The increasing application of artificial intelligence (AI) to healthcare raises both hope and ethical concerns. Some advanced machine learning methods provide accurate clinical predictions at the ...expense of a significant lack of explainability. Alex John London has defended that accuracy is a more important value than explainability in AI medicine. In this article, we locate the trade-off between accurate performance and explainable algorithms in the context of distributive justice. We acknowledge that accuracy is cardinal from outcome-oriented justice because it helps to maximize patients’ benefits and optimizes limited resources. However, we claim that the opaqueness of the algorithmic black box and its absence of explainability threatens core commitments of procedural fairness such as accountability, avoidance of bias, and transparency. To illustrate this, we discuss liver transplantation as a case of critical medical resources in which the lack of explainability in AI-based allocation algorithms is procedurally unfair. Finally, we provide a number of ethical recommendations for when considering the use of unexplainable algorithms in the distribution of health-related resources.
Our reality, our life, is already configured as a socio-technical system in which we interact with people, devices, data, algorithms, robots. Artificial intelligence, data science and robotics are ...disruptive technologies that are reconfiguring life. And we already know that technological artifacts incorporate values and have politics. That is why an ethical analysis of these technologies is essential, identifying the hazards we want to avoid and introducing from the very design the values we wish to promote. Not as an end in itself, but to generate citizen trust in the technologies and in the institutions that promote them, to foster their social acceptance and appropriation. Ethics constitutes a powerful tool for the technological empowerment of citizens, preventing algorithmic injustices (discrimination, profiling, biases) and promoting a necessary new “techno-social” contract.
Nuestra realidad y nuestra vida se configuran ya como un sistema sociotécnico en el que interactuamos personas, dispositivos, datos, algoritmos, robots. La inteligencia artificial, la ciencia de datos y la robótica constituyen tecnologías disruptivas que están reconfigurando la vida. Y ya sabemos que los artefactos tecnológicos incorporan valores y tienen política. Por ello se hace indispensable un análisis ético de dichas tecnologías, identificando los peligros que queremos evitar e introduciendo desde el diseño mismo los valores que queremos promover. No como un fin en sí mismo, sino para generar confianza ciudadana en las tecnologías y en las instituciones que las impulsan, para favorecer su aceptación y apropiación social. La ética constituye una poderosa herramienta para el empoderamiento tecnológico de la ciudadanía, previniendo las injusticias algorítmicas (discriminación, perfilamiento, sesgos) e impulsando un necesario nuevo contrato “tecno-social”.
The main aim of this article is to reflect on the impact of biases related to artificial intelligence (AI) systems developed to tackle issues arising from the COVID-19 pandemic, with special focus on ...those developed for triage and risk prediction. A secondary aim is to review assessment tools that have been developed to prevent biases in AI systems. In addition, we provide a conceptual clarification for some terms related to biases in this particular context. We focus mainly on non-racial biases that may be less considered when addressing biases in AI systems in the existing literature. In the manuscript, we found that the existence of bias in AI systems used for COVID-19 can result in algorithmic justice and that the legal frameworks and strategies developed to prevent the apparition of bias have failed to adequately consider social determinants of health. Finally, we make some recommendations on how to include more diverse professional profiles in order to develop AI systems that increase the epistemic diversity needed to tackle AI biases during the COVID-19 pandemic and beyond.
To assess—from a qualitative perspective—the perceptions and attitudes of Spanish rehabilitation professionals (e.g. rehabilitation doctors, speech therapists, physical therapists) about ...Brain–Computer Interface (BCI) technology. A qualitative, exploratory and descriptive study was carried out by means of interviews and analysis of textual content with mixed generation of categories and segmentation into frequency of topics. We present the results of three in-depth interviews that were conducted with Spanish speaking individuals who had previously completed a survey as part of a larger, 3-country/language, survey on BCI perceptions. 11 out of 15 of these Spanish respondents (survey) either strongly or somewhat accept the use of BCI in rehabilitation therapy. However, the results of our three in-depth interviews show how, due to a strong inertia of attitudes and perceptions about BCI technology, most professionals feel reluctant to use BCI technology in their daily practice (interview).
