Bioethics has developed approaches to address ethical issues in health care, similar to how technology ethics provides guidelines for ethical research on artificial intelligence, big data, and robotic applications. As these digital technologies are increasingly used in medicine, health care and public health, thus, it is plausible that the approaches of technology ethics have influenced bioethical research. Similar to the “empirical turn” in bioethics, which led to intense debates about appropriate moral theories, ethical frameworks and meta-ethics due to the increased (...) use of empirical methodologies from social sciences, the proliferation of health-related subtypes of technology ethics might have a comparable impact on current bioethical research. This systematic journal review analyses the reporting of ethical frameworks and non-empirical methods in argument-based research articles on digital technologies in medicine, health care and public health that have been published in high-impact bioethics journals. We focus on articles reporting non-empirical research in original contributions. Our aim is to describe currently used methods for the ethical analysis of ethical issues regarding the application of digital technologies in medicine, health care and public health. We confine our analysis to non-empirical methods because empirical methods have been well-researched elsewhere. Finally, we discuss our findings against the background of established methods for health technology assessment, the lack of a typology for non-empirical methods as well as conceptual and methodical change in bioethics. Our descriptive results may serve as a starting point for reflecting on whether current ethical frameworks and non-empirical methods are appropriate to research ethical issues deriving from the application of digital technologies in medicine, health care and public health. (shrink)

Much has been written about the need for trustworthy artificial intelligence (AI), but the underlying meaning of trust and trustworthiness can vary or be used in confusing ways. It is not always clear whether individuals are speaking of a technology’s trustworthiness, a developer’s trustworthiness, or simply of gaining the trust of users by any means. In sociotechnical circles, trustworthiness is often used as a proxy for ‘the good’, illustrating the moral heights to which technologies and developers ought to aspire, at (...) times with a multitude of diverse requirements; or at other times, no specification at all. In philosophical circles, there is doubt that the concept of trust should be applied at all to technologies rather than their human creators. Nevertheless, people continue to intuitively reason about trust in technologies in their everyday language. This qualitative study employed an empirical ethics methodology to address how developers and users define and construct requirements for trust throughout development and use, through a series of interviews. We found that different accounts of trust (rational, affective, credentialist, norms based, relational) served as the basis for individual granting of trust in technologies and operators. Ultimately, the most significant requirement for user trust and assessment of trustworthiness was the accountability of AI developers for the outputs of AI systems, hinging on the identification of accountable moral agents and perceived value alignment between the user and developer’s interests. (shrink)

The ability to interact in a natural language profoundly changes devices’ interfaces and potential applications of speaking technologies. Concurrently, this phenomenon challenges our mainstream theories of knowledge, such as how to analyze linguistic outputs of devices under existing anthropocentric theoretical assumptions. In section 1, I present the topic of machines that speak, connecting between Descartes and Generative AI. In section 2, I argue that accepted testimonial theories of knowledge and justification commonly reject the possibility that a speaking technological artifact can (...) give testimony. In section 3, I identify three assumptions underlying the view that rejects conversational AIs – AI-based technologies that converse, as testifiers: conversational AIs (1) lack intentions, (2) cannot be normatively assessed, and (3) cannot constitute an object in trust relations, while humans can. In section 4, I propose the concept ‘AI-testimony’ for analyzing outputs of conversational AIs, suggesting three conditions for technologies to deliver AI-testimony: (1) content is propositional, (2) generated and delivered with no other human directly involved, (3) the output is perceived as phenomenologically similar to that of a human. I conclude that this concept overcomes the limitations of the anthropocentric concept of testimony, opening future directions of research without associating conversational AIs with human-like agency. (shrink)

With an increasing use of artificial intelligence (AI) systems, theorists have analyzed and argued for the promotion of trust in AI and trustworthy AI. Critics have objected that AI does not have the characteristics to be an appropriate subject for trust. However, this argumentation is open to counterarguments. Firstly, rejecting trust in AI denies the trust attitudes that some people experience. Secondly, we can trust other non‐human entities, such as animals and institutions, so why can we not trust AI systems? (...) Finally, human–AI trust is criticized based on a conception of human–human trust, which does not recognize the distinctiveness of the human–AI relationship. This article aims to refute these counterarguments based on the genealogical analyses of ‘trust’ and ‘trustworthiness’ of Karen Jones and Thomas Simpson, who show that trust and trustworthiness help to overcome vulnerabilities. This function of trust gives reason to use human–human trust as a standard. For this function, it is important that trustees are responsive to trust. While animals and institutions could be responsive, narrow AI systems are unable to be responsive to trust. Therefore, we should not apply trust to AI and instead direct our trust to those who can be responsive to and held responsible for our trust. (shrink)

