Operationalizing WHO Ethical Principles for Healthcare AI: A Lifecycle-Aligned Governance-by-Design Framework

Artificial intelligence (AI) is rapidly transforming healthcare through applications in clinical decision support, diagnostic imaging, population health management, and workflow optimization. Despite these advances, real-world deployment continues to expose critical challenges related to safety, bias, transparency, and integration into clinical workflows. Algorithmic bias can exacerbate health disparities, limited explainability may undermine clinician trust, and insufficient validation and post-deployment monitoring can compromise patient safety. Although the World Health Organization (WHO) has established six ethical principles for AI in health, including autonomy, well-being and safety, transparency, accountability, equity, and sustainability, translating these high-level principles into practical and enforceable governance mechanisms remains a persistent challenge. This narrative review synthesizes insights from bioethics, health policy, computer science, and clinical medicine to identify gaps in current AI governance approaches and proposes a lifecycle-aligned governance-by-design framework that operationalizes WHO ethical principles across key stages of the healthcare AI lifecycle, including data collection, model development, validation, deployment, and post-deployment monitoring. The framework integrates concrete governance mechanisms such as consent governance, fairness evaluation, external validation, explainability, clinician oversight, and continuous performance monitoring. Overall, this work advances a practical, lifecycle-integrated approach to AI governance and provides a structured foundation for developing safe, equitable, and trustworthy AI systems in healthcare.