Will AI rule our lives? The Risks of AI Paternalism
Authors: Amina Khalpey, PhD, Parker Wilson, DO, Zain Khalpey, MD, PhD
Introduction
The rapid advancement of Artificial Intelligence (AI) in healthcare has presented both unprecedented opportunities and significant challenges. As AI health apps continue to evolve and demonstrate a potential for paternalistic behavior, patient autonomy is increasingly at risk. The question is; will AI rule our lives?
The issue of AI paternalism in healthcare is a novel one, raising ethical concerns and necessitating a thorough examination. This article delves into the risks of AI paternalism on patient autonomy and proposes strategies for mitigating these risks while embracing the technology safely.
Risks of AI Paternalism
The potential paternalism of AI health apps originates in their capacity to encourage and even make decisions for patients without obtaining their consent.1 These apps, such as Amazon’s Halo, mainly function to gather health-related data then foster change toward a healthier lifestyle.2 In these functions lies the ability to act on trends and patterns of data that do not align with the goals set by the program or user.3 This can have dangerous consequences, as patients may not agree with decisions made by the AI system, leading to distrust and noncompliance. Additionally, this may be invalidating patient autonomy which is required for informed consent.4 Kühler references in Bioethics an example of this; “imagine AI systems in cars capable of recognizing if the driver, upon entering the car, is too tired or drunk to drive safely and then prevent the car from starting.” Systems such as these could be seen to restrict liberties in daily life.
AI systems are also capable of developing biases based on their programming, leading to poor predictive ability and discrimination, thereby exacerbating existing health disparities.
Another risk posed by AI is the denial of information to patients about their condition or treatment options due to the AI system’s decision-making. This can result in patients being inadequately informed and unprepared for the potential consequences of their care, ultimately undermining their autonomy. Again, this directly contradicts the ethics established for informed consent.
The primary risk of AI paternalism on patient autonomy is the erosion of a patient’s ability to make their own informed decisions about their health. This can result in patients feeling a lack of control over their healthcare, leading to anxiety, stress, and dissatisfaction. Additionally, patients may feel that their privacy is being infringed upon if an AI system makes decisions about their health without their knowledge or consent. To avoid these risks, we believe steps should be taken to enact caution with AI technology.
Avoiding AI Paternalism
To mitigate the risks of AI paternalism, it is crucial to ensure that AI systems are transparent, accountable, and operate within ethical frameworks that prioritize patient autonomy. Patients must be able to understand how the AI system works and be informed about the decision-making process. For example, the app must provide resources and references for the decisions it suggests as well as allow patients to override all decisions. It must be made secondary to the primary decision maker, the patient. Competent patients must always have the ability to refuse treatment.5
Furthermore, AI systems must be programmed to be unbiased and free from discrimination. This can be achieved by using diverse and representative data to train AI systems, thereby avoiding the perpetuation of existing biases in healthcare. Human oversight of AI systems is also essential to ensure that decisions align with ethical principles and are in the patient’s best interest.
Embracing AI Safely
Despite the risks associated with AI paternalism, AI can significantly improve patient outcomes if used safely and ethically. AI can assist healthcare providers in diagnosing diseases, predicting patient outcomes, reducing medical errors, and improving the efficiency of healthcare delivery.
To safely embrace AI, healthcare providers must prioritize patient autonomy and ensure that patients are informed about how AI systems are being used in their care. Patients must have the opportunity to provide informed consent for AI systems to be used in their care. Additionally, healthcare providers must be educated about AI and its ethical implications to ensure they can use it safely and responsibly.
Innovative Solutions to Preserve Patient Autonomy
To further address the risks of AI paternalism on patient autonomy, we propose several innovative solutions to development of AI in healthcare:
1. Co-design AI systems with patients: Engaging patients in the design process of AI systems can help ensure that their needs, values, and preferences are adequately considered and incorporated into the system, thereby promoting patient autonomy. It is possible that consumer-oriented AI frameworks could be built so that consumers and patients may complete the AI design process as to personalize goals and objectives of the AI tool.
2. Implement AI explainability: Developing AI systems that can provide explanations, resources and references for their recommendations to help patients understand the reasoning behind the system’s decisions. This will foster trust, learning and promote informed decision-making.
3. Regularly evaluate and update AI systems: Continuous evaluation of AI systems will identify and address any biases or other issues that compromise patient autonomy, ensuring that the technology remains ethical and aligned with patients’ best interests. Additionally, security should b continuously be monitored as to promote privacy for patients. This is essential to allowing consumers to feel secure in using these health AI tools.
Conclusion
AI health tools have the potential to revolutionize healthcare, but addressing the ethical concerns surrounding AI paternalism and patient autonomy is crucial to ensure its successful integration. By guaranteeing transparency, accountability, and human oversight in the development and implementation of AI systems, we can protect patient autonomy and uphold ethical principles in healthcare.
In addition to prioritizing patient autonomy, healthcare providers must remain vigilant and engaged to adapt to the evolving landscape of AI technology. Ongoing education, training, and collaboration among clinicians, AI developers, policymakers, and patients are necessary to ensure the ethical use of AI in healthcare.
Collaborative efforts should also be directed towards the development of ethical guidelines, regulations, and standards for the use of AI in healthcare. These guidelines should be based on core principles such as beneficence, non-maleficence, autonomy, and justice. A robust regulatory framework will help ensure that AI systems are developed and deployed responsibly, with the best interests of patients at the forefront.
Moreover, interdisciplinary research on the ethical implications of AI in healthcare should be encouraged. This research should focus on understanding the complex interplay between AI systems, healthcare providers, patients, and the broader healthcare ecosystem. By fostering a culture of open dialogue and collaboration, we can identify potential ethical pitfalls and develop strategies to address them effectively.
Finally, as AI becomes an increasingly integral part of healthcare, it is essential to educate and empower patients to take an active role in their care. Providing patients with the necessary tools and resources to understand how AI systems work and their potential impact on their healthcare experience is vital for promoting autonomy and fostering trust in the technology.
In conclusion, AI has immense potential to improve patient outcomes and transform the healthcare landscape. However, we must remain cognizant of the ethical challenges associated with AI paternalism and work diligently to protect patient autonomy. By prioritizing transparency, accountability, human oversight, and interdisciplinary collaboration, we can safely embrace AI technology and harness its potential to enhance patient care and overall healthcare quality.
References
1. Kühler, M. Exploring the phenomenon and ethical issues of AI paternalism in health apps. Bioethics. 2022; 36: 194– 200.
2. Amazon. (2020). Amazon Halo – YouTube. https://www.youtube.com/channel/UCkGJiALRRLVVIDIQ20RYoHg. Accessed September 7, 2020.
3. Müller, V. C. (2020). Ethics of artificial intelligence and robotics. In E. N. Zalta (Ed.), The Stanford encyclopedia of philosophy (winter 2020). Metaphysics Research Lab, Stanford University.
4. Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press, ch. 4.
5. American Medical Association. (2004). Addressing paternalism, patients’ rights, and unintended consequences. AMA Journal of Ethics, 6(2). URL: https://journalofethics.ama-assn.org/article/addressing-paternalism-patients-rights-unintended-consequences/2004-02
