Approaches to clinical ethics dilemmas that rely on basic principles or rules are difficult to apply because of vagueness and conflict among basic values. In response, casuistry rejects the use of basic values, and specification produces a large set of specified rules that are presumably easily applicable. Balancing is a method employed to weigh the relative importance of different and conflicting values in application. We argue against casuistry and specification, claiming that balancing is superior partly because it most clearly exhibits (...) the reasoning behind moral decision-making. Hence, balancing may be most effective in teaching bioethics to medical professionals. (shrink)

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depend on patient preferences. In this paper, we focus on the ethical questions arising from the design, development and deployment of AI systems to support decision-making around (...) cardiopulmonary resuscitation and the determination of a patient’s Do Not Attempt to Resuscitate status (also known as code status). The COVID-19 pandemic has made us keenly aware of the difficulties physicians encounter when they have to act quickly in stressful situations without knowing what their patient would have wanted. We discuss the results of an interview study conducted with healthcare professionals in a university hospital aimed at understanding the status quo of resuscitation decision processes while exploring a potential role for AI systems in decision-making around code status. Our data suggest that (1) current practices are fraught with challenges such as insufficient knowledge regarding patient preferences, time pressure and personal bias guiding care considerations and (2) there is considerable openness among clinicians to consider the use of AI-based decision support. We suggest a model for how AI can contribute to improve decision-making around resuscitation and propose a set of ethically relevant preconditions—conceptual, methodological and procedural—that need to be considered in further development and implementation efforts. (shrink)

Organizations such as the EU High-Level Expert Group on AI and the IEEE have recently formulated ethical principles and (moral) values that should be adhered to in the design and deployment of artificial intelligence (AI). These include respect for autonomy, non-maleficence, fairness, transparency, explainability, and accountability. But how can we ensure and verify that an AI system actually respects these values? To help answer this question, I propose an account for determining when an AI system can be said to embody (...) certain values. This account understands embodied values as the result of design activities intended to embed those values in such systems. AI systems are here understood as a special kind of sociotechnical system that, like traditional sociotechnical systems, are composed of technical artifacts, human agents, and institutions but—in addition—contain artificial agents and certain technical norms that regulate interactions between artificial agents and other elements of the system. The specific challenges and opportunities of embedding values in AI systems are discussed, and some lessons for better embedding values in AI systems are drawn. (shrink)

Machine intelligence already helps medical staff with a number of tasks. Ethical decision-making, however, has not been handed over to computers. In this proof-of-concept study, we show how an algorithm based on Beauchamp and Childress’ prima-facie principles could be employed to advise on a range of moral dilemma situations that occur in medical institutions. We explain why we chose fuzzy cognitive maps to set up the advisory system and how we utilized machine learning to train it. We report on the (...) difficult task of operationalizing the principles of beneficence, non-maleficence and patient autonomy, and describe how we selected suitable input parameters that we extracted from a training dataset of clinical cases. The first performance results are promising, but an algorithmic approach to ethics also comes with several weaknesses and limitations. Should one really entrust the sensitive domain of clinical ethics to machine intelligence? (shrink)

In this paper we argue that transparency of machine learning algorithms, just as explanation, can be defined at different levels of abstraction. We criticize recent attempts to identify the explanation of black box algorithms with making their decisions (post-hoc) interpretable, focusing our discussion on counterfactual explanations. These approaches to explanation simplify the real nature of the black boxes and risk misleading the public about the normative features of a model. We propose a new form of algorithmic transparency, that consists in (...) explaining algorithms as an intentional product, that serves a particular goal, or multiple goals (Daniel Dennet’s design stance) in a given domain of applicability, and that provides a measure of the extent to which such a goal is achieved, and evidence about the way that measure has been reached. We call such idea of algorithmic transparency “design publicity.” We argue that design publicity can be more easily linked with the justification of the use and of the design of the algorithm, and of each individual decision following from it. In comparison to post-hoc explanations of individual algorithmic decisions, design publicity meets a different demand (the demand for impersonal justification) of the explainee. Finally, we argue that when models that pursue justifiable goals (which may include fairness as avoidance of bias towards specific groups) to a justifiable degree are used consistently, the resulting decisions are all justified even if some of them are (unavoidably) based on incorrect predictions. For this argument, we rely on John Rawls’s idea of procedural justice applied to algorithms conceived as institutions. (shrink)

Decision-making capacity is the gatekeeping element for a patient’s right to self-determination with regard to medical decisions. A DMC evaluation is not only conducted on descriptive grounds but is an inherently normative task including ethical reasoning. Therefore, it is dependent to a considerable extent on the values held by the clinicians involved in the DMC evaluation. Dealing with the question of how to reasonably support clinicians in arriving at a DMC judgment, a new tool is presented that fundamentally differs from (...) existing ones: the U-Doc. By putting greater emphasis on the judgmental process rather than on the measurement of mental abilities, the clinician as a decision-maker is brought into focus, rendering the tool more of an evaluation guide than a test instrument. In a qualitative study, the perceived benefits of and difficulties with the tool have been explored. The findings show on the one hand that the evaluation aid provides basic orientation, supports a holistic perspective on the patient, sensitizes for ethical considerations and personal biases, and helps to think through the decision, to argue, and to justify one’s judgment. On the other hand, the room for interpretation due to absent operationalisations, related ambiguities, and the confrontation with one’s own subjectivity may be experienced as unsettling. (shrink)

We describe a form of moral artificial intelligence that could be used to improve human moral decision-making. We call it the “artificial moral advisor”. The AMA would implement a quasi-relativistic version of the “ideal observer” famously described by Roderick Firth. We describe similarities and differences between the AMA and Firth’s ideal observer. Like Firth’s ideal observer, the AMA is disinterested, dispassionate, and consistent in its judgments. Unlike Firth’s observer, the AMA is non-absolutist, because it would take into account the human (...) agent’s own principles and values. We argue that the AMA would respect and indeed enhance individuals’ moral autonomy, help individuals achieve wide and a narrow reflective equilibrium, make up for the limitations of human moral psychology in a way that takes conservatives’ objections to human bioenhancement seriously, and implement the positive functions of intuitions and emotions in human morality without their downsides, such as biases and prejudices. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.