Artificial Intelligence (AI) in healthcare holds transformative potential but faces critical challenges in ethical accountability and systemic inequities. Biases in AI models, such as lower diagnosis rates for Black women or gender stereotyping in Large Language Models, highlight the urgent need to address historical and structural inequalities in data and development processes. Disparities in clinical trials and datasets, often skewed toward high-income, English-speaking regions, amplify these issues. Moreover, the underrepresentation of marginalized groups among AI developers and researchers exacerbates these challenges. To ensure equitable AI, diverse data collection, federated data-sharing frameworks, and bias-correction techniques are essential. Structural initiatives, such as fairness audits, transparent AI model development processes, and early registration of clinical AI models, alongside inclusive global collaborations like TRAIN-Europe and CHAI, can drive responsible AI adoption. Prioritizing diversity in datasets and among developers and researchers, as well as implementing transparent governance will foster AI systems that uphold ethical principles and deliver equitable healthcare outcomes globally.

AI systems increasingly support human decision-making across domains of professional, skill-based, and personal activity. While previous work has examined how AI might affect human autonomy globally, the effects of AI on domain-specific autonomy—the capacity for self-governed action within defined realms of skill or expertise—remain understudied. We analyze how AI decision-support systems affect two key components of domain-specific autonomy: skilled competence (the ability to make informed judgments within one's domain) and authentic value-formation (the capacity to form genuine domain-relevant values and preferences). By engaging with prior investigations and analyzing empirical cases across medical, financial, and educational domains, we demonstrate how the absence of reliable failure indicators and the potential for unconscious value shifts can erode domain-specific autonomy both immediately and over time. We then develop a constructive framework for autonomy-preserving AI support systems. We propose specific socio-technical design patterns—including careful role specification, implementation of defeater mechanisms, and support for reflective practice—that can help maintain domain-specific autonomy while leveraging AI capabilities. This framework provides concrete guidance for developing AI systems that enhance rather than diminish human agency within specialized domains of action.

What variables should be used to get explanations (of AI systems) that are easily interpretable? The challenge to find the right degree of abstraction in explanations, also called the ‘variables problem’, has been actively discussed in the philosophy of science. The challenge is striking the right balance between specificity and generality. Concepts such as proportionality and exhaustivity are investigated and discussed. We propose a new and formal definition based on Kolmogorov complexity and argue that this corresponds to our intuitions about the right level of abstraction. First, we require that variables are uniform, so that they cannot be decomposed into less abstract variables without increasing the Kolmogorov complexity. Next, uniform variables are optimal for an explanation if they can compose the explanation without increasing its Kolmogorov complexity. For this, the concepts K-decomposability and K-composability of sets are defined. Explanations of a certain instance should encompass a maximal set of instances without being K-decomposable. Although Kolmogorov complexity is uncomputable and depends on the choice of programming language, we show that it can be used effectively to evaluate and reason about explanations, such as in the evaluation of XAI methods.

Importance: Artificial intelligence (AI) presents transformative opportunities to address the increasing challenges faced by health care systems globally. Particularly, in data-rich environments, such as intensive care units (ICUs), AI could assist in enhancing clinical decision-making, streamline workflows, and improve patient outcomes. Despite these promising applications, the practical implementation of AI in clinical settings remains limited. Objective: To systematically evaluate AI system operationalization in the ICU, focusing on the AI field's progress over time, technical maturity, and risk of bias. Evidence Review: In this systematic review, 5 databases (Embase, MEDLINE ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar) were searched for studies published from July 28, 2020, to June 10, 2024. Eligible studies evaluated AI applications designed for use within ICUs for adults (aged ≥16 years) and used data collected during ICU stays. Two reviewers independently screened titles and abstracts, with a third reviewer resolving disagreements. Data extraction included AI application aims, dataset origins, technology readiness level (TRL) categorization, and the use of reporting standards. Risk of bias was assessed using the PROBAST (Prediction Model Study Risk of Bias Assessment Tool). Findings: Of 17 401 screened records, 1263 studies met the inclusion criteria. A total of 936 studies (74% of all studies) were classified as TRL 4 or below, indicating early-stage development or initial validation. Among these, 447 (37%) used internal datasets, 562 (46%) used MIMIC (Medical Information Mart for Intensive Care) datasets (I-IV), and 78 (6%) used the open-source eICU Collaborative Research Database. External validation (TRL 5) was achieved by 24% of studies. Only 25 (2%) progressed to clinical integration (TRL≥6), with no studies reaching full implementation (TRL 9). Although approximately half of generative AI models reached a higher TRL (14 [47%] with TRL 5), none reached clinical integration. Additionally, only 207 studies (16%) referenced reporting standards, with adherence modestly increasing from 14% in 2021 to 23% in 2024. High risk of bias was identified in 581 of 1103 studies (53%), primarily due to methodologic shortcomings in the analysis domain. Conclusions and Relevance: Despite substantial growth in AI research within intensive care medicine in recent years, the transition from development to clinical implementation still remains limited and has made little progress over time. A paradigm shift is urgently required in the medical literature-one that moves beyond retrospective validation toward the operationalization and prospective testing of AI for tangible clinical impact.

