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Compounding advantage: Medical AI and structural injustice
1Department of Radiology, Montefiore Nyack Hospital, Nyack, New York, USA. nikolicboris@ymail.com.
Monash Bioethics Review
|July 29, 2026
Summary
Artificial intelligence in clinical medicine, or AI, does not democratize healthcare but compounds existing inequalities. This self-amplifying mechanism creates dynamic, structural injustice, particularly as AI technology advances.
Area of Science:
- Medical Ethics
- Health Informatics
- Social Justice
Background:
- Artificial intelligence (AI) in clinical medicine is often framed as a democratizing force.
- However, prevailing market governance may lead to AI exacerbating existing inequalities.
Purpose of the Study:
- To analyze the structural injustices produced by AI in clinical medicine.
- To evaluate AI's impact on healthcare access and quality for different populations.
Main Methods:
- Critique of standard distributive justice principles (e.g., Rawlsian, Daniels).
- Application of Iris Marion Young's theory of structural injustice.
- Analysis of AI's self-amplifying and compounding mechanisms in healthcare.
Main Results:
- AI, under current market structures, acts as a compounding mechanism, amplifying institutional advantages.
- This creates a dynamic, 'ratchet' effect of injustice, not a static maldistribution.
- Injustice deepens as AI technology improves, affecting both access and quality, especially for under-represented groups.
Conclusions:
- Iris Marion Young's framework of structural injustice is more adequate for understanding AI's impact in medicine.
- The distribution of AI, a genuine good, accelerates disadvantage.
- Professional obligations must address these dynamics of diffusion and inequality.
