Having the final say: Machine support of ethical decisions of doctors

Abstract

Machines that support highly complex decisions of doctors have been a reality for almost half a century. In the 1950s, computer-supported medical diagnostic systems started with “punched cards in a shoe box”. In the 1960s and 1970s medicine was, to a certain extent, transformed into a quantitative science by intensive interdisciplinary research collaborations of experts from medicine, mathematics and electrical engineering; This was followed by a second shift in research on machine support of medical decisions from numerical probabilistic to knowledge based approaches. Solutions of the later form came to be known as (medical) expert systems, knowledge based systems research or Artificial Intelligence in Medicine. With growing complexity of machines physician patient interaction can be supported in various ways. This includes not only diagnosis and therapy options but could also include ethical problems like end-of-life decisions. Here questions of shared responsibility need to be answered: should machine or human have the last say? This chapter explores the question of shared responsibility mainly in ethical decision making in medicine. After addressing the historical development of decision support systems in medicine the demands of users on such systems are analyzed. Then the special structure of ethical dilemmas is explored. Finally, this chapter discusses the question how decision support systems can be used in ethical dilemma situations in medicine and how this translates into shared responsibility.