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This research introduces ETHOS, a modular meta-agent framework that embeds deterministic checks and runtime oversight directly into clinical multi-agent systems without altering their core architecture. The approach effectively mitigates safety risks by dynamically evaluating reasoning steps to suppress unreliable outputs or request revisions before final decisions are made in high-stakes healthcare environments. By operationalizing abstract ethical principles as executable governance layers, this work bridges the gap between conceptual guidelines and practical deployment of AI agents in medicine.
ETHOS: Towards a Modular Ethics Framework for Clinical Multi-Agent Systems
arXiv:2608.15424v1 Announce Type: cross Abstract: The rapid adoption of large language models has enabled the development of clinical multi-agent systems (MAS) capable of integrating multimodal patient data and supporting increasingly complex clinical decision-making. However, the deployment of these systems in real-world healthcare settings raises critical ethical concerns related to safety, fairness, accountability, transparency, and patient trust. While numerous organizations, including the World Health Organization, the National Academy of Medicine, and the FUTURE-AI consortium, have proposed ethical frameworks and governance principles for healthcare AI, these efforts remain largely conceptual. To address this challenge, we present ETHOS (Ethics and Trust through Hierarchical Oversight System), a modular ethics framework designed as a governance meta-agent that can be integrated with any existing multi-agent system without requiring changes to its underlying architecture. ETHOS translates stakeholder-informed ethical requirements into executable runtime oversight through a layered governance approach consisting of deterministic checks, contextual reviews, and a final ethics critic. These components continuously evaluate intermediate reasoning steps and final outputs, enabling the system to identify ethical risks, request revisions, or suppress responses that fail predefined safety and trustworthiness criteria. We demonstrate ETHOS within a hepatology clinical decision-support MAS. Results show that ETHOS improves decision reliability by detecting incomplete, inconsistent, or out-of-scope evidence and appropriately increasing abstention when safe recommendations cannot be supported. By embedding ethical governance directly into system operation, ETHOS provides a practical and auditable mechanism for transforming high-level AI ethics principles into deployable safeguards.
Authors:Rakesh Sharma, Sydney Pugh, Cameron Beeche, Pankhuri Singhal, Rachel Wu, Margaret Eby, Jeffrey Duda, James Gee, Kyra O'Brien, Hersh Sagreiya, Marina Serper, Victoria Gershuni, Angela Bradbury, Anurag Verma, Eric Eaton, Kevin B. Johnson, Walter Witschey
Abstract:The rapid adoption of large language models has enabled the development of clinical multi-agent systems (MAS) capable of integrating multimodal patient data and supporting increasingly complex clinical decision-making. However, the deployment of these systems in real-world healthcare settings raises critical ethical concerns related to safety, fairness, accountability, transparency, and patient trust. While numerous organizations, including the World Health Organization, the National Academy of Medicine, and the FUTURE-AI consortium, have proposed ethical frameworks and governance principles for healthcare AI, these efforts remain largely conceptual. To address this challenge, we present ETHOS (Ethics and Trust through Hierarchical Oversight System), a modular ethics framework designed as a governance meta-agent that can be integrated with any existing multi-agent system without requiring changes to its underlying architecture. ETHOS translates stakeholder-informed ethical requirements into executable runtime oversight through a layered governance approach consisting of deterministic checks, contextual reviews, and a final ethics critic. These components continuously evaluate intermediate reasoning steps and final outputs, enabling the system to identify ethical risks, request revisions, or suppress responses that fail predefined safety and trustworthiness criteria. We demonstrate ETHOS within a hepatology clinical decision-support MAS. Results show that ETHOS improves decision reliability by detecting incomplete, inconsistent, or out-of-scope evidence and appropriately increasing abstention when safe recommendations cannot be supported. By embedding ethical governance directly into system operation, ETHOS provides a practical and auditable mechanism for transforming high-level AI ethics principles into deployable safeguards.
Preprint of an article submitted for consideration in Pacific Symposium on Biocomputing \textcopyright\ 2027 World Scientific Publishing Company. \url{this https URL}
Multiagent Systems (cs.MA); Artificial Intelligence (cs.AI); Machine Learning (cs.LG)
arXiv:2608.15424 [cs.MA]
(or arXiv:2608.15424v1 [cs.MA] for this version)
https://doi.org/10.48550/arXiv.2608.15424 arXiv-issued DOI via DataCite (pending registration)
Full text under the publisher's open licence · 313 words
