The ‘black box problem’ is a long-standing talking point in debates about artificial intelligence. This is a significant point of tension between ethicists, programmers, clinicians and anyone else working on developing AI for healthcare applications. However, the precise definition of these systems are often left undefined, vague, unclear or are assumed to be standardised within AI circles. This leads to situations where individuals working on AI talk over each other and has been invoked in numerous debates between opaque and explainable (...) systems. This paper proposes a coherent and clear definition for the black box problem to assist in future discussions about AI in healthcare. This is accomplished by synthesising various definitions in the literature and examining several criteria that can be extrapolated from these definitions. There are no data in this work. (shrink)

The paper presents an ethical analysis and constructive critique of the current practice of AI ethics. It identifies conceptual substantive and procedural challenges and it outlines strategies to address them. The strategies include countering the hype and understanding AI as ubiquitous infrastructure including neglected issues of ethics and justice such as structural background injustices into the scope of AI ethics and making the procedures and fora of AI ethics more inclusive and better informed with regard to philosophical ethics. These measures (...) integrate the perspective of AI justice into AI ethics, strengthening its capacity to provide comprehensive normative orientation and guidance for the development and use of AI that actually improves human lives and living together. (shrink)

In this paper, we first classify different types of second opinions and evaluate the ethical and epistemological implications of providing those in a clinical context. Second, we discuss the issue of how artificial intelligent could replace the human cognitive labour of providing such second opinion and find that several AI reach the levels of accuracy and efficiency needed to clarify their use an urgent ethical issue. Third, we outline the normative conditions of how AI may be used as second opinion (...) in clinical processes, weighing the benefits of its efficiency against concerns of responsibility attribution. Fourth, we provide a ‘rule of disagreement’ that fulfils these conditions while retaining some of the benefits of expanding the use of AI-based decision support systems in clinical contexts. This is because the rule of disagreement proposes to use AI as much as possible, but retain the ability to use human second opinions to resolve disagreements between AI and physician-in-charge. Fifth, we discuss some counterarguments. (shrink)

In this paper, we discuss several problems with current Big data practices which, we claim, seriously erode the role of informed consent as it pertains to the use of personal information. To illustrate these problems, we consider how the notion of informed consent has been understood and operationalised in the ethical regulation of biomedical research (and medical practices, more broadly) and compare this with current Big data practices. We do so by first discussing three types of problems that can impede (...) informed consent with respect to Big data use. First, we discuss the transparency (or explanation) problem. Second, we discuss the re-repurposed data problem. Third, we discuss the meaningful alternatives problem. In the final section of the paper, we suggest some solutions to these problems. In particular, we propose that the use of personal data for commercial and administrative objectives could be subject to a ‘soft governance’ ethical regulation, akin to the way that all projects involving human participants (e.g., social science projects, human medical data and tissue use) are regulated in Australia through the Human Research Ethics Committees (HRECs). We also consider alternatives to the standard consent forms, and privacy policies, that could make use of some of the latest research focussed on the usability of pictorial legal contracts. (shrink)

Artificial Intelligence (AI) is already having a major impact on society. As a result, many organizations have launched a wide range of initiatives to establish ethical principles for the adoption of socially beneficial AI. Unfortunately, the sheer volume of proposed principles threatens to overwhelm and confuse. How might this problem of ‘principle proliferation’ be solved? In this paper, we report the results of a fine-grained analysis of several of the highest-profile sets of ethical principles for AI. We assess whether these (...) principles converge upon a set of agreed-upon principles, or diverge, with significant disagreement over what constitutes ‘ethical AI.’ Our analysis finds a high degree of overlap among the sets of principles we analyze. We then identify an overarching framework consisting of five core principles for ethical AI. Four of them are core principles commonly used in bioethics: beneficence, non-maleficence, autonomy, and justice. On the basis of our comparative analysis, we argue that a new principle is needed in addition: explicability, understood as incorporating both the epistemological sense of intelligibility (as an answer to the question ‘how does it work?’) and in the ethical sense of accountability (as an answer to the question: ‘who is responsible for the way it works?’). In the ensuing discussion, we note the limitations and assess the implications of this ethical framework for future efforts to create laws, rules, technical standards, and best practices for ethical AI in a wide range of contexts. (shrink)

