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Taheri Afshar M, Eshaghzadeh M, Nadi A, Poursadeghian M, Rajabzadeh M. The Ethical Dilemmas of Artificial Intelligence In Nursing: A Systematic Review. jrehab 2026; 26 (4) :490-509
URL: http://rehabilitationj.uswr.ac.ir/article-1-3626-en.html

Objective One of the most significant ethical challenges in using artificial intelligence (AI) is the presence of ethical dilemmas. An ethical dilemma, a type of ethical conflict, is defined as any incompatibility between motivations and desires, educational methods, values, and the fulfillment of moral duties and responsibilities. Ethical challenges associated with using AI in nursing care include dilemmas linked to patient privacy and data security, the impact on patient autonomy, informed consent, safety and clarity of guidelines, accountability, and transparency. Additionally, AI may have unintended consequences on nursing care provision. This study examined the ethical dilemmas of using AI in nursing through a systematic review.
Materials & Methods This research was conducted independently by two researchers based on the research objectives and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. A comprehensive search of articles was performed from the beginning of January 2018 to the end of April 2025 across the databases  Medline, Scopus, Web of Science, association for computing machinery (ACM) Digital Library, PubMed, as well as the Scientific Information Database (SID) and Magiran search engines. Moreover, the search employed a Medical Subject Headings (MeSH) strategy and the keywords “ethics,” “artificial intelligence,” and “nursing,” in both Persian and English, utilizing Boolean operators. The steps included designing the research question, article search and extraction, selection of relevant studies, tabulation and summarization of the information, and result reporting.
Results Out of the 62 articles retrieved, 17 were reviewed and included in the study. The results revealed that, despite numerous benefits, using AI in healthcare is accompanied by many ethical challenges that must be considered. These challenges include safety and clarity of guidelines, informed consent, accountability, patient data privacy, and the effect on patient autonomy. Establishing clear guidelines and regulations is crucial to ensuring AI development and implementation in an ethical and accountable manner. The review showed that bias and discrimination received the most attention, being reported in 14 studies (82%). Following this, nurse autonomy was the second most frequently addressed topic, covered in 13 studies (76%), and the accountability and responsibility principle was also a focus in 12 studies (71%). The algorithmic transparency and interpretability topic was addressed in 10 studies (59%). Security, privacy, and human rights, as well as non-maleficence and beneficence, were each reported in 9 studies (53%). Justice was identified in 8 studies (47%), and finally, regulatory and legal frameworks were the least frequent ethical challenge or dilemma, appearing in 5 studies (29%).
Conclusion This review demonstrates that ethical challenges in using AI in nursing care, particularly regarding justice, autonomy, non-maleficence, beneficence, and accountability, are common. Therefore, a comprehensive examination and the creation of effective solutions are crucial to guarantee the ethical and responsible use of AI in healthcare.