Showing posts with label medical. Show all posts
Showing posts with label medical. Show all posts

Wednesday, September 30, 2026

The Real AI Experience

A grayscale view of a hospital, with an 'H' and a '+' sign in a desaturated pink, and some of the windows
              and an awning that are both in a magenta color looking like two malevolent eyes and a mouth,
              as if the hospital were the picture of a face, perhaps an intelligent one, even if also evil.

Putting on the brakes

I try to always put “AI” in quotes because I do not personally think Large Language Models (LLMs) are artificially intelligent. That's someone else's word, and I use it, but grudgingly. But the conversation we need to have here doesn't hinge on issues of intelligence. It's enough that they are capable of making stabs at plausible things. And we're letting them.

Hopefully the part about stabbing is just metaphor, but that's part of the problem. We're handing them things that have the power to hurt us and hoping they will use such power “judiciously.” There are a lot of natural intelligences, humans, who don't do well with sharp things. And even if you believe the whole “AI” narrative, these things are in their infancy.

Before things have gone too far, we need to establish some power, some rights of action. A hold we retain over these “AI” systems that sets boundaries and regulates the flow of events. We would do this with children who are not yet experienced enough to see customary boundaries on their own.

Fairly-regulated rights are not rights denied

Even with adults, many situations are important or dangerous enough that humans apply safeguards routinely. For obvious reasons, we require specific authentication and authorization to have money withdrawn from our bank accounts. You have a right to take money from your account, but a bank may have a right, and responsibility, to assure that you are who you say you are and that the request is valid. For example, a check might get lost in the mail and you may have stopped payment on it so you could write a second check without overdrawing.

Airports and other buildings with security checkpoints are another example of carefully regulated rights of entry balanced against a right to make sure the person entering is safe. Even traffic law gives us a right of motion that is provisional on a green light, in order to efficiently keep cars that are crossing each others' paths from colliding. We might bristle a bit at having to wait for a light to change, but we would do more than bristle if we were running into other cars all the time.

The right rights

There is phrasing that is sometimes used when talking about rights, but just seldom enough that I'm not sure everyone uses it. We talk about rights against an entity. This sounds contentious, and in some contexts where the rights are challenged, it can be. But there are many ordinary situations where “against” does not imply conflict.

Freedom of speech, for example, is said to be a right against the government, but not because the government has any reason to fuss. It just tells you that, for example, it is not a right against a private company. The government may not justly censor you in most cases, but private companies more easily can. So it matters who the rights are against.

And, of course, it matters that rights be usable rights, not just pretty rights. Your rights to life, liberty, and pursuit of happiness may be with you in spirit, but are not particularly usable otherwise. So I've informally adopted Emily Hartstone's definitions of what she calls rules “written to work,” from her book The Third Voice as a reasonable approximation to what I think rights must achieve to be usable.

Hartstone makes an impassioned and convincing case that such rules must have “an enforcement mechanism, a named party responsible for it, a consequence attached to violation, and a person who can invoke it who is not the party being governed.” It's quite an ambition, actually, but I see no reason to pre-compromise in such a goal. If we ask for less, we'll surely get less.

In each of her several books, Hartstone ties these asks to frustrations working against corporate systems that are faceless and unaccountable and have made critical decisions about medical options affecting treatment of her leukemia, and her response is unabashedly a response to that. Her indignance speaks for all of us.

And some may find it odd that she relates problems with health care to coming problems with “AI” but I, for one, do not. This is as directly relevant as one can be, and here I want you to see it through my eyes because once you see the issue, it won't seem even slightly off topic at all.

The first “AI”

Some time back, before all the modern uproar about “AI,” I wrote an essay called Fiduciary Duty vs. The Three Laws of Robotics. In it, I made the point that if corporations are legal people, then if they are required to be single-mindedly focused on shareholder needs, they are effectively also required by fiduciary duty to be “legal sociopaths.”

Implicitly, this also means that the attention to a corporate charter and shareholder needs means corporations were what I think of as the first AI. Note I am not using quotes here because they were fully capable of real reasoning, unlike LLMs, which might yet lack capabilities humans have. In the case of a corporation, the “program” they are executing is the corporate mission, the by-laws, etc. The processor on which this program runs is the group of people running the corporation, its C-suite as it is now called (the CEO, COO, CFO, etc).

