Safe and Ethical AI (SEA) Platform Network · Linking Artificial Intelligence Principles (LAIP)

5 Ensure inclusiveness and equity

Inclusiveness requires that AI used in health care is designed to encourage the widest possible appropriate, equitable use and access, irrespective of age, gender, income, ability or other characteristics. Institutions (e.g. companies, regulatory agencies, health systems) should hire employees from diverse backgrounds, cultures and disciplines to develop, monitor and deploy AI. AI technologies should be designed by and evaluated with the active participation of those who are required to use the system or will be affected by it, including providers and patients, and such participants should be sufficiently diverse. Participation can also be improved by adopting open source software or making source codes publicly available. AI technology – like any other technology – should be shared as widely as possible. AI technologies should be available not only in HIC and for use in contexts and for needs that apply to high income settings but they should also be adaptable to the types of devices, telecommunications infrastructure and data transfer capacity in LMIC. AI developers and vendors should also consider the diversity of languages, ability and forms of communication around the world to avoid barriers to use. Industry and governments should strive to ensure that the “digital divide” within and between countries is not widened and ensure equitable access to novel AI technologies. AI technologies should not be biased. Bias is a threat to inclusiveness and equity because it represents a departure, often arbitrary, from equal treatment. For example, a system designed to diagnose cancerous skin lesions that is trained with data on one skin colour may not generate accurate results for patients with a different skin colour, increasing the risk to their health. Unintended biases that may emerge with AI should be avoided or identified and mitigated. AI developers should be aware of the possible biases in their design, implementation and use and the potential harm that biases can cause to individuals and society. These parties also have a duty to address potential bias and avoid introducing or exacerbating health care disparities, including when testing or deploying new AI technologies in vulnerable populations. AI developers should ensure that AI data, and especially training data, do not include sampling bias and are therefore accurate, complete and diverse. If a particular racial or ethnic minority (or other group) is underrepresented in a dataset, oversampling of that group relative to its population size may be necessary to ensure that an AI technology achieves the same quality of results in that population as in better represented groups. AI technologies should minimize inevitable power disparities between providers and patients or between companies that create and deploy AI technologies and those that use or rely on them. Public sector agencies should have control over the data collectedby private health care providers, and their shared responsibilities should be defined and respected. Everyone – patients, health care providers and health care systems – should be able to benefit from an AI technology and not just the technology providers. AI technologies should be accompanied by means to provide patients with knowledge and skills to better understand their health status and to communicate effectively with health care providers. Future health literacy should include an element of information technology literacy. The effects of use of AI technologies must be monitored and evaluated, including disproportionate effects on specific groups of people when they mirror or exacerbate existing forms of bias and discrimination. Special provision should be made to protect the rights and welfare of vulnerable persons, with mechanisms for redress if such bias and discrimination emerges or is alleged.

Principle: Key ethical principles for use of artificial intelligence for health, Jun 28, 2021

Published by World Health Organization (WHO)

Related Principles

4. Human centricity

AI systems should respect human centred values and pursue benefits for human society, including human beings’ well being, nutrition, happiness, etc. It is key to ensure that people benefit from AI design, development, and deployment while being protected from potential harms. AI systems should be used to promote human well being and ensure benefit for all. Especially in instances where AI systems are used to make decisions about humans or aid them, it is imperative that these systems are designed with human benefit in mind and do not take advantage of vulnerable individuals. Human centricity should be incorporated throughout the AI system lifecycle, starting from the design to development and deployment. Actions must be taken to understand the way users interact with the AI system, how it is perceived, and if there are any negative outcomes arising from its outputs. One example of how deployers can do this is to test the AI system with a small group of internal users from varied backgrounds and demographics and incorporate their feedback in the AI system. AI systems should not be used for malicious purposes or to sway or deceive users into making decisions that are not beneficial to them or society. In this regard, developers and deployers (if developing or designing inhouse) should also ensure that dark patterns are avoided. Dark patterns refer to the use of certain design techniques to manipulate users and trick them into making decisions that they would otherwise not have made. An example of a dark pattern is employing the use of default options that do not consider the end user’s interests, such as for data sharing and tracking of the user’s other online activities. As an extension of human centricity as a principle, it is also important to ensure that the adoption of AI systems and their deployment at scale do not unduly disrupt labour and job prospects without proper assessment. Deployers are encouraged to take up impact assessments to ensure a systematic and stakeholder based review and consider how jobs can be redesigned to incorporate use of AI. Personal Data Protection Commission of Singapore’s (PDPC) Guide on Job Redesign in the Age of AI6 provides useful guidance to assist organisations in considering the impact of AI on its employees, and how work tasks can be redesigned to help employees embrace AI and move towards higher value tasks.

Published by ASEAN in ASEAN Guide on AI Governance and Ethics, 2024

Fairness

Throughout their lifecycle, AI systems should be inclusive and accessible, and should not involve or result in unfair discrimination against individuals, communities or groups. This principle aims to ensure that AI systems are fair and that they enable inclusion throughout their entire lifecycle. AI systems should be user centric and designed in a way that allows all people interacting with it to access the related products or services. This includes both appropriate consultation with stakeholders, who may be affected by the AI system throughout its lifecycle, and ensuring people receive equitable access and treatment. This is particularly important given concerns about the potential for AI to perpetuate societal injustices and have a disparate impact on vulnerable and underrepresented groups including, but not limited to, groups relating to age, disability, race, sex, intersex status, gender identity and sexual orientation. Measures should be taken to ensure the AI produced decisions are compliant with anti‐discrimination laws.