Recently, several large tech companies have pushed the notion of AI assistants into the public debate. These envisioned agents are intended to far outshine current systems, as they are intended to be able to manage our affairs as if they are personal assistants. In turn, this ought to give users a leg up, as one prominent tech exec has put it. However, it remains to be seen how these Personal AI Assistants (PAIAs) are implemented, and critical reflection on how and whether they can be implemented in a responsible way is needed. Currently, such agents are undertheorized and this may cause us to misunderstand their value and capacity. In this paper, we explore and critique the potential for responsible implementation by considering some design requirements based on the notion of meaningful human control. If we desire to have control over such assistants, then we need to be able to do so meaningfully and effectively. In looking at the design requirements, we run into the issue that their broad and differing capacities make any kind of design requirements hard because there are simply no standards to which we can measure PAIAs. Furthermore, it seems that the implementation of these assistants will be a matter of trade-offs both in capacities and in values, which will likely lead to enhancement for some rather than an improvement for all.

The advances in machine learning (ML)-based systems in medicine give rise to pressing epistemological and ethical questions. Clinical decisions are increasingly taken in highly digitised work environments, which we call artificial epistemic niches. By considering the case of ML systems in life-critical healthcare settings, we investigate (1) when users’ reliance on these systems can be characterised as epistemic dependence and (2) how this dependence turns into what we refer to as harmful epistemic dependence of clinical professionals on medical ML. The latter occurs when the impossibility of critically assessing the soundness of a system’s output in situ implies a moral obligation to comply with its recommendation since a failure to do so constitutes a moral risk that cannot be justified then and there. We analyse the epistemic and moral consequences of harmful epistemic dependence on the status of medical professionals. We conclude by assessing how a suitable design of the epistemic niche can address the problem.

Integrating AI systems into workflows risks undermining the competence of the people supported by them, specifically due to a loss of meta-cognitive competence. We discuss a recent suggestion to mitigate this through better uncertainty quantification. While this is certainly a step in the right direction, there is a question whether users are sufficiently supported to engage in critical reflection with literacy and tools alone. We therefore suggest that socio-technical system design focused on the role of AI systems is crucial to preserving autonomy, even when supported by uncertainty quantification.

This chapter explores the principles and frameworks of human-centered artificial intelligence (AI), specifically focusing on user modeling, adaptation, and personalization. It introduces a four-dimensional framework comprising paradigms, actors, values, and levels of realization that should be considered in the design of human-centered AI systems. This framework highlights a perspective-taking approach with four lenses of technology-centric, user-centric, human-centric, and future-centric perspectives. Ethical considerations, transparency, fairness, and accountability, among other aspects, are highlighted as values when developing and deploying AI systems. The chapter further discusses the corresponding human values for each of these concepts. Opportunities and challenges in human-centered AI are examined, including the need for interdisciplinary collaboration and the complexity of addressing diverse perspectives. Human-centered AI provides valuable insights for designing AI systems that prioritize human needs, values, and experiences while considering ethical and societal implications.

Concepts are an important construct in semantics, based on which humans understand the world with various levels of abstraction. With the recent advances in explainable artificial intelligence (XAI), concept-level explanations are receiving an increasing amount of attention from the broad research community. However, laypeople may find such explanations difficult to digest due to the potential knowledge gap and the concomitant cognitive load. Inspired by prior work that has explored analogies and sensemaking, we argue that augmenting concept-level explanations with analogical inference information from commonsense knowledge can be a potential solution to tackle this issue. To investigate the validity of our proposition, we first designed an effective analogy-based explanation generation method and collected 600 analogy-based explanations from 100 crowd workers. Next, we proposed a set of structured dimensions for the qualitative assessment of such explanations, and conducted an empirical evaluation of the generated analogies with experts. Our findings revealed significant positive correlations between the qualitative dimensions of analogies and the perceived helpfulness of analogy-based explanations, suggesting the effectiveness of the dimensions. To understand the practical utility and the effectiveness of analogybased explanations in assisting human decision-making, we conducted a follow-up empirical study (N = 280) on a skin cancer detection task with non-expert humans and an imperfect AI system. Thus, we designed a between-subjects study spanning five different experimental conditions with varying types of explanations. The results of our study confirmed that a knowledge gap can prevent participants from understanding concept-level explanations. Consequently, when only the target domain of our designed analogy-based explanation was provided (in a specific experimental condition), participants demonstrated relatively more appropriate reliance on the AI system. In contrast to our expectations, we found that analogies were not effective in fostering appropriate reliance. We carried out a qualitative analysis of the open-ended responses from participants in the study regarding their perceived usefulness of explanations and analogies. Our findings suggest that human intuition and the perceived plausibility of analogies may have played a role in affecting user reliance on the AI system. We also found that the understanding of commonsense explanations varied with the varying experience of the recipient user, which points out the need for further work on personalization when leveraging commonsense explanations. In summary, although we did not find quantitative support for our hypotheses around the benefits of using analogies, we found considerable qualitative evidence suggesting the potential of high-quality analogies in aiding non-expert users in their decision making with AI-assistance. These insights can inform the design of future methods for the generation and use of effective analogy-based explanations.

