Along with potential benefits to healthcare delivery, machine learning healthcare applications raise a number of ethical concerns. Ethical evaluations of ML-HCAs will need to structure th...

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)

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)

This article reports the findings of AI4People, an Atomium—EISMD initiative designed to lay the foundations for a “Good AI Society”. We introduce the core opportunities and risks of AI for society; present a synthesis of five ethical principles that should undergird its development and adoption; and offer 20 concrete recommendations—to assess, to develop, to incentivise, and to support good AI—which in some cases may be undertaken directly by national or supranational policy makers, while in others may be led by other (...) stakeholders. If adopted, these recommendations would serve as a firm foundation for the establishment of a Good AI Society. (shrink)

Theories of social justice are necessarily abstract, reaching beyond the particular and the immediate to the general and the timeless. Yet such theories, addressing the world and its problems, must respond to the real and changing dilemmas of the day. A brilliant work of practical philosophy, Frontiers of Justice is dedicated to this proposition. Taking up three urgent problems of social justice neglected by current theories and thus harder to tackle in practical terms and everyday life, Martha Nussbaum seeks a (...) theory of social justice that can guide us to a richer, more responsive approach to social cooperation. The idea of the social contract--especially as developed in the work of John Rawls--is one of the most powerful approaches to social justice in the Western tradition. But as Nussbaum demonstrates, even Rawls's theory, suggesting a contract for mutual advantage among approximate equals, cannot address questions of social justice posed by unequal parties. How, for instance, can we extend the equal rights of citizenship--education, health care, political rights and liberties--to those with physical and mental disabilities? How can we extend justice and dignified life conditions to all citizens of the world? And how, finally, can we bring our treatment of nonhuman animals into our notions of social justice? Exploring the limitations of the social contract in these three areas, Nussbaum devises an alternative theory based on the idea of capabilities. She helps us to think more clearly about the purposes of political cooperation and the nature of political principles--and to look to a future of greater justice for all. (shrink)

Bentham's best-known book stands as a classic of both philosophy and jurisprudence. The 1789 work articulates an important statement of the foundations of utilitarian philosophy — it also represents a pioneering study of crime and punishment. Bentham's reasoning remains central to contemporary debates in moral and political philosophy, economics, and legal theory.

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.

There is a current debate about if, and in what sense, machine learning systems used in the medical context need to be explainable. Those arguing in favor contend these systems require post hoc explanations for each individual decision to increase trust and ensure accurate diagnoses. Those arguing against suggest the high accuracy and reliability of the systems is sufficient for providing epistemic justified beliefs without the need for explaining each individual decision. But, as we show, both solutions have limitations—and it (...) is unclear either address the epistemic worries of the medical professionals using these systems. We argue these systems do require an explanation, but an institutional explanation. These types of explanations provide the reasons why the medical professional should rely on the system in practice—that is, they focus on trying to address the epistemic concerns of those using the system in specific contexts and specific occasions. But ensuring that these institutional explanations are fit for purpose means ensuring the institutions designing and deploying these systems are transparent about the assumptions baked into the system. This requires coordination with experts and end-users concerning how it will function in the field, the metrics used to evaluate its accuracy, and the procedures for auditing the system to prevent biases and failures from going unaddressed. We contend this broader explanation is necessary for either post hoc explanations or accuracy scores to be epistemically meaningful to the medical professional, making it possible for them to rely on these systems as effective and useful tools in their practices. (shrink)

Following Kahneman and Tversky, I examine the term ‘bias’ as it is used to refer to systematic errors. Given the central role of error in this understanding of bias, it is helpful to consider what it is to err and to distinguish different kinds of error. I identify two main kinds of error, examine ethical issues that pertain to the relation of these types of error, and explain their moral significance. Next, I provide a four-level explanatory framework for understanding biases: (...) personal, sub-personal, situational, and systemic levels. Finally, I examine some of the ethical complexities involved in attributing biases to oneself and to others. (shrink)

