Robot in Health Care Services: Moral Judgment for the Existence of

Artificial Intelligence

Elsa Roselina

, Taufik Asmiyanto

Hospital Administration of Vocational Education Program, Universitas Indonesia, Kampus Baru UI Depok 16424,

Indonesia

Faculty of Humanities, Universitas Indonesia, Kampus Baru UI Depok 16424, Indonesia

Keywords: Health Care, Moral Agents, Information Ethics, The Centering Subject, Industry Revolution 4.0.

Abstract: This paper focusses on the usage of artificial intelligence in the health care services, from the perspectives of

ethical and humanitarian. In health care, the issue of using AI assistive technologies raises different

perspectives. First, the use of technology-assisted by artificial intelligence is predicted to replace human care.

Second, care assisted by AI technologies is not as good as social care. In other words, the issue is not about

replacement but replaceability. This research adopts the ontology of Floridian information based, which is

originated from ethical information theory. Using the hermeneutic phenomenology method, this study

performs a systematic literature review. The research findings showed that the artificial agents in health care

cause the reduction of the human position that creates social nervousness as a knowing subject. Based on

this study, ethical regulation is required on artificial agent construction effort as a moral agent within the

constellation of ethical actions in the information ecosystem.

1 INTRODUCTION

The discourse of artificial intelligence is widely

discussed in the last decade. Discussion of this

intelligent artefact dwells on the future, especially

on its impact on human life. Is this artefact will

bring significant benefits to humankind? Or its

presence would bring disaster to humans? Questions

and concerns about the future of AI are widely

discussed by several countries, both national and

supranational. Discussions were conducted generally

discuss the opportunities and risks of the presence of

artificial agencies is amid society. But of all these

things, one thing for sure that AI is a high strength,

an intelligence agency, which has been reshaping

our lives, interactions, and environment (Floridi,

2018).

The diversity of meaning arising in connection

with the phenomenon of AI causes differences in

interpreting the existence of these smart artefacts.

Floridi (2019, 1-2), at least, notice two things that

need to be studied more deeply associated with AI

development. First, the nature of the data is used by

AI to support its performance. Second, the quality of

the problem that AI can possibly solve. In this

article, I will not describe both things more deeply.

Stahl and Coeckelberg (2016, 153) managed to

summarize the main points of discussion and

philosophical reflection about ethical and social

issues related to intelligent artefacts, especially in

the context of health. They at least look at three

things to be a significant concern. First, a critical

evaluation of the vision of intelligent technology and

its implications on society and health care. In this

section, Stahl and Coeckelberg see that the issue of

the replacement of humans by robots enliven the

discussion by questioning the possibility that robots

and other technologies threaten social work?

Besides, the chance of robots can provide quality

work like humans that include emotions. Second, the

idea of a takeover of the role of man by intelligent

artefacts. The main issues addressed in this case are

the issue of autonomy, the role and duty, moral

agency, responsibility, deception and trust. Third,

the problems have been widely discussed about ICT

that involve human users, among other things:

privacy and data protection as well as safety and

avoidance of harm. This latter issue expressed by

Asimov in Coeckelbergh (2010a, 235) about robot

morality that gave birth to 'Laws of Robotics'.

The world community has undertaken

precautions for treating AI technology that will be

Roselina, E. and Asmiyanto, T.

Robot in Health Care Services: Moral Judgment for the Existence of Artiﬁcial Intelligence.

DOI: 10.5220/0010030500002967

In Proceedings of the 4th International Conference of Vocational Higher Education (ICVHE 2019) - Empowering Human Capital Towards Sustainable 4.0 Industry, pages 69-74

ISBN: 978-989-758-530-2; ISSN: 2184-9870

used as part of human life. High-Level Expert Group

on Artificial Intelligence (AI HLEG) has even

managed to put together a guide in connection with

efforts to develop an AI that bring benefit to

humankind. There are at least three things

highlighted by AI HLEG in the guide: [1] guarantee

attempt to maximize profits with the presence of AI

and also at the same time minimizing the risks of it;

[2] ensures that the development and utilization of AI

must be on the right track through a human-centric

approach where AI should not only serve as a means

but as a goal to improve human well-being; and [3]

build trustworthiness for AI because humans can be

fully confident and reap more benefits if they trust

the technology (European Commission, 2018).