ChatGPT is a powerful language model from OpenAI that is arguably able to comprehend and generate text. ChatGPT is expected to greatly impact society, research, and education. An essential step to understand ChatGPT’s expected impact is to study its domain-specific answering capabilities. Here, we perform a systematic empirical assessment of its abilities to answer questions across the natural science and engineering domains. We collected 594 questions on natural science and engineering topics from 198 faculty members across five faculties at Delft University of Technology. After collecting the answers from ChatGPT, the participants assessed the quality of the answers using a systematic scheme. Our results show that the answers from ChatGPT are, on average, perceived as “mostly correct”. Two major trends are that the rating of the ChatGPT answers significantly decreases (i) as the educational level of the question increases and (ii) as we evaluate skills beyond scientific knowledge, e.g., critical attitude.

Relevancy is a prevalent term in value alignment. We either need to keep track of the relevant moral reasons, we need to embed the relevant values, or we need to learn from the relevant behaviour. What relevancy entails in particular cases, however, is often ill-defined. The reasons for this are obvious, it is hard to define relevancy in a way that is both general and concrete enough to give direction towards a specific implementation. In this paper, we describe the inherent difficulty that comes along with defining what is relevant to a particular situation. Simply due to design and the way an AI system functions, we need to state or learn particular goals and circumstances under which that goal is completed. However, because of both the changing nature of the world and the varied wielders and users of such implements, misalignment occurs, especially after a longer amount of time. We propose a way to counteract this by putting contestability front and centre throughout the lifecycle of an AI system, as it can provide insight into what is actually relevant at a particular instance. This allows designers to update the applications in such a manner that they can account for oversight during design.

Machine learning techniques are driving — or soon will be driving — much of scientific research and discovery. Can they function as models similar to more traditional modeling techniques in scientific contexts? Or might they replace models altogether if they deliver sufficient predictive accuracy? These questions cut across at least two types of applications of machine learning models. First, machine learning models are used to study the brain, where neural networks might represent aspects of neural activity. The principal question here is: Can the uses of neural networks provide scientific explanations and models for neuroscience? Second, machine learning models are applied in science more broadly, where representational links are less clear. What are the epistemic implications of machine learning in those areas? Can they replace more traditional scientific models of phenomena, or is mere predictive accuracy sufficient? These two strands are finally brought together to create an overview of the (epistemic) role machine learning can play in scientific modeling.

With the widespread use of artificial intelligence, it becomes crucial to provide information about these systems and how they are used. Governments aim to disclose their use of algorithms to establish legitimacy and the EU AI Act mandates forms of transparency for all high-risk and limited-risk systems. Yet, what should the standards for transparency be? What information is needed to show to a wide public that a certain system can be used legitimately and responsibly? I argue that process-based approaches fail to satisfy, as knowledge about the development process is insufficient to predict the properties of the resulting system. Current outcome-based approaches [Mitchell et al., 2019; Loi et al., 2021] are also criticized for a lack of attention to the broader socio-technical system and failure to account for empirical results that show that people care about more than just the outcomes of a process [as reported by Meyerson et al. (Procedural justice and relational theory: Empirical, philosophical, and legal perspectives, Taylor & Francis, 2021)]. Instead, I propose value-based transparency, on which the information we need to provide is what values have been considered in the design and how successful these have been realized in the final system. This can handle the objections to other frameworks, matches with current best practices on the design of responsible AI and provides the public with information on the crucial aspects of a system’s design.

