2 Ethical Considerations
By the end of this chapter, you will be able to:
- Remember key ethical concerns related to AI use in occupational therapy
- Apply ethical frameworks to assess AI use in OT contexts.
- Evaluate the benefits and risks of AI technologies in OT practice.
- Understand responsible, transparent, and equitable AI use
2.1 Common Concerns
2.2 Ethical AI
Ethical AI refers to responsible development, use, and regulation of artificial intelligence systems. Everyone has a responsibility to understand the ethical considerations of AI including the computer programmers and data scientists developing the tools, regulatory bodies writing policies, and us, the students and practitioners using the tools in our work and personal lives.
Principles of Ethical AI
The United Nations Educational, Scientific, and Cultural Organization (UNESCO) identified 10 key principles of ethical AI. These principles are important to consider if you are thinking of using an AI tool, before you introduce a tool in a clinical setting, when you are evaluating the implementation of an AI tool, and if you get the opportunity to work on a team developing a new AI tool for OT practice.
1. Proportionality & Do No Harm
• The use of AI should be appropriate to the scope and seriousness of the problem it aims to address, not excessive or intrusive
• Regular risk assessments are necessary to avoid harm
• AI systems should not make any irreversible or serious decisions without human oversight
2. Safety & Security
• AI systems must be protected against safety & security risks such as malfunctions, data leaks, or cyberattacks
• Frameworks and policies must be in place to guide the development of AI systems and protect the data they use
3. Fairness & Non-Discrimination
• AI must not reinforce bias or discrimination
• Marginalized and vulnerable populations must be prioritized to ensure equitable access and benefits to all
• Global solidarity is vital in reducing digital divides
4. Sustainability
• AI should support human, social, environmental, and economic sustainability
• There must be ongoing evaluation and assessment of AI tools to ensure they are supporting long-term goals pertaining to the environment, well-being, and social equity
5. Privacy & Data Protection
• Privacy is a basic human right and must be upheld at all levels of the AI lifecycle
• Informed consent and compliance with legal standards are critical
6. Human Oversight & Responsibility
• Humans are responsible and accountable for all decisions made and actions taken by an AI system
• Decisions with life-or-death outcomes should not be made by AI without the final judgement of a human professional
7. Transparency & Explainability
• Humans have a right to know when AI is involved in decisions that affect them
• AI systems must be understandable, with clear reasoning provided for decisions that may impact rights and freedoms
8. Accountability
• Ethical and legal responsibility must be assigned throughout the entire AI lifecycle
• Regular audits and impact assessments should be in place when using any AI tool
9. Public Awareness & AI Literacy
• Education and public engagement are essential to empower people to understand and make informed choices about AI
10. Inclusive Governance
• Interprofessional collaboration is critical for fair, adaptive, and inclusive AI development and regulation
• Marginalized groups, communities, and individuals must have a seat at the table throughout the AI life cycle
Before using an AI tool, some important questions to consider include:
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What kind of data does the AI use? Is it representative?
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Can I explain how this tool works to a client or peer?
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Is there a risk this tool could misclassify someone?
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How does the tool reflect or challenge OT’s core values?
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If this tool caused harm, who would be accountable?
2.3 Why does this matter?
Connection to the AOTA Code of Ethics (2020)
Reflection Questions
- What ethical concerns are the most concerning to you?
- What is occupational therapy’s role in advocating for and helping to develop ethical AI
- How do these ethical considerations apply to AI in education
2.4 Where to learn more
UNESCO Recommendation on the Ethics of Artificial Intelligence (2022)
Survival of the Best Fit – Online Game for understanding how algorithms develop bias
References
American Occupational Therapy Association. (2020). Occupational therapy code of ethics. AOTA. https://www.aota.org
Morley, J., Machado, C. C. V., Burr, C., Cowls, J., Joshi, I., Taddeo, M., & Floridi, L. (2020). The ethics of AI in health care: A mapping review. Journal of Medical Internet Research, 22(8), e19264. https://doi.org/10.2196/19264
UNESCO. (2021). Recommendation on the ethics of artificial intelligence. https://unesdoc.unesco.org/ark:/48223/pf0000381137
AMEE. (2023). Ethical use of artificial intelligence in health professions education. AMEE Guide No. 158. https://doi.org/10.1080/0142159X.2023.2221563