Many ethical concerns have been voiced about Clinical Decision Support Systems (CDSSs). Special attention has been paid to the effect of CDSSs on autonomy, responsibility, fairness and transparency. This journal has featured a discussion between Rosalind McDougall and Ezio Di Nucci that focused on the impact of IBM’s Watson for Oncology (Watson) on autonomy. The present article elaborates on this discussion in three ways. First, using Jonathan Pugh’s account of rational autonomy we show that how Watson presents its results might impact decisional autonomy, while how Watson produces knowledge might affect practical autonomy. Second, by drawing an analogy with patient decision aids we identify an empirical way of estimating Watson’s impact on autonomy (ie, value-congruence). Lastly, McDougall introduced the notion of value-flexible design as a way to account for the diverging preferences patients hold. We will clarify its relation with the established domain of value-sensitive design. In terms of the tripartite methodology of value-sensitive design, we offer a conceptual clarification using Pugh’s account of rational autonomy, an empirical tool to evaluate Watson’s impact on autonomy and situate a group of technical options to incorporate autonomy in Watson’s design.
- clinical ethics
Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study.
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Contributors JD drafted the work. HM revised it critically for important intellectual content. Both authors approved the final version and agree to be accountable for all aspects of the work.
Funding This research was made possible by grant BOFSTG2020002501 of Ghent University’s Special Research Fund.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.