-/- Artificial intelligence powers Google’s search engine, enables Facebook to target advertising, and allows Alexa and Siri to do their jobs. AI is also behind self-driving cars, predictive policing, and autonomous weapons that can kill without human intervention. These and other AI applications raise complex ethical issues that are the subject of ongoing debate. This volume in the MIT Press Essential Knowledge series offers an accessible synthesis of these issues. Written by a philosopher of technology, AI Ethics goes beyond the (...) usual hype and nightmare scenarios to address concrete questions. -/- Mark Coeckelbergh describes influential AI narratives, ranging from Frankenstein’s monster to transhumanism and the technological singularity. He surveys relevant philosophical discussions: questions about the fundamental differences between humans and machines and debates over the moral status of AI. He explains the technology of AI, describing different approaches and focusing on machine learning and data science. He offers an overview of important ethical issues, including privacy concerns, responsibility and the delegation of decision making, transparency, and bias as it arises at all stages of data science processes. He also considers the future of work in an AI economy. Finally, he analyzes a range of policy proposals and discusses challenges for policymakers. He argues for ethical practices that embed values in design, translate democratic values into practices and include a vision of the good life and the good society . (shrink)

It is becoming more common that the decision-makers in private and public institutions are predictive algorithmic systems, not humans. This article argues that relying on algorithmic systems is procedurally unjust in contexts involving background conditions of structural injustice. Under such nonideal conditions, algorithmic systems, if left to their own devices, cannot meet a necessary condition of procedural justice, because they fail to provide a sufficiently nuanced model of which cases count as relevantly similar. Resolving this problem requires deliberative capacities uniquely (...) available to human agents. After exploring the limitations of existing formal algorithmic fairness strategies, the article argues that procedural justice requires that human agents relying wholly or in part on algorithmic systems proceed with caution: by avoiding doxastic negligence about algorithmic outputs, by exercising deliberative capacities when making similarity judgments, and by suspending belief and gathering additional information in light of higher-order uncertainty. (shrink)

We argue why interpretability should have primacy alongside empiricism for several reasons: first, if machine learning models are beginning to render some of the high-risk healthcare decisions instead of clinicians, these models pose a novel medicolegal and ethical frontier that is incompletely addressed by current methods of appraising medical interventions like pharmacological therapies; second, a number of judicial precedents underpinning medical liability and negligence are compromised when ‘autonomous’ ML recommendations are considered to be en par with human instruction in specific (...) contexts; third, explainable algorithms may be more amenable to the ascertainment and minimisation of biases, with repercussions for racial equity as well as scientific reproducibility and generalisability. We conclude with some reasons for the ineludible importance of interpretability, such as the establishment of trust, in overcoming perhaps the most difficult challenge ML will face in a high-stakes environment like healthcare: professional and public acceptance. (shrink)

Research on the ethics of algorithms has grown substantially over the past decade. Alongside the exponential development and application of machine learning algorithms, new ethical problems and solutions relating to their ubiquitous use in society have been proposed. This article builds on a review of the ethics of algorithms published in 2016, 2016). The goals are to contribute to the debate on the identification and analysis of the ethical implications of algorithms, to provide an updated analysis of epistemic and normative (...) concerns, and to offer actionable guidance for the governance of the design, development and deployment of algorithms. (shrink)

Research on the ethics of algorithms has grown substantially over the past decade. Alongside the exponential development and application of machine learning algorithms, new ethical problems and solutions relating to their ubiquitous use in society have been proposed. This article builds on a review of the ethics of algorithms published in 2016, 2016). The goals are to contribute to the debate on the identification and analysis of the ethical implications of algorithms, to provide an updated analysis of epistemic and normative (...) concerns, and to offer actionable guidance for the governance of the design, development and deployment of algorithms. (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)

