Algorithmic ethics and healthcare pluralism: rethinking care between automation and global inequality

Abstract Algorithmic systems in healthcare are increasingly recognised not only as technical devices but as infrastructures that embed, enact, and stabilise normative assumptions about care, clinical authority, and social worth. This article offers a comparative analysis of algorithmic governance across the Global North, addressing concerns about over-generalisation and insufficient engagement with Global South perspectives, with a case-study focus on Benin. The paper shows how algorithmic tools—when transplanted into African contexts—may reproduce or intensify forms of epistemic displacement, infrastructural dependency, and digital paternalism, while simultaneously overlooking locally embedded, relational, and community-based practices of care. Integrating new empirical insights from field studies conducted by the author in Benin (2016–2024), the article reframes algorithmic normativity as a dynamic, contested process shaped by sociotechnical imaginaries, political economies, and situated practices of health provision. In response, it elaborates a solidarity-based governance framework built around technological subsidiarity and epistemic solidarity, two principles that emerge directly from the comparative analysis rather than being externally imposed. This framework offers a means to align AI development with context-specific ethical commitments, plural knowledges, and participatory forms of clinical judgment, particularly in low-resource settings. By explicitly integrating decolonial critiques, Global South authorship, and empirical evidence, the paper contributes a revised, theoretically coherent, and policy-relevant model for understanding and governing algorithmic care across unequal healthcare ecologies.