Skip to main content
Top
Published in: Medicine, Health Care and Philosophy 1/2022

01-03-2022 | Expert Opinion | Scientific Contribution

Chatbot breakthrough in the 2020s? An ethical reflection on the trend of automated consultations in health care

Authors: Jaana Parviainen, Juho Rantala

Published in: Medicine, Health Care and Philosophy | Issue 1/2022

Login to get access

Abstract

Many experts have emphasised that chatbots are not sufficiently mature to be able to technically diagnose patient conditions or replace the judgements of health professionals. The COVID-19 pandemic, however, has significantly increased the utilisation of health-oriented chatbots, for instance, as a conversational interface to answer questions, recommend care options, check symptoms and complete tasks such as booking appointments. In this paper, we take a proactive approach and consider how the emergence of task-oriented chatbots as partially automated consulting systems can influence clinical practices and expert–client relationships. We suggest the need for new approaches in professional ethics as the large-scale deployment of artificial intelligence may revolutionise professional decision-making and client–expert interaction in healthcare organisations. We argue that the implementation of chatbots amplifies the project of rationality and automation in clinical practice and alters traditional decision-making practices based on epistemic probability and prudence. This article contributes to the discussion on the ethical challenges posed by chatbots from the perspective of healthcare professional ethics.
Literature
go back to reference Abd-Alrazaq, A., Z. Safi, M. Alajlani, J. Warren, M. Househ, and K. Denecke. 2020. Technical metrics used to evaluate health care chatbots: scoping review. Journal of Medical Internet Research 22 (6): 1–15.CrossRef Abd-Alrazaq, A., Z. Safi, M. Alajlani, J. Warren, M. Househ, and K. Denecke. 2020. Technical metrics used to evaluate health care chatbots: scoping review. Journal of Medical Internet Research 22 (6): 1–15.CrossRef
go back to reference Atique, S., J.R. Bautista, L.J. Block, J.J. Lee, E. Lozada-Perezmitre, R. Nibber, S. O’Connor, L.-M. Peltonen, C. Ronquillo, J. Tayaben, F.J.S. Thilo, and M. Topaz. 2020. A Nursing informatics response to COVID-19: Perspectives from five regions of the world. Journal of Advanced Nursing 76 (10): 2462–2468.CrossRef Atique, S., J.R. Bautista, L.J. Block, J.J. Lee, E. Lozada-Perezmitre, R. Nibber, S. O’Connor, L.-M. Peltonen, C. Ronquillo, J. Tayaben, F.J.S. Thilo, and M. Topaz. 2020. A Nursing informatics response to COVID-19: Perspectives from five regions of the world. Journal of Advanced Nursing 76 (10): 2462–2468.CrossRef
go back to reference Banerjee, A., S.L. Jadhav, and J.S. Bhawalkar. 2009. Probability, clinical decision making and hypothesis testing. Industrial Psychiatry Journal 18 (1): 64–69.CrossRef Banerjee, A., S.L. Jadhav, and J.S. Bhawalkar. 2009. Probability, clinical decision making and hypothesis testing. Industrial Psychiatry Journal 18 (1): 64–69.CrossRef
go back to reference Beil, M., I. Proft, D. van Heerden, S. Sviri, and P.V. van Heerden. 2019. Ethical considerations about artificial intelligence for prognostication in intensive care. Intensive Care Medicine Experimental 7 (1): 70.CrossRef Beil, M., I. Proft, D. van Heerden, S. Sviri, and P.V. van Heerden. 2019. Ethical considerations about artificial intelligence for prognostication in intensive care. Intensive Care Medicine Experimental 7 (1): 70.CrossRef
go back to reference Collins, H., and R. Evans. 2007. Rethinking expertise. Chicago: The University of Chicago Press.CrossRef Collins, H., and R. Evans. 2007. Rethinking expertise. Chicago: The University of Chicago Press.CrossRef
