Real engines of the artificial intelligence revolution, machine learning models, and algorithms are embedded nowadays in many services and products around us. As a society, we argue it is now necessary to transition into a phronetic paradigm focused on the ethical dilemmas stemming from the conception and application of AIs to define actionable recommendations as well as normative solutions. However, both academic research and society-driven initiatives are still quite far from clearly defining a solid program of study and intervention. In (...) this contribution, we will focus on selected ethical investigations around AI by proposing an incremental model of trust that can be applied to both human-human and human-AI interactions. Starting with a quick overview of the existing accounts of trust, with special attention to Taddeo’s concept of “e-trust,” we will discuss all the components of the proposed model and the reasons to trust in human-AI interactions in an example of relevance for business organizations. We end this contribution with an analysis of the epistemic and pragmatic reasons of trust in human-AI interactions and with a discussion of kinds of normativity in trustworthiness of AIs. (shrink)

In his recent article ‘Limits of trust in medical AI,’ Hatherley argues that, if we believe that the motivations that are usually recognised as relevant for interpersonal trust have to be applied to interactions between humans and medical artificial intelligence, then these systems do not appear to be the appropriate objects of trust. In this response, we argue that it is possible to discuss trust in medical artificial intelligence, if one refrains from simply assuming that trust describes human–human interactions. To (...) do so, we consider an account of trust that distinguishes trust from reliance in a way that is compatible with trusting non-human agents. In this account, to trust a medical AI is to rely on it with little monitoring and control of the elements that make it trustworthy. This attitude does not imply specific properties in the AI system that in fact only humans can have. This account of trust is applicable, in particular, to all cases where a physician relies on the medical AI predictions to support his or her decision making. (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)

In this paper we argue that transparency of machine learning algorithms, just as explanation, can be defined at different levels of abstraction. We criticize recent attempts to identify the explanation of black box algorithms with making their decisions (post-hoc) interpretable, focusing our discussion on counterfactual explanations. These approaches to explanation simplify the real nature of the black boxes and risk misleading the public about the normative features of a model. We propose a new form of algorithmic transparency, that consists in (...) explaining algorithms as an intentional product, that serves a particular goal, or multiple goals (Daniel Dennet’s design stance) in a given domain of applicability, and that provides a measure of the extent to which such a goal is achieved, and evidence about the way that measure has been reached. We call such idea of algorithmic transparency “design publicity.” We argue that design publicity can be more easily linked with the justification of the use and of the design of the algorithm, and of each individual decision following from it. In comparison to post-hoc explanations of individual algorithmic decisions, design publicity meets a different demand (the demand for impersonal justification) of the explainee. Finally, we argue that when models that pursue justifiable goals (which may include fairness as avoidance of bias towards specific groups) to a justifiable degree are used consistently, the resulting decisions are all justified even if some of them are (unavoidably) based on incorrect predictions. For this argument, we rely on John Rawls’s idea of procedural justice applied to algorithms conceived as institutions. (shrink)

Artificial intelligence (AI) systems are quickly gaining ground in healthcare and clinical decision-making. However, it is still unclear in what way AI can or should support decision-making that is based on incapacitated patients’ values and goals of care, which often requires input from clinicians and loved ones. Although the use of algorithms to predict patients’ most likely preferred treatment has been discussed in the medical ethics literature, no example has been realised in clinical practice. This is due, arguably, to the (...) lack of a structured approach to the epistemological, ethical and pragmatic challenges arising from the design and use of such algorithms. The present paper offers a new perspective on the problem by suggesting that preference predicting AIs be viewed as sociotechnical systems with distinctive life-cycles. We explore how both known and novel challenges map onto the different stages of development, highlighting interdisciplinary strategies for their resolution. (shrink)

Large language models (LLMs) have now entered the realm of medical ethics. In a recent study, Balaset alexamined the performance of GPT-4, a commercially available LLM, assessing its performance in generating responses to diverse medical ethics cases. Their findings reveal that GPT-4 demonstrates an ability to identify and articulate complex medical ethical issues, although its proficiency in encoding the depth of real-world ethical dilemmas remains an avenue for improvement. Investigating the integration of LLMs into medical ethics decision-making appears to be (...) an interesting avenue of research. However, despite the promising trajectory of LLM technology in medicine, it is crucial to exercise caution and refrain from attributing their expertise to medical ethics. Our thesis follows an examination of the nature of expertise and the epistemic limitations that affect LLM technology. As a result, we propose two more fitting applications of LLMs in medical ethics: first, as tools for mining electronic health records or scientific literature, thereby supplementing evidence for resolving medical ethics cases, and second, as educational platforms to foster ethical reflection and critical thinking skills among students and residents. The integration of LLMs in medical ethics, while promising, requires careful consideration of their epistemic limitations. Consequently, a well-considered definition of their role in ethically sensitive decision-making is crucial. (shrink)

Artificial intelligence has found its way into many areas of human life, serving a range of purposes. Sometimes AI tools are designed to help humans eliminate high-volume, tedious, routine tas...

