{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T09:02:47Z","timestamp":1763456567135,"version":"3.41.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4t Augsburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Digit. Soc."],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>The statement \u201cDecision Support in Medical Practice through Artificial Intelligence,\u201d (German: \u201cEntscheidungsunterst\u00fctzung \u00e4rztlicher T\u00e4tigkeit durch K\u00fcnstliche Intelligenz\u201d) by the Central Ethics Commission at the German Medical Association critically evaluates the implementation of Clinical Decision Support Systems (CDSS) from medical, ethical, and legal standpoints. While the statement highlights numerous advantages and challenges inherent in the use of AI in healthcare, it remains vague, particularly concerning the assignment of accountability, the delineation of professional responsibility, and the technical feasibility of integrating these systems in real-world clinical workflows. In the present paper, we scrutinize the statement from both philosophical and technical angles, offering concrete proposals aimed at clarifying the ethical ambiguities while also addressing the technological constraints that currently impede widespread adoption. By doing so, we aim to critically evaluate the governmental document against practical realities and bridge the gap between theoretical possibilities and practical applicability, thereby fostering a more nuanced and responsible use of AI in contemporary medical practice.<\/jats:p>","DOI":"10.1007\/s44206-025-00175-w","type":"journal-article","created":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T10:51:33Z","timestamp":1741258293000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Decision Support Systems at the Intersection of Technology and Ethics: A Critical Analysis of the Ethical Guidelines Issued by the German Medical Association"],"prefix":"10.1007","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1985-1642","authenticated-orcid":false,"given":"Paula","family":"Ziethmann","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6253-230X","authenticated-orcid":false,"given":"Miriam","family":"Elia","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3827-9809","authenticated-orcid":false,"given":"Fabian","family":"Stieler","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7931-1105","authenticated-orcid":false,"given":"Bernhard","family":"Bauer","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6099-7418","authenticated-orcid":false,"given":"Julia","family":"Welzel","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6957-9549","authenticated-orcid":false,"given":"Kerstin","family":"Schl\u00f6gl-Flierl","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2025,3,6]]},"reference":[{"key":"175_CR1","unstructured":"Bayerische Landes\u00e4rtzekammer. (2018). Medizinische Informatik. February 13, 2023, from https:\/\/www.blaek.de\/weiterbildung\/qualifikationen-nach-der-weiterbildungsordnung\/medizinische-informatik"},{"key":"175_CR3","doi-asserted-by":"publisher","first-page":"2051","DOI":"10.1007\/s11948-019-00146-8","volume":"26","author":"M. Coeckelbergh","year":"2020","unstructured":"Coeckelbergh, M. (2020). Artificial Intelligence, responsibility attribution, and a relational justification of explainability. Science and Engineering Ethics, 26, 2051\u20132068. https:\/\/doi.org\/10.1007\/s11948-019-00146-8","journal-title":"Science and Engineering Ethics"},{"key":"175_CR4","unstructured":"Deutsche Krankenhausgesellschaft. (2019). Qualit\u00e4t und Patientensicherheit. Positionen der Deutschen. Krankenhausgesellschaft. Resource document. Retrieved December 8, 2022, from https:\/\/www.dkgev.de\/fileadmin\/default\/Mediapool\/2_Themen\/2.6._Qualitaet_Hygiene_und_Sicherheit\/DKG_Qualitaet-Sicherheit_Positionen.pdf"},{"key":"175_CR6","unstructured":"German Ethics Council. (2017). Big Data und Gesundheit \u2013 Datensouver\u00e4nit\u00e4t als informationelle