Integrating AI into pharmacy practice is a promising avenue for innovation and enhanced patient care, but it also raises essential ethical considerations [6, 7]. This study aimed to explore the ethical dimensions of AI adoption in pharmacy practice in the MENA region and investigate the concerns and perspectives of pharmacy professionals. The results provide valuable insights into the potential challenges associated with the use of AI, framed within the principles of biomedical ethics, which include autonomy, beneficence, non-maleficence, and justice.
Concerns related to AI integration
Autonomy
One of the primary ethical concerns surrounding AI in pharmacy practice is the protection of patient autonomy and informed consent. Many participants expressed concerns about patients’ apprehension regarding AI’s ability to create suitable treatment plans. While this study examines the perspectives of pharmacy practice experts, it is essential to recognize that patient perspectives were similar in existing literature, which investigated patients’ apprehensions regarding AI in healthcare, emphasizing concerns related to safety, autonomy, and higher costs as factors influencing patient acceptance [18]. This raises questions about patients’ ability to make informed choices about their healthcare when it comes to AI systems. Patients should have the autonomy to decide whether or not they are comfortable with AI-driven recommendations and understand the implications. It is an obligation to provide patients with clear information about AI use, ensuring trust and informed decisions regarding their treatment plans. Moreover, nearly two-thirds of participants (62.4%) expressed concerns about physician reluctance to embrace AI, aligning with the broader sentiment observed in a systematic review where over 60% of physicians and medical students displayed positive yet reserved attitudes toward clinical AI, indicating a cautious approach despite increasing awareness of AI and its clinical applications [19]. However, more recent qualitative study findings highlighted low awareness and engagement among doctors working with AI in United Kingdom healthcare [20]. These concerns emphasize the importance of fostering trust and acceptance of AI technologies among healthcare professionals and patients. Ethical communication and transparency in AI implementation can help address these concerns and build confidence in AI-assisted healthcare. In addition to ethical considerations surrounding patient autonomy, it’s essential to address confidentiality issues, which directly intersect with autonomy. However, due to the serious harm of potential confidentiality breaches, further discussion is in the following section.
Beneficence and non-maleficence
The ethical principles of beneficence and non-maleficence require healthcare professionals to act in the best interests of their patients and avoid harm. In our context, over half of the participants (56.5%) had concerns about AI systems potentially overselling unnecessary medications and cosmetics to patients, raising questions about beneficence and potential maleficence. Such an act may be the result of a biased algorithmic system in the pharmaceutical market, and the absence of legally binding regulations in such a situation would harm consumers [21]. AI in pharmacy practice should prioritize patient well-being and ensure that recommendations are based on evidence-based guidelines rather than profit motives. Pharmacy professionals must critically evaluate AI-driven recommendations to ensure they align with patients’ best interests.
Additionally, the study revealed concerns about the impact of AI on patient counseling due to its limited communication skills and lack of body language. This is a significant ethical consideration, as it touches on the potential harm to the patient-provider relationship. Despite AI’s potential benefits in disease detection during the COVID-19 pandemic, our findings align with concerns raised in the literature in this regard and the need to ensure a positive impact on person-centered care [22, 23]. Especially in the deployment of mental health chatbots [24]. Pharmacy professionals must ensure that AI does not compromise the quality of care provided to patients. They must balance the efficiency gains AI offers with maintaining the human touch in patient interactions.
One primary concern in pharmacy practice was the risk to patient data privacy. Almost 60% of participants were apprehensive that AI threatened data privacy. Health data, unlike other types of data, is highly personal and confidential and might affect individuals’ health, well-being, and personal lives. Its sensitivity extends to the risk of shame, stigma, or discrimination, a concern particularly prevalent in developing countries [25, 26]. As AI systems typically involve collecting, storing, and analyzing sensitive patient information, these concerns are valid [4]. This underscores the need for robust data protection measures and adherence to privacy regulations such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States [27, 28]. In addition, the study highlighted worries about AI systems in pharmacies being vulnerable to hacking and cybersecurity threats. Over 58% of participants agreed with this concern. With the rise in cyberattacks on healthcare systems, as emphasized in a recent study, securing AI infrastructure is of paramount importance [29]. Potential patient confidentiality breaches are a primary ethical concern, and pharmacy stakeholders should prioritize data protection and security when implementing AI technologies. Investing in such cybersecurity solutions is essential to safeguarding data and maintaining trust between healthcare providers and patients [30].
