Extrinsic Trust as a Contractual Framework for Accountable AI in Health Care: Viewpoint
Abstract
Unlabelled: Artificial intelligence (AI) promises efficiency and equity in health care. However, adoption remains fragmented due to weak foundations of trust. This Viewpoint highlights the gap between intrinsic trust, based on interpretability, and extrinsic trust, based on functional validation. We propose a contractual framework between AI systems and users defined by 3 promises: reliability, scope and equity, and shift and uncertainty. Illustrated through a vignette, we show how health systems can operationalize these promises through structured evidence and governance, translating trustworthy AI into accountable clinical deployment.
Fields of Study & Subjects
Artificial Intelligence in Healthcare and Education
Ethics and Social Impacts of AI
Explainable Artificial Intelligence (XAI)
Publication details
- Journal / source
- Journal of Medical Internet Research
- Volume
- 28
- Pages
- e83903–e83903
- Publication date
- 4 February 2026
- Language
- EN