Abstract
Artificial intelligence (AI) is rapidly transforming surgical care, offering unprecedented capabilities in diagnostics, planning, and intraoperative guidance. However, its integration into clinical practice raises complex ethical challenges that must be addressed to ensure responsible and equitable use. This chapter aims to explore the ethical implications of AI in surgery through the lens of the four foundational principles of medical ethics: autonomy, beneficence, nonmaleficence, and justice. Respecting patient autonomy requires clinicians to disclose all relevant information and ensure understanding of a proposed intervention (or AI tool) for a patient to make an informed, voluntary decision. Numerous studies have shown that both patients and clinicians often lack sufficient understanding of AI tools, complicating efforts to explain their intended function, or obtain truly informed consent for their use in patient care. This has the potential to diminish trust in the patient-clinician relationship and must be considered when using AI tools. AI's potential to uphold beneficence is evident in its ability to enhance surgical precision and outcomes. Yet, its reliance on historical data introduces risks of bias and error, threatening the principle of nonmaleficence. In this chapter, we explore these topics further to highlight the need for robust oversight and clinician involvement to prevent harm to patients. When biased data are used to train an AI tool, it may lead to unequal care across patient populations-i.e., exacerbating existing disparities in health care. Additionally, the lack of clear accountability for AI-driven errors raises legal and ethical concerns about liability-whether it lies with clinicians, health care institutions, or developers. To ethically integrate AI into surgical practice, the chapter calls for comprehensive frameworks that ensure transparency, data integrity, clinician and patient education, and regulatory oversight. These measures are essential to safeguard patient welfare as AI continues to reshape the future of surgical care.