Furthermore, a significant portion of the participants (62.9%) believed that AI systems may replace non-specialized pharmacists. This raises ethical questions about its impact on employment within the pharmacy sector, which led to workforce displacement. The fear of job displacement due to automation is not unique to the pharmacy field alone but resonates across various sectors. A different pattern was noticed in a previous study, where the majority disagreed that pharmacists could be replaced [31]. This might be because we asked about ‘non-specialized pharmacists’ (not certified by the Board of Pharmacy Specialties®) and not the pharmacy profession. It is crucial to recognize that while AI can automate specific tasks, it can also enhance the capabilities of pharmacists, enabling them to focus on more complex, patient-centered aspects of their roles. Therefore, the integration of AI should be seen as a tool to augment and complement the skills of pharmacy professionals, rather than replace them. Similarly, in alignment with Arab Muslim societies, the belief that God is the sole sustainer coexists with the understanding that individuals must be proactive and exert morally reasonable effort to acquire their provision [32]. Ethical considerations must encompass strategies for retraining and reskilling pharmacy professionals most affected by these changes, ensuring they remain relevant and valuable in the evolving landscape of pharmacy practice.
Justice
The principle of justice emphasizes fair and equitable access to healthcare resources and benefits. The study highlighted concerns about the cost of AI subscriptions (63.7%) and the lack of accessibility (67.6%), posing barriers to pharmacy practice. This highlights the potential for AI to exacerbate healthcare disparities. It is essential to ensure that AI technologies are accessible to all, regardless of economic status or location [7, 31]. Ethical frameworks must be developed to address these concerns and promote equitable access to AI-driven healthcare tools. To ensure this, governments, healthcare organizations, and technology providers must work together to develop pricing models that do not exclude smaller or underfunded healthcare settings. The financial resources of the institution should not determine accessibility to AI technologies but rather be based on their clinical and patient care needs.
Legal regulation, education, and training
The concerns raised by participants regarding the lack of comprehensive legal regulation for AI use in current pharmacy practice (67.0%) and the need to educate AI developers about data privacy and ethics (59.4%) are intertwined. Ethical considerations encompass data privacy and the responsible development and deployment of AI technologies, which emphasizes the importance of educating AI developers about biomedical ethics principles. They must understand the ethical implications of their technologies and prioritize patient well-being. It is also essential for governments and professional bodies to establish clear regulations and ethical frameworks that guide the safe and effective use of AI in healthcare. A recently published meta-analysis of 200 policies and guidelines for AI usage aligns with our study, with no representation of the MENA region, and emphasizes the global need for a unified approach in shaping future regulations to guide the ethical use of AI across diverse domains, including healthcare and pharmacy practice [33]. Moreover, collaboration between healthcare professionals, ethicists, and AI developers is crucial to ensuring that AI systems are designed, deployed, and adhere to these ethical guidelines.
The ethical considerations highlighted in prior research on AI in medical education align with our findings, emphasizing the need for regulations and education to ensure responsible AI development and transparent implementation [34]. Almost 70% of participants believed there was a lack of proper training for pharmacists to effectively use AI in practice. Pharmacy professionals are ethically obligated to maintain their competence and continue their education. Adequate training programs should be established to prepare pharmacists with the skills and knowledge needed to use AI technologies effectively and ethically. Educational institutions should collaborate with other sectors to develop curricula and training programs that equip future pharmacists with the necessary workflow skills.
