IMIA Yearbook of Medical Informatics 2020 © 2020 IMIA and Georg Thieme Verlag KG Ethics in Health Informatics Kenneth W. Goodman Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, USA Summary Contemporary bioethics was fledged and is sustained by chal- lenges posed by new technologies. These technologies have affected many lives. Yet health informatics affects more lives than any of them. The challenges include the development and the appropriate uses and users of machine learning software, the balancing of privacy rights against the needs of public health and clinical practice in a time of Big Data analytics, whether and how to use this technology, and the role of ethics and standards in health policy. Historical antecedents in statistics and evidence-based practice foreshadow some of the difficulties now faced, but the scope and scale of these challenges requires that ethics, too, be brought to scale in parallel, especially given the size of contemporary data sets and the processing power of new computers. Fortunately, applied ethics affords a variety of tools to help identify and rank applicable values, support best practices, and contribute to standards. The bioethics community can in partnership with the informatics community arrive at policies that promote the health sciences while reaffirming the many and varied rights that patients expect will be honored. Keywords Artificial Intelligence, Big Data, Bioethics, Clinical Decision Support Systems, Public Policy Yearb Med Inform 2020 http://dx.doi.org/10.1055/s-0040-1701966 Introduction Ethics is a kind of lens we use to identify issues and a lever used to formulate and motivate best practices. Applied ethics is a tool to employ widely shared if not univer- sal values to contemporary questions and challenges in science and the professions. Bioethics is the branch of applied ethics that addresses issues in the health professions; it is often linked to other kinds of applied ethics, including business ethics, computer ethics, government ethics, and so on. It has become commonplace to observe or argue that science usually or even always outpaces, or advances, more swiftly than applied ethics. In the case of health informat- ics, this is a mistake. For some four decades, albeit with some exceptions, advances in biomedical informatics have been matched step for step by scholars who have identified and addressed the ethical, legal, and social issues (ELSI) raised by the expansion of a new science. This acronym, borrowed from the Human Genome Project, has ably served the informatics community as a label or guidepost for research and pedagogy. Though bioethics has moved forward, the same cannot be said for the law which continues to lag as a source of official gov- ernance and oversight in health informatics and other domains. It might be that the re- lationship between ethics and public policy represents the greatest challenge faced by health informatics and the society health informaticians seek to serve. What follows from these two obser- vations is this: we have an extraordinary opportunity at a crucial time to try to ensure that the insights and analyses provided by ethics continue to mature and, as important, that they are taken up and incorporated by academic and health care institutions, businesses, professional organizations, and governments. In what follows, I expand on these points by filtering them through a number of contemporary challenges. These include artificial intelligence and machine learning; Big Data, data sharing and privacy; duties to use and manage new technology; and ethics and public policy. 1 Artificial Intelligence, Machine Learning, and Ethics The ancient fantasy of an intelligent ma- chine or a smart homunculus became a research project in the 17 th century when Gottfried Leibniz, the philosopher and logician who, with Newton, discovered the infinitesimal calculus, suggested that human reason could be rendered in a uni- versal language such that argumentation could be reduced to calculation. He built a primitive calculator [1], arguably the first machine to replicate an aspect of human thinking. Leibniz thought that intelligent machines would formalize reason and end disagreements. They did not. During the greatest disagreement in the history of civilization – World War II – code-breaking machines represented nontrivial instantia- tions of Leibniz’ aspiration: “The first digi- tal, electronic and programmable computer was developed as an instrument of warcraft. The Colossus was a room-sized collection of racks, pulleys, wires and some 2,400 bottle-sized vacuum tubes built at Britain’s Bletchley Park to decipher encrypted Ger- man messages…. It became operational in 1944 and was used to prepare the D-Day invasion of Normandy. One could argue that it eventually saved more lives than most medical inventions” [2]. However, we want health informatics to save and improve lives, to reduce suffering, to help to achieve the larger goals of the Published online: 2020-04-17