The hype over artificial intelligence (AI) has spawned claims that clinicians (particularly radiologists) will become redundant. It is still moot as to whether AI will replace radiologists in day-today clinical practice, but more AI applications are expected to be incorporated into the workflows in the foreseeable future. These applications could produce significant ethical and legal issues in healthcare if they cause abrupt disruptions to its contextual integrity and relational dynamics. Sustaining trust and trustworthiness is a key goal of governance, which is necessary to promote collaboration among all stakeholders and to ensure the responsible development and implementation of AI in radiology and other areas of clinical work. In this paper, the nature of AI governance in biomedicine is discussed along with its limitations. It is argued that radiologists must assume a more active role in propelling medicine into the digital age. In this respect, professional responsibilities include inquiring into the clinical and social value of AI, alleviating deficiencies in technical knowledge in order to facilitate ethical evaluation, supporting the recognition, and removal of biases, engaging the "black box" obstacle, and brokering a new social contract on informational use and security. In essence, a much closer integration of ethics, laws, and good practices is needed to ensure that AI governance achieves its normative goals.

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Digitalization in nephrology has progressed in a manner that is disparate and siloed, even though learning (under a broader Learning Health System initiative) has been manifested in all the main areas of clinical application. Most applications based on artificial intelligence/machine learning (AI/ML) are still in the initial developmental stages and are yet to be adequately validated and shown to contribute to positive patient outcomes. There is also no consistent or comprehensive digitalization plan, and insufficient data are a limiting factor across all of these areas. In this article, we first consider how digitalization along nephrology care pathways relates to the Learning Health System initiative. We then consider the current state of AI/ML-based software and devices in nephrology and the ethical and regulatory challenges in scaling them up toward broader clinical application. We conclude with our proposal to establish a dedicated ethics and governance framework that is centered around health care providers in nephrology and the AI/ML-based software to which their work relates. This framework should help to integrate ethical and regulatory values and considerations, involve a wide range of stakeholders, and apply across normative domains that are conventionally demarcated as clinical, research, and public health. Semin Nephrol 41:282−293

Universal health coverage (UHC), variedly construed, is not a new concept. In international politics, it emerged as a global health agenda in the 1920s, became marginalised by the 1950s, but re-emerged as BHealth for All^in the Declaration of Alma-Ata in 1978 (Gorsky and Sirrs 2018). The commitment then was to advance primary health care by linking health with community action, multilateral collaboration and social justice. Since then, health and health-related campaigns such as, for example, the Millennium Development Goals achieved some success, particularly in reducing the maternal mortality and under-five mortality ratios (Cha 2017). UHC remains a prominent goal in the United Nations' Sustainable Development Goals, and for good reasons. Still more needs to be done to improve the global state of primary health care, and its role in promoting the health and wellbeing of people and communities. Alarmingly, essential health services delivered through primary care are inaccessible to half of the world's population (Primary Health Care Performance Initiative 2018). In the Western Pacific Region of the World Health Organisation (WPRO), a large number of people are still Bleft behind^as inequities persist between urban and rural areas, and across subnational regions (World Health Organization 2017). How can bioethics as a field contribute to UHC? This may be a fair question to ask in the light of the remark by the Director-General of World Health Organisation, Dr Tedros Ghebreyesus (2017), that: B… universal coverage is an ethical issue^. Perhaps a response to this question may be closely linked to the Astana Declaration (World Health Organization 2018), which seeks to draw the political focus back to the commitment of the Alma-Ata Declaration (World Health Organization 1978) to develop a people-centred primary healthcare as a critical step to realise health for all. If this is correct, then bioethical inquiry into the goals and implications of UHC will need to be broadened beyond its health financing aspect and related concerns in equity.