The Medicine Revolution Through Artificial Intelligence: Ethical Challenges of Machine Learning Algorithms in Decision-Making

The integration of artificial intelligence (AI) and its autonomous learning processes (or machine learning) in medicine has revolutionized the global health landscape, providing faster and more accurate diagnoses, personalization of medical treatment, and efficient management of clinical information. However, this transformation is not without ethical challenges, which require a comprehensive and responsible approach. There are many fields where AI and medicine intersect, such as health education, patient-doctor interface, data management, diagnosis, intervention, and decision-making processes. For some of these fields, there are some guidelines to regulate them. AI has numerous applications in medicine, including medical imaging analysis, diagnosis, predictive analytics for patient outcomes, drug discovery and development, virtual health assistants, and remote patient monitoring. It is also used in robotic surgery, clinical decision support systems, AI-powered chatbots for triage, administrative workflow automation, and treatment recommendations. Despite numerous applications, there are several problems related to the use of AI identified in the literature in general and in medicine in particular. These problems are data privacy and security, bias and discrimination, lack of transparency (Black Box Problem), integration with existing systems, cost and accessibility disparities, risk of overconfidence in AI, technical limitations, accountability for AI errors, algorithmic interpretability, data standardization issues, unemployment, and challenges in clinical validation. Of the various problems already identified, the most worrying are data bias, the black box phenomenon, questions about data privacy, responsibility for decision-making, security issues for the human species, and technological unemployment. There are still several ethical problems associated with the use of AI autonomous learning algorithms, namely epistemic, normative, and comprehensive ethical problems (overarching). Addressing all these issues is crucial to ensure that the use of AI in healthcare is implemented ethically and responsibly, providing benefits to populations without compromising fundamental values. Ongoing dialogue between healthcare providers and the industry, the establishment of ethical guidelines and regulations, and considering not only current ethical dilemmas but also future perspectives are fundamental points for the application of AI to medical practice. The purpose of this review is to discuss the ethical issues of AI algorithms used mainly in data management, diagnosis, intervention, and decision-making processes.