and normativism are (...) combined in defining mental disorders. They argue that a generic or universally designed AI or ML would not be appropriate in countries with strong and varied local contexts. Hence, they believe that current and future AI developers should consider the cultural nuances, value systems and contextual factors in designing and implementing AI technologies for mental health diagnosis in Africa. When the authors argue that a universal definition of mental health may not be appropriate in Africa, we would like to offer something in contrast. If nomenclature like the Diagnostic and Statistical Manual of Mental Disorders (DSM) can be widely accepted, why does AI, which relies on these codes, encounter scepticism? Recognising the significant influence of culture on all aspects of patient care in psychiatry, the DSM-IV introduced the …. (shrink)

Background There is a growing concern about artificial intelligence (AI) applications in healthcare that can disadvantage already under-represented and marginalised groups (eg, based on gender or race). Objectives Our objectives are to canvas the range of strategies stakeholders endorse in attempting to mitigate algorithmic bias, and to consider the ethical question of responsibility for algorithmic bias. Methodology The study involves in-depth, semistructured interviews with healthcare workers, screening programme managers, consumer health representatives, regulators, data scientists and developers. Results (...) Findings reveal considerable divergent views on three key issues. First, views on whether bias is a problem in healthcare AI varied, with most participants agreeing bias is a problem (which we call the bias-critical view), a small number believing the opposite (the bias-denial view), and some arguing that the benefits of AI outweigh any harms or wrongs arising from the bias problem (the bias-apologist view). Second, there was a disagreement on the strategies to mitigate bias, and who is responsible for such strategies. Finally, there were divergent views on whether to include or exclude sociocultural identifiers (eg, race, ethnicity or gender-diverse identities) in the development of AI as a way to mitigate bias. Conclusion/significance Based on the views of participants, we set out responses that stakeholders might pursue, including greater interdisciplinary collaboration, tailored stakeholder engagement activities, empirical studies to understand algorithmic bias and strategies to modify dominant approaches in AI development such as the use of participatory methods, and increased diversity and inclusion in research teams and research participant recruitment and selection. (shrink)

There is much interest in moving AI out into real world applications, a move which has been encouraged by recent funding which has attempted to show industry and commerce can benefit from the Fifth Generation of computing. In this article I suggest that the legal application area is one which is very much more complex than it might — at first sight — seem. I use arguments from the sociology of law to indicate that the viewing of the legal (...) system as simply a rule-bound discipline is inherently nave. This, while not new in jurisprudence, is — as the literature of AI and law indicates — certainly novel to the field of artificial intelligence. The socio-legal argument provided is set within the context of AI as one more example of the failure of scientific success and method to easily transmit itself over into the social sciences. (shrink)

Background While the theoretical benefits and harms of Artificial Intelligence (AI) have been widely discussed in academic literature, empirical evidence remains elusive regarding the practical ethical challenges of developing AI for healthcare. Bridging the gap between theory and practice is an essential step in understanding how to ethically align AI for healthcare. Therefore, this research examines the concerns and challenges perceived by experts in developing ethical AI that addresses the healthcare context and needs. Methods We conducted semi-structured (...) interviews with 41 AI experts and analyzed the data using reflective thematic analysis. Results We developed three themes that expressed the considerations perceived by experts as essential for ensuring AI aligns with ethical practices within healthcare. The first theme explores the ethical significance of introducing AI with a clear and purposeful objective. The second theme focuses on how experts are concerned about the tension that exists between economic incentives and the importance of prioritizing the interests of doctors and patients. The third theme illustrates the need to develop context-sensitive AI for healthcare that is informed by its underlying theoretical foundations. Conclusions The three themes collectively emphasized that beyond being innovative, AI must genuinely benefit healthcare and its stakeholders, meaning AI also aligns with intricate and context-specific healthcare practices. Our findings signal that instead of narrow product-specific AI guidance, ethical AI development may need a systemic, proactive perspective that includes the ethical considerations (objectives, actors, and context) and focuses on healthcare applications. Ethically developing AI involves a complex interplay between AI, ethics, healthcare, and multiple stakeholders. (shrink)

Digitalisation of health and the use of health data in artificial intelligence, and machine learning (ML), including for applications that will then in turn be used in healthcare are major themes permeating current UK and other countries’ healthcare systems and policies. Obtaining rich and representative data is key for robust ML development, and UK health data sets are particularly attractive sources for this. However, ensuring that such research and development is in the public interest, produces public benefit (...) and preserves privacy are key challenges. Trusted research environments (TREs) are positioned as a way of balancing the diverging interests in healthcare data research with privacy and public benefit. Using TRE data to train ML models presents various challenges to the balance previously struck between these societal interests, which have hitherto not been discussed in the literature. These challenges include the possibility of personal data being disclosed in ML models, the dynamic nature of ML models and how public benefit may be (re)conceived in this context. For ML research to be facilitated using UK health data, TREs and others involved in the UK health data policy ecosystem need to be aware of these issues and work to address them in order to continue to ensure a ‘safe’ health and care data environment that truly serves the public. (shrink)