Freiheitsgestaltung. Retrieved October 1, 2024 from https:\/\/www.ethikrat.org\/fileadmin\/Publikationen\/Stellungnahmen\/deutsch\/stellungnahme-big-data-und-gesundheit.pdf"},{"issue":"9","key":"175_CR8","doi-asserted-by":"publisher","first-page":"4571","DOI":"10.48550\/arXiv.1903.09731","volume":"117","author":"E. D. Gennatas","year":"2019","unstructured":"Gennatas, E. D., Friedman, J. H., Ungar, L. H., Pirracchio, R., Eaton, E., Reichman, L. G., Interian, Y., Simone, C. B., Auerbach, A., Delgado, E., Van der Laan, M., Solberg, T. D., & Valdes, G. (2019). Expert-augmented machine learning. Proceedings of the National Academy of Sciences of the United States of America., 117(9), 4571\u20134577. https:\/\/doi.org\/10.48550\/arXiv.1903.09731","journal-title":"Proceedings of the National Academy of Sciences of the United States of America."},{"key":"175_CR9","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1007\/s00399-022-00854-y","volume":"33","author":"W. Haverkamp","year":"2022","unstructured":"Haverkamp, W., Strodthoff, N., & Israel, C. (2022a). EKG-Diagnostik mithilfe k\u00fcnstlicher Intelligenz: Aktueller Stand und zuk\u00fcnftige Perspektiven \u2013 Teil 1. Grundlagen. Herzschrittmachertherapie + Elektrophysiologie, 33, 232\u2013240. https:\/\/doi.org\/10.1007\/s00399-022-00854-y","journal-title":"Herzschrittmachertherapie + Elektrophysiologie"},{"key":"175_CR10","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/s00399-022-00855-x","volume":"33","author":"W. Haverkamp","year":"2022","unstructured":"Haverkamp, W., Strodthoff, N., & Israel, C. (2022b). EKG-Diagnostik mithilfe k\u00fcnstlicher Intelligenz: Aktueller Stand und zuk\u00fcnftige Perspektiven \u2013 Teil 2. Aktuelle Studienlage und Ausblick. Herzschrittmachertherapie + Elektrophysiologie, 33, 305\u2013311. https:\/\/doi.org\/10.1007\/s00399-022-00855-x","journal-title":"Herzschrittmachertherapie + Elektrophysiologie"},{"key":"175_CR11","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-658-06110-4","volume-title":"Handbuch Verantwortung","author":"L. Heidbrink","year":"2017","unstructured":"Heidbrink, L., Sombetzki, J., & Langbehn, C. (2017). Handbuch Verantwortung. Springer."},{"key":"175_CR12","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1038\/s41746-022-00597-7","volume":"5","author":"K. E. Henry","year":"2022","unstructured":"Henry, K. E., Kornfield, R., Sridharan, A., Linton, R. C., Groh, C., Wang, T., Wu, A., Mutlu, B., & Saria, S. (2022). Human-machine teaming is key to AI adoption: Clinicians\u2019 experiences with a deployed machine learning system. NPJ Digital Medicine, 5, 97. https:\/\/doi.org\/10.1038\/s41746-022-00597-7","journal-title":"NPJ Digital Medicine"},{"key":"175_CR13","unstructured":"KI-Campus (n.d.). Erste zertifizierte Online-Kurse zu KI in der Medizin. Retrieved December 9, 2022, from https:\/\/ki-campus.org\/press\/zertifizierte-medizin-kurse"},{"key":"175_CR14","doi-asserted-by":"publisher","unstructured":"Koshiyama, A., Kazim, E., Treleaven, P., Rai, P., Szpruch, L., Pavey, G., Ahamat, G., Leutner, F., Goebel, R., Knight, A., Adams, J., Hitrova, C., Barnett, J., Nachev, P., Barber, D., Chamorro-Premuzic, T., Klemmer, K., Gregorovic, M., Khan, S., & Lomas, E. (2021). Towards algorithm auditing: A survey on managing legal, ethical and technological risks of AI, ML and associated algorithms. SSRN Online Publicationshttps:\/\/doi.org\/10.2139\/ssrn.3778998","DOI":"10.2139\/ssrn.3778998"},{"key":"175_CR15","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1515\/9783110645767-003","volume-title":"Ethische Perspektiven auf biomedizinische Technologie","author":"A. Lob-H\u00fcdepohl","year":"2020","unstructured":"Lob-H\u00fcdepohl, A. (2020). Autonomisierung von Maschinen und die Autonomie des Menschen. Ethische Sortierungen In A. Manzeschke & W. Niederlag (Eds.), Ethische Perspektiven auf biomedizinische Technologie (Vol. Health Academy 3, pp. 23\u201332). De Gruyter."