The ends of medicine are sometimes construed simply as promotion of health, treatment and prevention of disease, and alleviation of pain. Practitioners might agree that this simple formulation captures much of what medical practice is about. But while the ends of medicine may seem simple or even obvious, the essays in this issue demonstrate the wide variety of philosophical questions and issues associated with the ends of medicine. They raise questions about how to characterize terms like “health” and “disease”; whether (...) medicine’s goals should be extended to include enhancement beyond normal human function; and whether the ends of medicine are binding on those involved in health care outside of professional medicine, such as pharmaceutical companies. They also give philosophical attention to patient experiences, and so raise questions about whether current practices achieve the ends of medicine from the perspective of the patient. Together these essays demonstrate the important role played by a conception of medicine’s ends in a wide variety of issues and problems in the philosophy and ethics of medicine. (shrink)

In this paper, we argue that one way to approach what is known in the literature as the “Trust Gap” in Medical AI is to focus on explanations from an Explainable AI (xAI) perspective. Against the current framework on xAI – which does not offer a real solution – we argue for a pragmatist turn, one that focuses on understanding how we provide explanations in Traditional Medicine (TM), composed by human agents only. Following this, explanations have two specific relevant components: (...) they are usually (i) social and (ii) abductive. Explanations, in this sense, ought to provide understanding by answering contrastive _why-questions_: “Why had P happened instead of Q?” (Miller in AI 267:1–38, 2019) (Sect. 1 ). In order to test the relevancy of this concept of explanation in medical xAI, we offer several reasons to argue that abductions are crucial for medical reasoning and provide a crucial tool to deal with trust gaps between human agents (Sect. 2 ). If abductions are relevant in TM, we can test the capability of Artificial Intelligence systems on this merit. Therefore, we provide an analysis of the capacity for social and abductive reasoning of different AI technologies. Accordingly, we posit that Large Language Models (LLMs) and transformer architectures exhibit a noteworthy potential for effective engagement in abductive reasoning. By leveraging the potential abductive capabilities of LLMs and transformers, we anticipate a paradigm shift in the integration of explanations within AI systems. This, in turn, has the potential to enhance the trustworthiness of AI-driven medical decisions, bridging the Trust Gap that has been a prominent challenge in the field of Medical AI (Sect. 3 ). This development holds the potential to not only improve the interpretability of AI-generated medical insights but also to guarantee that trust among practitioners, patients, and stakeholders in the healthcare domain is still present. (shrink)

Machine Learning (ML) is on the rise in medicine, promising improved diagnostic, therapeutic and prognostic clinical tools. While these technological innovations are bound to transform health care, they also bring new ethical concerns to the forefront. One particularly elusive challenge regards discriminatory algorithmic judgements based on biases inherent in the training data. A common line of reasoning distinguishes between justified differential treatments that mirror true disparities between socially salient groups, and unjustified biases which do not, leading to misdiagnosis and erroneous (...) treatment. In the curation of training data this strategy runs into severe problems though, since distinguishing between the two can be next to impossible. We thus plead for a pragmatist dealing with algorithmic bias in healthcare environments. By recurring to a recent reformulation of William James’s pragmatist understanding of truth, we recommend that, instead of aiming at a supposedly objective truth, outcome-based therapeutic usefulness should serve as the guiding principle for assessing ML applications in medicine. (shrink)