The high predictive accuracy of contemporary machine learning-based AI systems has led some scholars to argue that, in certain cases, we should grant them epistemic expertise and authority over humans. This approach suggests that humans would have the epistemic obligation of relying on the predictions of a highly accurate AI system. Contrary to this view, in this work we claim that it is not possible to endow AI systems with a genuine account of epistemic expertise. In fact, relying on accounts (...) of expertise and authority from virtue epistemology, we show that epistemic expertise requires a relation with understanding that AI systems do not satisfy and intellectual abilities that these systems do not manifest. However, recent developments of large language models make us argue that in the future AI systems may endowed with a form of epistemic authority. Further, following the Distributed Cognition theory and adapting an account by Croce on the virtues of collective epistemic agents to the case of human-AI interactions we show that, if an AI system is successfully appropriated by a human agent, a hybrid epistemic agent emerges, which can become both an epistemic expert and an authority. Consequently, we claim that the aforementioned hybrid agent is the appropriate object of a discourse around trust in AI and the epistemic obligations that stem from its epistemic superiority. (shrink)

Human-centered explainable AI (HCXAI) advocates for the integration of social aspects into AI explanations. Central to the HCXAI discourse is the Social Transparency (ST) framework, which aims to make the socio-organizational context of AI systems accessible to their users. In this work, we suggest extending the ST framework to address the risks of social misattributions in Large Language Models (LLMs), particularly in sensitive areas like mental health. In fact LLMs, which are remarkably capable of simulating roles and personas, may lead (...) to mismatches between designers' intentions and users' perceptions of social attributes, risking to promote emotional manipulation and dangerous behaviors, cases of epistemic injustice, and unwarranted trust. To address these issues, we propose enhancing the ST framework with a fifth 'W-question' to clarify the specific social attributions assigned to LLMs by its designers and users. This addition aims to bridge the gap between LLM capabilities and user perceptions, promoting the ethically responsible development and use of LLM-based technology. (shrink)

In our recent article ‘The Ethics of the Algorithmic Prediction of Goal of Care Preferences: From Theory to Practice’1, we aimed to ignite a critical discussion on why and how to design artificial intelligence (AI) systems assisting clinicians and next-of-kin by predicting goal of care preferences for incapacitated patients. Here, we would like to thank the commentators for their valuable responses to our work. We identified three core themes in their commentaries: (1) the risks of AI paternalism, (2) worries about (...) attacks to our humanity stemming from the use of AI and (3) the possibility of designing AI systems for more relevant use cases than the one we consider in our work. We shall focus on these themes, leaving aside some other interesting suggestions, given the limited space available for our response. Diaz Milian and Bhattacharyya discuss the risks of AI paternalism highlighting how the use of an AI to predict goal of care preferences may incentivise clinicians and surrogates to shift the burden of decision making to the machine.2 In particular, ‘[i]f the AI-generated response is given priority above the other agents’2 and the AI makes decisions autonomously, then ‘AI paternalism’ would emerge.2 Against this possibility, the authors suggest four safeguards to be implemented in the AI life-cycle.2 These are procedures that may improve the trustworthiness of the AI and human control over it.3 We agree that it is important …. (shrink)

In their article ‘Who is afraid of black box algorithms? On the epistemological and ethical basis of trust in medical AI’, Durán and Jongsma discuss the epistemic and ethical challenges raised by black box algorithms in medical practice. The opacity of black box algorithms is an obstacle to the trustworthiness of their outcomes. Moreover, the use of opaque algorithms is not normatively justified in medical practice. The authors introduce a formalism, called computational reliabilism, which allows generating justified beliefs on the (...) algorithm reliability and trustworthy outcomes of artificial intelligence systems by means of epistemic warrants, called reliability indicators. However, they remark the need for reliability indicators specific to black box algorithms and that justified knowledge is not sufficient to justify normatively the actions of the physicians using medical AI systems. Therefore, Durán and Jongsma advocate for a more transparent design and implementation of black box algorithms, providing a series of recommendations to mitigate the epistemic and ethical challenges behind their use in medical practice. In this response, I argue that a peculiar form of black box algorithm transparency, called design publicity, may efficiently implement these recommendations. Design publicity encodes epistemic, that is, reliability indicators, and ethical recommendations for black box algorithms by means of four subtypes of transparency. These target the values and goals, their translation into design requirements, the performance and consistency of the algorithm altogether. I discuss design publicity applying it to a use case focused on the automated classification of skin lesions from medical images. (shrink)

We address an open problem in the epistemology of artificial intelligence (AI), namely, the justification of the epistemic attitudes we have towards the trustworthiness of AI systems. We start from a key consideration: the trustworthiness of an AI is a time-relative property of the system, with two distinct facets. One is the actual trustworthiness of the AI, and the other is the perceived trustworthiness of the system as assessed by its users while interacting with it. We show that credences, namely, (...) beliefs we hold with a degree of confidence, are the appropriate attitude for capturing the facets of trustworthiness of an AI over time. Then, we introduce a reliabilistic account providing justification to the credence in the trustworthiness of AI, which we derive from Tang’s probabilistic theory of justified credence. Our account stipulates that a credence in the trustworthiness of an AI system is justified if and only if it is caused by an assessment process that tends to result in a high proportion of credences for which the actual and perceived trustworthiness of the AI are calibrated. Our approach informs research on human-AI interactions and trustworthy AI by providing actionable recommendations on how to measure the reliability of the process through which users perceive the trustworthiness of the system and its calibration to the actual levels of trustworthiness of the AI. It also allows investigating the relation between reliability and the appropriate reliance on the system. (shrink)

Trust and monitoring are traditionally antithetical concepts. Describing trust as a property of a relationship of reliance, we introduce a theory of trust and monitoring, which uses mathematical models based on two classes of functions, including _q_-exponentials, and relates the levels of trust to the costs of monitoring. As opposed to several accounts of trust that attempt to identify the special ingredient of reliance and trust relationships, our theory characterizes trust as a quantitative property of certain relations of reliance that (...) can be quantified and expressed as a scalar quantity. Our theory is applicable to both human–human and human–artificial agent interactions, as it is agnostic with respect to the concrete realization of trustworthiness properties, and is compatible with many views differing on which properties contribute to trust and trustworthiness. Finally, as our mathematical models make the quantitative features of trust measurable, they provide empirical studies on trust with a rigorous methodology for its measurement. (shrink)