Ethics of the algorithmic prediction of goal of care preferences: from theory to practice

Abstract

Artificial intelligence (AI) systems are quickly gaining ground in healthcare and clinical decision-making. However, it is still unclear in what way AI can or should support decision-making that is based on incapacitated patients’ values and goals of care, which often requires input from clinicians and loved ones. Although the use of algorithms to predict patients’ most likely preferred treatment has been discussed in the medical ethics literature, no example has been realised in clinical practice. This is due, arguably, to the lack of a structured approach to the epistemological, ethical and pragmatic challenges arising from the design and use of such algorithms. The present paper offers a new perspective on the problem by suggesting that preference predicting AIs be viewed as sociotechnical systems with distinctive life-cycles. We explore how both known and novel challenges map onto the different stages of development, highlighting interdisciplinary strategies for their resolution.

For the sake of multifacetedness. Why artificial intelligence patient preference prediction systems shouldn’t be for next of kin

“…In their contribution ‘Ethics of the algorithmic prediction of goal of care preferences’1 Ferrario et al elaborate a from theory to practice contribution concerning the realisation of artificial intelligence (AI)-based patient preference prediction (PPP) systems. Such systems are intended to help find the treatment that the patient would have chosen in clinical situations—especially in the intensive care or emergency units—where the patient is no longer capable of making that decision herself.…”

Aneurysmal Subarachnoid Hemorrhage and Clinical Decision-Making: A Qualitative Pilot Study Exploring Perspectives of Those Directly Affected, Their Next of Kin, and Treating Clinicians

“…Due to the relative youth of those who experience aSAH and its typically sudden and unexpected onset, those directly affected tend to be unprepared and often lack written advance directives. Current studies have suggested the value of artificial intelligence to improve prognoses [ 16 ] and establish real-time decision-making support [ 17 , 18 , 19 ].…”

Fracking our humanity

“…Nietzche claimed that once we know why to live, we’ll suffer almost any how 1. Artificial intelligence (AI) is used widely for the how , but Ferrario et al now advocate using AI for the why 2. Here, I offer my doubts on practical grounds but foremost on ethical ones.…”