Reconsidering bioethical principles in the era of artificial intelligence: challenges for autonomy, justice, and beneficence in medicine

Abstract

The widespread integration of artificial intelligence (AI) algorithms into clinical practice, from disease diagnosis to robotic surgery, raises questions about the adequacy of traditional bioethical principles developed for human physician decision-making. This article aimed to assess the applicability of the Beauchamp principles, namely, respect for autonomy, beneficence, and justice, to the realities of AI-mediated medicine and to propose specific strategies for their adaptation. The study involved a systematic review and thematic analysis of international scientific data, clinical cases, and regulatory documents published between 2015 and 2023. The analysis revealed fundamental contradictions. The principle of beneficence is challenged by the black box problem and diffusion of responsibility; autonomy requires revision of informed consent models and codification of the right to explanation; justice is undermined by algorithmic bias; and data confidentiality demands new approaches such as federated learning. Therefore, maintaining trust in medicine requires not the rejection but the evolution of traditional bioethical principles through the incorporation of transparency, accountability, and technical fairness. This indicates the need for new regulatory standards, mandatory algorithmic audits, and the integration of ethical design into the creation of AI-based medical systems.

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