{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T12:49:45Z","timestamp":1782132585806,"version":"3.54.5"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001230","name":"Macquarie University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001230","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["AI Ethics"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The release of Generative AI and its availability to the general population was a game changer. Making Generative AI accessible to members of the public opened up knowledge that was previously guarded by experts. As a result, Generative AI is changing the relationship between AI, patient and clinicians. Ethics guidelines issued by governments lay out what should be considered when implementing AI-enabled healthcare. However, how these guidelines are implemented matters. This perspective reflects on the complexity of the task, and how to go about it. Systems Thinking is a well-suited discipline to the task of implementing AI-enabled healthcare and involves participatory processes. However, given the financial and epistemic power imbalance between the AI technology owners and its users, there is a need for strong stewardship of the process. First Nations of Australia cultural processes offer possible guidance about how to enact this stewardship.<\/jats:p>","DOI":"10.1007\/s43681-026-01155-7","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T08:03:29Z","timestamp":1778573009000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From the what to the how: why the stewardship of ethics implementation in AI healthcare matters"],"prefix":"10.1007","volume":"6","author":[{"given":"Magali","family":"Goirand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Austin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Clay-Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"1155_CR1","doi-asserted-by":"publisher","DOI":"10.3390\/life14050557","author":"R Hirani","year":"2024","unstructured":"Hirani, R., Noruzi, K., Khuram, H., et al.: Artificial intelligence and healthcare: a journey through history, present innovations, and future possibilities. Life (2024). https:\/\/doi.org\/10.3390\/life14050557","journal-title":"Life"},{"issue":"1","key":"1155_CR2","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","volume":"25","author":"EJ Topol","year":"2019","unstructured":"Topol, E.J.: High-performance medicine: the convergence of human and artificial intelligence. Nat. Med. 25(1), 44\u201356 (2019)","journal-title":"Nat. Med."},{"issue":"1","key":"1155_CR3","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.70312","volume":"8","author":"M Faiyazuddin","year":"2025","unstructured":"Faiyazuddin, M., Rahman, S.J.Q., Anand, G., et al.: The impact of artificial intelligence on healthcare: a comprehensive review of advancements in diagnostics, treatment, and operational efficiency. Health Sci. Rep. 8(1), e70312 (2025)","journal-title":"Health Sci. Rep."},{"key":"1155_CR4","unstructured":"A.R. Consulting. AI in Healthcare Market is forecasted to Reach USD 427.5 Billion by 2032, growing at a CAGR of 44.0% Over the Forecast Period 2023 to 2032. 2023 [cited 2025 22 December 2025]; Available from: https:\/\/www.globenewswire.com\/news-release\/2023\/10\/10\/2757664\/0\/en\/AI-in-Healthcare-Market-is-forecasted-to-Reach-USD-427-5-Billion-by-2032-growing-at-a-CAGR-of-44-0-Over-the-Forecast-Period-2023-to-2032.html."},{"issue":"11","key":"1155_CR5","doi-asserted-by":"publisher","first-page":"664","DOI":"10.5694\/mja2.70057","volume":"223","author":"IA Scott","year":"2025","unstructured":"Scott, I.A., Reddy, S., Kelly, T., Miller, T., Vegt, A.: Using generative artificial intelligence in clinical practice: a narrative review and proposed agenda for implementation. Med. J. Aust. 223(11), 664\u2013672 (2025)","journal-title":"Med. J. Aust."},{"issue":"6464","key":"1155_CR6","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1126\/science.aax2342","volume":"366","author":"Z Obermeyer","year":"2019","unstructured":"Obermeyer, Z., Powers, B., Vogeli, C., Mullainathan, S.: Dissecting racial bias in an algorithm used to manage the health of populations. Science 366(6464), 447\u2013453 (2019)","journal-title":"Science"},{"issue":"12","key":"1155_CR7","doi-asserted-by":"publisher","first-page":"866","DOI":"10.7326\/M18-1990","volume":"169","author":"A Rajkomar","year":"2018","unstructured":"Rajkomar, A., Hardt, M., Howell, M.D., Corrado, G., Chin, M.H.: Ensuring fairness in machine learning to advance health equity. Ann. Intern. Med. 169(12), 866\u2013872 (2018)","journal-title":"Ann. Intern. Med."