Artificial Intelligence (AI) continues to pervade several aspects of healthcare with pace and scale. The need for an ethical framework in AI to address this has long been recognized, but to date most efforts have delivered only high-level principles and value statements. Herein, we explain the need for an ethical framework in healthcare AI, the different moral theories that may serve as its basis, the rationale for why we believe this should be built around virtue ethics, and explore this in the context of five key ethical concerns for the introduction of AI in healthcare. Some existing work has suggested that AI may replace clinicians. We argue to the contrary, that the clinician will not be replaced, nor their role attenuated. Rather, they will be integral to the responsible design, deployment, and regulation of AI in healthcare, acting as the moral exemplar for the virtuous machine. We collate relevant points from the literature and formulate our own to present a coherent argument for the central role of clinicians in ethical AI and propose ideas to help advance efforts to employ ML-based solutions within healthcare. Finally, we highlight the responsibility of not only clinicians, but also data scientists, tech companies, ethicists, and regulators to act virtuously in realising the vision of ethical and accountable AI in healthcare.

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An appropriate ethical framework around the use of Artificial Intelligence (AI) in healthcare has become a key desirable with the increasingly widespread deployment of this technology. Advances in AI hold the promise of improving the precision of outcome prediction at the level of the individual. However, the addition of these technologies to patient–clinician interactions, as with any complex human interaction, has potential pitfalls. While physicians have always had to carefully consider the ethical background and implications of their actions, detailed deliberations around fast-moving technological progress may not have kept up. We use a common but key challenge in healthcare interactions, the disclosure of bad news (likely imminent death), to illustrate how the philosophical framework of the 'Felicific Calculus' developed in the eighteenth century by Jeremy Bentham, may have a timely quasi-quantitative application in the age of AI. We show how this ethical algorithm can be used to assess, across seven mutually exclusive and exhaustive domains, whether an AI-supported action can be morally justified.

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