go back to reference Dennis, A.R., A. Kim, M. Rahimi, and S. Ayabakan. 2020. User reactions to COVID-19 screening chatbots from reputable providers. Journal of the American Medical Informatics Association 27 (11): 1727–1731.CrossRef Dennis, A.R., A. Kim, M. Rahimi, and S. Ayabakan. 2020. User reactions to COVID-19 screening chatbots from reputable providers. Journal of the American Medical Informatics Association 27 (11): 1727–1731.CrossRef
go back to reference Erickson, P., J.L. Klein, L. Daston, R. Lemov, T. Sturm, and M.D. Gordin. 2013. How reason almost lost its mind. The strange career of cold war rationality. Chicago: The University of Chicago Press.CrossRef Erickson, P., J.L. Klein, L. Daston, R. Lemov, T. Sturm, and M.D. Gordin. 2013. How reason almost lost its mind. The strange career of cold war rationality. Chicago: The University of Chicago Press.CrossRef
go back to reference Eubanks, V. 2017. Automating inequality. How high-tech tools profile, police, and punish poor. New York: St Martin’s. Eubanks, V. 2017. Automating inequality. How high-tech tools profile, police, and punish poor. New York: St Martin’s.
go back to reference Finn, E. 2017. What algorithms want. Imagination in the age of computing. Cambridge: The MIT Press.CrossRef Finn, E. 2017. What algorithms want. Imagination in the age of computing. Cambridge: The MIT Press.CrossRef
go back to reference Fischer, M. and M. Lam. 2016. From Books to Bots: Using Medical Literature to Create a Chat Bot. IoT of Health '16: Proceedings of the First Workshop on IoT-enabled Healthcare and Wellness Technologies and Systems, 23–28. New York: Association for Computing Machinery. Fischer, M. and M. Lam. 2016. From Books to Bots: Using Medical Literature to Create a Chat Bot. IoT of Health '16: Proceedings of the First Workshop on IoT-enabled Healthcare and Wellness Technologies and Systems, 23–28. New York: Association for Computing Machinery.
go back to reference Galitsky, B. 2019. Developing enterprise chatbots. Learning linguistic structures. Cham: Springer.CrossRef Galitsky, B. 2019. Developing enterprise chatbots. Learning linguistic structures. Cham: Springer.CrossRef
go back to reference Gavaghan, C., A. Knott, J. Maclaurin, J. Zerilli, and J. Liddicoat. 2019. Government use of artificial intelligence in New Zealand. Final Report on Phase 1 of the New Zealand Law Foundation’s Artificial Intelligence and Law in New Zealand Project. Wellington: New Zealand Law Foundation. Gavaghan, C., A. Knott, J. Maclaurin, J. Zerilli, and J. Liddicoat. 2019. Government use of artificial intelligence in New Zealand. Final Report on Phase 1 of the New Zealand Law Foundation’s Artificial Intelligence and Law in New Zealand Project. Wellington: New Zealand Law Foundation.
go back to reference Gentner, T., T. Neitzel, J. Schulze, and R. Buettner. 2020. A Systematic Literature Review of Medical Chatbot Research from a Behavior Change Perspective. 2020 IEEE 44th Annual Computers, Software, and Applications Conference (COMPSAC), 735–740. Los Alamitos: IEEE Computer Society. Gentner, T., T. Neitzel, J. Schulze, and R. Buettner. 2020. A Systematic Literature Review of Medical Chatbot Research from a Behavior Change Perspective. 2020 IEEE 44th Annual Computers, Software, and Applications Conference (COMPSAC), 735–740. Los Alamitos: IEEE Computer Society.
go back to reference Goffey, A. 2008. Algorithm. In Software studies. A Lexicon, ed. M. Fuller, 15–20. Cambridge: The MIT Press. Goffey, A. 2008. Algorithm. In Software studies. A Lexicon, ed. M. Fuller, 15–20. Cambridge: The MIT Press.
