I know this is just an example, but I'm going to say this every time the subject comes up: since human lives are the cost of making the wrong decisions, AI can't be allowed to be a decision maker of any kind in healthcare.
If my blood pressure crashes because my nurse is caring for 15 patients at once and didn't notice that the AI decided to pause my norepinephrine, I won't consider "the AI did it" to be any acceptable excuse.
Replace AI with 'company' and you realize that we're living in that world already.
There's a reason it's called a Limited Liability Company. The whole point is to separate the company's liability from the individual that participates in it. For example, corporate financial liabilities of a company that is bankrupt.
You would not sue the nurse that makes a mistake. You would sue the company she works for. And if that company is bankrupt, well, that's it. There are rare instances where this isn't true, but generally it is.
Whether this is ethical or not, it's the system that we already have.
Do you think there's no difference in material outcomes when a company faces consequences of a specific human nurse being negligent vs an AI hallucinating?
I could've sworn that malpractice insurance cost is viewed as one of the driver's of high health care costs, and that it's expensive precisely because medical lawsuit payouts are large...
Your understanding of LLCs is a bit off. The LLC (or other corporate) structure does not protect the nurse from liability, nor any of the other directly-involved workers. The LLC protects the owners of the LLC - ie the ones turning the screws that spread workers ever-more thin. Workers generally avoid being sued mostly by custom, following procedures set by the LLC and/or professional bodies, being "judgement proof" (ie not having significant assets), and various types of insurances.
("Replace AI with 'company' and you realize that we're living in that world already." I 100% agree with this, though!)
> AI can't be allowed to be a decision maker of any kind in healthcare.
It will, except it will be snuck in through the back door. It won't be some kind of robo-doctor making care decisions, it will come in the form of insurance eligibility steering the approved care plans, which absolutely will be decided by AI. The doctors will remain to act as liability sinks, but functionally they will probably join the ranks of the meat proxies.
I see that already in veterinary medicine with the non-DVM office/practice managers (or whatever title that guy lurking around in the office may have) - in the vet practices belonging to large networks the DVMs and nurses constantly looking at those managers for approval.
Not to say that I don't agree with you to an extent, but you should see AI-delivered healthcare numbers to human-delivered and make it a fair comparison.
From Google:
"Annual Deaths: Over 250,000 people die each year in the U.S. due to medical errors made by healthcare professionals, including doctors and nurses.
Ranking: This figure positions medical errors as the third leading cause of death in the United States, following heart disease and cancer."
It is highly possible that in a few years, AI will be a lot safer in the majority of healthcare situations.
"Taking death statistics from a sample of Medicare patients and extrapolating it to all hospitalized patients is like turning apples into oranges"
"Using studies that identify medical errors that were followed by death to declare that these medical errors necessarily caused these deaths is not fair. What these studies do not take into account is how long these patients would have lived had they received optimal medical care."
The difference is that humans are at least supposed to be accountable for those 250,000 errors. Those humans can naturally care about doing a good job, or they can be motivated to care. They can fear consequences and take pride in avoiding mistakes.
AI can do none of this, and cannot be held accountable for mistakes.
I would take a human with a 10% mistake rate but who can be held accountable, over an AI with a 0.1% mistake rate that is totally unaccountable for its mistakes.
> I would take a human with a 10% mistake rate but who can be held accountable, over an AI with a 0.1% mistake rate that is totally unaccountable for its mistakes.
You would take those odds? 100x more deaths?
I agree that AI _companies_ should be accountable for the software they produce but I’m not convinced you would go for a 90% chance of survival if you can choose 99.9%.
I guess if you're dead, then it ultimately doesn't matter if someone can be held accountable, although it might matter to your next-of-kin.
But, yea, in general, it would take a huge (1000X or 10,000X) difference in expected outcome for me to trust something that is unaccountable. If the AI company was actually held accountable for its AI's mistakes, I'd definitely change my statement.
AI is a tool just like any other tool. Holding “AI” accountable is like holding JetBrains accountable for the bugs I wrote with their tool than endangered lives of people
There is simply too much money and too many interests vested in the narrative (which many people already believe) that LLMs are thinking, feeling, sapient beings already beyond the threshold of AGI that deserve some status of legal personhood and liability. It is impossible to create the future that these people want to create - one in which AI comprises the new legal class of nobility in an age of technofeudalism - if AI remains just a tool.
how will this manifest itself!? like you envision a future where there will be say a hospital, ran by anthropic which is AI powered fully, no company behind it, just plain Claude running everything from the moment you walk in till you walk out?
I am having a hard time imagining a future where “AI” isn’t just a tool that a given establishment decided to use much like anything else they use
> you envision a future where there will be say a hospital, ran by anthropic which is AI powered fully, no company behind it, just plain Claude running everything from the moment you walk in till you walk out
Everything as much as possible, yes, and the company behind it will be an AI driven autonomous corporation as well. Although I suspect that by then there will be some industry specific AI model being used by hospitals, not just plain Claude.
AI will handle patient data, diagnostics, prescriptions, everything that doesn't absolutely require a human and can't yet be done by a robot.
Somewhere, some human will be making money but they will be far from any legal liability, probably safely ensconced in a bunker on a private island when the gravy train really hits the fan.
>I am having a hard time imagining a future where “AI” isn’t just a tool that a given establishment decided to use much like anything else they use
The people making the decisions, investing the money and writing the laws imagine so much more, though. You assume the future of AI is governed by rational people making rational decisions but it isn't, it's governed by Musk and Thiel and sociopaths and grifters and cultists who want to immanentize the eschaton so they can stand at the right hand of God.
