Background: The development and introduction of an AI-based Clinical Decision Support System (CDSS) in surgical departments within the SURGE-Ahead project responds to the increasing aging population. Thereby, digital geriatric co-management with an evidence-based evaluation of the patient’s health condition and corresponding medical recommendations is aimed to improve the perioperative geriatric patient care. Objective: The use of an AI-based CDSS in patient care raises ethical challenges. The collection of opinions, expectations and concerns of older people as potential geriatric patients on the CDSS enables the identification of ethical chances, concerns and limitations that arise after implementing the technical device in hospitals. Methods: In total, five focus groups with participants aged 65 years and above were conducted. The transcripts were evaluated according to the qualitative content analysis and ethically analyzed: First, an inductive formation of categories was implemented, followed by a thematic classification of the participants’ statements. Thereby, we disproved technical understanding to impact the older people’s opinions. Results: Ethical chances and concerns were detected: The diagnosis and therapy could speed up, changes in the patient-AI-physician-interaction could improve medical treatment and enhance the coordination in hospitals. However, the quality of the CDSS depends on an adequate data basis and cyber security. A habituation effect and loss of a second medical option could develop, and the severity of an illness could be considered as an impact factor on the patient’s attitude towards medical suggestions. The risk of overdiagnosis and overtherapy was discussed controversially, and the range of therapy options could be influenced by interests and finances. Saving time resources would remain challenging, medical skills could decrease and the extent of the patient’s hospital stay could be affected. Conclusions: To respond to the ethical challenges, we recommend a time-sufficient use and emphasize an individual revision of the CDSS’s results. Furthermore, we suggest a limitation of private financial sponsoring.

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