Ethical Framework for AI Decision Making in Medical Insurance

This report delves into the ethical implications of utilizing artificial intelligence in the realm of medical insurance. It begins by outlining the growing adoption of AI for data analysis and decision-making within the healthcare sector, specifically focusing on its application in scrutinizing insurance claims. The report highlights both the positive consequences, such as increased efficiency and reduced processing times, and negative consequences, including potential job losses and ethical concerns surrounding AI-driven decision-making processes. It then proceeds to evaluate these consequences through established ethical decision-making frameworks, including utilitarianism, deontology, rights, and virtue ethics. The analysis considers how each framework informs the ethical dimensions of AI implementation, considering the impact on stakeholders. The report concludes by synthesizing the findings and offering recommendations for ethically responsible AI integration in the medical insurance industry, emphasizing the need for careful consideration of both the benefits and potential drawbacks.

Running head: ETHICAL DECISION MAKING FRAMEWORK
ETHICAL DECISION MAKING FRAMEWORK
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Table of Contents
Introduction................................................................................................................................2
Discussion..................................................................................................................................2
Positive Consequences of using the artificial intelligence in the decision making process:. 3
Evaluation of the consequences using the ethical decision making framework:...................5
Recommendations..................................................................................................................8
Conclusion..................................................................................................................................9
References................................................................................................................................10

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Introduction
The use of technology has been implemented in the different sections of the industry.
It has been seen that the use of the emerging technology is adopted for the analysis of the data
and the decision making process. Regarding this, the application of the artificial intelligence
is implemented for the analysis of the medical insurance and the decision making process
regarding this context. It has been seem in many cases, the artificial intelligence is doing
better than the analysis done by the human being (Dhar 2016). Apart from that, during the
scrutiny of the insurance claims and making decisions some of the factors are needed to be
considered those can be well understood by the human being. In this situation there is an
ethical decision making problem raises regarding the use of the artificial intelligence in the
medical insurance claim.
The main objective of the paper is to evaluate the use of the artificial intelligence in
the medical insurance analysis. The evaluation will be done on the ethical perspective. In
order to do this evaluation the ethical decision making framework is needed to be considered
in the system. The conclusion in drawn from the factors those are discussed in the paper.
Discussion
Use of the artificial intelligence in the health care sector has grown exceptionally.
One of major use of artificial intelligence in health care sector is analysis of the medical
insurance through the use of artificial intelligence (Ayoub and Payne 2016). Use of artificial
intelligence in the medical insurance has improved the efficiency effectively. Apart from that
the analysis process is time consuming. However, the use of the artificial intelligence helps to
do the analysis within a small time span.
There are certain ethical dilemmas those can be raised during implementation of the
artificial intelligence for analysis of the medical insurance policies and the decision making

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process through the system. The raise of these ethical dilemma makes it necessary to evaluate
this artificial intelligence driven system to be evaluated under the ethical decision making
system.
Ethical decision making framework will evaluate different perspective of using the
artificial intelligence in decision making process (Hall and Pesenti 2017). In this context, the
consequences of the use of artificial intelligence in the decision making process in context of
the medical insurance is necessary.
Positive Consequences of using the artificial intelligence in the decision making process:
The positive consequences of using artificial intelligence regarding the analysis of the
medical insuring and the decision making process:
 Efficiency: Analysis of medical insurance is a critical process. In this context, it can
be said that certain issues and the parameters are needed to be considered while
making the decision regarding the medical insurance. In that case, it can be said that
the whole process is a complex one (Boddington 2017). The analysis of the medical
plan by a person will take more time as the person has to consider all the parameters
present in the insurance scheme.
With the implementation of the artificial intelligence, it can be said that the
processioning of the medical document can be carried out in a better way. This system
will deliver the better analysis in a small time span that will eventually increase the
efficiency of the overall system.
 Reducing the time span: It has been seen that the use of the artificial intelligence will
help to decrease the time span of the processing of the data in the medical insurance.
This can be regarded as the positive outcome as the insurance provider can increase
the efficiency of the process.

