Clinical ethics can be viewed as a practical discipline that provides a structured approach to assist healthcare practitioners in identifying, analysing and resolving ethical issues that arise in practice. Clinical ethics can therefore promote ethically sound clinical and organisational practices and decision-making, thereby contributing to health organisation and system quality improvement. In order to develop students’ decision-making skills, as well as prepare them for practice, we decided to introduce a clinical ethics strand within an undergraduate medical curriculum. (...) We designed a programme of clinical ethics activities for teaching and assessment purposes that involved using ethical frameworks to analyse hypothetical and real-life cases in uni- and inter- professional groups. In this paper, we draw on medical student feedback collected over 6 years to illustrate the appeal to students of learning clinical ethics. We also outline the range of benefits for students, healthcare organisations, and the field of clinical ethics arising from tomorrow’s doctors experiencing clinical ethics early in their training. We conclude by briefly reflecting on how including clinical ethics within tomorrow’s doctors curricular can secure and continue future engagement in clinical ethics support services in the UK, alongside the dangers of preparing students for organisational cultures that might not exist. We anticipate the findings presented in the paper will contribute to wider debates examining the impact of ethics teaching, and its ability to inform future doctors’ practice. (shrink)

This paper investigates the medical law and ethics learning needs of Foundation doctors by means of a national survey developed in association with key stakeholders including the General Medical Council and Health Education England. Four hundred sevnty-nine doctors completed the survey. The average self-reported level of preparation in MEL was 63%. When asked to rate how confident they felt in approaching three cases of increasing ethical complexity, more FYs were fully confident in the more complex cases than in (...) the more standard case. There was no apparent relationship with confidence and reported teaching at medical school. The less confident doctors were no more likely to ask for further teaching on the topic than the confident doctors. This suggests that FYs can be vulnerable when facing ethical decisions by being underprepared, not recognising their lack of ability to make a reasoned decision or by being overconfident. Educators need to be aware of this and provide practical MEL training based on trainee experiences and real-world ethics and challenge learners’ views. Given the complexities of many ethical decisions, preparedness should not be seen as the ability to make a difficult decision but rather a recognition that such cases are difficult, that doubt is permissible and the solution may well be beyond the relatively inexperienced doctor. Educators and supervisors should therefore be ensuring that this is clear to their trainees. This necessitates an environment in which questions can be asked and uncertainty raised with the expectation of a supportive response. (shrink)

This paper develops an account of how the implementation of ML models into healthcare settings requires revising the methodological apparatus of philosophical bioethics. On this account, ML models are cognitive interventions that provide decision-support to physicians and patients. Due to reliability issues, opaque reasoning processes, and information asymmetries, ML models pose inferential problems for them. These inferential problems lay the grounds for many ethical problems that currently claim centre-stage in the bioethical debate. Accordingly, this paper argues that the best way (...) to make progress in remedying these ethical problems is to distil their epistemic core and to identify appropriate epistemic norms as guardrails. The viability of this approach will be highlighted based on four key issues: trust, responsibility, paternalism, and fairness. In that respect, the paper also contributes to a more pronounced view of the specific methodological challenges for ethical theorizing, when the point of reference are complex statistical models that make predictions, rather than individual agents, acting for reasons. (shrink)

Informed consent is at the core of the clinical relationship. With the introduction of machine learning in healthcare, the role of informed consent is challenged. This paper addresses the issue of whether patients must be informed about medical ML applications and asked for consent. It aims to expose the discrepancy between ethical and practical considerations, while arguing that this polarization is a false dichotomy: in reality, ethics is applied to specific contexts and situations. Bridging this gap and (...) considering the whole picture is essential for advancing the debate. In the light of the possible future developments of the situation and the technologies, as well as the benefits that informed consent for ML can bring to shared decision-making, the present analysis concludes that it is necessary to prepare the ground for a possible future requirement of informed consent for medical ML. (shrink)

Char et al. describe an interesting and useful approach in their paper, “Identifying ethical considerations for machine learning healthcare applications.” Their proposed framework, which see...

Increasingly, data scientists are training machine-learning models for diagnosis, treatment selection, and resource allocation. The U.S. Food and Drug Administration has given regulatory appro...

ML-HCAs have the potential to significantly change an entire healthcare system. It is not even necessary to presume that this will be disruptive but sufficient to assume that the mere adaptation of...

Along with potential benefits to healthcare delivery, machine learning healthcare applications raise a number of ethical concerns. Ethical evaluations of ML-HCAs will need to structure th...