The use of black box algorithms in medicine has raised scholarly concerns due to their opaqueness and lack of trustworthiness. Concerns about potential bias, accountability and responsibility, patient autonomy and compromised trust transpire with black box algorithms. These worries connect epistemic concerns with normative issues. In this paper, we outline that black box algorithms are less problematic for epistemic reasons than many scholars seem to believe. By outlining that more transparency in algorithms is not always necessary, and by explaining that (...) computational processes are indeed methodologically opaque to humans, we argue that the reliability of algorithms provides reasons for trusting the outcomes of medical artificial intelligence. To this end, we explain how computational reliabilism, which does not require transparency and supports the reliability of algorithms, justifies the belief that results of medical AI are to be trusted. We also argue that several ethical concerns remain with black box algorithms, even when the results are trustworthy. Having justified knowledge from reliable indicators is, therefore, necessary but not sufficient for normatively justifying physicians to act. This means that deliberation about the results of reliable algorithms is required to find out what is a desirable action. Thus understood, we argue that such challenges should not dismiss the use of black box algorithms altogether but should inform the way in which these algorithms are designed and implemented. When physicians are trained to acquire the necessary skills and expertise, and collaborate with medical informatics and data scientists, black box algorithms can contribute to improving medical care. (shrink)

Advanced AI systems are rapidly making their way into medical research and practice, and, arguably, it is only a matter of time before they will surpass human practitioners in terms of accuracy, reliability, and knowledge. If this is true, practitioners will have a prima facie epistemic and professional obligation to align their medical verdicts with those of advanced AI systems. However, in light of their complexity, these AI systems will often function as black boxes: the details of their contents, calculations, (...) and procedures cannot be meaningfully understood by human practitioners. When AI systems reach this level of complexity, we can also speak of black-box medicine. In this paper, we want to argue that black-box medicine conflicts with core ideals of patient-centered medicine. In particular, we claim, black-box medicine is not conducive for supporting informed decision-making based on shared information, shared deliberation, and shared mind between practitioner and patient. (shrink)

We are sceptical of concerns over the opacity of algorithmic decision tools. While transparency and explainability are certainly important desiderata in algorithmic governance, we worry that automated decision-making is being held to an unrealistically high standard, possibly owing to an unrealistically high estimate of the degree of transparency attainable from human decision-makers. In this paper, we review evidence demonstrating that much human decision-making is fraught with transparency problems, show in what respects AI fares little worse or better and argue that (...) at least some regulatory proposals for explainable AI could end up setting the bar higher than is necessary or indeed helpful. The demands of practical reason require the justification of action to be pitched at the level of practical reason. Decision tools that support or supplant practical reasoning should not be expected to aim higher than this. We cast this desideratum in terms of Daniel Dennett’s theory of the “intentional stance” and argue that since the justification of action for human purposes takes the form of intentional stance explanation, the justification of algorithmic decisions should take the same form. In practice, this means that the sorts of explanations for algorithmic decisions that are analogous to intentional stance explanations should be preferred over ones that aim at the architectural innards of a decision tool. (shrink)

Many of the computing systems programmed using Machine Learning are opaque: it is difficult to know why they do what they do or how they work. Explainable Artificial Intelligence aims to develop analytic techniques that render opaque computing systems transparent, but lacks a normative framework with which to evaluate these techniques’ explanatory successes. The aim of the present discussion is to develop such a framework, paying particular attention to different stakeholders’ distinct explanatory requirements. Building on an analysis of “opacity” from (...) philosophy of science, this framework is modeled after accounts of explanation in cognitive science. The framework distinguishes between the explanation-seeking questions that are likely to be asked by different stakeholders, and specifies the general ways in which these questions should be answered so as to allow these stakeholders to perform their roles in the Machine Learning ecosystem. By applying the normative framework to recently developed techniques such as input heatmapping, feature-detector visualization, and diagnostic classification, it is possible to determine whether and to what extent techniques from Explainable Artificial Intelligence can be used to render opaque computing systems transparent and, thus, whether they can be used to solve the Black Box Problem. (shrink)

Although decision‐making algorithms are not new to medicine, the availability of vast stores of medical data, gains in computing power, and breakthroughs in machine learning are accelerating the pace of their development, expanding the range of questions they can address, and increasing their predictive power. In many cases, however, the most powerful machine learning techniques purchase diagnostic or predictive accuracy at the expense of our ability to access “the knowledge within the machine.” Without an explanation in terms of reasons or (...) a rationale for particular decisions in individual cases, some commentators regard ceding medical decision‐making to black box systems as contravening the profound moral responsibilities of clinicians. I argue, however, that opaque decisions are more common in medicine than critics realize. Moreover, as Aristotle noted over two millennia ago, when our knowledge of causal systems is incomplete and precarious—as it often is in medicine—the ability to explain how results are produced can be less important than the ability to produce such results and empirically verify their accuracy. (shrink)

Book reviewed in this article: The Needs of Strangers. By Michael Ignatieff. The Health Economy. By Victor Fuchs. Just Health Care. By Norman Daniels.

