Joshua Hatherley

Joshua Hatherley, Sandrine R. Schiller, Iwan Williams et al.

Postmortem avatars (PMAs) -- AI systems that simulate a deceased person by being fine-tuned on data they generated or that was generated about them -- have attracted growing scholarly attention, yet their potential role in clinical settings remains largely unexplored. This paper examines the ethics of deploying PMAs as therapeutic tools in grief therapy. Drawing on the dual-process model of grief, the theory of continuing bonds, and the philosophical framework of fictionalism, we propose two potential therapeutic applications: incorporating PMAs into established imaginal exercises such as the empty chair exercise, and treating the process of PMA creation as an art-therapeutic exercise in its own right. We consider five ethical objections to these applications and argue that none constitute knock-down arguments against therapeutic use, particularly given the risk-mitigating role of the clinical context. We conclude by identifying outstanding governance challenges and calling for empirical research, without which neither the promise nor the dangers of therapeutic PMAs can be adequately assessed.

Andrea Ferrario, Joshua Hatherley

Machine learning models embedded in deployed AI systems are routinely updated to maintain correct functioning over time. Yet such updates can generate update opacity: users may not be able to understand why the same input now yields a different output. We argue that update opacity is best understood as a diachronic failure of epistemic accessibility: the problem is that materially relevant changes may fail to remain accessible to human users in forms that support understanding, calibrated reliance, and appropriate action under real role- and time-specific constraints. This makes update opacity a governance problem. Not all change is equally relevant, and disclosing every update would itself undermine use through overload. To address this problem, we combine two complementary governance approaches: the EU AI Act, which helps specify the system-level perimeter of normatively relevant change, and Machine Learning Operations, which provides operational tools for tracking and comparing change over time. On this basis, we propose a framework that models system change through trustworthiness profiles and trustworthiness levels, and uses threshold-based disclosure to surface materially relevant within-envelope change to different stakeholders over time. We illustrate the approach with a medical AI example and derive practical implications for lifecycle documentation, post-market monitoring, and update disclosure.

Joshua Hatherley

Artificial intelligence (AI) is expected to revolutionize the practice of medicine. Recent advancements in the field of deep learning have demonstrated success in a variety of clinical tasks: detecting diabetic retinopathy from images, predicting hospital readmissions, aiding in the discovery of new drugs, etc. AI's progress in medicine, however, has led to concerns regarding the potential effects of this technology upon relationships of trust in clinical practice. In this paper, I will argue that there is merit to these concerns, since AI systems can be relied upon, and are capable of reliability, but cannot be trusted, and are not capable of trustworthiness. Insofar as patients are required to rely upon AI systems for their medical decision-making, there is potential for this to produce a deficit of trust in relationships in clinical practice.

Robert Sparrow, Joshua Hatherley

In the much-celebrated book Deep Medicine, Eric Topol argues that the development of artificial intelligence for health care will lead to a dramatic shift in the culture and practice of medicine. In the next several decades, he suggests, AI will become sophisticated enough that many of the everyday tasks of physicians could be delegated to it. Topol is perhaps the most articulate advocate of the benefits of AI in medicine, but he is hardly alone in spruiking its potential to allow physicians to dedicate more of their time and attention to providing empathetic care for their patients in the future. Unfortunately, several factors suggest a radically different picture for the future of health care. Far from facilitating a return to a time of closer doctor-patient relationships, the use of medical AI seems likely to further erode therapeutic relationships and threaten professional and patient satisfaction.

Joshua Hatherley, Robert Sparrow

Objectives: Machine learning (ML) has the potential to facilitate "continual learning" in medicine, in which an ML system continues to evolve in response to exposure to new data over time, even after being deployed in a clinical setting. In this paper, we provide a tutorial on the range of ethical issues raised by the use of such "adaptive" ML systems in medicine that have, thus far, been neglected in the literature. Target audience: The target audiences for this tutorial are the developers of machine learning AI systems, healthcare regulators, the broader medical informatics community, and practicing clinicians. Scope: Discussions of adaptive ML systems to date have overlooked the distinction between two sorts of variance that such systems may exhibit -- diachronic evolution (change over time) and synchronic variation (difference between cotemporaneous instantiations of the algorithm at different sites) -- and under-estimated the significance of the latter. We highlight the challenges that diachronic evolution and synchronic variation present for the quality of patient care, informed consent, and equity, and discuss the complex ethical trade-offs involved in the design of such systems.