In this paper, we investigate how data about public preferences may be used to inform policy around the use of controversial novel technologies, using public preferences about autonomous vehicles (AVs) as a case study. We first summarize the recent ‘Moral Machine’ study, which generated preference data from millions of people regarding how they think AVs should respond to emergency situations. We argue that while such preferences cannot be used to directly inform policy, they should not be disregarded. We defend an (...) approach that we call ‘Collective Reflective Equilibrium in Practice’ (CREP). In CREP, data on public attitudes function as an input into a deliberative process that looks for coherence between attitudes, behaviours and competing ethical principles. We argue that in cases of reasonable moral disagreement, data on public attitudes should play a much greater role in shaping policies than in areas of ethical consensus. We apply CREP to some of the global preferences about AVs uncovered by the Moral Machines study. We intend this discussion both as a substantive contribution to the debate about the programming of ethical AVs, and as an illustration of how CREP works. We argue that CREP provides a principled way of using some public preferences as an input for policy, while justifiably disregarding others. (shrink)

Ageism has unfortunately become a salient phenomenon during the COVID-19 pandemic. In particular, triage decisions based on age have been hotly discussed. In this article, I first defend that, although there are ethical reasons (founded on the principles of benefit and fairness) to consider the age of patients in triage dilemmas, using age as a categorical exclusion is an unjustifiable ageist practice. Then, I argue that ageism during the pandemic has been fueled by media narratives and unfair assumptions which have (...) led to an ethically problematic group homogenization of the older population. Finally, I conclude that an intersectional perspective can shed light on further controversies on ageism and triage in the post-pandemic future. (shrink)

There is widespread agreement that there should be a principle requiring that artificial intelligence be ‘explicable’. Microsoft, Google, the World Economic Forum, the draft AI ethics guidelines for the EU commission, etc. all include a principle for AI that falls under the umbrella of ‘explicability’. Roughly, the principle states that “for AI to promote and not constrain human autonomy, our ‘decision about who should decide’ must be informed by knowledge of how AI would act instead of us” :689–707, 2018). There (...) is a strong intuition that if an algorithm decides, for example, whether to give someone a loan, then that algorithm should be explicable. I argue here, however, that such a principle is misdirected. The property of requiring explicability should attach to a particular action or decision rather than the entity making that decision. It is the context and the potential harm resulting from decisions that drive the moral need for explicability—not the process by which decisions are reached. Related to this is the fact that AI is used for many low-risk purposes for which it would be unnecessary to require that it be explicable. A principle requiring explicability would prevent us from reaping the benefits of AI used in these situations. Finally, the explanations given by explicable AI are only fruitful if we already know which considerations are acceptable for the decision at hand. If we already have these considerations, then there is no need to use contemporary AI algorithms because standard automation would be available. In other words, a principle of explicability for AI makes the use of AI redundant. (shrink)

A series of recent developments points towards auditing as a promising mechanism to bridge the gap between principles and practice in AI ethics. Building on ongoing discussions concerning ethics-based auditing, we offer three contributions. First, we argue that ethics-based auditing can improve the quality of decision making, increase user satisfaction, unlock growth potential, enable law-making, and relieve human suffering. Second, we highlight current best practices to support the design and implementation of ethics-based auditing: To be feasible and effective, ethics-based auditing (...) should take the form of a continuous and constructive process, approach ethical alignment from a system perspective, and be aligned with public policies and incentives for ethically desirable behaviour. Third, we identify and discuss the constraints associated with ethics-based auditing. Only by understanding and accounting for these constraints can ethics-based auditing facilitate ethical alignment of AI, while enabling society to reap the full economic and social benefits of automation. (shrink)

A series of recent developments points towards auditing as a promising mechanism to bridge the gap between principles and practice in AI ethics. Building on ongoing discussions concerning ethics-based auditing, we offer three contributions. First, we argue that ethics-based auditing can improve the quality of decision making, increase user satisfaction, unlock growth potential, enable law-making, and relieve human suffering. Second, we highlight current best practices to support the design and implementation of ethics-based auditing: To be feasible and effective, ethics-based auditing (...) should take the form of a continuous and constructive process, approach ethical alignment from a system perspective, and be aligned with public policies and incentives for ethically desirable behaviour. Third, we identify and discuss the constraints associated with ethics-based auditing. Only by understanding and accounting for these constraints can ethics-based auditing facilitate ethical alignment of AI, while enabling society to reap the full economic and social benefits of automation. (shrink)