What makes this an artificial intelligence and not a natural one is that while it has access to the full reasoning processes of the people that make it up, it is a new entity with an agenda potentially at odds with any or all employees, and hence its own identity A grayscale view of a hospital, with an 'H' and a '+' sign in a desaturated pink, and some of the windows
            and an awning that are both in a magenta color looking like two malevolent eyes and a mouth,
            as if the hospital were the picture of a face, perhaps an intelligent one, even if also evil. defined by that separate quest. And that entity is not human, hence artificial.

Reality coming into sharp focus

So we can now see that this is not a metaphor, but actually a description of a realized set of machines that have existed in the world for quite some time. They interact with us, and they do some things we like and some things we do not. But they are not mere abstraction. And as a consequence, we have some data about what an “AI” really does. We know that at least some such things will do things in the corporate interest, that is, in the interest of the “AI” that are not in the interest of the clients, the customers, that they allegedly serve. We know that notwithstanding the sometimes well-meaning nature of the people who built them, they can be anything from annoying to frightening.

We know that we wish we had more rights against them.

Hartstone says she has experience with a medical system that did not feel like it respected her needs or was properly responsive.

She says she wanted to ask questions and had no one to ask them of.

She said there were actions ordered that affected her that she could not countermand.

Suturing it all together

And so when Hartstone wants to use this experience to guide her ideas about what “AI” we should be building, and what rights we should demand, she is not just telling a vaguely related story. In my mind, because of my own thinking about corporations as the first AI, although these are not her words I'm quoting, but my best personal attempt to hear her in my dialect and translate them for you, I hear “I have experience with AI that some people do not. I am not predicting what it will do, I am telling you what it did. Past tense. This is not a hypothetical. This is something I have lived and that I have no protections against living again. And I have dedicated my life to trying to help others avoid this already-lived and real AI experience.”

Her response is to have written some books (several of which I have now read, and they are good). It is to pursue business ideas that have real ethics with real teeth at their core. And to create a site that proposes some very strong rights. You should read runtimerights.org. Another day I'll comment on that. But for now, don't trust me to summarize it. Her site speaks for itself. Take the time.

And if you like the ideas, don't come away saying “it will never happen” or else the reason it will never happen will be your choice to set low expectations. Allow yourself the right to say “I want this.” Do not prematurely foreclose the idea.

As with all aspirational things, it might fall short. But it will not succeed better by aiming lower. It will just fall short of that. Give the ideas their due. That's why I am writing this right now. Maybe she won't succeed. But at least I won't be the cause.

 


Author’s Notes:

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Emily Hartstone's book, The Third Voice, is available here. Her proposed standard for automated decisions, A Bill of Runtime Rights is available here.

The image generated at abacus.ai, using ChatLLM (Claude Opus 4.8 and GPT Image 2.5). I did light post-processing in Gimp to add some desaturated false color and to reduce the resulting image in size for faster web download.

Saturday, July 4, 2020

Death by Smugness

Just Getting Started

The numbers are going up. To round numbers it's now about 2.5 million cases and 125,000 deaths. So about 5%.

So one in twenty of us who get it are scheduled to die until we have an effective vaccine or a cure. Meanwhile our job isn't just to avoid spreading something, but to avoid spreading something we cannot see and don't know is there.

By nature, we prefer to react to visible threats. As a species we invented science as a kind of superpower to help us with invisible threats, to let us see ahead to coming things that might matter but are beyond our senses. But as individual members of our species, we struggle with accepting the things science tells us.

2.5 million infected. It sounds like a lot. But given how easily transmitted this virus is, and given the sense of extreme urgency to “return to normal” we see played out on the news every day. It could soon enough be 250 million infected and 12 million dead. So with 5% of 2.5 million dying, we may just be getting started.

Invisibility Plays Tricks on Us

The difficulty of fighting something invisible is that you don't know if you are fighting it. You might be. You must convince yourself to behave as if every encounter mattered. Just in case.

And yet the paradox is that you become adept at thinking, "I am good at this. I am daily fighting this thing, and winning. I am an expert." It's a natural feeling. But deadly wrong.

The truth is that every experience might matter. Things we do or things we have previously done might have saved our lives. But then again, maybe not. With an invisible threat, we have no proof that anything we have done is working. The virus might simply not have reached us yet. It might be we haven't yet faced it.

