Incorporating artificial intelligence (AI) in gastrointestinal surgery poses many ethical questions that have yet to be addressed, according to Heather Evans, MD, MS, professor at the Medical University of South Carolina, who is presenting on the topic at Digestive Disease Week^® (DDW) 2023.

“The ability to see patterns in data and understand relationships can guide us in surgical decision-making,” she said. “We currently rely on humans to determine who gets an operation, what operation they get and how we follow them after surgery. Incorporating AI into these decisions has the potential to impact every part of surgical care.”

Dr. Evans outlined several ethical considerations for incorporating AI into surgical care.

Administering informed consent.

AI uses massive amounts of patient data to create algorithms as an aid for decision-making. “If we are going to use AI, we have to be transparent and address our desire to optimize care using something other than a human being,” Dr. Evans said. “We also need to consider what it means when a patient consents for their data to be used. Consenting to an operation is typically confined to a prescribed point in time. But consenting for your data to be used is not. If we extend consent to include future use of a patient’s data, is it even possible to imagine how that data could be used in the future?”

Ensuring data privacy and security.

There have been non-medical examples of companies acquiring user data and using them for a purpose for which they did not originally provide consent. This would be a risk for medical data as well.

Bias within AI algorithms.

Algorithms are only as good as the data used to create them. There have been examples in the medical field of minority populations being negatively impacted by algorithms that do not accurately reflect the patient population. Representation within AI datasets is therefore critical. Algorithms must also take into account the fact that data might be collected differently or be less complete for certain patient populations.

Accountability.

Institutions must address how to determine who should be held responsible if something goes wrong during surgery. “We’ve always thought of the surgeon as responsible for an operation,” Dr. Evans said. “What happens if you follow the algorithm and the patient dies? Who should be held accountable? And who is providing oversight to monitor, correct and amend algorithms?”

Impact on surgeon/patient relationships.

“How we apply AI may impact how surgeons feel about their relationship with patients,” she said. “The human element is such an essential part of what it is to be a surgeon and to receive surgical care. This long-term acknowledgment of the deep human connection must remain for us to be able to ethically apply these methods.”

As the field navigates the incorporation of AI, “Surgeons must be careful about adopting any AI technology they don’t understand,” she said. “We have a responsibility to stay involved and direct how AI is implemented, or we will have no influence on how to maintain these ethical guardrails in the development, implementation and monitoring of these systems.”

She encouraged surgeons to do the following:

• Educate yourself. You don’t need a mathematics degree or deep understanding of statistics to acquire a basic understanding of AI methods. Surgeons have a responsibility to be able to communicate with those creating AI algorithms who don’t understand the clinical applications.

• Get involved in your institution. Surgeons can join advisory groups and committees at their institution to help make decisions on how new tools will be implemented.

• Build relationships with industry. Working with industry often carries a stigma, but Dr. Evans asserted that this is one of the key ways for surgeons to have influence.

Dr. Evans’ oral presentation, “Issues with ethics and AI in GI surgery” on Tuesday, May 9, at 11 a.m. CDT is part of the session “SSAT Panel VI: AI and GI Surgery: The Path Forward.”