Artificial intelligence for good health: a scoping review of the ethics literature

Abstract

Background: Artificial intelligence (AI) has been described as the "fourth industrial revolution" with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective?

Methods: Eight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed.

Results: Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs).

Conclusions: The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.

Keywords: Artificial intelligence; Ethics; Global health; Health care; Public and population health.

Fig. 1

Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flow diagram. This PRISMA flow diagram depicts the number of records identified at each state of the scoping review literature selection process

Fig. 2

Number of publications by country, based on first author affiliation. *Note that two records were published by international organizations, and the geographic origin of one record is unknown. These three records are not represented in the above figure. This map was created using mapchart.net

Fig. 3

Number of publications reviewed, categorized by year of publication. *The graph begins in year 2013, after which the majority of articles were published

Fig. 4

Publications reviewed according to the most frequently reported AI health applications. *The graph begins in year 2013, after which the majority of articles were published