Clinical Decision Support Systems at the Intersection of Technology and Ethics: A Critical Analysis of the Ethical Guidelines Issued by the German Medical Association

Abstract The statement “Decision Support in Medical Practice through Artificial Intelligence,” (German: “Entscheidungsunterstützung ärztlicher Tätigkeit durch Künstliche Intelligenz”) by the Central Ethics Commission at the German Medical Association critically evaluates the implementation of Clinical Decision Support Systems (CDSS) from medical, ethical, and legal standpoints. While the statement highlights numerous advantages and challenges inherent in the use of AI in healthcare, it remains vague, particularly concerning the assignment of accountability, the delineation of professional responsibility, and the technical feasibility of integrating these systems in real-world clinical workflows. In the present paper, we scrutinize the statement from both philosophical and technical angles, offering concrete proposals aimed at clarifying the ethical ambiguities while also addressing the technological constraints that currently impede widespread adoption. By doing so, we aim to critically evaluate the governmental document against practical realities and bridge the gap between theoretical possibilities and practical applicability, thereby fostering a more nuanced and responsible use of AI in contemporary medical practice.