M.J. van den Hoven
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The European Commission defines the Green Transition as the transformation set out in the European Green Deal. Ensuring that this transition is just is both an ethical requirement and a practical condition for maintaining public support and policy effectiveness. This Perspective proposes a multidimensional framework for assessing justice in Green Transition policies, encompassing distributional, procedural, recognitional, corrective, and transitional dimensions. Considering these dimensions in conjunction helps identify where justice claims converge and where genuine policy trade-offs arise, which should be made transparent and addressed through public deliberation. It sheds light on additional justice considerations which tend to get overlooked in many policy debates that focus predominantly on distributional justice concerns. Moreover, its multidimensionality is helpful in overcoming zero-sum framings which often present impediments for embedding justice throughout the policy cycle.
Responsible artificial intelligence in healthcare
A systematic review on the use of ethical principles in the development and deployment of artificial intelligence
As hospitals increasingly adopt artificial intelligence (AI) to manage rising patient volumes, workforce shortages and healthcare costs, concerns about ethical implementation have become prominent. This systematic review aims to assess how hospital-focused AI literature addresses the WHO’s six ethical AI principles—autonomy; well-being and safety; transparency and explainability; responsibility and accountability; inclusiveness and equity; and responsiveness and sustainability.
Methods and analysis
A systematic review (PROSPERO registration: CRD42022347871) was conducted by searching Embase, MEDLINE ALL, Web of Science and the Cochrane Central Register of Controlled Trials from inception to December 2023, supplemented by Google Scholar. English-language studies describing AI (machine learning, deep learning, predictive analytics) relevant to inpatient settings and referencing at least one WHO principle were included. Two reviewers independently screened titles, abstracts and full texts, extracting data on publication year, country, study design, AI type, technology readiness level and ethical considerations. Discrepancies were resolved by consensus.
Results
Of 4770 unique records, 673 were included. Most (83%) originated from high-income countries, with publication volume rising sharply after 2021. Of these, 558 (83%) addressed at least one WHO principle in depth, most frequently inclusiveness and equity (49%), transparency and explainability (45%) and autonomy (42%). Well-being and safety (26%) and responsibility and accountability (29%) were less frequently covered, while responsiveness and sustainability (6%) was rarely explored. Among 44 studies developing AI applications with technology readiness levels 1–6, ethical principles were acknowledged but rarely operationalised.
Conclusion
Hospital-based AI research demonstrates increasing attention to ethical principles but lacks comprehensive application, particularly regarding sustainability. High-income countries dominate this discourse, underscoring the need for broader global engagement. To achieve equitable, safe and sustainable AI in clinical practice, clearer operational guidance and more inclusive collaboration is warranted. ...
As hospitals increasingly adopt artificial intelligence (AI) to manage rising patient volumes, workforce shortages and healthcare costs, concerns about ethical implementation have become prominent. This systematic review aims to assess how hospital-focused AI literature addresses the WHO’s six ethical AI principles—autonomy; well-being and safety; transparency and explainability; responsibility and accountability; inclusiveness and equity; and responsiveness and sustainability.
Methods and analysis
A systematic review (PROSPERO registration: CRD42022347871) was conducted by searching Embase, MEDLINE ALL, Web of Science and the Cochrane Central Register of Controlled Trials from inception to December 2023, supplemented by Google Scholar. English-language studies describing AI (machine learning, deep learning, predictive analytics) relevant to inpatient settings and referencing at least one WHO principle were included. Two reviewers independently screened titles, abstracts and full texts, extracting data on publication year, country, study design, AI type, technology readiness level and ethical considerations. Discrepancies were resolved by consensus.
Results
Of 4770 unique records, 673 were included. Most (83%) originated from high-income countries, with publication volume rising sharply after 2021. Of these, 558 (83%) addressed at least one WHO principle in depth, most frequently inclusiveness and equity (49%), transparency and explainability (45%) and autonomy (42%). Well-being and safety (26%) and responsibility and accountability (29%) were less frequently covered, while responsiveness and sustainability (6%) was rarely explored. Among 44 studies developing AI applications with technology readiness levels 1–6, ethical principles were acknowledged but rarely operationalised.
Conclusion
Hospital-based AI research demonstrates increasing attention to ethical principles but lacks comprehensive application, particularly regarding sustainability. High-income countries dominate this discourse, underscoring the need for broader global engagement. To achieve equitable, safe and sustainable AI in clinical practice, clearer operational guidance and more inclusive collaboration is warranted.
“Foundation models for research
A matter of trust?”
Conceptual clarification of the notions of trust and reliance in science is pivotal in the face of foundation models. Trust and reliance form the glue for the increasingly distributed epistemic labour within contemporary technoscientific systems. We build on two concepts of trust in science, namely trust in science as shared values, and trust in science based on commitments to processes that provide objective claims. We analyse whether scientific foundation models are research tools to which the concept of reliance applies, or research partners that can be trustworthy or not. We consider these foundation models within their socio-technical contexts.
Allocation of trust should be reserved for human agents and the organizations they operate in. Reliance applies to foundation models and artificial intelligence agents. This distinction is important to unambiguously allocate responsibility, which is crucial in maintaining the fabric of trust that underpins science. ...
Conceptual clarification of the notions of trust and reliance in science is pivotal in the face of foundation models. Trust and reliance form the glue for the increasingly distributed epistemic labour within contemporary technoscientific systems. We build on two concepts of trust in science, namely trust in science as shared values, and trust in science based on commitments to processes that provide objective claims. We analyse whether scientific foundation models are research tools to which the concept of reliance applies, or research partners that can be trustworthy or not. We consider these foundation models within their socio-technical contexts.