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 Providing better service: With the use of the artificial intelligence can provide better
service to the consumers. From the above discussed point it has been seen that the use
of artificial intelligence can reduce the processing time and the efficiency will be
increased with this implementation (Crawford and Calo 2016). This will help the
insurance companies to provide better service to the consumers.
 Mitigation of the human risk: It has been seen that due to the increased efficiency of
the overall service, the mitigation of the human error can be achieved through the
system. It has been seen that there is a chance of human error while analysis of the
medical insurance scheme as various parameters are needed to be considered during
the implementation of the system (Dörr and Hollnbuchner 2017). The use of the
artificial intelligence can be adopted effectively in case of the repetitive tasks (Thrall
et al. 2018). For the analysis of the requirements, artificial intelligence can play a
significant role as the task is repetitive in nature. Apart from that the whole process is
become less time consuming and there are less chances of error present in the
analysis.
Some of the negative consequences of using the artificial intelligence regarding the
analysis of the medical insuring and the decision making process:
 Loss of the jobs: The adaptation of the artificial intelligence process will allow
the automation of the process. Through the system the evaluation of the data and
the information regarding the medical insurance can be accessed at any time and
any moment (Ezrachi and Stucke 2017). The system provides better efficiency
along with the timely solutions to the organization. In this case, the organizations
are preferring the se of the artificial intelligence driven system for the analysis of
the medical insurance claim. This situation decreases the need for the necessary
of human resources in the insurance companies. The situation leads to the loss of

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job. Apart from that number of vacancies for the job is decreasing which is going
to have the negative consequences on the society.
 Decision making process of the intelligent system: The decisions are made by the
artificial system. The ethical issues are related with this decisions making process.
It has been seen that as the overall process is a complex process, there is a chance
that cognitive intelligence is needed to make the decisions on the basis of the
dynamic and exceptional conditions (Deng 2015). In this situation the use of
artificial intelligence for the decision making process may a feasible solution.
 Fault in implementation: It has been seen that the making of the artificial
intelligence is one by the human being. In this case, there is a chance that the
presence of the technical fault occurs during the implementation stage (Johnson
2015). In this case, the artificial intelligence driven system may not deliver the
right outcome.
Evaluation of the consequences using the ethical decision making framework:
The consequences of the artificial intelligence driven system can be evaluated through
the use of the classical ethical theories (Pesapane et al. 2018). This will indicate the ethical
factors those are present in the process of using the artificial intelligence driven system.
Utilitarianism: Utilitarianism is an ethical theory which defines the ethical aspects of
the action or the rule. According to this theory the act or rule can be regarded as ethical if
and only if the consequences of the rules or the action can cause greater good for the large
number of the society (Luxton 2016). It has been seen that the use of the artificial intelligence
for the decision making process in the medical insurance can be beneficial for the
organization. In this case, the insurance companies can be benefitted from the higher
productivity in the small time span. However, it has been seen that the use of the information
technology in the decision making process in the medical insurance process will reduces the

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chances of the jobs for the people. This will bring the negative consequence in the
organization (Cath et al. 2018). Apart from that it has been seen that the use of the
technology will bring the efficiency for the medical insurance companies, however, in certain
cases, there are problems those can only be solved by the natural cognitive ability of the
human being. In this situation, there can be a chance that the decision making process is not
proper (Floridi and Taddeo 2016). However, it can be said that there are certain advantages of
using the artificial intelligence in the decision making process for the insurance companies
(Noorbakhsh-Sabet et al. 2019). Through this the users and the consumers can get faster
service. Form this it can be said that the use of the artificial intelligence in the decision
making process can be beneficial if there are certain modifications are made on the process or
the system. The decreased chance in the job is a serious problem due to the use of artificial
intelligence (Liew 2018). In this case, proper training is needed to be given to the candidate
so that they can cope up with the process. This will make the process more ethical with
respect to this theory.
Theory of deontology: the theory of deontology is another aspect of the ethical theory.
According to this theory the ethical aspect of the act is not dependent on the consequences of
the action (Bryson and Winfield 2017). The act can be regarded as ethical if the perspective
of act is ethical.
It has been seen that the use of the artificial intelligence in the decisions making
process for the insurance companies will be beneficial for these companies as the efficiency
of the organization along with the productivity will be delivered effectively in a short time
span. The main objective of taking this type initiatives is to improve the overall service of the
organization (Dignum 2018). In this case, the initiatives taken by the company are taken for
the good purpose. In this case, it can be said that from the act of the deontology perspective
the initiative of using the artificial intelligence system in the decision making process for the