It's tedious to keep taking precautions. But, unlike us, the virus is not bored with how things are going. It's patiently looking for a way in. We mustn't give it that opening.

The Avoidable Danger

Yes, some people are being stupid, and that will cost. Maybe they will get sick or die. Maybe nothing will happen directly to them but they will pass things on to others. There is probably nothing we can do to keep people who are bent on doing stupid things from actually doing them. It's not a perfect world.

But some of us are trying to do the right thing, and even we can get tricked because invisibility is hard to reason about. That is the danger I see. That is the avoidable danger. We have to make sure we're thinking right.

We've been doing this awhile now, and our urge is to declare ourselves experts. We think we've seen it. We think we're good at it. We think we can streamline it. A few people go back to work, and no one has died, so we figure we're doing it right and maybe a few more can come back. That's faulty reasoning.

We can take a test, but as soon we're out of the room where we took it, we're contacting things again. We do not go through the day with an aura of testedness protecting us. We can contract the virus on the doorknob as we leave the testing room.

The one thing we know, as there are more cases, is that there will be more chances to find out that what we are doing is insufficient. But we do not know if we are being daily stressed and our defenses are good, or if we're just lucky our neighbors have been careful, and so the virus hasn't reached us at all.

A Deadly, Paradoxical Conclusion

With more and more virus out there, we're tempted to conclude we are surviving more and more onslaught. But we cannot know. For now there is only one thing to do: Be relentlessly safe.

No, let me put that in even stronger terms. Be more safe. Don't think yourself practiced. Think of yourself as still new, still learning, still all too able to make mistakes if you fail to pay attention. Rather than try to streamline what you're doing, find ways to bolster your protections, because what you're doing so far may not be enough as numbers rise and the invisible enemy is ever more likely to be really making contact.

Some of the risk can't be avoided. The existence of people too lazy or indifferent to care may be an inevitability. But getting too smug about that can kill us, too. We need to all stay humble in the face of this, so we don't fail to address the issues that are within our control simply for not having taken the time to look for them.


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Sunday, November 15, 2009

Seeing Roe v. Wade as a Political Compromise

It seems to be the case that much of the pro-Life camp regards Roe v. Wade as a kind of left liberal “pro-abortion” plot of some sort. It is not.

Although I can see how if you live at the extreme end of the spectrum, anything toward the center might be regarded as a plot, or perhaps a capitulation, I don't think it's politically useful to think this way.

Let me begin by identifying that my personal position is pro-choice. That is, I think the question of whether to have an abortion or not must be chosen by the woman who is pregnant. That isn't to say that I think one should always have abortions or always not have abortions. I think these are things anyone can hold individual opinions on, and yet I also think the ultimate choice at any time during pregnancy in the sense of legally authorizing an action and in the sense of being immune from legal prosecution should be with the woman who is pregnant. That's what I think is right and just. But it's not a position I will argue for here as an outcome.

My analysis here is not for the purpose of advocating my personal preference. If it were, other people would just express their personal preference and there would be a lot of “Oh, yeah, so who put you in charge?” or “What makes your position any more valid than mine?” While I don't agree with the positions others take on this, I think that in a pluralistic society, one has to regard the positions of others, especially large numbers of others, with a degree of respect at least to the extent of hearing them out and seeing if they can be accommodated. I expect the same of those on the other side, of course.

I begin with the assumption that this debate will not be won by everyone on one side changing the mind of everyone on the other side. Therefore, I think that, absent genocide (which I'm going to assume most rational people do not want), the right answer will not be at one end of the spectrum or the other. So we can line out “no abortion” and we can line out “unconditional abortion any time for any reason.” I can see the pro-Life camp wincing because already it's as if their mission has failed. But what you should understand is that I may have already pissed off a great many pro-choice women by this remark. Even people I agree with on principle.

I don't make this first observation out of some desire for a particular outcome, however. I am merely observing that these are not legitimate hopes for anyone with any understanding of politics. They will not, as a practical reality, happen. Or, if they do, it will be a period of time in American history that is as unstable as Prohibition was. Whatever your feeling about alcohol, there's simply no question that outlawing it was not a good plan. The same will be true with either a law that allows no abortion or a law that allows utterly unfettered abortions.

