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Should we have a right to refuse diagnostics and treatment planning by artificial intelligence?

Abstract

Should we be allowed to refuse any involvement of artificial intelligence (AI) technology in diagnosis and treatment planning? This is the relevant question posed by Ploug and Holm in a recent article in Medicine, Health Care and Philosophy. In this article, I adhere to their conclusions, but not necessarily to the rationale that supports them. First, I argue that the idea that we should recognize this right on the basis of a rational interest defence is not plausible, unless we are willing to judge each patient’s ideology or religion. Instead, I consider that the right must be recognized by virtue of values such as social pluralism or individual autonomy. Second, I point out that the scope of such a right should be limited at least under three circumstances: (1) if it is against a physician’s obligation to not cause unnecessary harm to a patient or to not provide futile treatment, (2) in cases where the costs of implementing this right are too high, or (3) if recognizing the right would deprive other patients of their own rights to adequate health care.

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References

  1. Article 29 Data Protection Working Party. 2018. ARTICLE29 Guidelines on Automated Individual Decision-Making and Profiling for the Purposes of Regulation 2016/679 (wp251rev.01). https://ec.europa.eu/newsroom/article29/item-detail.cfm?item_id=612053. Accessed 20 July 2019

  2. Charter of Fundamental Rights of the European Union (CFR), 2012/C 326/02. https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:12012P/TXT. Accessed 20 July 2019

  3. Council of Europe, European Convention for the Protection of Human Rights and Fundamental Freedoms, as amended by Protocols Nos. 11 and 14, 4 November 1950, ETS 5. https://www.refworld.org/docid/3ae6b3b04.html. Accessed 18 Jan 2020

  4. Dreyer, S., and W. Schulz. 2019. The General Data Protection Regulation and Automated Decision-making: Will it deliver? Potentials and limitations in ensuring the rights and freedoms of individuals, groups and society as a whole. Working Paper. Bertelsmann Stiftung. https://www.bertelsmann-stiftung.de/fileadmin/files/BSt/Publikationen/GrauePublikationen/GDPR.pdf. Accessed 11 Aug 2019

  5. Hartzband, P., and J. Groopman. 2009. Keeping the patient in the equation—Humanism and health care reform. New England Journal of Medicine 361: 554–555.

    Article  Google Scholar 

  6. Howard, B.M. 2008. First, do not punish: Individual incentives in health policy, virtual mentor. AMA Journal of Ethics 10 (11): 719–723. https://doi.org/10.1001/virtualmentor.2008.10.11.conl1-0811.

    Article  Google Scholar 

  7. Luce, J.M. 1995. Physicians do not have a responsibility to provide futile or unreasonable care if a patient or family insists. Critical Care Medicine 23: 760–766.

    Article  Google Scholar 

  8. Macklin, R. 2003. Applying the four principles. Journal of Medical Ethics 29: 275–280.

    Article  Google Scholar 

  9. Mitchell, C., and C. Ploem. 2018. Legal challenges for the implementation of advanced clinical digital decision support systems in Europe. Journal of Clinical and Translational Research 3 (Suppl 3): 424–430.

    Google Scholar 

  10. Nikolentzos, A., E. Nolte, and N. Mays. 2008. Paying for (expensive) drugs in the statutory system: An overview of experiences in 13 countries. London: London School of Hygiene & Tropical Medicine. https://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_ 089990. Accessed 20 Aug 2019.

  11. Paris, J.J. 2010. Autonomy does not confer sovereignty on the patient: A commentary on the Golubchuk case. American Journal of Bioethics 10 (3): 54–56.

    Article  Google Scholar 

  12. Petrini, C. 2014. Ethical and legal aspects of refusal of blood transfusions by Jehovah's Witnesses, with particular reference to Italy. Blood Transfusion 12 (Suppl 1): s395–s401. https://doi.org/10.2450/2013.0017-13.

    Article  Google Scholar 

  13. Ploug, T., and S. Holm., 2019. The right to refuse diagnostics and treatment planning by artificial intelligence. Medicine, Health Care and Philosophy. https://doi.org/10.1007/s11019-019-09912-8. [Epub ahead of print]

    Article  Google Scholar 

  14. Schmidt, H. 2007. Patients' charters and health responsibilities. BMJ 335 (7631): 1188.

    Article  Google Scholar 

  15. Turner, L. 2004. Bioethics in pluralistic societies. Medicine, Health Care and Philosophy 7 (2): 201–208.

    Article  Google Scholar 

  16. Varelius, J. 2006. The value of autonomy in medical ethics. Medicine, Health Care and Philosophy 9 (3): 377–788.

    Article  Google Scholar 

  17. Wachter, S., B. Mittelstadt, and L. Floridi. 2017. Why a right to explanation of automated decision-making does not exist in the general data protection regulation. International Data Privacy Law 7 (2): 76–99.

    Article  Google Scholar 

  18. Wilkinson, D., and J. Savulescu. 2018. Cost-equivalence and pluralism in publicly-funded health-care systems. Health Care Analysis 26 (4): 287.

    Article  Google Scholar 

Download references

Acknowledgements

Iñigo de Miguel Beriain’s work was supported by the Government of the Basque Country, Grant IT-1066-16 and the EU Commission, H2020 SWAFS Programme, PANELFIT Project, research Grant Number 788039.

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Correspondence to Iñigo de Miguel Beriain.

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de Miguel Beriain, I. Should we have a right to refuse diagnostics and treatment planning by artificial intelligence?. Med Health Care and Philos 23, 247–252 (2020). https://doi.org/10.1007/s11019-020-09939-2

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Keywords

  • Artificial intelligence
  • Right to refuse treatment
  • Health care
  • Patients autonomy