Moral MedTech: Exploring Ethics-by-Design for Artificial Intelligence in Healthcare via Serious Gaming

Artificial Intelligence (AI) is reshaping healthcare through data-driven medical technologies. While offering efficiency and personalization, these systems also pose ethical challenges around fairness, transparency, accountability, and patient autonomy. Existing guidelines to tackle these challenges such as the HLEG guideline for trustworthy AI of the European Commission provide high-level principles but little if any practical guidance for MedTech design. To address this, we developed Moral MedTech, a serious game that combines Value Sensitive Design, Agile methods, and the EU principles for trustworthy AI. The game engages patients, clinicians, developers, and regulators in collaboratively identifying values, formulating requirements, weighing priorities, and resolving ethical tensions. Tested in eight MedTech use cases, it evolved into a structured yet flexible tool fostering engagement, inclusivity, and actionable outcomes. Our findings show that Moral MedTech not only facilitates dialogue between technical and non-technical stakeholders but also translates abstract ethical values into concrete design requirements, supporting responsible, ethics-by-design AI in healthcare.