It's hard to summarize a whole movement in concise form, so I won't attempt to. I'll assume anyone reading this has read and discussed the matter extensively before and I will appeal to shorthand descriptions that others have used before me. For simplicity of discussion, let's assume this comes down to a question of whether personhood begins at conception or at birth. The entire argument seems to revolve around this. If you believe that a group of a few cells is “a person” that's going to lead you to a certain line of thinking whereas if you think it's not, it will lead you to a different line of thinking. And that's how the discussion ends up breaking down. So where is the middle ground?

Well, speaking in my role as neutral arbitrator, and leaving my personal preference aside, it's pretty clear that there's a continuum between these points of view. The pro-Life group is quick to point out that if something is a person at the moment of birth, then it's hard to argue that it's a not a person just a moment before. But let's be careful. This implies a certain transitivity that may apply locally in a kind of ad hoc way, but that clearly doesn't apply as you get farther away in time, away from birth and toward conception.

For example, by the same fuzzy argument, Boston is close to San Francisco. How do I know this? Well, ten feet away from anything is close to something. And so if I'm only ten feet away from something that's close to something, surely I must be close. And if ten feet away from Boston is close, then so is ten feet away from ten feet away. And so on. Until ten feet turns into three thousand miles. Clearly, at some point I'm far away. But where? Does the fact that I cannot articulate that precise point at which I am far rather than close mean that I am never far away? Or is the precise point simply elusive? There may not even be a single point in the sense of working for all purposes. Philadelphia may be close to Boston for some purposes and far for others. In fact, western Massachusetts may be close to Boston for some purposes and far for others.

And so one possible analysis (not my personal way of analyzing this, incidentally—I'll write about that another day) is to say that at one end of the pregnancy, there is personhood, and at the other end there is not, and so presumably in the middle it gets a little fuzzy, with properties of each.

And so along comes Roe v. Wade, which I will argue reached the most politically optimal and correct conclusion, even if for the wrong reasons. The rationale offered in Roe was based on viability, which seems to me an objective quality that is irrelevant. Moreover, it is a messy quantity because viability clearly has no uniquely determined sense. Relying on such a definition puts the debate into the hands of those in control of dictionaries rather than leaving it in the control of public discourse between aggrieved parties. So I don't like the rationale for the reasons that the terminology has been possible to co-opt and manipulate. What I do like, not in my personal point of view but in my role as neutral arbitrator, is structure of the decision. That is, it's a good decision for reasons independent of its stated rationale.

I think what saves Roe is that it creates a staged transition between opposing communities unlikely to agree. A trimester in which those who claim that a fetus is not a lot like a person have a strong case to make, a trimester at the other end in which those who claim a fetus is a lot like a person have a strong case to make, and a trimester in between when there are interests on both sides, and where some negotiation seems possible.

Structurally, as a political compromise, this is not ideal for either side. And this is what makes it a good political compromise.

I think the pro-Choice community already sees Roe v. Wade, as a compromise, and there are those who seek for greater autonomy. I personally think they are right. What they say is compatible with my personal theory of how the world operates. But they ask for anything beyond this compromise at some peril in a world where the opposing side seems committed to pushing back.

By contrast, I think the pro-Life community mostly does not see Roe v. Wade as a compromise. I think they view it as a victory for what they call the “pro-abortion” side. I think this is a political mistake because I think they can't do better than this middle point without risking backlash.

The two sides should recognize this impasse and agree to terms. I think pushing this forward risks eternal strife and to no good end.

I also doubt the pro-Life camp will take my advice. They will continue to push, and so this notion of compromise will have no purpose. In that world, expect me to simply champion the pro-Choice position right up to birth. Adopting this middle ground is only useful in exchange for a promise of cessation of conflict, and I think would be well worth that price.

Then again, in the coming years, as population increases further on a crowded planet of finite size, this issue may become moot.


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Originally published Nov 15, 2009 at Open Salon, where I wrote under my own name, Kent Pitman. Click that link to see some interesting discussion that ensued at Open Salon.

Tags (from Open Salon): politics, right, pro-life, pro-choice, anti-choice, pro-abortion, anti-abortion, absolute, clash of absolutes, legal, fair, unfair, safe and legal, coat hanger, coathanger, roe, roe v. wade, roe vs. wade, law, personal, choice, compromise, neutral, middle ground, acceptable, unacceptable, political, philosophy, health, medical, abortion