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Implementing Ethics in Healthcare AI-Based Applications: A Scoping Review

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Abstract

A number of Artificial Intelligence (AI) ethics frameworks have been published in the last 6 years in response to the growing concerns posed by the adoption of AI in different sectors, including healthcare. While there is a strong culture of medical ethics in healthcare applications, AI-based Healthcare Applications (AIHA) are challenging the existing ethics and regulatory frameworks. This scoping review explores how ethics frameworks have been implemented in AIHA, how these implementations have been evaluated and whether they have been successful. AI specific ethics frameworks in healthcare appear to have a limited adoption and they are mostly used in conjunction with other ethics frameworks. The operationalisation of ethics frameworks is a complex endeavour with challenges at different levels: ethics principles, design, technology, organisational, and regulatory. Strategies identified in this review are proactive, contextual, technological, checklist, organisational and/or evidence-based approaches. While interdisciplinary approaches show promises, how an ethics framework is implemented in an AI-based Healthcare Application is not widely reported, and there is a need for transparency for trustworthy AI.

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Acknowledgements

Ms Mary Simons contributed to the development of the search strategy and Professor Wendy Rogers and Associate Professor Farah Magrabi to its refinement. Dr Catalin Tufanaru provided guidance on the scoping review process and the selection of risk of bias tools for critical appraisal.

Funding

None.

Author information

Authors and Affiliations

  1. Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

    Magali Goirand, Elizabeth Austin & Robyn Clay-Williams

Authors
  1. Magali Goirand
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  2. Elizabeth Austin
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  3. Robyn Clay-Williams
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Contributions

MG, EA, RC-W conceived the review, MG conducted the search. MG, EA, RC-W screened titles and abstracts and full texts. MG, EA, RC-W extracted data and undertook the critical appraisal. MG undertook the qualitative analysis. MG wrote the introduction and the discussion. EA, RC-W revised the first draft of the paper and the final draft. All authors approved the final version.

Corresponding author

Correspondence to Magali Goirand.

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The authors declare that they have no conflict of interest.

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Appendices

Appendix 1: Grey literature search strategy

  • Scienceresearch.com limited to Food and Drug Administration using the following query: (artificial intelligence or machine learning or deep learning or robot* or chatbot* or intelligent assistive or decision support) AND (ethic* or privacy or fairness or equity).

  • Manual search of the websites of the following organisations:

Organisation name

Organisation type

Accenture

Consultancy

ACM

Professional organisation

Amazon care

Technology company

Apple

Technology company

Bain & co

Consultancy

Cap Gemini

Consulting

CEPEJ (Council of Europe European Commission for the Efficiency of Justice)

Government

CNIL

Government

DeepMind

Technology company

Department of industry innovation and science Australia

Government

EP think tank

Government

European Parliament

Government

Future Advocacy

Consultancy

GE healthcare partners

Consultancy

Google research publication

Technology company

Gov of the republic of Korea

Government

IBM

Technology company

ICO

Government

IEEE

Professional organisation

Intel

Technology company

McKinsey

Consultancy

Microsoft

Technology company

Ministry of economic affairs and employment Finland

Government

Mission Villani, AI for humanity

Government

National Science and technology council (USA white house)

Government

NHSX

Government

NITI Indian Gov

Government

Novartis foundation

Technology company

OpenAI

Technology company

Partnership on AI

Think tank

Personal Data protection Commission Singapore

Government

PWC UK

Consulting

SAP

Technology company

Tata Consultancy Services

Consultancy

The Boston Consulting Group

Consultancy

The Norwegian Data Protection Authority

Government

Tieto

Technology company

UK Government

Government

UK Parliament

Government

Verily (Google life sciences)

Technology company

Appendix 2: Peer-reviewed literature search strategy

See Table 1.

Table 1 Bibliographic databases search strategy
Full size table

Appendix 3: Quality assessment results

See Tables 2 and 3.

Table 2 Qualitative study appraisal tool results
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Table 3 Text and opinion appraisal tool results
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Appendix 4: Article characteristics

See Tables 4, 5 and 6.

Table 4 Characteristics of articles
Full size table
Table 5 Distribution of ethics principles – yes means it is included, while a blank means it is not
Full size table
Table 6 Distribution of lifecycle stages—yes means it is included, while a blank means it is not
Full size table

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Goirand, M., Austin, E. & Clay-Williams, R. Implementing Ethics in Healthcare AI-Based Applications: A Scoping Review. Sci Eng Ethics 27, 61 (2021). https://doi.org/10.1007/s11948-021-00336-3

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