JMIR Publications

ABSTRACT

Trustworthy AI has become a key concept for the ethical development and application of artificial intelligence (AI) in medicine. Various guidelines have formulated key principles—such as fairness, robustness, and explainability—as essential components to achieve trustworthy AI. However, conceptualizations of trustworthy AI often emphasize technical requirements and computational solutions, frequently overlooking broader aspects of fairness and potential biases. These include not only algorithmic bias but also human, institutional, social, and societal factors, which are critical to foster AI systems that are both ethically sound and socially responsible. This article presents an interdisciplinary approach to analyzing trust in AI and trustworthy AI within the medical context, focusing on (1) social sciences and humanities conceptualizations and legal perspectives on trust and (2) their implications for trustworthy AI in healthcare. It focuses on real-world challenges in medicine that are often underrepresented in theoretical discussions to propose a more practice-oriented understanding. Insights were gathered from an interdisciplinary workshop with experts from various disciplines involved in the development and application of medical AI, particularly in oncological imaging and genomics, complemented by theoretical concepts related to trust in AI. Results emphasize that, beyond common issues of bias and fairness, knowledge and human involvement are essential for trustworthy AI. Stakeholder engagement throughout the AI lifecycle emerged as crucial, supporting a human- and multi-centered framework for trustworthy AI implementation. Findings emphasize that trustworthiness in medical AI depends on providing meaningful, user-oriented information and balancing knowledge with acceptable uncertainty. Experts highlighted the importance of confidence in the tool's functionality, specifically that it performs as expected. Trustworthiness was shown to be a relational process, involving humans, their expertise, and the broader social or institutional contexts in which AI tools operate. Trust is dynamic, shaped by interactions among individuals, technologies, and institutions, and ultimately centers on people rather than tools alone. Tools are evaluated based on reliability and credibility yet trust fundamentally relies on human connections. The article underscores the development of AI tools that are not only technically sound but also ethically robust and broadly accepted by end-users, contributing to more effective and equitable AI-mediated healthcare. Findings highlight that building AI trustworthiness in healthcare requires a human-centered, multi-stakeholder approach with diverse and inclusive engagement. To promote equity, we recommend that AI development teams involve all relevant stakeholders at every stage of the AI lifecycle—from conception, technical development, clinical validation, and real-world deployment.