Background While the theoretical benefits and harms of Artificial Intelligence (AI) have been widely discussed in academic literature, empirical evidence remains elusive regarding the practical ethical challenges of developing AI for healthcare. Bridging the gap between theory and practice is an essential step in understanding how to ethically align AI for healthcare. Therefore, this research examines the concerns and challenges perceived by experts in developing ethical AI that addresses the healthcare context and needs. Methods We conducted semi-structured interviews with 41 (...) AI experts and analyzed the data using reflective thematic analysis. Results We developed three themes that expressed the considerations perceived by experts as essential for ensuring AI aligns with ethical practices within healthcare. The first theme explores the ethical significance of introducing AI with a clear and purposeful objective. The second theme focuses on how experts are concerned about the tension that exists between economic incentives and the importance of prioritizing the interests of doctors and patients. The third theme illustrates the need to develop context-sensitive AI for healthcare that is informed by its underlying theoretical foundations. Conclusions The three themes collectively emphasized that beyond being innovative, AI must genuinely benefit healthcare and its stakeholders, meaning AI also aligns with intricate and context-specific healthcare practices. Our findings signal that instead of narrow product-specific AI guidance, ethical AI development may need a systemic, proactive perspective that includes the ethical considerations (objectives, actors, and context) and focuses on healthcare applications. Ethically developing AI involves a complex interplay between AI, ethics, healthcare, and multiple stakeholders. (shrink)

As the artificial intelligence (AI) ethics field is currently working towards its operationalisation, ethics review as carried out by research ethics committees (RECs) constitutes a powerful, but so far underdeveloped, framework to make AI ethics effective in practice at the research level. This article contributes to the elaboration of research ethics frameworks for research projects developing and/or using AI. It highlights that these frameworks are still in their infancy and in need of a structure and criteria to ensure AI research (...) projects advance in a way that respects norms and principles. This article proposes to draw from the European Union’s AI Act currently in development to shape these frameworks. Although, in the current form of the draft (as of August 2023), the obligations of the AI Act do not apply to scientific research, it is most likely that they will still have a strong impact on AI research considering the need to anticipate market placement or to test new tools in real world conditions. This article investigates what the risk-based approach in the AI Act implies for research ethics and highlights some AI Act obligations of particular value to implement for ethics review processes. (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)

As AI technologies are increasingly deployed in work, welfare, healthcare, and other domains, there is a growing realization not only of their power but of their problems. AI has the capacity to reinforce historical injustice, to amplify labor precarity, and to cement forms of racial and gendered inequality. An alternate set of values, paradigms, and priorities are urgently needed. How might we design and evaluate AI from an indigenous perspective? This article draws upon the five Tests developed by Māori scholar (...) Sir Hirini Moko Mead. This framework, informed by Māori knowledge and concepts, provides a method for assessing contentious issues and developing a Māori position. This paper takes up these tests, considers how each test might be applied to data-driven systems, and provides a number of concrete examples. This intervention challenges the priorities that currently underpin contemporary AI technologies but also offers a rubric for designing and evaluating AI according to an indigenous knowledge system. (shrink)

The effects that artificial intelligence (AI) technologies will have on society in the short- and long-term are inherently uncertain. For this reason, many governments are avoiding strict command and control regulations for this technology and instead rely on softer ethics-based approaches. The Russian approach to regulating AI is characterized by the prevalence of unenforceable ethical principles implemented via industry self-regulation. We analyze the emergence of the regulatory regime for AI in Russia to illustrate the limitations of this approach. The article (...) is based on 50 interviews with policymakers, representatives of AI companies, and academics in the country. The findings show that this regulatory regime was formed under the strong influence of Russian big tech companies, which saw an opportunity to avoid regulatory oversight by washing out concrete regulatory measures from the policy. This approach is part of a broader protectionist sanction-proofing strategy for the local IT sector designed by the government, which can be characterized by lifting regulatory barriers for local companies. Unenforceable ethics-based self-regulation is a _regulatory gift_ from the Russian government to the industry. This _gift_ was intentionally designed because the government thought that prioritizing local innovation over consumer protection would benefit the public. However, the _gift_ can also unintentionally undermine the public interest by providing an opportunity for _ethics washing_. (shrink)

While the technologies that enable Artificial Intelligence (AI) continue to advance rapidly, there are increasing promises regarding AI’s beneficial outputs and concerns about the challenges of human–computer interaction in healthcare. To address these concerns, institutions have increasingly resorted to publishing AI guidelines for healthcare, aiming to align AI with ethical practices. However, guidelines as a form of written language can be analyzed to recognize the reciprocal links between its textual communication and underlying societal ideas. From this perspective, we conducted a (...) discourse analysis to understand how these guidelines construct, articulate, and frame ethics for AI in healthcare. We included eight guidelines and identified three prevalent and interwoven discourses: (1) AI is unavoidable and desirable; (2) AI needs to be guided with (some forms of) principles (3) trust in AI is instrumental and primary. These discourses signal an over-spillage of technical ideals to AI ethics, such as over-optimism and resulting hyper-criticism. This research provides insights into the underlying ideas present in AI guidelines and how guidelines influence the practice and alignment of AI with ethical, legal, and societal values expected to shape AI in healthcare. (shrink)

