May 2024

For example, a screening test for detecting Hepatitis C

Background:

Recently, the revolution of Artificial Intelligence (AI) and CHAT GPT has entered our lives, and healthcare systems around the world have already begun to implement smart algorithms based on machine learning for various purposes.

There is no doubt that the use of such systems can assist physicians, reduce bureaucracy, decrease inequality, identify at-risk patients, and even save lives. However, vigilance is necessary, as improper application of advanced technologies could undermine the ethical principles of medicine.

In recent years, with the advent of medications capable of curing patients with Hepatitis C, a national program for identifying carriers of this viral infection was launched in Israel. One of the health maintenance organizations in Israel has introduced an AI-based tool that identifies individuals at risk and automatically updates a referral in the fund’s systems, so that the next time the patient has a blood test, a Hepatitis C test will also be conducted. This referral is updated in the system without informing the patient and without the ability of the treating doctor to approve or cancel the test.

The Ethics Office debated whether the fact that this test could save lives outweighs the principles of patient autonomy and the fact that the test is conducted without the treating doctor’s discretion. Following this discussion, the following position paper was drafted:

Position Paper:

1. The use of new technologies in general, and Artificial Intelligence (AI) in particular, can assist physicians, reduce bureaucracy, decrease inequality, identify at-risk populations, and even save lives. Therefore, the use of new technologies should be encouraged, provided that their effectiveness and safety are scientifically proven.
2. Vigilance must be maintained to ensure that these technologies do not compromise medical ethics.
3. AI and machine learning systems in healthcare should serve as decision-support tools and should not replace the physician’s judgment.

As part of the principle of autonomy, patients have the right to participate in decisions regarding the medical treatment they receive. Therefore, referrals for laboratory tests, imaging studies, or any other ancillary tests, without obtaining the patient's consent or the discretion of the treating physician, are unethical and should be prevented.