BackgroundArtificial intelligence has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: (...) What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective?MethodsEight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed.ResultsUpon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries.ConclusionsThe ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere. (shrink)

Despite the widespread use of automated decision-making (ADM) systems, they are often developed without involving the public or those directly affected, leading to concerns about systematic biases that may perpetuate structural injustices. Existing formal fairness approaches primarily focus on statistical outcomes across demographic groups or individual fairness, yet these methods reveal ambiguities and limitations in addressing fairness comprehensively. This paper argues for a holistic approach to algorithmic fairness that integrates procedural fairness, considering both decision-making processes and their outcomes. Procedural fairness (...) emphasizes the importance of fair decision-making procedures, which aligns with theories of relational justice that stress the quality of social relations and power dynamics. We highlight the need for substantive procedural fairness to ensure better outcomes and address forward-looking responsibilities. Additionally, we propose leveraging Public Engagement, a core dimension within the well-established Responsible Research and Innovation framework, to enhance procedural fairness in ADM systems. Our contribution underscores the value of Public Engagement in fostering fairer ADM processes, thereby expanding the current focus beyond technical outcome-based approaches to encompass broader procedural considerations. (shrink)