Moreover, a group of people in Europe who call

themselves Atomium European Institute for Science,

Media, and Democracy (Atomium EISMD) develop

a forum named AI4People. The Forum is built to

create an open discussion space to lay the

foundations that contain principles, policies, and

practices in building "Good AI Society". There are at

least three important things are highlighted as the

outcome of the Forum, namely: [1] the opportunities

and risks of AI technology to uphold the dignity and

human growth; [2] 5 principles that support the

adoption of AI technology; and [3] 20

recommendations for stakeholders to be able to take

advantage of opportunities, minimize and offset the

risk, and respect the principles that can build Good

AI Society (Floridi, 2018). The emergence of

intelligence agency has developed a man's

consciousness of the potential benefits and risks at

the same time, both of which cannot be predicted

early from the moment they were created. Therefore,

efforts that can be done is to minimize the risk that

impacts on humans because of the existence of AI.

This article discusses the position of AI amid a

vortex of debate which predicted its existence could

threaten human life. However, the discussion

emphasized the use of AI in health care by using

Luciano Floridi's information ethics binoculars.

2 LITERATURE REVIEW

Floridi (2013) information ethics is a 'new' ethical

theory which focuses on the actions the recipient

(patient) as opposed to the majority of existing

methods of ethics which is precisely oriented

towards moral agents. This information ethics is not

to answer the question of how agents should behave,

but rather to answer questions about what qualifies

as the honourable recipient, namely objects that

deserve moral consideration or respect, and how

different classes of distinguished recipients are

treated.

Floridi (2013) defines a class of moral recipients

by taking a radical view that everything in the world

is an honourable recipient. That is, everything that

exists deserves appreciation, although minimal.

Floridi idea is beyond the classical anthropocentric

position where moral receiver class includes only

human, and outside the biocentric location and

ecocentric with consideration where precise receiver

class is composed of a living organism or ecosystem

elements.

Floridi's ethical position is categorized as into

centrism or infocentrism, where the main idea is not

just humans or animals that deserve moral respect,

but also inanimate entities. Floridi wants any moral

agents behaviour should be guided by the fact that

his actions could cause a negative or positive impact

on the environment. Thus, it is not only the form of

life that deserve respect and brings moral interest,

but also everything that fits in that environment.

The idea was introduced when he published an

article entitled "Information Ethics: on the

Theoretical Foundations of Computer Ethics" on an

international scale discussion in 1999. This article

highlights the relationship between information and

computer ethics. Shifting Floridi of computer ethics

to the ethics of information based on the observation

that the ethical issues that arise not only address the

issue of how far computer challenged the morality of

human action. But also the question of how now a

person, not just a computer professional but

throughout the policyholder, challenged by what

called infosphere (Floridi, 1999: 38). This shift then

obscures our view, through the mediation of ICT, on

the meaning of life online where so far, we

conceptualize as life has two sides, one is analogue,

carbon-based, and offline and the other side of the

digital, silicon-based, and online. So, a mix

between human agents of evolutionary adaptation

to the digital environment, and as a form of post-

modern life is becoming increasingly unclear.

Floridi (2013, 8) then call it as life experience in an

online (online).

The fundamental moral claim about the ethics of

information is that all entities that inhabit infosphere

are an information object. Because of their status as

objects of knowledge, all of the bodies are entitled

to an intrinsic moral value, which means that they

have a moral value that cannot be deprived of their

own and therefore deserve ethical consideration and

respect. The correct amount may be quite minimal

but could be supplemented by other moral factors.

This minimum moral value then is premised on the

ICVHE 2019 - The International Conference of Vocational Higher Education (ICVHE) “Empowering Human Capital Towards Sustainable

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argument that any information objects should

develop itself, and other entities should not inhibit

and eliminate each object. Therefore, by the

minimum rights attached to the agent, then the agent

should respect the information object as an end in

themselves. In this context, the agent has a

responsibility of stewardship towards infosphere

overall, to contribute to the growth and maintain its

sustainability by reducing entropy and not to increase

it. Floridi (1999, 44) proposes a set of structured

tasks towards infosphere, including jobs that may

not cause, prevent and remove entropy from

infosphere and promote the development of

information and infosphere entity as a whole.

Thus, we can conclude that ethics Floridi's

information ethics is based on the Four Formal Moral

Principles. This ethics does not show concretely a

moral action that should be done. In other words,

information ethics does not provide material content

about what a virtuous agent must do in a concrete

situation.