In the past few years, machine learning (ML) tools have been implemented with success in the medical context. However, several practitioners have raised concerns about the lack of transparency—at the algorithmic level—of many of these tools; and solutions from the field of explainable AI (XAI) have been seen as a way to open the ‘black box’ and make the tools more trustworthy. Recently, Alex London has argued that in the medical context we do not need machine (...) class='Hi'>learning tools to be interpretable at the algorithmic level to make them trustworthy, as long as they meet some strict empirical desiderata. In this paper, we analyse and develop London’s position. In particular, we make two claims. First, we claim that London’s solution to the problem of trust can potentially address another problem, which is how to evaluate the reliability of ML tools in medicine for regulatory purposes. Second, we claim that to deal with this problem, we need to develop London’s views by shifting the focus from the opacity of algorithmic details to the opacity of the way in which ML tools are trained and built. We claim that to regulate AI tools and evaluate their reliability, agencies need an explanation of how ML tools have been built, which requires documenting and justifying the technical choices that practitioners have made in designing such tools. This is because different algorithmic designs may lead to different outcomes, and to the realization of different purposes. However, given that technical choices underlying algorithmic design are shaped by value-laden considerations, opening the black box of the design process means also making transparent and motivating (technical and ethical) values and preferences behind such choices. Using tools from philosophy of technology and philosophy of science, we elaborate a framework showing how an explanation of the training processes of ML tools in medicine should look like. (shrink)

In this paper, we discuss epistemic and ethical concerns brought about by machine learning (ML) systems implemented in medicine. We begin by fleshing out the logic underlying a common approach in the specialized literature (which we call the _informativeness account_). We maintain that the informativeness account limits its analysis to the impact of epistemological issues on ethical concerns without assessing the bearings that ethical features have on the epistemological evaluation of ML systems. We argue that according to this (...) methodological approach, epistemological issues are _instrumental_ to and _autonomous_ of ethical considerations. This means that the informativeness account considers epistemological evaluation uninfluenced and unregulated by an ethical counterpart. Using an example that does not square well into the _informativeness account_, we argue for ethical assessments that have a substantial influence on the epistemological assessment of ML and that such influence should not be understood as merely informative but rather regulatory. Drawing on the case analyzed, we claim that within the theoretical framework of the informativeness approach, forms of epistemic injustice—especially _epistemic objectification_—remain unaddressed. Our analysis should motivate further research investigating the regulatory role that ethical elements play in the epistemology of ML. (shrink)

Prediction-based decisions, which are often made by utilizing the tools of machine learning, influence nearly all facets of modern life. Ethical concerns about this widespread practice have given rise to the field of fair machine learning and a number of fairness measures, mathematically precise definitions of fairness that purport to determine whether a given prediction-based decision system is fair. Following Reuben Binns (2017), we take ‘fairness’ in this context to be a placeholder for a variety of (...) normative egalitarian considerations. We explore a few fairness measures to suss out their egalitarian roots and evaluate them, both as formalizations of egalitarian ideas and as assertions of what fairness demands of predictive systems. We pay special attention to a recent and popular fairness measure, counterfactual fairness, which holds that a prediction about an individual is fair if it is the same in the actual world and any counterfactual world where the individual belongs to a different demographic group (cf. Kusner et al. (2018)). (shrink)

Char and colleagues provide a useful conceptual framework for the proactive identification of ethical issues arising throughout the lifecycle of machine learning applications in healthcare. Th...

BackgroundMachine learning-based clinical decision support systems (ML_CDSS) are increasingly employed in various sectors of health care aiming at supporting clinicians’ practice by matching the characteristics of individual patients with a computerised clinical knowledge base. Some studies even indicate that ML_CDSS may surpass physicians’ competencies regarding specific isolated tasks. From an ethical perspective, however, the usage of ML_CDSS in medical practice touches on a range of fundamental normative issues. This article aims to add to the ethical discussion by using professionalisation (...) theory as an analytical lens for investigating how medical action at the micro level and the physician–patient relationship might be affected by the employment of ML_CDSS.Main textProfessionalisation theory, as a distinct sociological framework, provides an elaborated account of what constitutes client-related professional action, such as medical action, at its core and why it is more than pure expertise-based action. Professionalisation theory is introduced by presenting five general structural features of professionalised medical practice: (i) the patient has a concern; (ii) the physician deals with the patient’s concern; (iii) s/he gives assistance without patronising; (iv) s/he regards the patient in a holistic manner without building up a private relationship; and (v) s/he applies her/his general expertise to the particularities of the individual case. Each of these five key aspects are then analysed regarding the usage of ML_CDSS, thereby integrating the perspectives of professionalisation theory and medical ethics.ConclusionsUsing ML_CDSS in medical practice requires the physician to pay special attention to those facts of the individual case that cannot be comprehensively considered by ML_CDSS, for example, the patient’s personality, life situation or cultural background. Moreover, the more routinized the use of ML_CDSS becomes in clinical practice, the more that physicians need to focus on the patient’s concern and strengthen patient autonomy, for instance, by adequately integrating digital decision support in shared decision-making. (shrink)

