Humanizing AI in Health: the ethics challenges Outcomes of stakeholder engagements in India

Background Responding to rapid developments in Artificial Intelligence and Machine Learning and the deployment of its applications in healthcare in India, the Indian Council of Medical Research (ICMR) published Guidelines on the Ethical Use of AI in Biomedical Research and Healthcare in March 2023. We conducted stakeholder engagements to understand the challenges inherent in putting guidelines and policy into practice. Methods Two stakeholder workshops were convened - one in-person, where 22 participants discussed the ethical dilemmas of applying AI to health and health research, using 6 case studies or real-life scenarios, and a virtual one with 27 participants that focussed on the future of bioethics and AI in health. Outcomes Key elements emerged from the deliberations, as core prerequisites to enable ethical AI in health research and healthcare in the Indian context. Not in an order of priority or importance, they were: 1. Better data systems, to strengthen data quality, fidelity, storage and oversight, 2. User participation in AI development from the start and strengthening of frontline workers to critically engage with AI, 3. Capacity building of (a) technology developers, computational scientists and other non-health collaborators in ethics and AI, (b) health professionals, (c) Ethics Committees and regulators, to critically engage with AI 4. Strengthen organizational values to centre equity and justice at all stages of AI application design and deployment, 5. Civic engagement in health, research, technology, and bioethics to help hold all players accountable and safeguard public interest. Conclusion Ethical and responsible AI in health and health research in the Indian context requires prioritizing and strengthening the ethics oversight capacity from academia to industry to regulatory bodies with constant communication, public engagement and transparency to ensure the lessons from practice are fed back into policy and governance systems.