The counterfactual approach to explainable AI (XAI) seeks to provide understanding of AI systems through the provision of counterfactual explanations. In a recent systematic review, Chou et al. (Inform Fus 81:59–83, 2022) argue that the counterfactual approach does not clearly provide causal understanding. They diagnose the problem in terms of the underlying framework within which the counterfactual approach has been developed. To date, the counterfactual approach has not been developed in concert with the approach for specifying causes developed by Pearl (...) (Causality: Models, reasoning, and inference. Cambridge University Press, 2000) and Woodward (Making things happen: A theory of causal explanation. Oxford University Press, 2003). In this paper, I build on Chou et al.’s work by applying the Pearl-Woodward approach. I argue that the standard counterfactual approach to XAI is capable of delivering causal understanding, but that there are limitations on its capacity to do so. I suggest a way to overcome these limitations. (shrink)

Definition of the problem The umbrella term “explicability” refers to the reduction of opacity of artificial intelligence (AI) systems. These efforts are challenging for medical AI applications because higher accuracy often comes at the cost of increased opacity. This entails ethical tensions because physicians and patients desire to trace how results are produced without compromising the performance of AI systems. The centrality of explicability within the informed consent process for medical AI systems compels an ethical reflection on the trade-offs. Which (...) levels of explicability are needed to obtain informed consent when utilizing medical AI? Arguments We proceed in five steps: First, we map the terms commonly associated with explicability as described in the ethics and computer science literature, i.e., disclosure, intelligibility, interpretability, and explainability. Second, we conduct a conceptual analysis of the ethical requirements for explicability when it comes to informed consent. Third, we distinguish hurdles for explicability in terms of epistemic and explanatory opacity. Fourth, this then allows to conclude the level of explicability physicians must reach and what patients can expect. In a final step, we show how the identified levels of explicability can technically be met from the perspective of computer science. Throughout our work, we take diagnostic AI systems in radiology as an example. Conclusion We determined four levels of explicability that need to be distinguished for ethically defensible informed consent processes and showed how developers of medical AI can technically meet these requirements. (shrink)

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)

Assistive systems based on Artificial Intelligence (AI) are bound to reshape decision-making in all areas of society. One of the most intricate challenges arising from their implementation in high-stakes environments such as medicine concerns their frequently unsatisfying levels of explainability, especially in the guise of the so-called black-box problem: highly successful models based on deep learning seem to be inherently opaque, resisting comprehensive explanations. This may explain why some scholars claim that research should focus on rendering AI systems understandable, rather (...) than explainable. Yet, there is a grave lack of agreement concerning these terms in much of the literature on AI. We argue that the seminal distinction made by the philosopher and physician Karl Jaspers between different types of explaining and understanding in psychopathology can be used to promote greater conceptual clarity in the context of Machine Learning (ML). Following Jaspers, we claim that explaining and understanding constitute multi-faceted epistemic approaches that should not be seen as mutually exclusive, but rather as complementary ones as in and of themselves they are necessarily limited. Drawing on the famous example of Watson for Oncology we highlight how Jaspers’ methodology translates to the case of medical AI. Classical considerations from the philosophy of psychiatry can therefore inform a debate at the centre of current AI ethics, which in turn may be crucial for a successful implementation of ethically and legally sound AI in medicine. (shrink)

Previous research in Explainable Artificial Intelligence (XAI) suggests that a main aim of explainability approaches is to satisfy specific interests, goals, expectations, needs, and demands regarding artificial systems (we call these “stakeholders' desiderata”) in a variety of contexts. However, the literature on XAI is vast, spreads out across multiple largely disconnected disciplines, and it often remains unclear how explainability approaches are supposed to achieve the goal of satisfying stakeholders' desiderata. This paper discusses the main classes of stakeholders calling for explainability (...) of artificial systems and reviews their desiderata. We provide a model that explicitly spells out the main concepts and relations necessary to consider and investigate when evaluating, adjusting, choosing, and developing explainability approaches that aim to satisfy stakeholders' desiderata. This model can serve researchers from the variety of different disciplines involved in XAI as a common ground. It emphasizes where there is interdisciplinary potential in the evaluation and the development of explainability approaches. (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)