3 METHODOLOGY

Paul Ricoeur's Hermeneutics Phenomenology

methods used to understand the constellation of the

existence of AI in the context of health care by

referring to the idea of Luciano Floridi's information

ethics. Reading of the text and AI phenomenon in the

context of health care with this method is expected to

bring interpreters at a better understanding of

themselves (appropriation) through the process of

negation dichotomy between the subjective

dimension of the subject and the object objectivity.

The interpretive activity includes four

methodological categories, namely: objectivation

through the structure, instantiation through writing,

instantiation through the world of texts, and

appropriation (or self- understanding).

4 RESULTS AND DISCUSSION

4.1 Robot as a Moral Responsibility

Floridi's information ethics wants to expand its

moral judgment by including non-human entities

(e.g. Robots, AI, information systems, etc.) as part of

a moral centre. The basis of his argument is that this

inanimated object is an honourable recipient and in

certain circumstances can be a moral agent at a

minimal level. Another basis of his evidence is that

the object of information, as are humans and animals.

As such, deserves to sit alongside an animate entity

within a moral framework.

The basis of Floridi's views is influenced by his

knowledge that there is currently a rife of

technological discovery activities which led to the

birth of intelligent artefacts resulting from research

conducted in the fields of neuroscience, bio-

engineering, gene editing, and others with the

support of ICT. The impact of this is the reduction

of human dignity because people considered to have

a moral equivalence with other information objects.

Humans are no different from an artificial agent that

has interactive capability, autonomous, and

adaptation because they are equally intelligent. It

was this reduction that became Floridi's foundation

in developing his argument about the position of

artificial agents.

His view is contrary to the current philosophical

perspective in which non-human entities cannot

possibly be the subject of responsibility. The issue

only may be pinned on the man as the only being

who has consciousness and freedom. Awareness is

undoubtedly different from intelligence. Artificial

intelligence agent may have equal or even exceed

human intelligence. However, these agents have no

knowledge that makes his actions could be qualified

as a moral act. Floridi (2013: 110) also view that not

all artificial agent is a moral agent, but some moral

agents can be held accountable.

Thus, if a robot performs moral actions that

deviate from what was programmed at the

beginning, then the moral responsibility, if a

beachhead of view Floridi, embedded on the robot. In

other words, the designer or creator of the robot

cannot be held liable for accountability, but only

moral responsibility alone.

Floridi effort in expanding the classification of

these moral agency marks a shift in the centre of the

moral and ethical as well as build demarcation with

anthropocentric because ethics so far have been

based on moral considerations only on humans.

However, when viewed more deeply, the

information ethics of Floridi does not fully indicate

separation from human centralization. Indeed, the

reduction of human is seen as the centre of moral

action. This reduction process has begun when

biocentric ethics emphasizes its moral judgment on

the value of life and suffering, where even the

honourable recipients in this ethics do not always

have to be humans. For example, land ethics

focuses on the concept of moral recipients on the

environment (non-human entities), where humans

Robot in Health Care Services: Moral Judgment for the Existence of Artiﬁcial Intelligence

need to consider how to treat them in an ethical

framework.

The rejection of the exotic idea of Floridi come

from various experts. One is Rafael Capurro that

commented quite spicy. According to him, for what

man creates, artificial agents are held responsible for

their actions. Meanwhile, at this time, the earth

which people live have packed filled with about 6

billion moral agents. Therefore, for what else we

create millions or even billions of artificial agents?

He reminded analogy of Ockham's knife, entia non

sunt multiplicanda sine necessitate. Thinking about

the possibility of artificial moral agents is not a

realistic and rational alternative, at least in the light

of what needs to be done and thought out

beforehand. Furthermore, Capurro (2008: 171) has

seen that the effort carried by Floridi is related to the

epistemological and moral status of this digital agent,

in fact only a repetition of the argument that

occurred in the 1970s about artificial intelligence.

By saying that any artificial agent is a moral agent,

then the statement is simply to dilute the concept of

morality.

4.2 Considering Robot as Moral Agents

The main problem in ethics is to treat the inanimate

entity as a moral agent. Does this matter raise

questions about whether it might create artificial

intelligence that is morally responsible for his

actions? The argument on this question is based on

the capacity of technology that can solve several

problems faced by humans, and even artificial

intelligence can match human capabilities. This

condition is the cornerstone of Floridi and Sanders

idea. According to them, moral agents do not need to

show free will, emotional or mental awareness.