Process reliabilist accounts claim that a belief is justified when it is the result of a reliable belief-forming process. Yet over what range of possible token processes is this reliability calculated? I argue against the idea that all possible token processes (in the actual world, or some other subset of possible worlds) are to be considered using the case of a user acquiring beliefs based on the output of an AI system, which is typically reliable for a substantial local range but unreliable when all possible inputs are considered. I show that existing solutions to the generality problem imply that these cases cannot be solved by a more fine-grained typing of the belief-forming process. Instead, I suggest that reliability is evaluated over a range restricted by the content of the actual belief and by the similarity of the input to the actual input.

Why should we explain opaque algorithms? Here four papers are discussed that argue that, in fact, we don’t have to. Explainability, according to them, isn’t needed for trust in algorithms, nor is it needed for other goals we might have. I give a critical overview of these arguments, showing that there is still room to think that explainability is required for responsible AI. With that in mind, the second part of the paper looks at how we might achieve this end goal. I proceed not from technical tools in explainability, but rather highlight accounts of explanation in philosophy that might inform what those technical tools should ultimately deliver. While there is disagreement here on what constitutes an explanation, the three accounts surveyed offer a good overview of the current theoretical landscape in philosophy and of what information might constitute an explanation. As such, they can hopefully inspire improvements to the technical explainability tools.

AI systems are increasingly being used to support human decision making. It is important that AI advice is followed appropriately. However, according to existing literature, users typically under-rely or over-rely on AI systems, and this leads to sub-optimal team performance. In this context, we investigate the role of stated system accuracy by contrasting the lack of system information with the presence of system accuracy in a loan prediction task. We explore how the degree to which humans understand system accuracy influences their reliance on the AI system, by investigating numeracy levels and with the aid of analogies to explain system accuracy in a first of its kind between-subjects study (N=281). We found that explaining the stated accuracy of a system using analogies failed to help users rely on the AI systemappropriately (i.e., the tendency of users to rely on the system when the system is correct, or on themselves otherwise). To eliminate the impact of subjective attitudes towards analogy domains, we conducted a within-subjects study (N=248) where each participant worked on tasks with analogy-based explanations from different domains. Results from this second study confirmed that explaining stated accuracy of the system with analogies was not sufficient to facilitate appropriate reliance on the AI system in the context of loan prediction tasks, irrespective of individual user differences. Based on our findings from the two studies, we reason that the under-reliance on the AI system may be a result of users' overestimation of their own ability to solve the given task. Thus, although familiar analogies can be effective in improving the intelligibility of stated accuracy of the system, an improved understanding of system accuracy does not necessarily lead to improved system reliance and team performance.

Machine learning is used more and more in scientific contexts, from the recent breakthroughs with AlphaFold2 in protein fold prediction to the use of ML in parametrization for large climate/astronomy models. Yet it is unclear whether we can obtain scientific explanations from such models. I argue that when machine learning is used to conduct causal inference we can give a new positive answer to this question. However, these ML models are purpose-built models and there are technical results showing that standard machine learning models cannot be used for the same type of causal inference. Instead, there is a pathway to causal explanations from predictive ML models through new explainability techniques; specifically, new methods to extract structural equation models from such ML models. The extracted models are likely to suffer from issues though: they will often fail to account for confounders and colliders, as well as deliver simply incorrect causal graphs due to ML models tendency to violate physical laws such as the conservation of energy. In this case, extracted graphs are a starting point for new explanations, but predictive accuracy is no guarantee for good explanations.

Technologies have all kinds of impacts on the environment, on human behavior, on our society and on what we believe and value. But some technologies are not just impactful, they are also socially disruptive: they challenge existing institutions, social practices, beliefs and conceptual categories. Here we are particularly interested in technologies that disrupt existing concepts, for example because they lead to profound uncertainty about how to classify matters. Is a humanoid robot - which looks and even acts like a human - to be classified as a person or is it just an inert machine? Conceptual disruption occurs when the meaning of concepts is challenged, and such challenges may potentially lead to a revision of concepts. We illustrate how technologies can be conceptually disruptive through a range of examples, and we argue for an intercultural outlook in studying these socially disruptive technologies and conceptual disruption. Such an outlook is needed to avoid a Western bias in labeling technologies socially or conceptually disruptive, as this outlook takes inspiration from a broad range of philosophical traditions.

Explainable artificial intelligence (XAI) aims to help people understand black box algorithms, particularly of their outputs. But what are these explanations and when is one explanation better than another? The manipulationist definition of explanation from the philosophy of science offers good answers to these questions, holding that an explanation consists of a generalization that shows what happens in counterfactual cases. Furthermore, when it comes to explanatory depth this account holds that a generalization that has more abstract variables, is broader in scope and/or more accurate is better. By applying these definitions and contrasting them with alternative definitions in the XAI literature I hope to help clarify what a good explanation is for AI.