In this article, we use the account of the “inhuman” that is developed in the work of the French philosopher Jean-François Lyotard to develop a critique of human-centred AI. We argue that Lyotard’s philosophy not only provides resources for a negative critique of human-centred AI discourse, but also contains inspiration for a more constructive account of how the discourse around human-centred AI can take a broader view of the human that includes key dimensions of Lyotard’s inhuman, namely performativity, vulnerability, and (...) novelty. We link these dimensions to questions of epistemic injustice and social recognition. In this way, we hope to develop a proposal for what a richer and more meaningful understanding of human-centred AI might look like. (shrink)

BackgroundDespite the recognition that developing artificial intelligence (AI) that is trustworthy is necessary for public acceptability and the successful implementation of AI in healthcare contexts, perspectives from key stakeholders are often absent from discourse on the ethical design, development, and deployment of AI. This study explores the perspectives of birth parents and mothers on the introduction of AI-based cardiotocography (CTG) in the context of intrapartum care, focusing on issues pertaining to trust and trustworthiness.MethodsSeventeen semi-structured interviews were conducted with birth parents (...) and mothers based on a speculative case study. Interviewees were based in England and were pregnant and/or had given birth in the last two years. Thematic analysis was used to analyze transcribed interviews with the use of NVivo. Major recurring themes acted as the basis for identifying the values most important to this population group for evaluating the trustworthiness of AI.ResultsThree themes pertaining to the perceived trustworthiness of AI emerged from interviews: (1) trustworthy AI-developing institutions, (2) trustworthy data from which AI is built, and (3) trustworthy decisions made with the assistance of AI. We found that birth parents and mothers trusted public institutions over private companies to develop AI, that they evaluated the trustworthiness of data by how representative it is of all population groups, and that they perceived trustworthy decisions as being mediated by humans even when supported by AI.ConclusionsThe ethical values that underscore birth parents and mothers’ perceptions of trustworthy AI include fairness and reliability, as well as practices like patient-centered care, the promotion of publicly funded healthcare, holistic care, and personalized medicine. Ultimately, these are also the ethical values that people want to protect in the healthcare system. Therefore, trustworthy AI is best understood not as a list of design features but in relation to how it undermines or promotes the ethical values that matter most to its end users. An ethical commitment to these values when creating AI in healthcare contexts opens up new challenges and possibilities for the design and deployment of AI. (shrink)

Following the publication of numerous ethical principles and guidelines, the concept of 'Trustworthy AI' has become widely used. However, several AI ethicists argue against using this concept, often backing their arguments with decades of conceptual analyses made by scholars who studied the concept of trust. In this paper, I describe the historical-philosophical roots of their objection and the premise that trust entails a human quality that technologies lack. Then, I review existing criticisms about 'Trustworthy AI' and the consequence of ignoring (...) these criticisms: if the concept of 'Trustworthy AI' is kept being used, we risk attributing responsibilities to agents who cannot be held responsible, and consequently, deteriorate social structures which regard accountability and liability. Nevertheless, despite suggestions to shift the paradigm from 'Trustworthy AI' to 'Reliable AI', I argue that, realistically, this concept will be kept being used. I end by arguing that, ultimately, AI ethics is also about power, social justice, and scholarly activism. Therefore, I propose that community-driven and social justice-oriented ethicists of AI and trust scholars further focus on (a) democratic aspects of trust formation; and (b) draw attention to critical social aspects highlighted by phenomena of distrust. This way, it will be possible to further reveal shifts in power relations, challenge unfair status quos, and suggest meaningful ways to keep the interests of citizens. (shrink)

Artificial intelligence is changing healthcare and the practice of medicine as data-driven science and machine-learning technologies, in particular, are contributing to a variety of medical and clinical tasks. Such advancements have also raised many questions, especially about public trust. As a response to these concerns there has been a concentrated effort from public bodies, policy-makers and technology companies leading the way in AI to address what is identified as a "public trust deficit". This paper argues that a focus on trust (...) as the basis upon which a relationship between this new technology and the public is built is, at best, ineffective, at worst, inappropriate or even dangerous, as it diverts attention from what is actually needed to actively warrant trust. Instead of agonising about how to facilitate trust, a type of relationship which can leave those trusting vulnerable and exposed, we argue that efforts should be focused on the difficult and dynamic process of ensuring reliance underwritten by strong legal and regulatory frameworks. From there, trust could emerge but not merely as a means to an end. Instead, as something to work in practice towards; that is, the deserved result of an ongoing ethical relationship where there is the appropriate, enforceable and reliable regulatory infrastructure in place for problems, challenges and power asymmetries to be continuously accounted for and appropriately redressed. Data sharing not applicable as no datasets generated and/or analysed for this study. (shrink)