Published by Department of Industry, Innovation and Science, Australian Government in AI Ethics Principles, Nov 7, 2019

· 2. The Principle of Non maleficence: “Do no Harm”

AI systems should not harm human beings. By design, AI systems should protect the dignity, integrity, liberty, privacy, safety, and security of human beings in society and at work. AI systems should not threaten the democratic process, freedom of expression, freedoms of identify, or the possibility to refuse AI services. At the very least, AI systems should not be designed in a way that enhances existing harms or creates new harms for individuals. Harms can be physical, psychological, financial or social. AI specific harms may stem from the treatment of data on individuals (i.e. how it is collected, stored, used, etc.). To avoid harm, data collected and used for training of AI algorithms must be done in a way that avoids discrimination, manipulation, or negative profiling. Of equal importance, AI systems should be developed and implemented in a way that protects societies from ideological polarization and algorithmic determinism. Vulnerable demographics (e.g. children, minorities, disabled persons, elderly persons, or immigrants) should receive greater attention to the prevention of harm, given their unique status in society. Inclusion and diversity are key ingredients for the prevention of harm to ensure suitability of these systems across cultures, genders, ages, life choices, etc. Therefore not only should AI be designed with the impact on various vulnerable demographics in mind but the above mentioned demographics should have a place in the design process (rather through testing, validating, or other). Avoiding harm may also be viewed in terms of harm to the environment and animals, thus the development of environmentally friendly AI may be considered part of the principle of avoiding harm. The Earth’s resources can be valued in and of themselves or as a resource for humans to consume. In either case it is necessary to ensure that the research, development, and use of AI are done with an eye towards environmental awareness.

Published by The European Commission’s High-Level Expert Group on Artificial Intelligence in Draft Ethics Guidelines for Trustworthy AI, Dec 18, 2018

1 Protect autonomy

Adoption of AI can lead to situations in which decision making could be or is in fact transferred to machines. The principle of autonomy requires that any extension of machine autonomy not undermine human autonomy. In the context of health care, this means that humans should remain in full control of health care systems and medical decisions. AI systems should be designed demonstrably and systematically to conform to the principles and human rights with which they cohere; more specifically, they should be designed to assist humans, whether they be medical providers or patients, in making informed decisions. Human oversight may depend on the risks associated with an AI system but should always be meaningful and should thus include effective, transparent monitoring of human values and moral considerations. In practice, this could include deciding whether to use an AI system for a particular health care decision, to vary the level of human discretion and decision making and to develop AI technologies that can rank decisions when appropriate (as opposed to a single decision). These practicescan ensure a clinician can override decisions made by AI systems and that machine autonomy can be restricted and made “intrinsically reversible”. Respect for autonomy also entails the related duties to protect privacy and confidentiality and to ensure informed, valid consent by adopting appropriate legal frameworks for data protection. These should be fully supported and enforced by governments and respected by companies and their system designers, programmers, database creators and others. AI technologies should not be used for experimentation or manipulation of humans in a health care system without valid informed consent. The use of machine learning algorithms in diagnosis, prognosis and treatment plans should be incorporated into the process for informed and valid consent. Essential services should not be circumscribed or denied if an individual withholds consent and that additional incentives or inducements should not be offered by either a government or private parties to individuals who do provide consent. Data protection laws are one means of safeguarding individual rights and place obligations on data controllers and data processors. Such laws are necessary to protect privacy and the confidentiality of patient data and to establish patients’ control over their data. Construed broadly, data protection laws should also make it easy for people to access their own health data and to move or share those data as they like. Because machine learning requires large amounts of data – big data – these laws are increasingly important.

Published by World Health Organization (WHO) in Key ethical principles for use of artificial intelligence for health, Jun 28, 2021

6 Promote artificial intelligence that is responsive and sustainable

Responsiveness requires that designers, developers and users continuously, systematically and transparently examine an AI technology to determine whether it is responding adequately, appropriately and according to communicated expectations and requirements in the context in which it is used. Thus, identification of a health need requires that institutions and governments respond to that need and its context with appropriate technologies with the aim of achieving the public interest in health protection and promotion. When an AI technology is ineffective or engenders dissatisfaction, the duty to be responsive requires an institutional process to resolve the problem, which may include terminating use of the technology. Responsiveness also requires that AI technologies be consistent with wider efforts to promote health systems and environmental and workplace sustainability. AI technologies should be introduced only if they can be fully integrated and sustained in the health care system. Too often, especially in under resourced health systems, new technologies are not used or are not repaired or updated, thereby wasting scare resources that could have been invested in proven interventions. Furthermore, AI systems should be designed to minimize their ecological footprints and increase energy efficiency, so that use of AI is consistent with society’s efforts to reduce the impact of human beings on the earth’s environment, ecosystems and climate. Sustainability also requires governments and companies to address anticipated disruptions to the workplace, including training of health care workers to adapt to use of AI and potential job losses due to the use of automated systems for routine health care functions and administrative tasks.