Legal and Ethical Challenges in Integrating AI Into Clinical Practice: Qualitative Study of Physicians’ Real-World Experiences

Background: The adoption of artificial intelligence (AI) in health care has accelerated; however, physicians continue to face substantial legal, ethical, and regulatory uncertainties when considering AI integration into clinical practice. Although the literature on AI in health care is expanding, there is limited insight into the real-world concerns voiced by clinicians navigating these uncharted territories. Objective: This study aimed to explore the legal and ethical uncertainties raised by Canadian physicians in relation to AI use in clinical care, using actual medicolegal advice requests as a window into their practical concerns. Methods: We conducted a comprehensive thematic analysis of 46 medicolegal advice cases made by physicians to a national medicolegal advisory service between March 2023 and February 2025. The cases were analyzed to identify key themes and patterns in physicians' questions and perceived risks regarding AI tools in clinical contexts. Results: Eight key themes emerged, including the use of AI scribes, data privacy and security, patient consent, data ownership, regulatory uncertainty, medicolegal liability, vendor agreements, and concerns about accuracy and bias. Many of the inquiries focused on administrative and documentation-related AI applications rather than on diagnostic tools, reflecting the current stage of AI integration in everyday clinical workflows. Physicians expressed uncertainty regarding legal responsibility, alignment with privacy laws, and appropriate communication with patients about AI use. Conclusions: This study offers unique insight into frontline physicians' real-time concerns about AI, highlighting the need for clearer regulatory guidance, clinical standards, and legal frameworks to support safe and ethical AI adoption in health care.