Ethical Incorporation of Artificial Intelligence into Neurosurgery: A Generative Pre-Trained Transformer Chatbot-Based, Human-Modified Approach

Nathan A Shlobin; Max Ward; Harshal A Shah; Ethan D L Brown; Daniel M Sciubba; David Langer; Randy S D'Amico

doi:10.1016/j.wneu.2024.04.165

Ethical Incorporation of Artificial Intelligence into Neurosurgery: A Generative Pre-Trained Transformer Chatbot-Based, Human-Modified Approach

World Neurosurg. 2024 May 7:S1878-8750(24)00738-1. doi: 10.1016/j.wneu.2024.04.165. Online ahead of print.

Authors

Nathan A Shlobin¹, Max Ward², Harshal A Shah², Ethan D L Brown², Daniel M Sciubba², David Langer², Randy S D'Amico²

Affiliations

¹ Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: nathan.shlobin@northwestern.edu.
² Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA.

PMID: 38723944
DOI: 10.1016/j.wneu.2024.04.165

Abstract

Introduction: Artificial intelligence (AI) has become increasingly used in neurosurgery. Generative pre-trained transformers (GPTs) have been of particular interest. However, ethical concerns regarding the incorporation of AI into the field remain underexplored. We delineate key ethical considerations using a novel GPT-based, human-modified approach, synthesize the most common considerations, and present an ethical framework for the involvement of AI in neurosurgery.

Methods: GPT-4, ChatGPT, Bing Chat / Copilot, You, Perplexity.ai, and Google Bard were queried with the prompt "How can artificial intelligence be ethically incorporated into neurosurgery?". Then, a layered GPT-based thematic analysis was performed. The authors synthesized the results into considerations for the ethical incorporation of AI into neurosurgery. Separate Pareto analyses with 20% threshold and 10% threshold were conducted to determine salient themes. The authors refined these salient themes.

Results: Twelve key ethical considerations focusing on stakeholders, clinical implementation, and governance were identified. Refinement of the Pareto analysis of the top 20% most salient themes in the aggregated GPT outputs yielded ten key considerations. Additionally, from the top 10% most salient themes, five considerations were retrieved. An ethical framework for the use of AI in neurosurgery was developed.

Conclusion: It is critical to address the ethical considerations associated with the use of AI in neurosurgery. The framework described in this manuscript may facilitate the integration of AI into neurosurgery, benefitting both patients and neurosurgeons alike. We urge neurosurgeons to use AI only for validated purposes and caution against automatic adoption of its outputs without neurosurgeon interpretation.

Keywords: ChatGPT; bioethics; deep learning; machine learning; medical ethics; neurological surgery.