Then, Floridi and Sanders proposed the concept of

morality without consciousness (mind-less morality)

to avoid the above questions and concerns about

artificial intelligence (Floridi, 2004: 351). This view

would say that artificial intelligence, animals and the

company can be considered as a moral agent. Floridi

and Sanders called it a morality without awareness

(mind-less morality). This concept of morality was

built to strengthen further Floridi's view that to be a

moral agent does not require the existence of

awareness.

These claims are of course raises our doubts and

questions on how might be software or computer

system, which has autonomous character and

programmed by the designer (human) to be able to

"act" in a certain way, can be a moral agent

responsible (accountability) for these actions. In

other words, Floridi and Sanders would like to say

that designers and users, regardless of responsibility

(accountability) of the moral agent. To explain this

view, Floridi and Sanders uses the famous

epistemological conception is Levels of Abstraction

/ LoA.

Floridi and Sanders believe that artificial agents

can lead to crime, namely artificial crime. Both of

them want to expand the existing classification of

crimes, from moral evil and natural evil to artificial

evil. The extension argument is based on the claim

that the classification of moral evil or natural evil

cannot explain all kinds of evil (Floridi, 2001: 60).

In strengthening the argument, Floridi presents

some examples that show the artificial crime. For

example, the analogy of an ambulance driver who

brings emergency patients were stuck in traffic due to

a mistake (error) of traffic lights. If a traffic jam is a

common thing like in Jakarta, every day jammed,

probably an ambulance driver could have chosen

another route or send a helicopter ambulance.

Therefore, the event cannot be said to be a crime. If

it is a crime, if it means Floridi will blame the traffic

lights? This does not make sense.

Meanwhile, a second analogy, the occurrence of a

system error while surgery patients. It may be a

human error. This means that the system developer

as the person responsible for the sustainability of the

system forgets to do adequate testing before the

operation runs. To strengthen their claims, Floridi

and Sanders stated that moral accountability could

be embedded in "autonomous" software because of

the software (although developed by humans), can

learn and "change" its behaviour in ways that cannot

be explained by the original developer. (Floridi,

2001: 62)

Seeing the thesis that non-human entities (for

example, software) can be categorized as morally

responsible agents, of course, it is entirely

unreasonable at least until this moment. Floridi and

Sanders would like to say that when someone uses a

computer and then suddenly the computer has a

problem, and then the person quickly blames the

computer for the incident. This is considered as an

attempt by the person to avoid responsibility for the

mistakes that occur. Floridi and Sanders point of

view is, of course, contrary to one purpose of

developing information ethics which overcome the

problem of depersonalization, and moral action

agents do not understand the consequences of their

actions. With this view, Floridi instead led to the

depersonalization.

Floridi and Sanders' claim seems like an attempt

to transfer human responsibility to non-human

ICVHE 2019 - The International Conference of Vocational Higher Education (ICVHE) “Empowering Human Capital Towards Sustainable

4.0 Industry”

agents instead of the developer and people who

deliberately act carelessly, causing the wrong moral

action to occur. It is hard to imagine, that people will

blame an atomic bomb that exploded unexpectedly,

where the bomb has the character as a moral agent

(interactive, autonomous, and able to adapt).

Floridi and Sanders' argument that when this view

is rejected will lead to a more significant increase in

individual moral responsibility, it is illogical.

Moreover, when related to their previous ideas where

they claim that the main problem is humans do not

see and understand the real consequences of their

actions. However, at present, Floridi and Sanders

claim that there is right to much moral responsibility

on the "shoulders" of individuals so that it must be

removed by putting it on the "shoulders" of non-

human entities, such as computer software. The two

views are opposite each other.

4.3 Robot and Health Care

Robot discourse used in health care was present at

least more than a decade ago. The discourse is

increasingly growing and developing rapidly since

the emergence of intelligent artefacts that have

interactive characters, autonomous, and adaptive,

who later became known as artificial intelligence. AI

and human allusion are what gave birth to the needs

of more modern footing ethics because ethics that

currently exist do not speak specifically about

human interaction with these intelligent robots.

This discourse has also led to the pro-cons,

especially related to the use of intelligent robots in

performing health care activities. Robert and Linda

Sparrow, for example, opposed the replacement of

human nurses by the robot in elderly care because the

robot is not able to meet the social and emotional

needs of the elderly. According to him, this work can

only be done through contact with humans (Sparrow

and Sparrow, 2006). While, Coeckelbergh (2010b,

185) found a priori rejection and common like

Sparrow and Sparrow is unacceptable because the

existence of intelligent artefacts, of course, must be

placed on its use in health care on a case-by-case

basis.

