Vardit Ravitsky’s research while affiliated with The Hastings Center and other places

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Publications (171)


Figure 1. Healthcare AI ethics lifecycle with patients as stakeholders in the center as a use-case.
Addressing ethical issues in healthcare artificial intelligence using a lifecycle-informed process
  • Article
  • Full-text available

November 2024

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5 Reads

JAMIA Open

Benjamin X Collins

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Barbara J Evans

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Bradley A Malin

Objectives Artificial intelligence (AI) proceeds through an iterative and evaluative process of development, use, and refinement which may be characterized as a lifecycle. Within this context, stakeholders can vary in their interests and perceptions of the ethical issues associated with this rapidly evolving technology in ways that can fail to identify and avert adverse outcomes. Identifying issues throughout the AI lifecycle in a systematic manner can facilitate better-informed ethical deliberation. Materials and Methods We analyzed existing lifecycles from within the current literature for ethical issues of AI in healthcare to identify themes, which we relied upon to create a lifecycle that consolidates these themes into a more comprehensive lifecycle. We then considered the potential benefits and harms of AI through this lifecycle to identify ethical questions that can arise at each step and to identify where conflicts and errors could arise in ethical analysis. We illustrated the approach in 3 case studies that highlight how different ethical dilemmas arise at different points in the lifecycle. Results, Discussion, and Conclusion Through case studies, we show how a systematic lifecycle-informed approach to the ethical analysis of AI enables mapping of the effects of AI onto different steps to guide deliberations on benefits and harms. The lifecycle-informed approach has broad applicability to different stakeholders and can facilitate communication on ethical issues for patients, healthcare professionals, research participants, and other stakeholders.

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Workshop summaries from the 2024 voice AI symposium, presented by the Bridge2AI-voice consortium

Frontiers in Digital Health

Introduction The 2024 Voice AI Symposium, presented by the Bridge2AI-Voice Consortium, featured deep-dive educational workshops conducted by experts from diverse fields to explore the latest advancements in voice biomarkers and artificial intelligence (AI) applications in healthcare. Through five workshops, attendees learned about topics including international standardization of vocal biomarker data, real-world deployment of AI solutions, assistive technologies for voice disorders, best practices for voice data collection, and deep learning applications in voice analysis. These workshops aimed to foster collaboration between academia, industry, and healthcare to advance the development and implementation of voice-based AI tools. Methods Each workshop featured a combination of lectures, case studies, and interactive discussions. Transcripts of audio recordings were generated using Whisper (Version 7.13.1) and summarized by ChatGPT (Version 4.0), then reviewed by the authors. The workshops covered various methodologies, from signal processing and machine learning operations (MLOps) to ethical concerns surrounding AI-powered voice data collection. Practical demonstrations of AI-driven tools for voice disorder management and technical discussions on implementing voice AI models in clinical and non-clinical settings provided attendees with hands-on experience. Results Key outcomes included the discussion of international standards to unify stakeholders in vocal biomarker research, practical challenges in deploying AI solutions outside the laboratory, review of Bridge2AI-Voice data collection processes, and the potential of AI to empower individuals with voice disorders. Additionally, presenters shared innovations in ethical AI practices, scalable machine learning frameworks, and advanced data collection techniques using diverse voice datasets. The symposium highlighted the successful integration of AI in detecting and analyzing voice signals for various health applications, with significant advancements in standardization, privacy, and clinical validation processes. Discussion The symposium underscored the importance of interdisciplinary collaboration to address the technical, ethical, and clinical challenges in the field of voice biomarkers. While AI models have shown promise in analyzing voice data, challenges such as data variability, security, and scalability remain. Future efforts must focus on refining data collection standards, advancing ethical AI practices, and ensuring diverse dataset inclusion to improve model robustness. By fostering collaboration among researchers, clinicians, and technologists, the symposium laid a foundation for future innovations in AI-driven voice analysis for healthcare diagnostics and treatment.


