# Scientific Explanations in Health Sciences: Causality, Trust, and Epistemic Adequacy

arXiv: https://arxiv.org/abs/2606.31616 · HTML: https://mlsanity.com/paper/2606.31616/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 7 of its 37 references that are in the map.
- First posted on arXiv 30 Jun 2026.

## Builds on (most cited first, 7 of 7)

- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [A Survey on Explainable Artificial Intelligence (XAI): Towards Medical XAI](https://mlsanity.com/paper/1907.07374/) (2019)
- [Faithfulness vs. Plausibility: On the (Un)Reliability of Explanations from Large Language Models](https://mlsanity.com/paper/2402.04614/) (2024)
- [The Pragmatic Turn in Explainable Artificial Intelligence (XAI)](https://mlsanity.com/paper/2002.09595/) (2020)
- [GANterfactual - Counterfactual Explanations for Medical Non-Experts using Generative Adversarial Learning](https://mlsanity.com/paper/2012.11905/) (2020)
- [Axe the X in XAI: A Plea for Understandable AI](https://mlsanity.com/paper/2403.00315/) (2024)
- [Understanding XAI Through the Philosopher's Lens: A Historical Perspective](https://mlsanity.com/paper/2407.18782/) (2024)

## Abstract (arXiv)

Medical Artificial Intelligence (AI) is widely expected to transform clinical practice, yet the decision-making processes of many Machine Learning (ML) models remain opaque. Explainability has been advanced as a partial remedy to clarify why AI generates predictions, particularly in high-stakes contexts. Despite ongoing efforts, debates on what constitutes an adequate medical explanation remain unsettled. Yet, explanation has long been a central topic of inquiry in the philosophy of science and medicine. The insights developed in these fields, however, have been largely overlooked in contemporary explainable AI (XAI) research, leaving its foundational assumptions insufficiently examined. To address this gap, this paper develops a critical review at the intersection of philosophy of science and XAI. It examines prevailing accounts of what counts as an explanation in the health sciences and assesses their adequacy for informing XAI in medicine, arguing that they provide necessary conditions for a philosophically grounded approach to explainability in this domain. Building on this foundational philosophical literature, the discussion identifies three central axes of analysis: the role of causality in medical reasoning, the epistemic and relational dimensions of medical trust, and the criteria of explanatory adequacy as shaped by the pragmatic needs of diverse stakeholders. By integrating philosophical analysis with current developments in medical AI, the paper outlines principles for designing XAI systems that offer explanations that are not only epistemically robust but also aligned with the epistemic and practical requirements of clinical decision-making, shaping ongoing debates in medical XAI toward underexplored conceptual foundations.