## 3 Transformative Impact and Ethical Implications of AI in Healthcare
### Implementing Ethical AI in Healthcare
#### 3.3.1 Blockchain Technology: Reinforcing Security and Transparency in Healthcare AI  
Integrating Artificial Intelligence (AI) in healthcare marks a significant advancement in medical technology, offering potential benefits in enhancing patient care. However, it also introduces substantial ethical challenges concerning privacy and patient autonomy. These concerns necessitate the adoption of advanced technologies that can safeguard patient data while leveraging the benefits of AI in healthcare [11]. Blockchain technology has emerged as a promising solution to enhance data security and integrity in healthcare AI. Its decentralized nature eliminates the need for central authority, reducing the risk of a single point of failure that could compromise the entire system. In healthcare, blockchain can create a secure and unforgeable record of patient data transactions, ensuring that medical records are accurate, consistent, and tamper-proof. For a detailed exploration of how blockchain technology influences privacy and decision-making in AI healthcare, see the insights in Table 2. The blockchain application extends beyond just data storage; it can also facilitate secure data sharing between different healthcare stakeholders. Smart contracts, which are self-executing contracts with the terms of the agreement directly written into code, can automate the consent process for data sharing, ensuring that patient data are only accessed by authorized parties and under specific conditions agreed upon by the patient. Moreover, blockchain can be integrated with other technologies, such as AI and IoT devices, to enable secure and real-time monitoring of patient health data, providing healthcare professionals with reliable data for decision-making while preserving patient privacy [7; 12]. Recent research underscores the collective potential of blockchain technology in bolstering the security and privacy of healthcare AI systems. The authors of [14] introduced an IoT-based model for secure big data transfer in healthcare, leveraging blockchain for data integrity and security. The authors of [15] proposed an architecture combining AI and blockchain to protect smart healthcare systems from data integrity attacks, focusing on wearable devices. The authors of [16] envisioned a healthcare metaverse where AI and blockchain work together to offer secure and efficient remote health monitoring and virtual consultations. The authors of [17] provided a bibliometric analysis highlighting the synergy between AI and blockchain in enhancing security and calling for more research to develop stable systems. These studies collectively advocate for integrating blockchain with AI to address security concerns, each contributing unique perspectives on system architecture, data transmission, and the application of smart contracts. By synthesizing their findings, it becomes evident that the convergence of these technologies can lead to innovative solutions for managing healthcare data with improved security and patient privacy. However, they also agree on the necessity for continued research to overcome data privacy, security, and trust challenges, ensuring the practical implementation of these advanced systems in real-world healthcare settings. Continuing from the synthesized research findings, it is clear that the application area of blockchain in healthcare AI is vast and multifaceted. The integration of blockchain technology is not limited to securing electronic health records but extends to enhancing the entire healthcare delivery system. This includes patient data management, drug traceability, clinical trials, and personalized medicine, where secure and transparent data handling is paramount. As the healthcare industry continues to innovate, blockchain and AI will likely expand into new areas, such as advanced biometrics for patient identification and decentralized autonomous organizations (DAOs) for patient-led research initiatives.