go back to reference Golumbia, D. 2009. The cultural logic of computation. Cambridge: Harvard University Press.CrossRef Golumbia, D. 2009. The cultural logic of computation. Cambridge: Harvard University Press.CrossRef
go back to reference Hacking, I. 1975. The emergence of probability: a philosophical study of early ideas about probability, induction and statistical inference. Cambridge: Cambridge University Press. Hacking, I. 1975. The emergence of probability: a philosophical study of early ideas about probability, induction and statistical inference. Cambridge: Cambridge University Press.
go back to reference Harerimana, G., B. Jang, J.W. Kim, and H.K. Park. 2018. Health big data analytics: a technology survey. IEEE Access 6: 65661–65678.CrossRef Harerimana, G., B. Jang, J.W. Kim, and H.K. Park. 2018. Health big data analytics: a technology survey. IEEE Access 6: 65661–65678.CrossRef
go back to reference Hariman, R., ed. 2003. Prudence: classical virtue, postmodern practice. University Park: Pennsylvania State University Press. Hariman, R., ed. 2003. Prudence: classical virtue, postmodern practice. University Park: Pennsylvania State University Press.
go back to reference Heinrichs, J. 2007. Thank you for arguing: what aristotle, lincoln and homer Simpson can teach us about the art of persuasion. New York: Three Rivers Press. Heinrichs, J. 2007. Thank you for arguing: what aristotle, lincoln and homer Simpson can teach us about the art of persuasion. New York: Three Rivers Press.
go back to reference Judson, T.J., A.Y. Odisho, J.J. Young, O. Bigazzi, D. Steuer, R. Gonzales, and A.B. Neinstein. 2020. Implementation of a digital chatbot to screen health system employees during the COVID-19 pandemic. Journal of the American Medical Informatics Association 27 (9): 1450–1455.CrossRef Judson, T.J., A.Y. Odisho, J.J. Young, O. Bigazzi, D. Steuer, R. Gonzales, and A.B. Neinstein. 2020. Implementation of a digital chatbot to screen health system employees during the COVID-19 pandemic. Journal of the American Medical Informatics Association 27 (9): 1450–1455.CrossRef
go back to reference Kaldjian, L.C. 2014. Practicing medicine and ethics: integrating wisdom, conscience, and goals of care. New York: Cambridge University Press.CrossRef Kaldjian, L.C. 2014. Practicing medicine and ethics: integrating wisdom, conscience, and goals of care. New York: Cambridge University Press.CrossRef
go back to reference Lee, J.H., H. Yang, D. Shin, and H. Kim. 2020. Chatbots. ELT Journal 74 (3): 338–344.CrossRef Lee, J.H., H. Yang, D. Shin, and H. Kim. 2020. Chatbots. ELT Journal 74 (3): 338–344.CrossRef
go back to reference McGreevey, J.D., C.W. Hanson, and R. Koppel. 2020. Clinical, legal, and ethical aspects of artificial intelligence-assisted conversational agents in health care. JAMA 324 (6): 552–553.CrossRef McGreevey, J.D., C.W. Hanson, and R. Koppel. 2020. Clinical, legal, and ethical aspects of artificial intelligence-assisted conversational agents in health care. JAMA 324 (6): 552–553.CrossRef
go back to reference Montgomery, K. 2006. How doctors think: clinical judgment and the practice of medicine. Oxford: Oxford University Press. Montgomery, K. 2006. How doctors think: clinical judgment and the practice of medicine. Oxford: Oxford University Press.
go back to reference Morley, J., C.C.V. Machado, C. Burr, J. Cowls, I. Joshi, M. Taddeo, and L. Floridi. 2019. The Debate on the Ethics of AI in Health Care: A Reconstruction and Critical Review (Unpublished). https://philpapers.org/rec/MORTDO-58. Accessed 15 January 2021. Morley, J., C.C.V. Machado, C. Burr, J. Cowls, I. Joshi, M. Taddeo, and L. Floridi. 2019. The Debate on the Ethics of AI in Health Care: A Reconstruction and Critical Review (Unpublished). https://​philpapers.​org/​rec/​MORTDO-58. Accessed 15 January 2021.