Just as humans can draw conclusions responsibly or irresponsibly, so too can computers. Machine learning systems that have been trained on data sets that include irresponsible judgments are likely to yield irresponsible predictions as outputs. In this paper I focus on a particular kind of inference a computer system might make: identification of the intentions with which a person acted on the basis of photographic evidence. Such inferences are liable to be morally objectionable, because of a way in (...) which they are presumptuous. After elaborating this moral concern, I explore the possibility that carefully procuring the training data for image recognition systems could ensure that the systems avoid the problem. The lesson of this paper extends beyond just the particular case of image recognition systems and the challenge of responsibly identifying a person’s intentions. Reflection on this particular case demonstrates the importance (as well as the difficulty) of evaluating machine learning systems and their training data from the standpoint of moral considerations that are not encompassed by ordinary assessments of predictive accuracy. (shrink)

We argue why interpretability should have primacy alongside empiricism for several reasons: first, if machine learning models are beginning to render some of the high-risk healthcare decisions instead of clinicians, these models pose a novel medicolegal and ethical frontier that is incompletely addressed by current methods of appraising medical interventions like pharmacological therapies; second, a number of judicial precedents underpinning medical liability and negligence are compromised when ‘autonomous’ ML recommendations are considered to be en par with human instruction (...) in specific contexts; third, explainable algorithms may be more amenable to the ascertainment and minimisation of biases, with repercussions for racial equity as well as scientific reproducibility and generalisability. We conclude with some reasons for the ineludible importance of interpretability, such as the establishment of trust, in overcoming perhaps the most difficult challenge ML will face in a high-stakes environment like healthcare: professional and public acceptance. (shrink)

We explore multi-scale relations in artificial intelligence (AI) use in order to identify difficulties with coordinating relations between users, machine learning (ML) processes, and “sociobuilt contexts”—specifically in terms of their applications to medical technologies and decisions. We begin by analyzing a recent COVID-19 machine learning case study in order to present the difficulty of traversing the detailed causal topography of “sociobuilt contexts.” We propose that the adequate representation of the interactions between social and built processes that (...) occur on many scales ought to drive interdisciplinary approaches for ML modification. Next, we describe ML algorithm development as a process that is partly dependent on methodological stabilization for reliability and partly on coordinating relations. In the coordination between user, ML process, and sociobuilt contexts, we propose that new methods can be explored that promote the inclusion of patients and communities for the purpose of cross-checking portions of the ML process. Finally, we suggest that the advantages of responsible innovation emerge through the iterative entanglement of ethical, methodological, and ontological considerations within the broader conceptual infrastructure of epistemic responsibility. (shrink)

The application of artificial intelligence and machine learning technologies in healthcare have immense potential to improve the care of patients. While there are some emerging practices surro...

Machine learning algorithms may radically improve our ability to diagnose and treat disease. For moral, legal, and scientific reasons, it is essential that doctors and patients be able to understand and explain the predictions of these models. Scalable, customisable, and ethical solutions can be achieved by working together with relevant stakeholders, including patients, data scientists, and policy makers.

There has been an increased focus within the AI ethics literature on questions of power, reflected in the ideal of accountability supported by many Responsible AI guidelines. While this recent debate points towards the power asymmetry between those who shape AI systems and those affected by them, the literature lacks normative grounding and misses conceptual clarity on how these power dynamics take shape. In this paper, I develop a workable conceptualization of said power dynamics according to Cristiano Castelfranchi’s conceptual (...) framework of power and argue that end-users depend on a system’s developers and users, because end-users rely on these systems to satisfy their goals, constituting a power asymmetry between developers, users and end-users. I ground my analysis in the neo-republican moral wrong of domination, drawing attention to legitimacy concerns of the power-dependence relation following from the current lack of accountability mechanisms. I illustrate my claims on the basis of a risk-prediction machine learning system, and propose institutional and project-specific solutions to mitigate domination. (shrink)

Buchman et al.'s (2024) paper illuminates a pressing issue concerning the utilization of machine learning (ML) in psychiatric care, shedding light on its potential to exacerbate stigma and social d...