Besides, the problem of the use of AI in health

care is feared to leave the issue in the breach of

privacy because the patient medical data can be

accessed by the system and open opportunities others

can view such data. Assurance that the patient

medical data is not used for the benefit of others and

the other party is still an issue today. Therefore,

Coeckelbergh (2010b, 186-187) suggest that system

developers consider the matter of privacy in the

design of the system and its use as well as follow AI

technology regulations.

5 CONCLUSION

Ethical binoculars related to the existence of AI in

the context of

health care should be discussed more.

Therefore, the presence of AI stores the potential to

reduce the position of humans. Humans are no

longer subject (anthropocentric); even human

position is equivalent to other lifeless objects (info

centric). The takeover of social roles by intelligent

artefacts, especially those concerning issues of

autonomous, roles and tasks, moral agency,

responsibility, deception, and trust will occur if AI's

existence is not adequately addressed. The

interaction of AI and humans has the potential to

threaten privacy, data theft, and even to the point of

threatening human safety. Doubts about the existence

of robots or AI appears because the current

AI has not been able to provide proper care

where excellent treatment course requires

interaction with humans who have social and

emotional needs.

Moreover, doubts that AI can provide genuine

care as is done by human nurses, raises the problem

that AI assistive technology such as robots tend to

give 'false' care so that 'cheat' human by making

them think that they receive the real treatment.

Floridi ethical information's binoculars, although

it is formal, it has managed to distinguish between

moral agents who have the responsibility

(responsibility) and moral agents who are held

accountable (accountability). This view can clear up

the issue of morality and law, both of which have

been mixed up unconsciously. While on the other

hand, this view also gave rise to controversy, namely

that artificial moral agents can be subject to legal

sanctions (accountability). Meanwhile, human moral

agents are only asked for moral responsibility

(responsibility).

With this ethics of information, a foothold is

available that provides space for humans to think

and renegotiate anthropocentric morality which is

narrow and not flexible. This makes people aware

that the problem of morality in the future will face

challenges and problems that are more complicated

than the past and present. Therefore, it requires a

flexible ethic and broader scope.

Robot in Health Care Services: Moral Judgment for the Existence of Artiﬁcial Intelligence

REFERENCES

Capurro, Rafael. (2008). "On Floridi's Metaphysical

Foundation of Information Ecology". Ethics and

Information Technology, 10: 167- 173.

Coeckelbergh, Mark. (2010a). "Moral Appearances:

Emotions, Robots, and Human Morality". Ethics of

Information Technology, 12: 235-241.

Coeckelbergh, Mark. (2010b). "Health Care, Capabilities,

and AI Assistive Technologies". Ethical Theory and

Moral Practice, 13 (2), 181-190.

The European Commissions. High-Level Expert Group on

Artificial Intelligence. (2018). Draft Ethics Guidelines

for Trustworthy AI. Brussels: European Commission.

Floridi, Luciano. (1999). "Information Ethics: on the

Philosophical Foundation of Computer Ethics". Ethics

and Computer Technology, 1: 37-56.

Floridi, Luciano. (2001). "Artificial Evil and The

Foundation of Computer Ethics". Ethics and Computer

Technology, 3: 55-66.

Floridi, Luciano. (2004). "On the Morality of Artificial

Agents". Minds and Machine, 14: 349-379.

Floridi, Luciano. (2013). The Ethics of Information.

Oxford: Oxford University Press.

Floridi, Luciano et al. (2018). "AI4People – An Ethical

Framework for a Good Society: Opportunities, Risks,

Principles, and Recommendations". Minds and

Machines, 28 (4), 689-707.

Floridi, Luciano. (2019). What the Near Future of

Artificial Intelligence Could Be. Philosophy and

Technology, 32 (1), 1-12.

Sparrow, Robert and Sparrow, Linda. (2006). In the Hands

of Machines? The Future of Aged Care. Minds and

Machines, 16 (2), 141-161.

Stahl, Bernd C. and Coeckelbergh, Mark. (2016). Ethics of

Healthcare robotics: Towards Responsible Research

and Innovation. Robotics and Autonomous Systems, 86

(1), 152-161.

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4.0 Industry”