You can bet that every major company CEO on the planet is creaming his jeans at the thought of AI doing every task (except their own) that they currently pay humans to do. Their ideal end state is that the company is themself, thousands of AIs and thousands of robots, zero payroll. Every one of them is dreaming of this.
I do not disagree but I also do not see how, without liability for its action, would a business have customers. Surely there are idiots but if someone put up a sign in front of the hospital like "we are not liable for anything that happens inside these walls" I will venture a guess that business will suffer. This will also open up business opportunities for other businesses to jump in with "we stand by what we do, you'd be crazy to go to _____ for services we are offering."
I might be naive to the core but I think, in the long run, I am not very Doom&Gloom about AI like you are sounding, people have a way of (eventually) making their own decisions and won't put up with this world you are pitching (I hope lol)
I'm not pitching it per se, I'm just claiming that's what I think the endgame for AI is. Corporations (especially in the medical, pharmaceutical and insurance fields) are already masters at avoiding legal liability. What are you [royal] going to do, bleed to death in the streets? Not get your insulin or heart medication? What decisions are you going to make when every company does the same thing? Get your chemo from a shaman? People already put up with massive cruelty and corruption from the medical industry, they would roll over for this as well.
I can even see it being sold as part of healthcare reform. After all, we don't trust doctors anymore, we don't trust science, surely AI would be more fair, more rational and ethical. AI can't be paid off by big pharma to push pills you don't need. AI doesn't care what race or gender you are. AI doesn't get exhausted after a 24 hour rotation. Costs would go down, quality would go up. That would be the pitch anyway. The rest would be in the fine print, not a sign in front of the hospital.
I don't want to live in that world, but I can see a path to it from where we are now. I think some kind of legal personhood for AI as a pretense to apply legal liability to AI is inevitable.
You’re painting a pretty dystopian picture of a hyper capitalist society where the rich have shaped the law in a way that the poor have no recourse. I think it could happen but it’s completely unrelated to anything AI and more to do with your government.
But what's the point of holding something accountable here? Creating an incentive for them to take your needs seriously? Why does an incentive matter if you already know that one has a superior expected outcome?
Human doctors and nurses are not accountable for outcomes, and they can not be accountable or our medical system (and any other medical system) would cease to function.
A nurse and doctor have personal liability in the US.
Imagine having to do paperwork as a nurse after working a 12 hour physical job, overnight, 8pm to 8am.
The idea mistakes happen because the nurse doesn't "care" is utter bullshit.
I think of how if I am really tired I just don't do anything that risky at my job until the next day. A nurse doesn't really have that option and it is all the highest risk there is. Every day, all day. All with a chronic, massive work shortage for dogshit pay.
The most brutal thing I have read about nursing are nurses saying the lucky people are the ones who failed out of nursing school.
> human lives are the cost of making the wrong decisions ...
True.
> ... AI can't be allowed to be a decision maker
Non sequitur.
Part 2 only follows from the Part 1 if you can demonstrate that AI makes more errors, or more severe errors, than humans in the identical situation.
And for those situations, I agree with you.
But there are already many situations where the AI is making fewer errors than humans, and for those situations, it would be unethical to exclude AI (see Part 1).
Surely the only rational reason to care about liability is you get paid in the bad outcome.
Let's assume you get paid 0$ for AI mistakes -- no liability at all. Then your EV is roughly:
(AI accuracy - human accuracy) * (cost of accident) - (1 - human accuracy) * (human payout)
Now I don't know about you, but even with pretty big numbers on the human payout scale and relatively small differences, I would not accept 10 million (presumably paid to my next of kin) to die. Does lead to weird situations where I may prefer humans for minor medical procedures where I can take the risk -- but only in edge cases.
Or is there some weird punishment thing going on here?
Not true. The company deploying or using the AI (not the frontier AI lab building it) needs to make sure that the AI works. Just like anything else. Not sure why this is complicated.
Better error rates are an argument for AI into the process, but that doesn't justify making it the decision maker. Ethics concerns more than just the error rate, it also concerns the accountability, ability to appeal, due process, explainability, distribution of harm, and so on.
Ethically, we can easily justify refusing to delegate responsibility and accountability to a system that has no responsibility or accountability.
> If my blood pressure crashes because my nurse is caring for 15 patients at once and didn't notice that the AI decided to pause my norepinephrine, I won't consider "the AI did it" to be any acceptable excuse.
While not quite as direct as automatically stopping vasopressors, using proprietary prediction models touted by vendors to be safe has backfired in a major way before:
Why wouldn't they just blame the nurse anyway? The law always puts somebody on the hook. The nurse's job will be to do what the AI says and take the blame when it fails.
This is the same faulty standard you constantly hear applied to self-driving cars, where human lives are also often at stake. You don't need the AI to be perfect. You just need it to be substantially better than the average human (which self-driving cars are). Your nurse who's caring for 15 patients at once might not make perfect decisions either. That doesn't categorically disqualify humans from delivering health care
It will be depending on how much you paid. My bet is that in the near future normal people (like most of us) will be attended by AI in pretty much everywhere: the bank, the hospital, shops, hotels, etc.
You will need to pay extra premium to be attended by a human being. Actually that’s what’s been happening to the ultra rich since a very long time ago (e.g. a millionaire doesn’t book an appointment by using their phones, they ask their assistant to book for them; they don’t go online shopping, they get people do the shopping for them, etc)
I want to emphasize your point. As a basic matter of valuing humanity qua humanity, this holds even if the AI could be shown to make the decisions more accurately than a human could.
In fact, especially in those circumstances, if we take the warnings of X-risk even slightly seriously.
If my blood pressure crashes because my nurse is caring for 15 patients at once and didn't notice that the AI decided to pause my norepinephrine, I won't consider "the AI did it" to be any acceptable excuse.