Case 4. AI Diagnostic Error and Physician Responsibility

1. What is the clinical situation?

A physician uses an artificial intelligence–based diagnostic tool to assist in interpreting imaging results. The system suggests a low likelihood of serious disease, and the physician relies on this recommendation. As a result, further testing is delayed. The patient’s condition later worsens, and it becomes clear that an earlier diagnosis could have significantly improved the outcome.

The AI system was approved for clinical use and widely adopted, but its internal decision-making process is not fully transparent to clinicians.

2. What are the ethical issues?

This case raises ethical questions about responsibility when technology influences medical decisions. While AI systems can improve efficiency and accuracy, they may also create overreliance and reduce critical scrutiny. The ethical issue centers on whether responsibility lies with the physician, the technology developer, the institution, or the system itself.

Another concern is whether patients can truly give informed consent when AI tools are involved in their care but are not fully explainable.

3. Who is affected?

The patient is directly affected by delayed diagnosis and harm. Physicians are affected as decision makers who must balance trust in technology with professional judgment. Healthcare institutions, technology companies, and regulators are also implicated, as their policies and designs shape how AI tools are used in clinical practice.

4. What options exist?

Physicians may rely heavily on AI recommendations, treating them as authoritative. Alternatively, they may use AI only as a supplementary tool while maintaining independent clinical judgment. Institutions may restrict AI use or require additional oversight. Each option involves trade-offs between efficiency, accuracy, and accountability.

5. What decision is ethically justifiable?

Maintaining physician responsibility for final clinical decisions is ethically justifiable, even when AI tools are involved. While AI can support medical judgment, it cannot replace the physician’s obligation to critically evaluate recommendations and consider the patient’s unique context. Ethical practice requires that physicians remain accountable for decisions and transparent with patients about the role of technology in their care.

Reflection

This case illustrates that technological advancement does not eliminate ethical responsibility, but instead reshapes it. As AI becomes more integrated into medicine, physicians must learn not only how to use these tools, but how to question them. For future physicians, this case emphasizes that judgment, accountability, and human oversight remain essential, even in an increasingly automated healthcare system.