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)

It has been argued that our currently most satisfactory social epistemology of science can’t account for science that is based on artificial intelligence (AI) because this social epistemology requires trust between scientists that can take full responsibility for the research tools they use, and scientists can’t take full responsibility for the AI tools they use since these systems are epistemically opaque. I think this argument overlooks that much AI-based science can be done without opaque models, and that agents can take (...) full responsibility for the systems they use even if these systems are opaque. Requiring that an agent fully understand how a system works is an untenably strong condition for that agent to take full responsibility for the system and risks absolving AI developers from responsibility for their products. AI-based science need not create trust-related social epistemological problems if we keep in mind that what makes both individual scientists and their use of AI systems trustworthy isn’t full transparency of the internal processing but their adherence to social and institutional norms that ensure that scientific claims can be trusted. (shrink)