Defining ethical criteria to guide the expanded use of Noninvasive Prenatal Screening (NIPS): Lessons about severity from preimplantation genetic testing

European Journal of Human Genetics

We hypothesized that ethical criteria that guide the use of preimplantation genetic testing (PGT) could be used to inform policies about expanded use of non-invasive prenatal screening (NIPS). We used a systematic review of reasons approach to assess ethical criteria used to justify using (or not using) PGT for genetic conditions. Out of 1135 identified documents, we retained and analyzed 216 relevant documents. Results show a clear distinction in acceptability of PGT for medical vs. non-medical conditions. Criteria to decide on use of PGT for medical conditions are largely based on their severity, but there is no clear definition of “severity”. Instead, characteristics of the condition that relate to severity are used as sub-criteria to assess severity. We found that characteristics that are used as sub-criteria for assessing severity include monogenic etiology, high penetrance, absence of treatment, early age of onset, shortened lifespan, and reduced quality of life. Consensus about the use of PGT is highest for conditions that meet most of these criteria. There is no consensus around the acceptability of using PGT to detect non-medical conditions. We propose that the same severity criteria could be used by policymakers to assess the acceptability of using other genetic tests in screening and practice, including for the use of NIPS for additional conditions as indications broaden.







Selection and inclusion process
Methods (research design). The parts with the patterned fill represent an overlap of study types
Co-occurrence of keywords (clusters). We invite the reader to consult the interactive version of this figure, available online at https://app.vosviewer.com/?json=https://drive.google.com/uc?id=1WbO3RpMAt6Jyo4ds8iCGqcm6SBg4F5sB
Clusters of research questions
Mapping Ethical, Legal, and Social Implications (ELSI) of gamete donation

Journal of Assisted Reproduction and Genetics

Research question This scoping review investigates the Ethical, Legal, and Social Implications (ELSI) of gamete donation, a critical facet of Assisted Reproductive Technologies, by analyzing the evolving research scope, methodological approaches, and the geographical skew in the literature. Despite the increased global uptake of donor gametes, current scholarship predominantly emanates from Western contexts and focuses on majoritized groups. This bias constrains the universality of research findings and limits their applicability across varied legal, cultural, and social contexts, underscoring a need for broader inclusivity. Design We addressed 867 pivotal articles published between 1999 and 2019. Results Our analysis reveals a discernible escalation in research volume, with 62% based on empirical research. The intellectual landscape unfolds into four dominant clusters: Regulatory Frameworks, Incentives, and Access; Family Dynamics and Genetic Linkages; Identity and Privacy in Donor Conception; and Cultural and Societal Attitudes towards GD. Each cluster highlights nuanced dimensions of gamete donation, from regulatory intricacies and psychological welfare to identity ethics and cultural perceptions. Conclusion Our findings advocate for a shift towards more globally representative and methodologically inclusive research. By integrating diverse cultural narratives and expanding geographical breadth, future research can offer holistic understandings of gamete donation, fostering equitable and culturally resonant practices and policies worldwide.


Citations (58)


... Another dimension is the pathology associated with a disease, which can vary greatly in severity between individuals. The seriousness of a disease is commonly a consideration in decision-making in a wide range of areas (Kleiderman et al. 2024): the use of risky interventions and whether they are justified, funding allocations and even the likelihood of charitable donations are all likely to have seriousness -especially 'life-threatening or not?' -as a central consideration. But not all diseases are life-limiting. ...

Reference:

Preclinical research (on rare diseases): we need to talk about health equity
Unpacking the notion of “serious” genetic conditions: towards implementation in reproductive decision-making?

European Journal of Human Genetics

... The current issue of JME presents a synthesis of perspectives on what we might call multigenerational bioethics, with a particular focus on the risks and benefits of AI and how these (diachronically) interact with concerns about fairness and equity. In the featured article by Jecker et al., 13 the authors leverage critiques both of longtermism and of what they describe as AI "catastrophizing" to inform the "balanced" approach they advise. As they put it, longtermism ...

AI and the falling sky: interrogating X-Risk

Journal of Medical Ethics

... A group of researchers from Quebec have conducted a survey of adolescent sexual health service access in Colombia. Brisson, Ravitsky, and Williams-Jones (2024) report that whereas hitherto the main issue is seen as a need for young people to be able to access these services without parental involvement or knowledge, a more nuanced picture emerged from the semi-structured interviews with young people accessing a Colombian sexual health clinic. Parental and family support was appreciated and perhaps a more social understanding was required. ...