Typically, fair machine learning research focuses on a single decision maker and assumes that the underlying population is stationary. However, many of the critical domains motivating this work are characterized by competitive marketplaces with many decision makers. Realistically, we might expect only a subset of them to adopt any non-compulsory fairness-conscious policy, a situation that political philosophers call partial compliance. This possibility raises important questions: how does partial compliance and the consequent strategic behavior of decision subjects affect the (...) allocation outcomes? If k% of employers were to voluntarily adopt a fairness-promoting intervention, should we expect k% progress (in aggregate) towards the benefits of universal adoption, or will the dynamics of partial compliance wash out the hoped-for benefits? How might adopting a global (versus local) perspective impact the conclusions of an auditor? In this paper, we propose a simple model of an employment market, leveraging simulation as a tool to explore the impact of both interaction effects and incentive effects on outcomes and auditing metrics. Our key findings are that at equilibrium: (1) partial compliance by k% of employers can result in far less than proportional (k%) progress towards the full compliance outcomes; (2) the gap is more severe when fair employers match global (vs local) statistics; (3) choices of local vs global statistics can paint dramatically different pictures of the performance vis-a-vis fairness desiderata of compliant versus non-compliant employers; (4) partial compliance based on local parity measures can induce extreme segregation. Finally, we discuss implications for auditors and insights concerning the design of regulatory frameworks. (shrink)

Objectives: Machine learning (ML) has the potential to facilitate “continual learning” in medicine, in which an ML system continues to evolve in response to exposure to new data over time, even after being deployed in a clinical setting. In this article, we provide a tutorial on the range of ethical issues raised by the use of such “adaptive” ML systems in medicine that have, thus far, been neglected in the literature. -/- Target audience: The target audiences for (...) this tutorial are the developers of ML AI systems, healthcare regulators, the broader medical informatics community, and practicing clinicians. -/- Scope: Discussions of adaptive ML systems to date have overlooked the distinction between 2 sorts of variance that such systems may exhibit—diachronic evolution (change over time) and synchronic variation (difference between cotemporaneous instantiations of the algorithm at different sites)—and underestimated the significance of the latter. We highlight the challenges that diachronic evolution and synchronic variation present for the quality of patient care, informed consent, and equity, and discuss the complex ethical trade-offs involved in the design of such systems. (shrink)

Machine learning (ML) systems play an increasingly relevant role in medicine and healthcare. As their applications move ever closer to patient care and cure in clinical settings, ethical concerns about the responsibility of their use come to the fore. I analyse an aspect of responsible ML use that bears not only an ethical but also a significant epistemic dimension. I focus on ML systems’ role in mediating patient–physician relations. I thereby consider how ML systems may silence patients’ voices (...) and relativise the credibility of their opinions, which undermines their overall credibility status without valid moral and epistemic justification. More specifically, I argue that withholding credibilitydue tohow ML systems operate can be particularly harmful to patients and, apart from adverse outcomes, qualifies as a form of testimonial injustice. I make my case for testimonial injustice in medical ML by considering ML systems currently used in the USA to predict patients’ risk of misusing opioids (automated Prediction Drug Monitoring Programmes, PDMPs for short). I argue that the locus of testimonial injustice in ML-mediated medical encounters is found in the fact that these systems are treated asmarkers of trustworthinesson which patients’ credibility is assessed. I further show how ML-based PDMPs exacerbate and further propagate social inequalities at the expense of vulnerable social groups. (shrink)

Whether it would take one decade or several centuries, many agree that it is possible to create a *superintelligence*---an artificial intelligence with a godlike ability to achieve its goals. And many who have reflected carefully on this fact agree that our best hope for a "friendly" superintelligence is to design it to *learn* values like ours, since our values are too complex to program or hardwire explicitly. But the value learning approach to AI safety faces three particularly philosophical puzzles: (...) first, it is unclear how any intelligent system could learn its final values, since to judge one supposedly "final" value against another seems to require a further background standard for judging. Second, it is unclear how to determine the content of a system's values based on its physical or computational structure. Finally, there is the distinctly ethical question of which values we should best aim for the system to learn. I outline a potential answer to these interrelated puzzles, centering on a "miktotelic" proposal for blending a complex, learnable final value out of many simpler ones. (shrink)