Algorithms silently structure our lives. Algorithms can determine whether someone is hired, promoted, offered a loan, or provided housing as well as determine which political ads and news articles consumers see. Yet, the responsibility for algorithms in these important decisions is not clear. This article identifies whether developers have a responsibility for their algorithms later in use, what those firms are responsible for, and the normative grounding for that responsibility. I conceptualize algorithms as value-laden, rather than neutral, in that algorithms (...) create moral consequences, reinforce or undercut ethical principles, and enable or diminish stakeholder rights and dignity. In addition, algorithms are an important actor in ethical decisions and influence the delegation of roles and responsibilities within these decisions. As such, firms should be responsible not only for the value-laden-ness of an algorithm but also for designing who-does-what within the algorithmic decision. As such, firms developing algorithms are accountable for designing how large a role individual will be permitted to take in the subsequent algorithmic decision. Counter to current arguments, I find that if an algorithm is designed to preclude individuals from taking responsibility within a decision, then the designer of the algorithm should be held accountable for the ethical implications of the algorithm in use. (shrink)

The use of machine learning systems for decision-support in healthcare may exacerbate health inequalities. However, recent work suggests that algorithms trained on sufficiently diverse datasets could in principle combat health inequalities. One concern about these algorithms is that their performance for patients in traditionally disadvantaged groups exceeds their performance for patients in traditionally advantaged groups. This renders the algorithmic decisions unfair relative to the standard fairness metrics in machine learning. In this paper, we defend the permissible use of affirmative algorithms; (...) that is, algorithms trained on diverse datasets that perform better for traditionally disadvantaged groups. Whilst such algorithmic decisions may be unfair, the fairness of algorithmic decisions is not the appropriate locus of moral evaluation. What matters is the fairness of final decisions, such as diagnoses, resulting from collaboration between clinicians and algorithms. We argue that affirmative algorithms can permissibly be deployed provided the resultant final decisions are fair. (shrink)

Predictive algorithms are playing an increasingly prominent role in society, being used to predict recidivism, loan repayment, job performance, and so on. With this increasing influence has come an increasing concern with the ways in which they might be unfair or biased against individuals in virtue of their race, gender, or, more generally, their group membership. Many purported criteria of algorithmic fairness concern statistical relationships between the algorithm’s predictions and the actual outcomes, for instance requiring that the rate of false (...) positives be equal across the relevant groups. We might seek to ensure that algorithms satisfy all of these purported fairness criteria. But a series of impossibility results shows that this is impossible, unless base rates are equal across the relevant groups. What are we to make of these pessimistic results? I argue that none of the purported criteria, except for a calibration criterion, are necessary conditions for fairness, on the grounds that they can all be simultaneously violated by a manifestly fair and uniquely optimal predictive algorithm, even when base rates are equal. I conclude with some general reflections on algorithmic fairness. (shrink)

The use of opaque, uninterpretable artificial intelligence systems in health care can be medically beneficial, but it is often viewed as potentially morally problematic on account of this opacity—because the systems are black boxes. Alex John London has recently argued that opacity is not generally problematic, given that many standard therapies are explanatorily opaque and that we can rely on statistical validation of the systems in deciding whether to implement them. But is statistical validation sufficient to justify implementation of these (...) AI systems in health care, or is it merely one of the necessary criteria? I argue that accountability, which holds an important role in preserving the patient‐physician trust that allows the institution of medicine to function, contributes further to an account of AI system justification. Hence, I endorse the vanishing accountability principle: accountability in medicine, in addition to statistical validation, must be preserved. AI systems that introduce problematic gaps in accountability should not be implemented. (shrink)

Introduction to one of the most important, controversial, and suggestive works of moral philosophy ever written.

Machine learning algorithms may radically improve our ability to diagnose and treat disease. For moral, legal, and scientific reasons, it is essential that doctors and patients be able to understand and explain the predictions of these models. Scalable, customisable, and ethical solutions can be achieved by working together with relevant stakeholders, including patients, data scientists, and policy makers.