Allocation of trust should be reserved for human agents and the organizations they operate in. Reliance applies to foundation models and artificial intelligence agents. This distinction is important to unambiguously allocate responsibility, which is crucial in maintaining the fabric of trust that underpins science.
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.
Charting a new course in healthcare
Early-stage AI algorithm registration to enhance trust and transparency
AI holds the potential to transform healthcare, promising improvements in patient care. Yet, realizing this potential is hampered by over-reliance on limited datasets and a lack of transparency in validation processes. To overcome these obstacles, we advocate the creation of a detailed registry for AI algorithms. This registry would document the development, training, and validation of AI models, ensuring scientific integrity and transparency. Additionally, it would serve as a platform for peer review and ethical oversight. By bridging the gap between scientific validation and regulatory approval, such as by the FDA, we aim to enhance the integrity and trustworthiness of AI applications in healthcare.
This handbook presents the concept of ‘meaningful human control’ (MHC) over AI systems from the perspectives of (i) philosophy and ethics, (ii) law and governance, and (iii) design and engineering. The introductory chapter addresses the motivations and recent developments in MHC, introducing each perspective and related chapters. These three disciplinary perspectives scrutinize how MHC intertwines with philosophical debates on moral responsibility, societal concerns regarding control over technological advancements in legal frameworks, and the engineering complexities of designing and developing AI systems while ensuring human control and responsibility. Additionally, cross-cutting aspects on MHC over AI systems are also introduced and discussed through (iv) interdisciplinary and systemic perspectives. By offering a contextualized introduction to the perspectives considered in this handbook, this chapter aims to present the handbook’s various approaches and points of interest for a diverse audience, highlighting potential entry points into this multidisciplinary volume.
Values in challenging times
Strategic crisis management in the EU
The rapid dynamics of COVID-19 calls for quick and effective tracking of virus transmission chains and early detection of outbreaks, especially in the “phase 2” of the pandemic, when lockdown and other restriction measures are progressively withdrawn, in order to avoid or minimize contagion resurgence. For this purpose, contact-tracing apps are being proposed for large scale adoption by many countries. A centralized approach, where data sensed by the app are all sent to a nation-wide server, raises concerns about citizens’ privacy and needlessly strong digital surveillance, thus alerting us to the need to minimize personal data collection and avoiding location tracking. We advocate the conceptual advantage of a decentralized approach, where both contact and location data are collected exclusively in individual citizens’ “personal data stores”, to be shared separately and selectively (e.g., with a backend system, but possibly also with other citizens), voluntarily, only when the citizen has tested positive for COVID-19, and with a privacy preserving level of granularity. This approach better protects the personal sphere of citizens and affords multiple benefits: it allows for detailed information gathering for infected people in a privacy-preserving fashion; and, in turn this enables both contact tracing, and, the early detection of outbreak hotspots on more finely-granulated geographic scale. The decentralized approach is also scalable to large populations, in that only the data of positive patients need be handled at a central level. Our recommendation is two-fold. First to extend existing decentralized architectures with a light touch, in order to manage the collection of location data locally on the device, and allow the user to share spatio-temporal aggregates—if and when they want and for specific aims—with health authorities, for instance. Second, we favour a longer-term pursuit of realizing a Personal Data Store vision, giving users the opportunity to contribute to collective good in the measure they want, enhancing self-awareness, and cultivating collective efforts for rebuilding society.
Ethics of smart cities
Towards value-sensitive design and co-evolving city life
The digital revolution has brought about many societal changes such as the creation of “smart cities”. The smart city concept has changed the urban ecosystem by embedding digital technologies in the city fabric to enhance the quality of life of its inhabitants. However, it has also led to some pressing issues and challenges related to data, privacy, ethics inclusion, and fairness. While the initial concept of smart cities was largely technology-and data-driven, focused on the automation of traffic, logistics and processes, this concept is currently being replaced by technology-enabled, human-centred solutions. However, this is not the end of the development, as there is now a big trend towards “design for values”. In this paper, we point out how a value-sensitive design approach could promote a more sustainable pathway of cities that better serves people and nature. Such “valuesensitive design” will have to take ethics, law and culture on board. We discuss how organising the digital world in a participatory way, as well as leveraging the concepts of self-organisation, selfregulation, and self-control, would foster synergy effects and thereby help to leverage a sustainable technological revolution on a global scale. Furthermore, a “democracy by design” approach could also promote resilience.
Correction to
An ethico-legal framework for social data science (International Journal of Data Science and Analytics, (2021), 11, 4, (377-390), 10.1007/s41060-020-00211-7)
In this article, we report on eight grand challenges for value sensitive design, which were developed at a one-week workshop, Value Sensitive Design: Charting the Next Decade, Lorentz Center, Leiden, The Netherlands, November 14–18, 2016. A grand challenge is a substantial problem, opportunity, or question that motives sustained research and design activity. The eight grand challenges are: (1) Accounting for Power, (2) Evaluating Value Sensitive Design, (3) Framing and Prioritizing Values, (4) Professional and Industry Appropriation, (5) Tech policy, (6) Values and Human Emotions, (7) Value Sensitive Design and Intelligent Algorithms, and (8) Value Tensions. Each grand challenge consists of a discussion of its importance and a set of tractable key questions.