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

Bioethics has changed considerably over the last few years. Increased global interaction, through the off-shoring of clinical trials, cross-border surrogacy, organ trafficking, and medical tourism, among others practices, has brought additional considerations to a discipline that has been, until recently, relatively contained within national borders. We aim to contribute to the discourse on exploitation and vulnerability in a way that reflects such global changes. We will explore the link between vulnerability and exploitation, and argue that exploitation can be understood as (...) taking advantage of vulnerabilities, provided we recognize that vulnerabilities are often embedded within existing structural injustices. (shrink)

The human right to health has been established in international law since 1976. However, philosophers have often regarded human rights doctrine as a marginal contribution to political philosophy, or have attempted to distinguish ‘human rights proper’ from ‘aspirations’, with the human right to health often considered as falling into the latter category. Here the human right to health is defended as an attractive approach to global health, and responses are offered to a series of criticisms concerning its demandingness.

Though the revised edition of A Theory of Justice, published in 1999, is the definitive statement of Rawls's view, so much of the extensive literature on Rawls's theory refers to the first edition. This reissue makes the first edition once again available for scholars and serious students of Rawls's work.

The increased presence of medical AI in clinical use raises the ethical question which standard of explainability is required for an acceptable and responsible implementation of AI-based applications in medical contexts. In this paper, we elaborate on the emerging debate surrounding the standards of explainability for medical AI. For this, we first distinguish several goods explainability is usually considered to contribute to the use of AI in general, and medical AI in specific. Second, we propose to understand the value of (...) explainability relative to other available norms of explainable decision-making. Third, in pointing out that we usually accept heuristics and uses of bounded rationality for medical decision-making by physicians, we argue that the explainability of medical decisions should not be measured against an idealized diagnostic process, but according to practical considerations. We conclude, fourth, to resolve the issue of explainability-standards by relocating the issue to the AI’s certifiability and interpretability. (shrink)

In recent years, a plethora of high-profile scientific publications has been reporting about machine learning algorithms outperforming clinicians in medical diagnosis or treatment recommendations. This has spiked interest in deploying relevant algorithms with the aim of enhancing decision-making in healthcare. In this paper, we argue that instead of straightforwardly enhancing the decision-making capabilities of clinicians and healthcare institutions, deploying machines learning algorithms entails trade-offs at the epistemic and the normative level. Whereas involving machine learning might improve the accuracy of medical (...) diagnosis, it comes at the expense of opacity when trying to assess the reliability of given diagnosis. Drawing on literature in social epistemology and moral responsibility, we argue that the uncertainty in question potentially undermines the epistemic authority of clinicians. Furthermore, we elucidate potential pitfalls of involving machine learning in healthcare with respect to paternalism, moral responsibility and fairness. At last, we discuss how the deployment of machine learning algorithms might shift the evidentiary norms of medical diagnosis. In this regard, we hope to lay the grounds for further ethical reflection of the opportunities and pitfalls of machine learning for enhancing decision-making in healthcare. (shrink)

Artificial intelligence is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM’s Watson for Oncology. I argue that use of this type of system creates (...) both important risks and significant opportunities for promoting shared decision making. If value judgements are fixed and covert in AI systems, then we risk a shift back to more paternalistic medical care. However, if designed and used in an ethically informed way, AI could offer a potentially powerful way of supporting shared decision making. It could be used to incorporate explicit value reflection, promoting patient autonomy. In the context of medical treatment, we need value-flexible AI that can both respond to the values and treatment goals of individual patients and support clinicians to engage in shared decision making. (shrink)

Political philosophers have become increasingly interested in questions of justice as applied to health. Much of this literature works from a distributive understanding of justice. In the recent debate, however, ‘relational’ egalitarians have proposed a different way of conceptualising equality, which focuses on the quality of social relations among citizens and/or how social institutions ‘treat’ citizens. This paper explores some implications of a relational approach to health, with particular focus on health care, health inequalities and health policy. While the relational (...) account can add interesting perspectives to current debates on justice and health, we also highlight some tensions and difficulties relational egalitarians might encounter and some discontinuities between the implications of a relational account and current discourse on health equity. (shrink)