go back to reference Nordheim, C.B., A. Følstad, and C.A. Bjørkli. 2019. An initial model of trust in chatbots for customer service—Findings from a questionnaire study. Interacting with Computers 31 (3): 317–335.CrossRef Nordheim, C.B., A. Følstad, and C.A. Bjørkli. 2019. An initial model of trust in chatbots for customer service—Findings from a questionnaire study. Interacting with Computers 31 (3): 317–335.CrossRef
go back to reference Oakley, J., and D. Cocking. 2001. Virtue ethics and professional roles. New York: Cambridge University Press.CrossRef Oakley, J., and D. Cocking. 2001. Virtue ethics and professional roles. New York: Cambridge University Press.CrossRef
go back to reference Palanica, A., P. Flaschner, A. Thommandram, M. Li, and Y. Fossat. 2019. Physicians’ perceptions of chatbots in health care: cross-sectional web-based survey. Journal of Medical Internet Research 21 (4): e12887.CrossRef Palanica, A., P. Flaschner, A. Thommandram, M. Li, and Y. Fossat. 2019. Physicians’ perceptions of chatbots in health care: cross-sectional web-based survey. Journal of Medical Internet Research 21 (4): e12887.CrossRef
go back to reference Pasquale, F. 2020. New laws of robotics. Defending human expertise in the age of AI. Cambridge: Harvard University Press.CrossRef Pasquale, F. 2020. New laws of robotics. Defending human expertise in the age of AI. Cambridge: Harvard University Press.CrossRef
go back to reference Pellegrino, E.D., and D.C. Thomasma. 1993. The virtues in medical practice. Oxford: OUP. Pellegrino, E.D., and D.C. Thomasma. 1993. The virtues in medical practice. Oxford: OUP.
go back to reference Powell, J. 2019. Trust Me, I’m a Chatbot: How artificial intelligence in health care fails the turing test. Journal of Medical Internet Research 21 (10): e16222.CrossRef Powell, J. 2019. Trust Me, I’m a Chatbot: How artificial intelligence in health care fails the turing test. Journal of Medical Internet Research 21 (10): e16222.CrossRef
go back to reference Prior, L. 2003. Belief, knowledge and expertise: The emergence of the lay expert in medical sociology. Sociology of Health & Illness 25: 41–57.CrossRef Prior, L. 2003. Belief, knowledge and expertise: The emergence of the lay expert in medical sociology. Sociology of Health & Illness 25: 41–57.CrossRef
go back to reference Pynnönen, T., K. Rantala, and R. Räsänen. 2020. Kokemuksia Omaolo-palvelusta (Experiences with the Omaolo Service). Bachelor’s thesis. Tampere: Tampere University of Applied Sciences. Pynnönen, T., K. Rantala, and R. Räsänen. 2020. Kokemuksia Omaolo-palvelusta (Experiences with the Omaolo Service). Bachelor’s thesis. Tampere: Tampere University of Applied Sciences.
go back to reference Rigby, M.J. 2019. Ethical dimensions of using artificial intelligence in health care. AMA Journal of Ethics 21 (2): E121-124.CrossRef Rigby, M.J. 2019. Ethical dimensions of using artificial intelligence in health care. AMA Journal of Ethics 21 (2): E121-124.CrossRef
go back to reference Shum, H.-Y., X.-D. He, and D. Li. 2018. From eliza to xiaoice: Challenges and opportunities with social chatbots. Frontiers of Information Technology & Electronic Engineering 19: 10–26.CrossRef Shum, H.-Y., X.-D. He, and D. Li. 2018. From eliza to xiaoice: Challenges and opportunities with social chatbots. Frontiers of Information Technology & Electronic Engineering 19: 10–26.CrossRef
go back to reference Simondon, Gilbert. 2017. On the Mode of Existence of Technical Objects (1958). Trans. C. Malaspina & J. Rogove. Minneapolis: University of Minnesota Press. Simondon, Gilbert. 2017. On the Mode of Existence of Technical Objects (1958). Trans. C. Malaspina & J. Rogove. Minneapolis: University of Minnesota Press.
