Beyond the Algorithm: Artificial Intelligence, Clinical Decision-Making, and the Moral Ecology of Care in Africa.

Artificial intelligence (AI) is increasingly promoted as a tool to enhance clinical decision-making and thus improve the quality of healthcare. While much of the emerging scholarship on AI and healthcare in Africa has focused broadly on opportunities and systemic challenges, what remains underexplored is the specific application of AI to clinical decision-making. This paper contributes to addressing this gap by offering a conceptual and critical analysis of AI-based clinical decision support systems (AI-CDSS) in African contexts. Drawing on philosophical accounts of medical reasoning and relational moral frameworks such as Ubuntu, the paper draws on the moral ecology of care and shows that algorithmic systems can reconfigure epistemic authority, redistribute responsibility, and risk marginalising context-sensitive and relational dimensions of care. The paper further argues that AI systems are better understood as socio-technical mirrors that reflect and amplify existing human values, institutional arrangements, and power asymmetries. Moving beyond the algorithm, it proposes a shift toward relational and context-sensitive AI governance, including the development of relational impact assessments, the redistribution of responsibility across the AI lifecycle, and the co-production of knowledge with local stakeholders. While focusing on African clinical contexts, the analysis offers broader insights for global debates on AI ethics and clinical decision-making.