Responsibility and decision-making authority in using clinical decision support systems: an empirical-ethical exploration of German prospective professionals’ preferences and concerns

Journal of Medical Ethics, vol. 50, pp. 6–11

Abstract

Machine learning-driven clinical decision support systems (ML-CDSSs) seem impressively promising for future routine and emergency care. However, reflection on their clinical implementation reveals a wide array of ethical challenges. The preferences, concerns and expectations of professional stakeholders remain largely unexplored. Empirical research, however, may help to clarify the conceptual debate and its aspects in terms of their relevance for clinical practice. This study explores, from an ethical point of view, future healthcare professionals' attitudes to potential changes of responsibility and decision-making authority when using ML-CDSS. Twenty-seven semistructured interviews were conducted with German medical students and nursing trainees. The data were analysed based on qualitative content analysis according to Kuckartz. Interviewees' reflections are presented under three themes the interviewees describe as closely related: (self-)attribution of responsibility, decision-making authority and need of (professional) experience. The results illustrate the conceptual interconnectedness of professional responsibility and its structural and epistemic preconditions to be able to fulfil clinicians' responsibility in a meaningful manner. The study also sheds light on the four relata of responsibility understood as a relational concept. The article closes with concrete suggestions for the ethically sound clinical implementation of ML-CDSS.

Authors 8

1. Florian Funer corresponding

   Medizinische Hochschule Hannover · University of Tübingen

   Affiliation as printed

   Institute of Ethics and History of Medicine, Eberhard Karls University Tübingen, Tübingen, Germany

   Institute of Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany

   Institute of Ethics and History of Medicine, Eberhard Karls University Tübingen, Tübingen, Baden-Württemberg, Germany

2. Wenke Liedtke

   Protestant University of Applied Sciences Rhineland-Westphalia-Lippe

   Affiliation as printed

   Department of Social Work, Protestant University of Applied Sciences RWL, Bochum, Germany

3. Sara Tinnemeyer

   Medizinische Hochschule Hannover

   Affiliation as printed

   Institute of Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany

4. Andrea Diana Klausen Aachen Institute of Medical Informatics

   RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany

5. Diana Schneider

   Fraunhofer Institute for Systems and Innovation Research

   Affiliation as printed

   Competence Center Emerging Technologies, Fraunhofer Institute for Systems and Innovation Research ISI, Karlsruhe, Germany

6. Helena U. Zacharias

   Medizinische Hochschule Hannover · Technische Universität Braunschweig

   Affiliation as printed

   Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover Medical School, Hannover, Germany

7. Martin Langanke

   Protestant University of Applied Sciences Rhineland-Westphalia-Lippe

   Affiliation as printed

   Department of Social Work, Protestant University of Applied Sciences RWL, Bochum, Germany

8. Sabine Salloch

   Medizinische Hochschule Hannover

   Affiliation as printed

   Institute of Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany