Addressing ethical issues in healthcare artificial intelligence using a lifecycle-informed process

Artificial intelligence (AI) proceeds through an iterative and evaluative process of development, use, and refinement which may be characterized as a lifecycle. Within this context, stakeholders can vary in their interests and perceptions of the ethical issues associated with this rapidly evolving technology in ways that can fail to identify and avert adverse outcomes. Identifying issues throughout the AI lifecycle in a systematic manner can facilitate better-informed ethical deliberation.

We analyzed existing lifecycles from within the current literature for ethical issues of AI in healthcare to identify themes, which we relied upon to create a lifecycle that consolidates these themes into a more comprehensive lifecycle. We then considered the potential benefits and harms of AI through this lifecycle to identify ethical questions that can arise at each step and to identify where conflicts and errors could arise in ethical analysis. We illustrated the approach in 3 case studies that highlight how different ethical dilemmas arise at different points in the lifecycle.

Through case studies, we show how a systematic lifecycle-informed approach to the ethical analysis of AI enables mapping of the effects of AI onto different steps to guide deliberations on benefits and harms. The lifecycle-informed approach has broad applicability to different stakeholders and can facilitate communication on ethical issues for patients, healthcare professionals, research participants, and other stakeholders.