The increasing implementation of and reliance on machine-learning (ML) algorithms to perform tasks, deliver services and make decisions in health and healthcare have made the need for fairness in ML, and more specifically in healthcare ML algorithms (HMLA), a very important and urgent task. However, while the debate on fairness in the ethics of artificial intelligence (AI) and in HMLA has grown significantly over the last decade, the very concept of fairness as an ethical value has not (...) yet been sufficiently explored. Our paper aims to fill this gap and address the AI ethics principle of fairness from a conceptual standpoint, drawing insights from accounts of fairness elaborated in moral philosophy and using them to conceptualise fairness as an ethical value and to redefine fairness in HMLA accordingly. To achieve our goal, following a first section aimed at clarifying the background, methodology and structure of the paper, in the second section, we provide an overview of the discussion of the AI ethics principle of fairness in HMLA and show that the concept of fairness underlying this debate is framed in purely distributive terms and overlaps with non-discrimination, which is defined in turn as the absence of biases. After showing that this framing is inadequate, in the third section, we pursue an ethical inquiry into the concept of fairness and argue that fairness ought to be conceived of as an ethical value. Following a clarification of the relationship between fairness and non-discrimination, we show that the two do not overlap and that fairness requires much more than just non-discrimination. Moreover, we highlight that fairness not only has a distributive but also a socio-relational dimension. Finally, we pinpoint the constitutive components of fairness. In doing so, we base our arguments on a renewed reflection on the concept of respect, which goes beyond the idea of equal respect to include respect for individual persons. In the fourth section, we analyse the implications of our conceptual redefinition of fairness as an ethical value in the discussion of fairness in HMLA. Here, we claim that fairness requires more than non-discrimination and the absence of biases as well as more than just distribution; it needs to ensure that HMLA respects persons both as persons and as particular individuals. Finally, in the fifth section, we sketch some broader implications and show how our inquiry can contribute to making HMLA and, more generally, AI promote the social good and a fairer society. (shrink)

The increasing integration of Machine Learning (ML) techniques into clinical care, driven in particular by Deep Learning (DL) using Artificial Neural Nets (ANNs), promises to reshape medical practice on various levels and across multiple medical fields. Much recent literature examines the ethical consequences of employing ML within medical and psychiatric practice but the potential impact on psychiatric diagnostic systems has so far not been well-developed. In this article, we aim to explore the challenges that arise from the (...) recent use of ANNs for the old problems of psychiatric nosology. To enable an empirically supported critical reflection on the topic, we conducted semi-structured qualitative interviews with Swiss and German experts in computational psychiatry. Here, we report our findings structured around two themes, namely (1) the possibility of using ML for defining or refining of psychiatric classification, and (2) the desirability of employing ML for psychiatric nosology. We discuss these themes by relating them to recent debates about network theory for psychiatric nosology and show why empirical research in the field should critically reflect on its contribution to psychopathology research. In sum, we argue that beyond technical, regulatory, and ethical challenges, philosophical reflection is crucial to harness the potential of ML in psychiatry. (shrink)

Through hypothetical scenarios, this paper analyses whether machine learning (ML) could resolve one of the main shortcomings present in Christopher Boorse’s Biostatistical Theory of health (BST). In doing so, it foregrounds the boundaries and challenges of employing ML in formulating a naturalist (i.e., prima facie value-free) definition of health. The paper argues that a sweeping dataist approach cannot fully make the BST truly naturalistic, as prior theories and values persist. It also points out that supervised learning introduces (...) circularity, rendering it incompatible with a naturalistic perspective. Additionally, it underscores the need for pre-existing auxiliary theories to assess results from unsupervised learning. It emphasizes the importance of understanding the epistemological entanglements between data and data processing methods to manage expectations about what data patterns can predict. In conclusion, the paper argues against delegating the final authority for defining complex concepts like health to AI systems, as it necessitates ethical judgment and capacities for deliberation that AI currently lacks. It also warns against granting creators and deployers of AI systems the discretionary authority to determine these definitions outside the wider social discussion, advocating for ongoing public engagement on normative notions. Failure to do so risks limiting individuals and collectives’ ability to shape a just digital future and diminishes their fundamental epistemic agency. (shrink)