},{"key":"175_CR16","unstructured":"NKLM. (n.d.). Nationaler Kompetenzbasierter Lernzielkatalog Medizin. Retrieved February 13, 2023, from https:\/\/nklm.de\/zend\/objective\/list\/lve\/1845\/objective\/10006411"},{"key":"175_CR17","doi-asserted-by":"publisher","unstructured":"Okolo, C. T., Dell, N., & Vashistha, A. (2022). Making AI explainable in the global south: A systematic review. Proceedings of the 5th ACM SIGCAS\/SIGCHI Conference on Computing and Sustainable Societies (COMPASS \u201922). Association for Computing Machinery. 439\u2013452. https:\/\/doi.org\/10.1145\/3530190.3534802","DOI":"10.1145\/3530190.3534802"},{"key":"175_CR18","unstructured":"Settles, B. (2010). Active learning literature survey. Retrieved October 1, 2024, from https:\/\/burrsettles.com\/pub\/settles.activelearning.pdf"},{"key":"175_CR19","unstructured":"Soudain, G. (2024). EASA Artificial Intelligence concept paper. First useable guidance for Level 1&2 machine learning applications. Issue 02. Retrieved October 1, 2024, from https:\/\/horizoneuropencpportal.eu\/sites\/default\/files\/2024-06\/easa-concept-paper-guidance-for-level-1-and-2-machine-learning-applications-2024.pdf"},{"key":"175_CR20","doi-asserted-by":"publisher","unstructured":"Stieler, F., & Bauer, B. (2023). Git workflow for active learning: A development methodology proposal for data-centric AI projects. Proceedings of the 18th International Conference on Evaluation of Novel Approaches to Software Engineering.https:\/\/doi.org\/10.5220\/0011988400003464","DOI":"10.5220\/0011988400003464"},{"key":"175_CR22","doi-asserted-by":"publisher","unstructured":"Susskind, Z., Arden, B., John, L. K., Stockton, P., & John, E. B. (2021). Neuro-symbolic AI: An emerging class of AI workloads and their characterization. ArXiv, Abs\/2109.06133. https:\/\/doi.org\/10.48550\/arXiv.2109.06133","DOI":"10.48550\/arXiv.2109.06133"},{"key":"175_CR23","unstructured":"The Alan Turing Institute. (2024). Clinical AI. Retrieved December 9, 2022, from https:\/\/www.turing.ac.uk\/research\/interest-groups\/clinical-ai"},{"issue":"34","key":"175_CR24","doi-asserted-by":"publisher","first-page":"E1351","DOI":"10.1503\/cmaj.202434","volume":"193","author":"A. A. Verma","year":"2021","unstructured":"Verma, A. A., Murray, J., Greiner, R., Cohen, J. P., Shojania, K. G., Ghassemi, M., Straus, S. E., Pou-Prom, C., & Mamdani, M. (2021). Implementing machine learning in medicine. CMAJ: Canadian Medical Association Journal = Journal de l\u2019Association Medicale Canadienne, 193(34), E1351\u2013E1357. https:\/\/doi.org\/10.1503\/cmaj.202434","journal-title":"CMAJ: Canadian Medical Association Journal = Journal de l\u2019Association Medicale Canadienne"},{"key":"175_CR26","unstructured":"Zentrale Ethikkommission. (2021). K\u00fcnstliche Intelligenz \u2013 Teil der \u00e4rztlichen Entscheidung. Deutsches \u00c4rzteblatt, 118(33\u201334). Retrieved October 1, 2024, from https:\/\/www.zentrale-ethikkommission.de\/fileadmin\/user_upload\/_old-files\/downloads\/pdf-Ordner\/Zeko\/Kuenstliche_Intelligenz.pdf"}],"container-title":["Digital Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44206-025-00175-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s44206-025-00175-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44206-025-00175-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T14:43:40Z","timestamp":1747925020000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s44206-025-00175-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,6]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["175"],"URL":"https:\/\/doi.org\/10.1007\/s44206-025-00175-w","relation":{},"ISSN":["2731-4650","2731-4669"],"issn-type":[{"type":"print","value":"2731-4650"},{"type":"electronic","value":"2731-4669"}],"subject":[],"published":{"date-parts":[[2025,3,6]]},"assertion":[{"value":"8 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 March 2025","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 have no competing interests to declare that are relevant to the content of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interest"}}],"article-number":"15"}}