Artificial Intelligence and Decision-Making in Oncology: A Review of Ethical, Legal, and Informed Consent Challenges

Artificial Intelligence (AI) integration in oncology is transforming therapeutic decision-making by providing clinical decision support. AI may improve treatment precision, but it raises ethical, legal, and informed consent issues. This review examines these paramount AI implementation issues in cancer care. This systematic review followed the PRISMA 2020 guidelines and was prospectively registered in the PROSPERO (CRD420251046482) database. A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane CENTRAL Library to identify studies published between January 2015 and May 2025. AI-supported oncology therapeutic decision-making studies with ethical, legal, or informed consent implications were eligible.

Fifteen studies met the inclusion criteria. AI applications were found to support treatment recommendations, personalize drug dosing, and improve adherence and patient management. Despite these benefits, the review highlighted key concerns, including algorithmic transparency, unclear accountability in AI-guided decisions, data privacy, and gaps in patient understanding of AI's role in their care. AI has the potential to enhance oncological care, but ethical and legal issues must be addressed for safe and equitable implementation. Emphasis should be placed on developing robust informed consent models, mitigating algorithmic bias, and establishing clear legal accountability. Future research must establish ethical frameworks and regulatory mechanisms to protect patient autonomy and responsibly integrate AI into oncology.