This study focuses on a traditional business ethics question and aims to use advanced techniques to improve the performance of corporate fraud prediction. Based on the GONE framework, we adopt the machine learning model to predict the occurrence of corporate fraud in China. We first identify a comprehensive set of fraud-related variables and organize them into each category (i.e., Greed, Opportunity, Need, and Exposure) of the GONE framework. Among the six machine learning models tested, the (...) Random Forest (RF) model outperforms the other five models in corporate fraud prediction. Based on the RF model, we show that Exposure variables play a more important role in predicting corporate fraud than other input variables. These results highlight the importance of Exposure variables in corporate fraud prediction and promote the practical use of the machine learning model in solving business ethics questions. (shrink)

In their article “A Research Ethics Framework for the Clinical Translation of Healthcare Machine Learning,” McCradden et al. highlight the various gaps that emerge when artificial intelligen...

Industry involvement in the machine learning (ML) community seems to be increasing. However, the quantitative scale and ethical implications of this influence are rather unknown. For this purpose, we have not only carried out an informed ethical analysis of the field, but have inspected all papers of the main ML conferences NeurIPS, CVPR, and ICML of the last 5 years—almost 11,000 papers in total. Our statistical approach focuses on conflicts of interest, innovation, and gender equality. We have obtained (...) four main findings. (1) Academic–corporate collaborations are growing in numbers. At the same time, we found that conflicts of interest are rarely disclosed. (2) Industry papers amply mention terms that relate to particular trending machine learning topics earlier than academia does. (3) Industry papers are not lagging behind academic papers with regard to how often they mention keywords that are proxies for social impact considerations. (4) Finally, we demonstrate that industry papers fall short of their academic counterparts with respect to the ratio of gender diversity. We believe that this work is a starting point for an informed debate within and outside of the ML community. (shrink)

The use of counterfactuals for considerations of algorithmic fairness and explainability is gaining prominence within the machine learning community and industry. This paper argues for more caution with the use of counterfactuals when the facts to be considered are social categories such as race or gender. We review a broad body of papers from philosophy and social sciences on social ontology and the semantics of counterfactuals, and we conclude that the counterfactual approach in machine learning fairness (...) and social explainability can require an incoherent theory of what social categories are. Our findings suggest that most often the social categories may not admit counterfactual manipulation, and hence may not appropriately satisfy the demands for evaluating the truth or falsity of counterfactuals. This is important because the wide- spread use of counterfactuals in machine learning can lead to misleading results when applied in high-stakes domains. Accordingly, we argue that even though counterfactuals play an essential part in some causal inferences, their use for questions of algorithmic fairness and social explanations can create more problems than they resolve. Our positive result is a set of tenets about using counterfactuals for fairness and explanations in machine learning. (shrink)

As machine learning informs increasingly consequential decisions, different metrics have been proposed for measuring algorithmic bias or unfairness. Two popular “fairness measures” are calibration and equality of false positive rate. Each measure seems intuitively important, but notably, it is usually impossible to satisfy both measures. For this reason, a large literature in machine learning speaks of a “fairness tradeoff” between these two measures. This framing assumes that both measures are, in fact, capturing something important. To date, (...) philosophers have seldom examined this crucial assumption, and examined to what extent each measure actually tracks a normatively important property. This makes this inevitable statistical conflict – between calibration and false positive rate equality – an important topic for ethics. In this paper, I give an ethical framework for thinking about these measures and argue that, contrary to initial appearances, false positive rate equality is in fact morally irrelevant and does not measure fairness. (shrink)

The research ethics framework put forward by McCradden et al. to support systematic inquiry in the development of artificial intelligence and machine learning technologies in healt...

The increasing precision of observations of the large-scale structure of the universe has created a problem for simulators: running the simulations necessary to interpret these observations has become impractical. Simulators have thus turned to machine learning (ML) algorithms instead. Though ML decreases computational expense, one might be worried about the use of ML for scientific investigations: How can algorithms that have repeatedly been described as black-boxes deliver scientific understanding? In this paper, I investigate how cosmologists employ ML, arguing (...) that in this context, ML algorithms should not be considered black-boxes and can deliver genuine scientific understanding. Accordingly, understanding the methodological role of ML algorithms is crucial to understanding the types of questions they are capable of, and ought to be responsible for, answering. (shrink)

