Evidence map›Paper›PMID 42130876›Full record

ReviewFrontiers in public health2026

Ethical issues in multi-agent AI systems for healthcare: a narrative review.

Zhibin Xie, Hongyu Wang, Lexuan Dai, Zikai Wang, Haitao Song, Jingzhe Qian

Abstract readReview
In one paragraph

Review in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Zhibin Xie *KoGuan School of Law, Shanghai Jiao Tong University, Shanghai, China.
Hongyu Wang *The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Lexuan DaiUniversity of Southern California, Los Angeles, CA, United States.
Zikai WangShanghai Artificial Intelligence Research Institute, Shanghai, China.
Haitao SongShanghai Artificial Intelligence Research Institute, Shanghai, China.
Jingzhe QianShanghai Artificial Intelligence Research Institute, Shanghai, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Multi-agent AI systems are believed to bring significant improvements in digital health, but it also brings new and more serious ethical issues. Such systems distribute the decision-making process among multiple interacting agents, and this decentralized decision-making system has raised ethical concerns in the medical field. On the one hand, it continues the ethical issues of traditional AI tools; on the other hand, the interaction processes within complex systems have also brought about new dilemmas. This narrative review aims to synthesize the ethical issues related to multi-agent AI systems in healthcare presented and explore the corresponding mitigation strategies. Methods: The study outcomes were synthesized using a narrative approach. Relevant records were gathered through Boolean searches in databases such as PubMed, Scopus, and Web of Science. A total of 21 articles related to multi-agent AI, healthcare, and ethical issues are included in this review. Results: Seven key ethical challenges were identified: (1) compound opacity, where interacting AI agents create layers of inscrutable decision-making; (2) error propagation and attribution difficulties, complicating accountability for clinical harm; (3) increased clinician dependence and automation bias, leading to potential deskilling and overreliance; (4) erosion of human oversight, as multi-agent AI systems operate beyond effective human control; (5) privacy and data security risks, stemming from complex data flows among agents; (6) threats to patient autonomy and informed consent, due to opaque or paternalistic AI recommendations; and (7) contextual blindness, reflecting a loss of individualized patient understanding in modular AI workflows. Furthermore, this review also summarized solutions proposed in the existing literature for these ethical issues. Conclusions: Multi-agent AI systems intensify existing ethical concerns in healthcare by distributing decision-making and blurring responsibility. To mitigate these issues, recent research advocates for the development of adaptive governance models, clear accountability frameworks, human-AI collaboration structures that preserve clinician authority, enhanced systems for explainability, and privacy-centered designs. In order to successfully incorporate agentic AI into healthcare, it is essential to maintain transparency, protect patient rights, and ensure that human-centered values continue to guide clinical decision-making in an era dominated by autonomous, interacting AI systems.

Indexed as

Artificial IntelligenceDelivery of Health CareDigital HealthHumansagentic AI systemsautonomous decision-makingdigital healthhealthcare ethicsresponsibility and accountability

Identifiers

PMID42130876
PMCPMC13160892

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.