Simion and Kelp develop the obligation-based account of trustworthiness as a compelling general account of trustworthiness and then apply this account to various instances of AI. By doing so, they explain in what way any AI can be considered trustworthy, as per the general account. Simion and Kelp identify that any account of trustworthiness that relies on assumptions of agency that are too anthropocentric, such as that being trustworthy, must involve goodwill. I argue that goodwill is a necessary condition for (...) being trustworthy and further suggest a network account of trustworthy AI, which retains the goodwill as the essential requirement for the concept of trustworthiness and meanwhile predicts that current AI can be trustworthy. The alternative account suggests that the focus of trustworthy AI is not merely AI technology, but the whole network of AI involving AI technology, AI designers, AI companies, and other social and legal institutions. A trustworthy AI requires that AI technology is reliable and that other involved agents are trustworthy. (shrink)

As the use of AI systems continues to increase, so do concerns over their lack of fairness, legitimacy and accountability. Such harmful automated decision-making can be guarded against by ensuring AI systems are contestable by design: responsive to human intervention throughout the system lifecycle. Contestable AI by design is a small but growing field of research. However, most available knowledge requires a significant amount of translation to be applicable in practice. A proven way of conveying intermediate-level, generative design knowledge is (...) in the form of frameworks. In this article we use qualitative-interpretative methods and visual mapping techniques to extract from the literature sociotechnical features and practices that contribute to contestable AI, and synthesize these into a design framework. (shrink)

Critics currently argue that applied ethics approaches to artificial intelligence (AI) are too principles-oriented and entail a theory–practice gap. Several applied ethical approaches try to prevent such a gap by conceptually translating ethical theory into practice. In this article, we explore how the currently most prominent approaches of AI ethics translate ethics into practice. Therefore, we examine three approaches to applied AI ethics: the embedded ethics approach, the ethically aligned approach, and the Value Sensitive Design (VSD) approach. We analyze each (...) of these three approaches by asking how they understand and conceptualize theory and practice. We outline the conceptual strengths as well as their shortcomings: an embedded ethics approach is context-oriented but risks being biased by it; ethically aligned approaches are principles-oriented but lack justification theories to deal with trade-offs between competing principles; and the interdisciplinary Value Sensitive Design approach is based on stakeholder values but needs linkage to political, legal, or social governance aspects. Against this background, we develop a meta-framework for applied AI ethics conceptions with three dimensions. Based on critical theory, we suggest these dimensions as starting points to critically reflect on the conceptualization of theory and practice. We claim, first, that the inclusion of the dimension of affects and emotions in the ethical decision-making process stimulates reflections on vulnerabilities, experiences of disregard, and marginalization already within the AI development process. Second, we derive from our analysis that considering the dimension of justifying normative background theories provides both standards and criteria as well as guidance for prioritizing or evaluating competing principles in cases of conflict. Third, we argue that reflecting the governance dimension in ethical decision-making is an important factor to reveal power structures as well as to realize ethical AI and its application because this dimension seeks to combine social, legal, technical, and political concerns. This meta-framework can thus serve as a reflective tool for understanding, mapping, and assessing the theory–practice conceptualizations within AI ethics approaches to address and overcome their blind spots. (shrink)

Background The use of Artificial Intelligence (AI) has the potential to provide relief in the challenging and often stressful clinical setting for physicians. So far, however, the actual changes in work for physicians remain a prediction for the future, including new demands on the social level of medical practice. Thus, the question of how the requirements for physicians will change due to the implementation of AI is addressed. Methods The question is approached through conceptual considerations based on the potentials that (...) AI already offer and the focus on central normative concepts of trust, explainability, and responsibility which play an important role when implementing AI in everyday clinical practice. Conclusion Interpersonal communication will not disappear upon implementation of AI. Instead, it is much more likely that the exchange between various actors in medical practice will become increasingly important. This adds another level of complexity to practical concepts such as Shared-Decision-Making, which must be addressed in empirical research, including the involvement of AI systems as actors in communication. (shrink)