Digital phenotyping is the term given to the capturing and use of user log data from health and wellbeing technologies used in apps and cloud-based services. This paper explores ethical issues in making use of digital phenotype data in the arena of digital health interventions. Products and services based on digital wellbeing technologies typically include mobile device apps as well as browser-based apps to a lesser extent, and can include telephony-based services, text-based chatbots, and voice-activated chatbots. Many of these digital (...) products and services are simultaneously available across many channels in order to maximize availability for users. Digital wellbeing technologies offer useful methods for real-time data capture of the interactions of users with the products and services. It is possible to design what data are recorded, how and where it may be stored, and, crucially, how it can be analyzed to reveal individual or collective usage patterns. The paper also examines digital phenotyping workflows, before enumerating the ethical concerns pertaining to different types of digital phenotype data, highlighting ethical considerations for collection, storage, and use of the data. A case study of a digital health app is used to illustrate the ethical issues. The case study explores the issues from a perspective of data prospecting and subsequent machine learning. The ethical use of machine learning and artificial intelligence on digital phenotype data and the broader issues in democratizing machine learning and artificial intelligence for digital phenotype data are then explored in detail. (shrink)

When applied in the health sector, AI-based applications raise not only ethical but legal and safety concerns, where algorithms trained on data from majority populations can generate less accurate or reliable results for minorities and other disadvantaged groups.

Rapid advancements in machine learning techniques allow mass surveillance to be applied on larger scales and utilize more and more personal data. These developments demand reconsideration of the privacy-security dilemma, which describes the tradeoffs between national security interests and individual privacy concerns. By investigating mass surveillance techniques that use bulk data collection and machine learning algorithms, we show why these methods are unlikely to pinpoint terrorists in order to prevent attacks. The diverse characteristics of terrorist attacks—especially (...) when considering lone-wolf terrorism—lead to irregular and isolated footprints. The irregularity of data affects the accuracy of machine learning algorithms and the mass surveillance that depends on them which can be explained by three kinds of known problems encountered in machine learning theory: class imbalance, the curse of dimensionality, and spurious correlations. Proponents of mass surveillance often invoke the distinction between collecting data and metadata, in which the latter is understood as a lesser breach of privacy. Their arguments commonly overlook the ambiguity in the definitions of data and metadata and ignore the ability of machine learning techniques to infer the former from the latter. Given the sparsity of datasets used for machine learning in counterterrorism and the privacy risks attendant with bulk data collection, policymakers and other relevant stakeholders should critically re-evaluate the likelihood of success of the algorithms and the collection of data on which they depend. (shrink)

This paper provides an analysis of the way in which two foundational principles of medical ethics–the trusted doctor and patient autonomy–can be undermined by the use of machine learning (ML) algorithms and addresses its legal significance. This paper can be a guide to both health care providers and other stakeholders about how to anticipate and in some cases mitigate ethical conflicts caused by the use of ML in healthcare. It can also be read as a road map (...) as to what needs to be done to achieve an acceptable level of explainability in an ML algorithm when it is used in a healthcare context. (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)

The pipeline framework for identifying ethical issues in machine learning healthcare applications outlined by Char et al. is a very useful starting point for the systematic consideration...

The rapid adoption and implementation of artificial intelligence in medicine creates an ontologically distinct situation from prior care models. There are both potential advantages and disadvantages with such technology in advancing the interests of patients, with resultant ontological and epistemic concerns for physicians and patients relating to the instatiation of AI as a dependent, semi- or fully-autonomous agent in the encounter. The concept of libertarian paternalism potentially exercised by AI (and those who control it) has created challenges to conventional assessments (...) of patient and physician autonomy. The unclear legal relationship between AI and its users cannot be settled presently, an progress in AI and its implementation in patient care will necessitate an iterative discourse to preserve humanitarian concerns in future models of care. This paper proposes that physicians should neither uncritically accept nor unreasonably resist developments in AI but must actively engage and contribute to the discourse, since AI will affect their roles and the nature of their work. One’s moral imaginative capacity must be engaged in the questions of beneficence, autonomy, and justice of AI and whether its integration in healthcare has the potential to augment or interfere with the ends of medical practice. (shrink)