This paper provides a comprehensive exploration of the transformative role of generative AI models, specifically Generative Adversarial Networks (GANs) and Variational Autoencoders (VAEs), in the realm of medical diagnosis. Drawing from the philosophy of medicine and epidemiology, the paper examines the technical, ethical, and philosophical dimensions of integrating generative models into healthcare. A case study featuring Emily underscores the pivotal support generative AI can offer in complex medical diagnoses. The discussion extends to the application of GANs and VAEs in (...) medical imaging, emphasizing their potential in improving diagnostics, treatment planning, and medical research. The paper further delves into challenges and controversies, addressing issues of anatomical accuracy, biases in training data, interpretability of AI-generated medical images, and ethical considerations, for example, the phenomenon of "Dr. Google" and its implications for self-diagnosis, particularly in the context of the increasing role of generative AI models in healthcare. The concluding section emphasizes the need for health literacy, responsible use of online information, and collaborative decision-making between patients and healthcare providers. We advocate for interdisciplinary collaborations to establish ethical guidelines and ensure responsible AI use in healthcare. (shrink)

Healthcare is becoming increasingly automated with the development and deployment of care robots. There are many benefits to care robots but they also pose many challenging ethical issues. This paper takes care robots for the elderly as the subject of analysis, building on previous literature in the domain of the ethics and design of care robots. Using the value sensitive design approach to technology design, this paper extends its application to care robots by integrating the values of care, values (...) that are specific to AI, and higher-scale values such as the United Nations Sustainable Development Goals. The ethical issues specific to care robots for the elderly are discussed at length alongside examples of specific design requirements that work to ameliorate these ethical concerns. (shrink)

AI and robotic technologies attract much hype, including utopian and dystopian future visions of technologically driven provision in the health and care sectors. Based on 30 interviews with scientists, clinicians and other stakeholders in the UK, Europe, USA, Australia, and New Zealand, this paper interrogates how those engaged in developing and using AI and robotic applications in health and care characterize their future promise, potential and challenges. We explore the ways in which these professionals articulate and navigate a range (...) of high and low expectations, and promissory and cautionary future visions, around AI and robotic technologies. We argue that, through these articulations and navigations, they construct their own perceptions of socially and ethically ‘acceptable futures’ framed by an ‘ethics of expectations.’ This imbues the envisioned futures with a normative character, articulated in relation to the present context. We build on existing work in the sociology of expectations, aiming to contribute towards better understanding of how technoscientific expectations are navigated and managed by professionals. This is particularly timely since the COVID-19 pandemic gave further momentum to these technologies. (shrink)

The application of machine learning algorithms to healthcare data can enhance patient care while also reducing healthcare worker cognitive load. These algorithms can be used to detect anomalous physiological readings, potentially leading to expedited emergency response or new knowledge about the development of a health condition. However, while there has been much research conducted in assessing the performance of anomaly detection algorithms on well-known public datasets, there is less conceptual comparison across unsupervised and supervised performance on physiological data. (...) Moreover, while heart rate data are both ubiquitous and noninvasive, there has been little research specifically for anomaly detection of this type of data. Considering that heart rate data are indicative of both potential health complications and an individual’s physical activity, this is a rich source of largely overlooked data. To this end, we employed and evaluated five machine learning algorithms, two of which are unsupervised and the remaining three supervised, in their ability to detect anomalies in heart rate data. These algorithms were then evaluated on real heart rate data. Findings supported the effectiveness of local outlier factor and random forests algorithms in the task of heart rate anomaly detection, as each model generalized well from their training on simulated heart rate data to real world heart rate data. Furthermore, results support that simulated data can help configure algorithms to a degree of performance when real labeled data are not available and that this type of learning might be especially helpful in initial deployment of a system without prior data. (shrink)

The application of artificial intelligence (AI) in hospitals yields many advantages but also confronts healthcare with ethical questions and challenges. While various disciplines have conducted specific research on the ethical considerations of AI in hospitals, the literature still requires a holistic overview. By conducting a systematic discourse approach highlighted by expert interviews with healthcare specialists, we identified the status quo of interdisciplinary research in academia on ethical considerations and dimensions of AI in hospitals. We found 15 fundamental manuscripts (...) by constructing a citation network for the ethical discourse, and we extracted actionable principles and their relationships. We provide an agenda to guide academia, framed under the principles of biomedical ethics. We provide an understanding of the current ethical discourse of AI in clinical environments, identify where further research is pressingly needed, and discuss additional research questions that should be addressed. We also guide practitioners to acknowledge AI-related benefits in hospitals and to understand the related ethical concerns. (shrink)

The ‘black box problem’ is a long-standing talking point in debates about artificial intelligence. This is a significant point of tension between ethicists, programmers, clinicians and anyone else working on developing AI for healthcare applications. However, the precise definition of these systems are often left undefined, vague, unclear or are assumed to be standardised within AI circles. This leads to situations where individuals working on AI talk over each other and has been invoked in numerous debates between opaque (...) and explainable systems. This paper proposes a coherent and clear definition for the black box problem to assist in future discussions about AI in healthcare. This is accomplished by synthesising various definitions in the literature and examining several criteria that can be extrapolated from these definitions. There are no data in this work. (shrink)