},{"key":"1155_CR8","unstructured":"The Ethics and Research Integrity Sector, Ethics by Design and Ethics of Use Approaches for Artificial Intelligence. 2021, DG Research and Innovation."},{"issue":"1","key":"1155_CR9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjhci-2024-101102","volume":"31","author":"CR Blease","year":"2024","unstructured":"Blease, C.R., Locher, C., Gaab, J., H\u00e4gglund, M., Mandl, K.D.: Generative artificial intelligence in primary care: an online survey of UK general practitioners. BMJ Health Care Inform. 31(1), e101102 (2024)","journal-title":"BMJ Health Care Inform."},{"key":"1155_CR10","volume-title":"60% of Americans Would be Uncomfortable with Provider Relying on AI in Their Own Health Care","author":"A Tyson","year":"2023","unstructured":"Tyson, A., Pasquini, G., Spencer, A., Funk, C.: 60% of Americans Would be Uncomfortable with Provider Relying on AI in Their Own Health Care. Pew Research Center (2023)"},{"issue":"4","key":"1155_CR11","doi-asserted-by":"publisher","first-page":"210","DOI":"10.5694\/mja2.52598","volume":"222","author":"J Ayre","year":"2025","unstructured":"Ayre, J., Cvejic, E., McCaffery, K.J.: Use of ChatGPT to obtain health information in Australia, 2024: insights from a nationally representative survey. Med. J. Aust. 222(4), 210\u2013212 (2025)","journal-title":"Med. J. Aust."},{"key":"1155_CR12","unstructured":"M. Presiado, A. Montero, L. Lopes, and L. Hamel. KFF Health Misinformation Tracking Poll: Artificial Intelligence and Health Information. 2025 [cited 2025 19\/12\/2025]; Available from: https:\/\/www.kff.org\/public-opinion\/kff-health-misinformation-tracking-poll-artificial-intelligence-and-health-information\/."},{"key":"1155_CR13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2025-085325","volume":"391","author":"D Fraile Navarro","year":"2025","unstructured":"Fraile Navarro, D., Lewis, M., Blease, C., et al.: Generative AI and the changing dynamics of clinical consultations. BMJ 391, e085325 (2025)","journal-title":"BMJ"},{"key":"1155_CR14","volume-title":"Ethical, Social, and Political Challenges of Artificial Intelligence in Health: a Report with Wellcome Trust","author":"M Fenech","year":"2018","unstructured":"Fenech, M., Strukelj, N., Buston, O.: Ethical, Social, and Political Challenges of Artificial Intelligence in Health: a Report with Wellcome Trust. Future Advocacy (2018)"},{"key":"1155_CR15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0288448","author":"M Goirand","year":"2023","unstructured":"Goirand, M., Austin, E., Clay-Williams, R.: Mapping the flow of knowledge as guidance for ethics implementation in medical AI: a qualitative study. PLoS ONE (2023). https:\/\/doi.org\/10.1371\/journal.pone.0288448","journal-title":"PLoS ONE"},{"key":"1155_CR16","doi-asserted-by":"publisher","DOI":"10.1016\/j.clsr.2025.106163","volume":"58","author":"CL Saw","year":"2025","unstructured":"Saw, C.L., Tan, B.Z.Y.: Unpacking copyright infringement issues in the GenAI development lifecycle and a peek into the future. Comput. Law Secur. Rev. 58, 106163 (2025)","journal-title":"Comput. Law Secur. Rev."},{"issue":"6","key":"1155_CR17","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1093\/bib\/bbx044","volume":"19","author":"R Miotto","year":"2018","unstructured":"Miotto, R., Wang, F., Wang, S., Jiang, X., Dudley, J.T.: Deep learning for healthcare: review, opportunities and challenges. Brief. Bioinform. 19(6), 1236\u20131246 (2018)","journal-title":"Brief. Bioinform."},{"issue":"4","key":"1155_CR18","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s12553-017-0179-1","volume":"7","author":"J Powles","year":"2017","unstructured":"Powles, J., Hodson, H.: Google DeepMind and healthcare in an age of algorithms. Health Technol. 7(4), 351\u2013367 (2017)","journal-title":"Health Technol."},{"issue":"4\u20135","key":"1155_CR19","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1177\/1367549415584857","volume":"18","author":"K Crawford","year":"2015","unstructured":"Crawford, K., Lingel, J., Karppi, T.: Our metrics, ourselves: a hundred years of self-tracking from the weight scale to the wrist wearable device. Eur. J. Cult. Stud. 18(4\u20135), 479\u2013496 (2015)","journal-title":"Eur. J. Cult. Stud."