Ethical Considerations of Using Machine Learning for Decision Support in Occupational Health: An Example Involving Periodic Workers' Health Assessments.

Purpose Computer algorithms and Machine Learning (ML) will be integrated into clinical decision support within occupational health care. This will change the interaction between health care professionals and their clients, with unknown consequences. The aim of this study was to explore ethical considerations and potential consequences of using ML based decision support tools (DSTs) in the context of occupational health. Methods We conducted an ethical deliberation. This was supported by a narrative literature review of publications about ML and DSTs in occupational health and by an assessment of the potential impact of ML-DSTs according to frameworks from medical ethics and philosophy of technology. We introduce a hypothetical clinical scenario from a workers' health assessment to reflect on biomedical ethical principles: respect for autonomy, beneficence, non-maleficence and justice. Results Respect for autonomy is affected by uncertainty about what future consequences the worker is consenting to as a result of the fluctuating nature of ML-DSTs and validity evidence used to inform the worker. A beneficent advisory process is influenced because the three elements of evidence based practice are affected through use of a ML-DST. The principle of non-maleficence is challenged by the balance between group-level benefits and individual harm, the vulnerability of the worker in the occupational context, and the possibility of function creep. Justice might be empowered when the ML-DST is valid, but profiling and discrimination are potential risks. Conclusions Implications of ethical considerations have been described for the socially responsible design of ML-DSTs. Three recommendations were provided to minimize undesirable adverse effects of the development and implementation of ML-DSTs.

The Care of Our Hybrid Selves: Ethics in Times of Technical Mediation.

What can the art of living after Foucault contribute to ethics in relation to the mediation of human existence by technology? To develop the relation between technical mediation and ethics, firstly the theme of technical mediation is elaborated in line with Foucault's notion of ethical problematization. Every view of what technology does to us at the same time expresses an ethical concern about technology. The contemporary conception of technical mediation tends towards the acknowledgement of ongoing hybridization, not ultimately good or bad but ambivalent, which means for us the challenge of taking care of ourselves as hybrid beings. Secondly, the work of Foucault provides elements for imagining this care for our hybrid selves, notably his notions of freedom as a practice and of the care of the self. A conclusions about technical mediation and ethics is that whereas the approaches of the delegation of morality to technology by Latour and mediated morality by Verbeek see technical mediation of behavior and moral outlook as an answer in ethics, this should rather be considered the problem that ethics is about.

The Uses of Reason in Times of Technical Mediation.

The art of living idiom suits well a practice-oriented approach in ethics of technology. But what remains or becomes of the functioning and use of reason in ethics? In reaction to the comments by Huijer this reply elaborates in more detail how Foucault's art of living can be adapted for a critical contemporary ethics of technology. And the aesthetic-political rationality in Foucault's ethics is compared with Wellner's suggestions of holding on to the notion of code but with a new meaning. Foucault's fourfold scheme of subjectivation and a distinction of "below and above reason" structure the argument.

Design for Usability; practice-oriented research for user-centered product design.

The Design for Usability project aims at improving the usability of electronic professional and consumer products by creating new methodology and methods for user-centred product development, which are feasible to apply in practice. The project was focused on 5 key areas: (i) design methodology, expanding the existing approach of scenario-based design to incorporate the interaction between product design, user characteristics, and user behaviour; (ii) company processes, barriers and enablers for usability in practice; (iii) user characteristics in relation to types of products and use-situations; (iv) usability decision-making; and (v) product impact on user behaviour. The project team developed methods and techniques in each of these areas to support the design of products with a high level of usability. This paper brings together and summarizes the findings.