Factors influencing concerns
Participants from different countries in the MENA region had varying levels of concern (p = 0.005). This is in line with the observed regional disparities in the findings of a review article that identified challenges and opportunities in MENA’s health systems, such as financial, organizational, and behavioral factors [35]. Also, the digital health technologies in less fortunate and conflict-affected areas of the MENA region have been explored and revealed some considerations for the adoption of digital health, such as computer literacy, weak technological infrastructure, and privacy concerns, which align with the acknowledgment of varying concerns among participants from different MENA regions [36]. Both discussions suggest the importance of considering regional, cultural, and contextual factors in shaping attitudes toward AI in pharmacy practice to address possible challenges in diverse settings. Less experienced individuals tended to have slightly higher concerns (r = -0.105, p = 0.018). Married individuals expressed higher concerns (p = 0.003), which could be related to the specific considerations and responsibilities associated with their status. These findings highlight the need for tailored strategies to address the concerns of different demographic groups, as these groups may perceive themselves as more vulnerable to being replaced with AI. Participants working in specific settings, such as drug stores or companies, reported higher concerns (p = 0.007). A drug store or company operates in a different professional setting from a community pharmacy, with a focus beyond direct patient care and medication dispensing. It encompasses various roles and functions related to the managerial, operational, and strategic aspects of the pharmaceutical industry [37]. These include marketing, business development, quality assurance, formulation, regulatory affairs, and other related tasks. This suggests that the institutional and workplace contexts can significantly impact attitudes toward AI integration, and participants affiliated with these places might have more interaction with new technologies such as AI, virtual reality, and robotics, leading to distrust and, eventually, fewer work opportunities [38]. Participants with higher levels of tech-savviness and basic AI understanding reported higher concerns (p < 0.001 for both). This finding underscores the importance of technology literacy and education in shaping attitudes and concerns related to AI. A similar trend was observed in a Jordanian study about using an AI-powered chatbot, namely ChatGPT, in pharmacy, with higher concerns strongly associated with more awareness [39]. Further analysis revealed that tech-savviness and basic AI understanding were positively correlated with higher concern scores. Age exhibited a negative but weak correlation and a relatively small effect on overall concerns. These findings suggest that individuals with better technology and AI literacy tend to have greater concerns about AI integration, as they carefully examined AI systems and might be more relevant and oriented with the complexity behind its adoption, advanced issues surrounding it, and potential misuse of such technology. Pharmacy professionals who are more familiar with AI technology may have a competitive advantage in future pharmacy practice settings [40]. These identified predictors provide valuable insights for educational institutions and policymakers and emphasize the importance of promoting AI literacy and awareness to facilitate informed ethical decision-making.
Implications of the findings
The insights garnered from this study hold significant implications for informing policy, shaping practice, and guiding education in the field. It is crucial to develop strategies that foster trust and enhance transparency when implementing AI. One practical recommendation is implementing educational programs for healthcare professionals and patients. These AI literacy programs can demystify these technologies, clarify their role in treatment plans, and address misconceptions. Additionally, creating user-friendly interfaces that explain AI-driven recommendations in plain language can empower patients to make more informed decisions about their healthcare. To overcome pharmacy professionals’ and healthcare providers’ reluctance, targeted interventions are needed. This includes incorporating AI education into medical curricula, providing hands-on training opportunities, and developing guides on effectively communicating AI’s role in treatment plans to ensure informed consent and trust. Policymakers can use these insights to develop robust regulations based on global best practices. Such policies should safeguard patient confidentiality and establish consequences for breaches. Acknowledging and actively addressing these concerns through powerful regulatory frameworks, stringent data privacy measures, and ongoing algorithmic audits can help build a more ethical foundation for AI implementation in pharmacy practice.
Limitations of the study and future research
The sample size may not represent the entire pharmacy community, limiting the generalizability of the findings. Additionally, the survey methodology relied on self-reported concerns, which could be subject to response bias. Future studies could benefit from more diverse and larger samples. Future research could conduct in-depth interviews to gain a more comprehensive understanding of the ethical concerns and perspectives of pharmacy professionals and stakeholders. Longitudinal studies could track changes in attitudes and concerns over time as AI becomes more integrated into pharmacy practice. Comparative studies across different countries could highlight variations in concerns and the readiness of varying healthcare systems for AI integration. They are investigating the effectiveness of specific interventions, such as education programs, in mitigating ethical concerns and improving the responsible implementation of AI in pharmacy practice.
In conclusion, this study offers important insights into the ethical considerations of integrating AI into pharmacy practice in the MENA region. Patient autonomy, beneficence, non-maleficence, and justice emerge as critical guiding principles, emphasizing the need for responsible adoption that prioritizes patient welfare, data security, and accessibility. The results underscore the need for robust ethical frameworks, regulatory guidelines, and educational initiatives. Collaboration among healthcare professionals, AI developers, and regulatory bodies is essential to developing ethical guidelines and policies prioritizing patient interests and preserving the human element in pharmacy practice. As AI continues to transform the future of healthcare, addressing these ethical concerns is essential for maintaining trust and integrity in the evolving landscape of AI integration, requiring ongoing research and collaborative endeavors to uphold the highest ethical standards.
