Improving the Selection of Patients for High-Risk Surgery: The Ethical Use of Artificial Intelligence

Patient selection for complex surgery is as much an ethical as a scientific undertaking. Surgeons must balance doing good with avoiding unnecessary harm, and prioritize the patient’s own values and preferences. Objective surgical risk calculators have been developed to improve on individual subjective surgical judgment which might be subject to underestimates of benefit, and overestimates of risk. However, these tools lack personalization and do not fully take into account factors that might influence risk, such as surgeon and hospital volume. Artificial Intelligence (AI) offers an opportunity to significantly improve how patients are selected for major surgery by offering highly personalized and objective predictions. However, AI is not without its own ethical concerns. This chapter addresses the current ways in which surgeons select patients for major surgery, the improvements offered by AI, and the ethical concerns which are raised when AI is used to make surgical predictions.