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The increasing implementation of and reliance on machine-learning (ML) algorithms to perform tasks, deliver services and make decisions in health and healthcare have made the need for fairness in ML, and more specifically in healthcare ML algorithms (HMLA), a very important and urgent task. However, while the debate on fairness in the ethics of artificial intelligence (AI) and in HMLA has grown significantly over the last decade, the very concept of fairness as an ethical value has not yet been sufficiently explored. Our paper aims to fill this gap and address the AI ethics principle of fairness from a conceptual standpoint, drawing insights from accounts of fairness elaborated in moral philosophy and using them to conceptualise fairness as an ethical value and to redefine fairness in HMLA accordingly. To achieve our goal, following a first section aimed at clarifying the background, methodology and structure of the paper, in the second section, we provide an overview of the discussion of the AI ethics principle of fairness in HMLA and show that the concept of fairness underlying this debate is framed in purely distributive terms and overlaps with non-discrimination, which is defined in turn as the absence of biases. After showing that this framing is inadequate, in the third section, we pursue an ethical inquiry into the concept of fairness and argue that fairness ought to be conceived of as an ethical value. Following a clarification of the relationship between fairness and non-discrimination, we show that the two do not overlap and that fairness requires much more than just non-discrimination. Moreover, we highlight that fairness not only has a distributive but also a socio-relational dimension. Finally, we pinpoint the constitutive components of fairness. In doing so, we base our arguments on a renewed reflection on the concept of respect, which goes beyond the idea of equal respect to include respect for individual persons. In the fourth section, we analyse the implications of our conceptual redefinition of fairness as an ethical value in the discussion of fairness in HMLA. Here, we claim that fairness requires more than non-discrimination and the absence of biases as well as more than just distribution; it needs to ensure that HMLA respects persons both as persons and as particular individuals. Finally, in the fifth section, we sketch some broader implications and show how our inquiry can contribute to making HMLA and, more generally, AI promote the social good and a fairer society. [ABSTRACT FROM AUTHOR]

In Homo Deus, Yuval Noah Harari argues that technological advances of the twenty-first century will usher in a significant shift in how humans make important life decisions. Instead of turning to the Bible or the Quran, to the heart or to our therapists, parents, and mentors, people will turn to Big Data recommendation algorithms to make these choices for them. Much as we rely on Spotify to recommend music to us, we will soon rely on algorithms to decide our careers, spouses, and commitments. Harari also predicts that next, the state will take away individuals’ rights to make their own choices about their lives. If Google knows where your children would flourish best in school, why should the state allow a fallible human parent to decide? Liberalism—which, as Harari uses this term, refers to a state of society in which human freedom to choose is respected and championed—will collapse. In this paper, I argue that Harari’s conception of the future implications of recommendation algorithms is deeply flawed, for two reasons. First, users will not rely on algorithms to make decisions for them because they have no reason to trust algorithms, which are developed by companies with their own incentives, such as profit. Second, for most of our life decisions, algorithms will not be able to be developed, because the factors relevant to the decisions we face are unique to our situation. I present an alternative depiction of the future: instead of relying on algorithms to make decisions for us, humans will use algorithms to enhance our decision-making by helping us consider the most relevant choices first and notice information we might not otherwise. Finally, I will also argue that even if computers could make many of our decisions for us, liberalism as a political system would emerge unscathed. [ABSTRACT FROM AUTHOR]