Co-design and Ethical Artificial Intelligence for Health

Abstract

Applications of artificial intelligence / machine learning (AI/ML) are dynamic and rapidly growing, and although multi-purpose, are particularly consequential in health care. One strategy for anticipating and addressing ethical challenges related to AI/ML for health care is co-design - or involvement of end users in design. Co-design has a diverse intellectual and practical history, however, and has been conceptualized in many different ways. Moreover, the unique features of AI/ML introduce challenges to co-design that are often underappreciated. This review summarizes the research literature on involvement in health care and design, and informed by critical data studies, examines the extent to which co-design as commonly conceptualized is capable of addressing the range of normative issues raised by AI/ML for health. We suggest that AI/ML technologies have amplified existing challenges related to co-design, and created entirely new challenges. We outline five co-design 'myths and misconceptions' related to AI/ML for health that form the basis for future research and practice. We conclude by suggesting that the normative strength of a co-design approach to AI/ML for health can be considered at three levels: technological, health care system, and societal. We also suggest research directions for a 'new era' of co-design capable of addressing these challenges.

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