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medical insurance company is ethical as the objective of this initiative supports the ethical
perspective of the business.
Rights: The right is the factor in the ethical theory that identified the rightness of the
act or the rule. Determination of the rightness of the act can be done by the people of the
society. It has been seen that the act can be regarded as the right act if the act is endorsed by
the most of the people in the society. It has been seen that regarding the use of artificial
intelligence for the decision making process in the organization s accepted and supported by
some of the people in the organization (Hamet and Tremblay 2017). However, as there is
chance for the decrease in the job posts after the implementation of the artificial intelligence
some of the people from the society does not support this change. Regarding this it can be
said that there is a mixed reaction regarding the use of artificial intelligence for the decision
making process in the medical insurance company.
Virtue: The virtue does not judge the perspective or the rightness of the consequence
of the work. The virtue will evaluate the intention of the person or the individuals. In case, if
the intention of the individuals is proper, the act done by that person can be regarded as
ethical.
The main intention of using the artificial intelligence for the decisions making process
in case of the medical insurance is to increase the efficiency of the overall process. It has
been seen that the use of the artificial intelligence in the organization has gained popularity as
it will help the insurance company to deliver the decision making process in a proper way.
Apart from that consumers will get the proper service in the right time through the
implementation of this system (Baum 2017). From all these points of view it can be said that
the use of the artificial intelligence in the decision making process is ethical with respect to
the virtue theory.

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Recommendations
It has been seen that the use of the artificial intelligence in the decision making
process for the medical insurance has improved the overall process. The analysis is done
accurately considering all the parameters. It has been seen that the replacement of the human
work force for the analysis of the medical insurance claim. It has been seen that the use of the
technology in this field has both positive and negative consequences. The positive
consequence supports the mitigation of the processing time of the medical insurance files.
Apart from that the implemented system will deliver the accurate analysis and outcome. This
will be helpful for both the medical insurance service provider and the consumers using their
service.
Apart from that, in the negative consequence, the decrease in the job vacancies can be
mentioned. It has been seen that the many people are not getting job due to this digitization
process. Apart from that it has been seen that the major part of the people in the organization
are not supporting the use of the artificial intelligence for the decision making process.
It can be said that the use of the artificial intelligence for the medical insurance
industry has certain advantages. The main disadvantage regarding this system is sociological.
In this context, it can be said that the solution of this problem can be done through giving the
proper training to the candidates. Apart from that it can has been seen the demand of the
expert people in the field of artificial intelligence has increased. This can be regarded as a
positive trait of using the artificial intelligence. This can be also indicated that through the
proper training and the implementation of the plan the current issue regarding the job vacancy
can be mitigated.
Apart from that it can be recommended for the insurance companies are needed to be
the semi automation. It has been seen during the analysis of the medical insurance policy for

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the decisions making needs the cognitive ability of the human brain. Sometimes there can be
dynamic condition on basis of which the decisions has to be made. In that case, the human
interaction is needed to be done by the organization.
Conclusion
The discussion is regarding the evaluation of the ethical perspective of using the
artificial intelligence system in the medical insurance system. In order to evaluate the ethical
perspective, the use of the ethical decision making framework has been used. It has been seen
that the using of the artificial intelligence will server several advantages in the functionalities
for the organization. However, there are certain problems those can be faced by the people of
the society regarding the use of this technology. There can be a depression in the job
vacancies. Apart from that in some rare and exceptional cases, the decision making process
by the system may not be accurate. However, though the implementation of the proper
system and the steps these problems can be mitigated. After the mitigation of these problems
it can be said that these use of the artificial intelligence system in the decision making process
for the insurance companies is ethical.

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