journal article Open Access Apr 08, 2025

Ethical challenges and evolving strategies in the integration of artificial intelligence into clinical practice

View at Publisher Save 10.1371/journal.pdig.0000810
Abstract
Artificial intelligence (AI) has rapidly transformed various sectors, including healthcare, where it holds the potential to transform clinical practice and improve patient outcomes. However, its integration into medical settings brings significant ethical challenges that need careful consideration. This paper examines the current state of AI in healthcare, focusing on five critical ethical concerns: justice and fairness, transparency, patient consent and confidentiality, accountability, and patient-centered and equitable care. These concerns are particularly pressing as AI systems can perpetuate or even exacerbate existing biases, often resulting from non-representative datasets and opaque model development processes. The paper explores how bias, lack of transparency, and challenges in maintaining patient trust can undermine the effectiveness and fairness of AI applications in healthcare. In addition, we review existing frameworks for the regulation and deployment of AI, identifying gaps that limit the widespread adoption of these systems in a just and equitable manner. Our analysis provides recommendations to address these ethical challenges, emphasizing the need for fairness in algorithm design, transparency in model decision-making, and patient-centered approaches to consent and data privacy. By highlighting the importance of continuous ethical scrutiny and collaboration between AI developers, clinicians, and ethicists, we outline pathways for achieving more responsible and inclusive AI implementation in healthcare. These strategies, if adopted, could enhance both the clinical value of AI and the trustworthiness of AI systems among patients and healthcare professionals, ensuring that these technologies serve all populations equitably.
Topics

No keywords indexed for this article. Browse by subject →

References
46
[2]
Dermatologist-level classification of skin cancer with deep neural networks

Andre Esteva, Brett Kuprel, Roberto A. Novoa et al.

Nature 2017 10.1038/nature21056
[3]
D Ouyang "Video-based AI for beat-to-beat assessment of cardiac function" Nature (2020) 10.1038/s41586-020-2145-8
[4]
DK Eng "Artificial intelligence algorithm improves radiologist performance in skeletal age assessment: a prospective multicenter randomized controlled trial" Radiology (2021) 10.1148/radiol.2021204021
[5]
N Tomita "Deep neural networks for automatic detection of osteoporotic vertebral fractures on CT scans" Comput Biol Med (2018) 10.1016/j.compbiomed.2018.05.011
[6]
J Wei "Pathologist-level classification of histologic patterns on resected lung adenocarcinoma slides with deep neural networks" Sci Rep (2019) 10.1038/s41598-019-40041-7
[7]
J Wei "Automated detection of celiac disease on duodenal biopsy slides: a deep learning approach" J Pathol Inform (2019)
[8]
N Tomita "Attention-based deep neural networks for detection of cancerous and precancerous esophagus tissue on histopathological slides" JAMA Netw Open (2019) 10.1001/jamanetworkopen.2019.14645
[9]
N Tomita "Automatic post-stroke lesion segmentation on MR images using 3D residual convolutional neural network" Neuroimage Clin (2020) 10.1016/j.nicl.2020.102276
[10]
M Zhu "Development and evaluation of a deep neural network for histologic classification of renal cell carcinoma on biopsy and surgical resection slides" Sci Rep (2021) 10.1038/s41598-021-86540-4
[11]
M Nasir-Moin "Evaluation of an artificial intelligence-augmented digital system for histologic classification of colorectal polyps" JAMA Netw Open (2021) 10.1001/jamanetworkopen.2021.35271
[12]
W Barrios "Bladder cancer prognosis using deep neural networks and histopathology images" J Pathol Inform (2022) 10.1016/j.jpi.2022.100135
[13]
Deep learning

Yann LeCun, Yoshua Bengio, Geoffrey Hinton

Nature 2015 10.1038/nature14539
[14]
N Kanwal (2022)
[15]
J Shah "Clinical narrative summarization based on the MIMIC III dataset" Int J Multimed Ubiquitous Eng (2020)
[16]
Wang S, McDermott MBA, Chauhan G, Ghassemi M, Hughes MC, Naumann T. MIMIC-extract: a data extraction, preprocessing, and representation pipeline for MIMIC-III. Proceedings of the ACM conference on health, inference, and learning [Internet]. New York (NY): Association for Computing Machinery; 2020 [cited 2024 Mar 11]. p. 222–35. (CHIL’20). Available from: https://dl.acm.org/doi/10.1145/3368555.3384469 10.1145/3368555.3384469
[17]
Q Wei "Relation extraction from clinical narratives using pre-trained language models" AMIA Annu Symp Proc (2020)
[18]
S Nuthakki (2019)
[19]
Predicting 30-days mortality for MIMIC-III patients with sepsis-3: a machine learning approach using XGboost

Nianzong Hou, Mingzhe Li, Lu He et al.