Supervised machine learning has found its way into ever more areas of scientific inquiry, where the outcomes of supervised machine learning applications are almost universally classified as predictions. I argue that what researchers often present as a mere terminological particularity of the field involves the consequential transformation of tasks as diverse as classification, measurement, or image segmentation into prediction problems. Focusing on the case of machine-learning enabled poverty prediction, I explore how reframing a measurement (...) problem as a prediction task alters the primary epistemic aim of the application. Instead of measuring a property, machine learning developers conceive of their models as predicting a given measurement of this property. I argue that this _predictive reframing_ common to supervised machine learning applications is epistemically and ethically problematic, as it allows developers to externalize concerns critical to the epistemic validity and ethical implications of their model’s inferences. I further hold that the predictive reframing is not a necessary feature of supervised machine learning by offering an alternative conception of machine learning models as measurement models. An interpretation of supervised machine learning applications to measurement tasks as _automatically-calibrated model-based measurements_ internalizes questions of construct validity and ethical desirability critical to the measurement problem these applications are intended to and presented as solving. Thereby, this paper introduces an initial framework for exploring technical, historical, and philosophical research at the intersection of measurement and machine learning. (shrink)

The pipeline model framework proposed by Char et al. makes a timely contribution to the literature in allowing one to take a step back and consider machine learning healthcare app...

Certain research strands can yield “forbidden knowledge”. This term refers to knowledge that is considered too sensitive, dangerous or taboo to be produced or shared. Discourses about such publication restrictions are already entrenched in scientific fields like IT security, synthetic biology or nuclear physics research. This paper makes the case for transferring this discourse to machine learning research. Some machine learning applications can very easily be misused and unfold harmful consequences, for instance, with regard to generative (...) video or text synthesis, personality analysis, behavior manipulation, software vulnerability detection and the like. Up till now, the machine learning research community embraces the idea of open access. However, this is opposed to precautionary efforts to prevent the malicious use of machine learning applications. Information about or from such applications may, if improperly disclosed, cause harm to people, organizations or whole societies. Hence, the goal of this work is to outline deliberations on how to deal with questions concerning the dissemination of such information. It proposes a tentative ethical framework for the machine learning community on how to deal with forbidden knowledge and dual-use applications. (shrink)

Healthcare professionals decide wisely about personalized medicine, treatment plans, and resource allocation by utilizing big data analytics and machine learning. To guarantee that algorithmic recommendations are impartial and fair, however, ethical issues relating to prejudice and data privacy must be taken into account. Big data analytics and machine learning have a great potential to disrupt healthcare, and as these technologies continue to evolve, new opportunities to reform healthcare and enhance patient outcomes may arise. In order to (...) investigate the patient’s outcomes with empirical evidence, this research was conducted using an online survey to incorporate healthcare professionals, patient’s reviews, and clinical staff. The data were analyzed using SmartPLS 4.0 to predict the structural model. The findings revealed a direct impact as positive influence of using machine learning on healthcare performance and patient outcomes through big data analytics. Moreover, it is evident that this can lead to personalized treatment plans, early interventions, and improved patient outcomes. Additionally, big data analytics can help healthcare providers optimize resource allocation, improve operational efficiency, and reduce costs. The impact of big data analytics on patient outcome and healthcare performance is expected to continue to grow, making it an important area for investment and research. (shrink)

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 article addresses the need for adaptive ethical analysis within machine learning that accounts for emerging problems concerning social bias and generative adversarial networks. I use John Dewey’s criticisms of the reflex arc concept in psychology as a basis for understanding how these problems stem from human-gan interaction. By combining Dewey’s criticisms with Donna Haraway’s idea of cyborgs, Luciano Floridi’s concept of distributed morality, and Shaowen Bardzell’s recommendations for a feminist approach to human-computer interaction, I suggest a dynamic (...) perspective from which to begin analyzing and solving issues of injustice evident in this particular domain of machine learning. (shrink)

ABSTRACT The ubiquity of social media usage has led to exciting new technologies such as machine learning. Machine learning is poised to change many fields of health, including psychology. The wealth of information provided by each social media user in combination with machine-learning technologies may pave the way for automated psychological assessment and diagnosis. Assessment of individuals’ social media profiles using machine-learning technologies for diagnosis and screening confers many benefits ; however, the (...) implementation of these technologies will pose unique challenges to the professional ethics of psychology. Namely, psychologists must understand the impact of these assessment technologies on privacy and confidentiality, informed consent, recordkeeping, bases for assessments, and diversity and justice. This paper offers a brief review of the current applications of machine-learning technologies in psychology and public health, provides an overview of potential implementations in clinical settings, and introduces ethical considerations for professional psychologists. This paper presents considerations which may aid in the extension of the current Ethical Principles of Psychologists and Code of Conduct to address these important technological advancements in the field of clinical psychology. (shrink)