The application of Artificial Intelligence (AI) in healthcare and epidemiology undoubtedly has many benefits for the population. However, due to its environmental impact, the use of AI can produce ...social inequalities and long-term environmental damages that may not be thoroughly contemplated. In this paper, we propose to consider the impacts of AI applications in medical care from the One Health paradigm and long-term global health. From health and environmental justice, rather than settling for a short and fleeting green honeymoon between health and sustainability caused by AI, it should aim for a lasting marriage. To this end, we conclude by proposing that, in the upcoming years, it could be valuable and necessary to promote more interconnected health, call for environmental cost transparency, and increase green responsibility.
Using AI in medicine and epidemiology has some benefits in the short term.AI usage may cause social inequalities and environmental damage in the long term.Health justice should be rethought from the One Health perspective.Going beyond anthropocentric and myopic cost-benefit analysis would expand health justice to include an environmental dimension.Greening AI would help to reconcile public and global health measures.
To develop a support tool to decision-making in the framework of the COVID-19 pandemic.
Different ethical recommendations that emerged in Spain on prioritizing scarce health resources in the COVID-19 ...pandemic first wave were searched; it was conducted a narrative review of theoretical models on distribution in pandemics to define an ethical foundation. Finally, recommendations are drawn to be applied in different healthcare settings.
Three principles are identified; strict equality, equity and efficiency, which are substantiated in specific distribution criteria.
A model for the distribution of scarce health resources in a pandemic situation is proposed, starting with a decision-making procedure and adapting the distribution criteria to different healthcare scenarios: primary care settings, nursing homes and hospitals.
Prácticamente cualquier propiedad o estado de cosas implicado en el debate bioético —así como en la vida cotidiana y en la mayoría de las ciencias— posee unos límites difusos y comprende casos ...fronterizos, sin unas líneas de demarcación precisas, como sucede con la eutanasia, el aborto, la investigación con embriones, los híbridos, la experimentación con animales, etc. Sin embargo, existe una profunda discordancia entre una realidad continua y gradual, caracterizada por los matices y las transiciones, una realidad en grises, y una lógica, un análisis descriptivo de esta realidad, bivalente, cifrado entre la verdad absoluta y la completa falsedad, en términos de “todo- o-nada”, blanco o negro. Como alternativa a este ‘principio de bivalencia’ que caracteriza en general el análisis estándar de la realidad y, en particular, de la bioética, sostenemos el ‘principio de gradualidad’ según el cual todo es cuestión de grado, por lo que un enfoque lógico-gradualista sería el método apropiado para la bioética.
During the COVID-19 pandemic, technology has been used to carry out numerous activities. These uses have often been poorly
planned, as the urgency of the situation did not allow for careful ...considerations. Technology has helped us to maintain many aspects
of life that the pandemic had done difficult; however, it has also brought some new problems, especially when it comes to situations
of vulnerability and care settings. In this article we analyse the nature and use of technology in assistive and care settings during
the pandemic, its basis, its scope, and its limitations. To do so, we study the specific case of the use of digital video-calling platforms
during the forced isolations caused by the pandemic.
Durante la pandemia de la COVID-19 se ha hecho uso de la tecnología para llevar a cabo numerosas actividades. Estos usos han sido
a menudo poco meditados, puesto que la urgencia de la situación no permitía una reflexión sostenida al respecto. La tecnología nos
ha ayudado a mantener muchos aspectos de la vida que la pandemia había dificultado; sin embargo, también ha supuesto algunos
nuevos problemas, especialmente cuando hablamos de situaciones de vulnerabilidad y entornos de cuidado. En este artículo evaluamos
el carácter y uso de la tecnología en entornos asistenciales y de cuidados durante la pandemia, sus presupuestos, su alcance y
sus limitaciones. Para ello analizamos el caso concreto del uso de plataformas digitales de videollamadas durante los aislamientos
forzosos provocados por la pandemia.
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