A Mixed-Methods Study Exploring Colombian Adolescents’ Access to Sexual and Reproductive Health Services: The Need for a Relational Autonomy Approach
  • Citing Article
  • March 2024

Journal of Bioethical Inquiry

... " We hold a much different view. In the face of unjust laws and human rights violations, more than one response is ethically defensible -as some of us have argued Jecker et al. 2024a;Jecker et al. 2024b;Jecker, Verweij, et al. 2023;Ghaly, El Akoum, and Afdhal 2023). Boycotting is one way to seek to change an unjust situation, but so too is engaging with people who are willing to host, hear, and take seriously challenges and objections to their prevailing norms ). ...

The Ethics of International Bioethics Conferencing: Continuing the Conversation
  • Citing Article
  • March 2024

... On the other hand, Alon, Bussod & Ravitsky (2024) highlight that preimplantation genetic testing (PGT) has attracted considerable ethical, legal, and social scrutiny, but academic debate often does not reflect clinical realities. To address this gap, a review of 506 articles from 1999 to 2019 in humanities and social sciences was conducted to synthesize the ethical, legal, and social implications (ELSI) of PGT. ...

Mapping ethical, legal, and social implications (ELSI) of preimplantation genetic testing (PGT)

Journal of Assisted Reproduction and Genetics

... Additionally, many patients undergoing OTC are pre-pubertal, thus their tissue is thought to contain only primordial follicles. It is possible to achieve spontaneous conception with re-implantation, but there is also potential to stimulate growth of follicles in vitro [22]. In cases where whole ovarian tissue should not be transplanted, multiple methods are being developed to try and mitigate the potential harm of re-introducing cancer cells such as ivFM using scaffolds to mature pre-antral follicles, eradication of malignant cells, stem cell oogenesis, and maturation of oocytes [23]. ...

Ethical, legal, social, and policy issues of ovarian tissue cryopreservation in prepubertal girls: a critical interpretive review

Journal of Assisted Reproduction and Genetics

... Considering bioethical aspects of population health wrought by war requires looking beyond clinical settings in which healthcare is practiced and reflecting on war's wider effects on health. Just as bioethics as a field has moved well beyond its original moorings in clinical and research ethics (Ravitsky 2023), bioethical approaches to armed conflict must too. Broadly considered, war is not just an individual tragedy but a public health crisis. ...

A Path Forward-and Outward: Repositioning Bioethics to Face Future Challenges
  • Citing Article
  • September 2023

The Hastings Center Report

... Social cognitive theory suggests that the environment infuences individual cognition and behaviour [44]. Te ethical climate of an organization is comprised of the collective knowledge and understanding of its members regarding what constitutes ethical conduct and how to resolve ethical dilemmas or problems [45], inevitably infuencing the proactive behaviour and cognition of nurses [46][47][48]. ...

Generative AI, Specific Moral Values: A Closer Look at ChatGPT’s New Ethical Implications for Medical AI
  • Citing Article
  • October 2023

... These advancements, coupled with genomic tools and personalized activation of specific alleles 88 , have the potential to address individual health challenges encountered in space. However, careful consideration must be given to ethical concerns such as informed consent 96 , crew ownership of data [97][98][99] and adherence to full Institutional Review Board (IRB) protocols as research in this evolving landscape progresses, especially for long-duration missions (Fig. 3), as well as for ground-based studies. ...

Ethically cleared to launch?
  • Citing Article
  • September 2023

Science

... " We hold a much different view. In the face of unjust laws and human rights violations, more than one response is ethically defensible -as some of us have argued Jecker et al. 2024a;Jecker et al. 2024b;Jecker, Verweij, et al. 2023;Ghaly, El Akoum, and Afdhal 2023). Boycotting is one way to seek to change an unjust situation, but so too is engaging with people who are willing to host, hear, and take seriously challenges and objections to their prevailing norms ). ...

Academic freedom under siege

Journal of Medical Ethics