Journal of Translational Medicine 2020 10.1186/s12967-020-02620-5
[20]
F Li "Prediction model of in-hospital mortality in intensive care unit patients with heart failure: machine learning-based, retrospective analysis of the MIMIC-III database" BMJ Open (2021) 10.1136/bmjopen-2020-044779
[21]
N Ding "An artificial neural networks model for early predicting in-hospital mortality in acute pancreatitis in MIMIC-III" Biomed Res Int (2021) 10.1155/2021/6638919
[22]
E Kumar (2020)
[23]
U Hahn "Medical information extraction in the age of deep learning" Yearb Med Inform (2020) 10.1055/s-0040-1702001
[24]
S Wu "Deep learning in clinical natural language processing: a methodical review" J Am Med Inform Assoc (2020) 10.1093/jamia/ocz200
[25]
C Holmvall "Applying justice and commitment constructs to patient-health care provider relationships" Can Fam Physician (2012)
[26]
F Li "Ethics & AI: a systematic review on ethical concerns and related strategies for designing with AI in healthcare" AI (2022) 10.3390/ai4010003
[27]
Z Obermeyer "Dissecting racial bias in an algorithm used to manage the health of populations" Science (2019) 10.1126/science.aax2342
[28]
Iloanusi N-J, Chun SA. AI impact on health equity for marginalized, racial, and ethnic minorities. Proceedings of the 25th annual international conference on digital government research [Internet]. Taipei Taiwan: ACM; 2024 [cited 2025 Jan 7]. p. 841–8. Available from: https://dl.acm.org/doi/10.1145/3657054.3657152 10.1145/3657054.3657152
[29]
S Polevikov "Advancing AI in healthcare: a comprehensive review of best practices" Clin Chim Acta (2023) 10.1016/j.cca.2023.117519
[30]
B Wang "What may impact trustworthiness of AI in digital healthcare: discussion from patients’ viewpoint" Proc Int Symp Hum Factors Ergon Health Care (2023) 10.1177/2327857923121001
[31]
M Goirand "Implementing ethics in healthcare AI-based applications: a scoping review" Sci Eng Ethics (2021) 10.1007/s11948-021-00336-3
[32]
W Seymour "Detecting bias: does an algorithm have to be transparent in order to be fair?" (2018)
[33]
A Leimanis "Ethical guidelines for artificial intelligence in healthcare from the sustainable development perspective" Eur J Sustain Dev (2021) 10.14207/ejsd.2021.v10n1p90
[34]
H Park "Patient perspectives on informed consent for medical AI: a web-based experiment" Digit Health (2024) 10.1177/20552076241247938
[35]
M Abdelwanis "Exploring the risks of automation bias in healthcare artificial intelligence applications: a Bowtie analysis" J Saf Sci Resil (2024)
[36]
C Longoni "Resistance to medical artificial intelligence" J Consum Res (2019) 10.1093/jcr/ucz013
[37]
Ahmad MA, Eckert C, Allen C, Kumar V, Hu J, Teredesai A. Fairness in healthcare AI. 2021 IEEE 9th international conference on healthcare informatics (ICHI) [Internet]; 2021 [cited 2024 Jan 30]. p. 554–5. Available from: https://ieeexplore.ieee.org/document/9565788 10.1109/ichi52183.2021.00104
[38]
M Smallman "Multi scale ethics—why we need to consider the ethics of ai in healthcare at different scales" Sci Eng Ethics (2022) 10.1007/s11948-022-00396-z
[39]
H Siala "SHIFTing artificial intelligence to be responsible in healthcare: a systematic review" Soc Sci Med (2022) 10.1016/j.socscimed.2022.114782
[40]
J Gichoya "AI pitfalls and what not to do: mitigating bias in AI" Br J Radiol (2023) 10.1259/bjr.20230023
[41]
R Garcia "Racial and ethnic differences in bystander CPR for witnessed cardiac arrest" N Engl J Med (2022) 10.1056/nejmoa2200798
[42]
PS Chan "Race and sex differences in the association of bystander CPR for cardiac arrest" Circulation (2024) 10.1161/circulationaha.124.068732
[43]
(2024)
[44]
A Shuaib "Transforming healthcare with AI: promises, pitfalls, and pathways forward" Int J Gen Med (2024) 10.2147/ijgm.s449598
[45]
R Chopra
[46]
P Esmaeilzadeh "Challenges and strategies for wide-scale artificial intelligence (AI) deployment in healthcare practices: a perspective for healthcare organizations" Artif Intell Med (2024) 10.1016/j.artmed.2024.102861
Cited By
106
Journal of Human Nutrition and Diet...
International Journal of Medical In...
Kerala Journal of Ophthalmology
WIREs Data Mining and Knowledge Dis...
Breast Cancer: Targets and Therapy
Metrics
106
Citations
46
References
Details
Published
Apr 08, 2025
Vol/Issue
4(4)
Pages
e0000810
License
View
Cite This Article
Ellison B. Weiner, Irene Dankwa-Mullan, William A. Nelson, et al. (2025). Ethical challenges and evolving strategies in the integration of artificial intelligence into clinical practice. PLOS Digital Health, 4(4), e0000810. https://doi.org/10.1371/journal.pdig.0000810
Related

You May Also Like

Bias in medical AI: Implications for clinical decision-making

James L. Cross, Michael A. Choma · 2024

361 citations

Digital literacy as a new determinant of health: A scoping review

Maria del Pilar Arias López, Bradley A. Ong · 2023

289 citations