With the growing application of machine learning models in medicine, principlist bioethics has been put forward as needing revision. This paper reflects on the dominant trope in AI ethics to include a new ‘principle of explicability’ alongside the traditional four principles of bioethics that make up the theory of principlism. It specifically suggests that these four principles are sufficient and challenges the relevance of explicability as a separate ethical principle by emphasizing the coherentist affinity of principlism. We argue that, through (...) specification, the properties of explicability are already covered by the four bioethical principles. The paper finishes by anticipating an objection that coherent principles could not facilitate technology induced change and are not well-suited to tackle moral differences. (shrink)

As artificial intelligence (AI) integrates across social domains, prevailing technical paradigms often overlook human relational needs vital for cooperative resilience. Alternative pathways consciously supporting dignity and wisdom warrant consideration. Integrating seminal insights from virtue and care ethics, this article delineates the following four cardinal design principles prioritizing communal health: (1) affirming the sanctity of life; (2) nurturing healthy attachment; (3) facilitating communal wholeness; and (4) safeguarding societal resilience. Grounding my analysis in the rich traditions of moral philosophy, I argue that (...) these principles scaffold sustainable innovation trajectories that consciously center shared welfare advancement over detached technical capabilities or efficiency benchmarks alone. Elucidating connections with pioneering initiatives demonstrates fragments of this vision taking embryonic shape, yet pervasive adoption remains largely aspirational to date. Fulfilling dignity-based artificial intelligence demands ongoing collective commitment beyond firms’ profit motives or governance proceduralism. My conclusions urge technology policies and priorities directed toward empowering the vulnerability of people rather than controlling the optimization of systems. (shrink)

Health Recommender Systems are promising Articial-Intelligence-based tools endowing healthy lifestyles and therapy adherence in healthcare and medicine. Among the most supported areas, it is worth mentioning active aging. However, current HRS supporting AA raise ethical challenges that still need to be properly formalized and explored. This study proposes to rethink HRS for AA through an autonomy-based ethical analysis. In particular, a brief overview of the HRS’ technical aspects allows us to shed light on the ethical risks and challenges they might (...) raise on individuals’ well-being as they age. Moreover, the study proposes a categorization, understanding, and possible preventive/mitigation actions for the elicited risks and challenges through rethinking the AI ethics core principle of autonomy. Finally, elaborating on autonomy-related ethical theories, the paper proposes an autonomy-based ethical framework and how it can foster the development of autonomy-enabling HRS for AA. (shrink)

The rapid diffusion of artificial intelligence (AI) technologies in the defence domain raises challenges for the ethical governance of these systems. A recent shift from the what to the how of AI ethics sees a nascent body of literature published by defence organisations focussed on guidance to implement AI ethics principles. These efforts have neglected a crucial intermediate step between principles and guidance concerning the elicitation of ethical requirements for specifying the guidance. In this article, we outline the key normative (...) choices and corresponding tradeoffs that are involved in specifying guidance for the implementation of AI ethics principles in the defence domain. These correspond to: the AI lifecycle model used; the scope of stakeholder involvement; the accountability goals chosen; the choice of auditing requirements; and the choice of mechanisms for transparency and traceability. We provide initial recommendations for navigating these tradeoffs and highlight the importance of a pro-ethical institutional culture. (shrink)

Responsible AI (RAI) guidelines aim to ensure that AI systems respect democratic values. While a step in the right direction, they currently fail to impact practice. Our work discusses reasons for this lack of impact and clusters them into five areas: (1) the abstract nature of RAI guidelines, (2) the problem of selecting and reconciling values, (3) the difficulty of operationalising RAI success metrics, (4) the fragmentation of the AI pipeline, and (5) the lack of internal advocacy and accountability. Afterwards, (...) we introduce a number of approaches to RAI from a range of disciplines, exploring their potential as solutions to the identified challenges. We anchor these solutions in practice through concrete examples, bridging the gap between the theoretical considerations of RAI and on-the-ground processes that currently shape how AI systems are built. Our work considers the socio-technical nature of RAI limitations and the resulting necessity of producing socio-technical solutions. (shrink)

This article provides a methodology for the interpretation of AI ethics principles to specify ethical criteria for the development and deployment of AI systems in high-risk domains. The methodology consists of a three-step process deployed by an independent, multi-stakeholder ethics board to: (1) identify the appropriate level of abstraction for modelling the AI lifecycle; (2) interpret prescribed principles to extract specific requirements to be met at each step of the AI lifecycle; and (3) define the criteria to inform purpose- and (...) context-specific balancing of the principles. The methodology presented in this article is designed to be agile, adaptable, and replicable, and when used as part of a pro-ethical institutional culture, will help to foster the ethical design, development, and deployment of AI systems. The application of the methodology is illustrated through reference to the UK Ministry of Defence AI ethics principles. (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)