go back to reference Suarez-Villa, L. 2012. Globalization and technocapitalism. The political economy of corporate power and technological domination. Surrey: Ashgate. Suarez-Villa, L. 2012. Globalization and technocapitalism. The political economy of corporate power and technological domination. Surrey: Ashgate.
go back to reference Tiirinki, H., L.-K. Tynkkynen, M. Sovala, S. Atkins, M. Koivusalo, P. Rautiainen, V. Jormanainen, and I. Keskimäki. 2020. COVID-19 pandemic in Finland—Preliminary analysis on health system response and economic consequences. Health Policy and Technology 9 (4): 649–662.CrossRef Tiirinki, H., L.-K. Tynkkynen, M. Sovala, S. Atkins, M. Koivusalo, P. Rautiainen, V. Jormanainen, and I. Keskimäki. 2020. COVID-19 pandemic in Finland—Preliminary analysis on health system response and economic consequences. Health Policy and Technology 9 (4): 649–662.CrossRef
go back to reference Toon, P. 2014. A flourishing practice? London: Royal College of General Practitioners.CrossRef Toon, P. 2014. A flourishing practice? London: Royal College of General Practitioners.CrossRef
go back to reference Topol, E.J. 2019. Deep medicine. New York: Basic Books. Topol, E.J. 2019. Deep medicine. New York: Basic Books.
go back to reference Wachter, R. 2015. The digital doctor: hope, hype and harm at the dawn of medicine’s computer age. New York: McGraw-Hill Education. Wachter, R. 2015. The digital doctor: hope, hype and harm at the dawn of medicine’s computer age. New York: McGraw-Hill Education.
go back to reference Weizenbaum, J. 1966. ELIZA—A computer program for the study of natural language communication between man and machine. Computational Linguistics 9 (1): 36–45. Weizenbaum, J. 1966. ELIZA—A computer program for the study of natural language communication between man and machine. Computational Linguistics 9 (1): 36–45.
go back to reference Wulff, H.R., S.A. Pedersen, and R. Rosenberg. 1986. Probability and belief. In Philosophy of medicine, ed. H.R. Wulff, S.A. Pedersen, and R. Rosenberg, 89–104. Oxford: Blackwell Scientific Publications. Wulff, H.R., S.A. Pedersen, and R. Rosenberg. 1986. Probability and belief. In Philosophy of medicine, ed. H.R. Wulff, S.A. Pedersen, and R. Rosenberg, 89–104. Oxford: Blackwell Scientific Publications.
go back to reference Zerilli, J., A. Knott, J. Maclaurin, and C. Gavaghan. 2019. Algorithmic decision-making and the control problem. Minds and Machines 29 (4): 555–578.CrossRef Zerilli, J., A. Knott, J. Maclaurin, and C. Gavaghan. 2019. Algorithmic decision-making and the control problem. Minds and Machines 29 (4): 555–578.CrossRef
go back to reference Zhou, J., S.Z. Arshad, S. Luo, and F. Chen. 2017. Effects of uncertainty and cognitive load on user trust in predictive decision making. In Human-computer interaction—INTERACT 2017, ed. R. Bernhaupt, G. Dalvi, A. Joshi, D.K. Balkrishan, J. O’Neill, and M. Winckler, 23–39. Cham: Springer.CrossRef Zhou, J., S.Z. Arshad, S. Luo, and F. Chen. 2017. Effects of uncertainty and cognitive load on user trust in predictive decision making. In Human-computer interaction—INTERACT 2017, ed. R. Bernhaupt, G. Dalvi, A. Joshi, D.K. Balkrishan, J. O’Neill, and M. Winckler, 23–39. Cham: Springer.CrossRef
Metadata
Title
Chatbot breakthrough in the 2020s? An ethical reflection on the trend of automated consultations in health care
Authors
Jaana Parviainen
Juho Rantala
Publication date
01-03-2022
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy / Issue 1/2022
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-021-10049-w

Other articles of this Issue 1/2022

Medicine, Health Care and Philosophy 1/2022 Go to the issue