},{"key":"1155_CR20","volume-title":"Teenager died after asking ChatGPT for \u2018most successful\u2019 way to take his life, inquest told","author":"N Badshah","year":"2026","unstructured":"Badshah, N.: Teenager died after asking ChatGPT for \u2018most successful\u2019 way to take his life, inquest told. The Guardian (2026)"},{"key":"1155_CR21","volume-title":"Parents of teenager who took his own life sue OpenAI","author":"N Yousif","year":"2025","unstructured":"Yousif, N.: Parents of teenager who took his own life sue OpenAI. BBC (2025)"},{"key":"1155_CR22","unstructured":"AI Psychological Research Coalition. [cited 2026 16 April 2026]; Available from: https:\/\/aiprc.org"},{"key":"1155_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.tics.2026.01.003","author":"Z Sourati","year":"2026","unstructured":"Sourati, Z., Ziabari, A.S., Dehghani, M.: The homogenizing effect of large language models on human expression and thought. Trends Cognit. Sci. (2026). https:\/\/doi.org\/10.1016\/j.tics.2026.01.003","journal-title":"Trends Cognit. Sci."},{"key":"1155_CR24","unstructured":"B. Perrigo, Exclusive: OpenAI used Kenyan workers on less than $2 per hour to make ChatGPT less toxic, in Time Magalzine. 2023"},{"key":"1155_CR25","unstructured":"Safe and Responsible Artificial Intelligence in Health Care\u2014Legislation and Regulation Review. 2025, Australia Government, Department of Health, Disability and Ageing"},{"key":"1155_CR26","unstructured":"Australian Commission on Safety and Quality in Health Care, AI Clinical Use Guide. 2025, Australian Government Department of Health, Disability and Ageing"},{"issue":"5","key":"1155_CR27","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s11948-021-00336-3","volume":"27","author":"M Goirand","year":"2021","unstructured":"Goirand, M., Austin, E., Clay-Williams, R.: Implementing ethics in healthcare AI-based applications: a scoping review. Sci. Eng. Ethics 27(5), 61 (2021)","journal-title":"Sci. Eng. Ethics"},{"key":"1155_CR28","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/978-981-15-0720-5_7","volume-title":"Handbook of Systems Sciences","author":"G Midgley","year":"2021","unstructured":"Midgley, G., Rajagopalan, R.: Critical systems thinking, systemic intervention and beyond. In: Metcalf, G.S., Kijima, K., Deguchi, H. (eds.) Handbook of Systems Sciences, pp. 107\u2013157. Springer Publishing Company, New York (2021)"},{"issue":"1-2","key":"1155_CR29","first-page":"190","volume":"13","author":"WR Ashby","year":"2011","unstructured":"Ashby, W.R.: Variety, constraint, and the law of requisite variety. Emergence (Mahwah, N.J.) 13(1\u20132), 190\u2013207 (2011)","journal-title":"Emergence (Mahwah, N.J.)"},{"key":"1155_CR30","volume-title":"The Systems Approach. A Delta Book","author":"CW Churchman","year":"1979","unstructured":"Churchman, C.W.: The Systems Approach. A Delta Book. Dell, New York (1979)"},{"key":"1155_CR31","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/978-1-4471-7472-1_6","volume-title":"Systems Approaches to Making Change: a Practical Guide","author":"W Ulrich","year":"2020","unstructured":"Ulrich, W., Reynolds, M.: Critical Systems Heuristics: the idea and practice of boundary critique. In: Reynolds, M., Holwell, S. (eds.) Systems Approaches to Making Change: a Practical Guide, pp. 255\u2013306. Springer, London, London (2020)"},{"key":"1155_CR32","unstructured":"AH&MRC.: NSW Aboriginal Health Ethics Guidelines: Key Principles. 2023."},{"issue":"1","key":"1155_CR33","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1007\/s43681-025-00879-2","volume":"6","author":"M Maldonado","year":"2025","unstructured":"Maldonado, M., C\u00f3rdova-Pintado, D.: Indigenous ethics and artificial intelligence. A.I. Ethics 6(1), 70 (2025)","journal-title":"A.I. Ethics"},{"key":"1155_CR34","unstructured":"PwC. PwC\u2019s 2025 US Healthcare Consumer Insights Survey: The consumer-first era of health. 2025 2025 [cited 2025 22 December 2025]; Available from: https:\/\/www.pwc.com\/us\/en\/industries\/health-industries\/library\/healthcare-consumer-insights-survey.html."},{"key":"1155_CR35","volume-title":"Science, Order, And Creativity","author":"D Bohm","year":"2000","unstructured":"Bohm, D., Peat, F.D.: Science, Order, And Creativity, 2nd ed. Routledge, London (2000)","edition":"2nd ed."}],"container-title":["AI and Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43681-026-01155-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43681-026-01155-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43681-026-01155-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T12:07:09Z","timestamp":1782130029000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43681-026-01155-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["1155"],"URL":"https:\/\/doi.org\/10.1007\/s43681-026-01155-7","relation":{},"ISSN":["2730-5953","2730-5961"],"issn-type":[{"value":"2730-5953","type":"print"},{"value":"2730-5961","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]},"assertion":[{"value":"21 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"297"}}