Ferrario A, Loi M, Viganò E.
Journal of Medical Ethics
Published Online First: 25 November 2020.
In his recent article ‘Limits of trust in medical AI,’ Hatherley argues that, if we believe that the motivations that are usually recognised as relevant for interpersonal trust have to be applied to interactions between humans and medical artificial intelligence, then these systems do not appear to be the appropriate objects of trust. In this response, we argue that it is possible to discuss trust in medical artificial intelligence (AI), if one refrains from simply assuming that trust describes human–human interactions. To do so, we consider an account of trust that distinguishes trust from reliance in a way that is compatible with trusting non-human agents. In this account, to trust a medical AI is to rely on it with little monitoring and control of the elements that make it trustworthy. This attitude does not imply specific properties in the AI system that in fact only humans can have. This account of trust is applicable, in particular, to all cases where a physician relies on the medical AI predictions to support his or her decision making.
Here is an excerpt:
Let us clarify our position with an example. Medical AIs support decision making by the provision of predictions, often in the form of machine learning model outcomes, to identify and plan better prognoses, diagnoses and treatments.3 These outcomes are the result of complex computational processes on high-dimensional data that are difficult to understand by physicians. Therefore, it may be convenient to look at the medical AI as a ‘black box’, or an input–output system whose internal mechanisms are not directly accessible or understandable. Through a sufficient number of interactions with the medical AI, its developers and AI-savvy colleagues, and by analysing different types of outputs (eg, those of young patients or multimorbid ones), the physician may develop a mental model, that is, a set of beliefs, on the performance and error patterns of the AI. We describe this phase in the relation between the physician and the AI as the ‘mere reliance’ phase, which does not need to involve trust (or at best involves very little trust).