Joshua Hatherley

It is commonly accepted that clinicians are ethically obligated to disclose their use of medical machine learning systems to patients, and that failure to do so would amount to a moral fault for which clinicians ought to be held accountable. Call this "the disclosure thesis." Four main arguments have been, or could be, given to support the disclosure thesis in the ethics literature: the risk-based argument, the rights-based argument, the materiality argument, and the autonomy argument. In this article, I argue that each of these four arguments are unconvincing, and therefore, that the disclosure thesis ought to be rejected. I suggest that mandating disclosure may also even risk harming patients by providing stakeholders with a way to avoid accountability for harm that results from improper applications or uses of these systems.

Joshua Hatherley, Anders Søgaard, Angela Ballantyne et al.

Federated learning (FL) is a machine learning approach that allows multiple devices or institutions to collaboratively train a model without sharing their local data with a third-party. FL is considered a promising way to address patient privacy concerns in medical artificial intelligence. The ethical risks of medical FL systems themselves, however, have thus far been underexamined. This paper aims to address this gap. We argue that medical FL presents a new variety of opacity -- federation opacity -- that, in turn, generates a distinctive double black box problem in healthcare AI. We highlight several instances in which the anticipated benefits of medical FL may be exaggerated, and conclude by highlighting key challenges that must be overcome to make FL ethically feasible in medicine.

Joshua Hatherley

Machine learning (ML) systems are vulnerable to performance decline over time due to dataset shift. To address this problem, experts often suggest that ML systems should be regularly updated to ensure ongoing performance stability. Some scholarly literature has begun to address the epistemic and ethical challenges associated with different updating methodologies. Thus far, however, little attention has been paid to the impact of model updating on the ML-assisted decision-making process itself, particularly in the AI ethics and AI epistemology literatures. This article aims to address this gap in the literature. It argues that model updating introduces a new sub-type of opacity into ML-assisted decision-making -- update opacity -- that occurs when users cannot understand how or why an update has changed the reasoning or behaviour of an ML system. This type of opacity presents a variety of distinctive epistemic and safety concerns that available solutions to the black box problem in ML are largely ill-equipped to address. A variety of alternative strategies may be developed or pursued to address the problem of update opacity more directly, including bi-factual explanations, dynamic model reporting, and update compatibility. However, each of these strategies presents its own risks or carries significant limitations. Further research will be needed to address the epistemic and safety concerns associated with model updating and update opacity going forward.

Iwan Williams, Ninell Oldenburg, Ruchira Dhar et al.

Mechanistic interpretability (MI) aims to explain how neural networks work by uncovering their underlying causal mechanisms. As the field grows in influence, it is increasingly important to examine not just models themselves, but the assumptions, concepts and explanatory strategies implicit in MI research. We argue that mechanistic interpretability needs philosophy: not as an afterthought, but as an ongoing partner in clarifying its concepts, refining its methods, and assessing the epistemic and ethical stakes of interpreting AI systems. Taking three open problems from the MI literature as examples, this position paper illustrates the value philosophy can add to MI research, and outlines a path toward deeper interdisciplinary dialogue.

Joshua Hatherley, Lauritz Munch, Jens Christian Bjerring

Since the early days of the Explainable AI movement, post-hoc explanations have been praised for their potential to improve user understanding, promote trust, and reduce patient safety risks in black box medical AI systems. Recently, however, critics have argued that the benefits of post-hoc explanations are greatly exaggerated since they merely approximate, rather than replicate, the actual reasoning processes that black box systems take to arrive at their outputs. In this article, we aim to defend the value of post-hoc explanations against this recent critique. We argue that even if post-hoc explanations do not replicate the exact reasoning processes of black box systems, they can still improve users' functional understanding of black box systems, increase the accuracy of clinician-AI teams, and assist clinicians in justifying their AI-informed decisions. While post-hoc explanations are not a "silver bullet" solution to the black box problem in medical AI, we conclude that they remain a useful strategy for addressing the black box problem in medical AI.

Joshua Hatherley

Recently, a growing number of experts in artificial intelligence (AI) and medicine have be-gun to suggest that the use of AI systems, particularly machine learning (ML) systems, is likely to humanise the practice of medicine by substantially improving the quality of clinician-patient relationships. In this thesis, however, I argue that medical ML systems are more likely to negatively impact these relationships than to improve them. In particular, I argue that the use of medical ML systems is likely to comprise the quality of trust, care, empathy, understanding, and communication between clinicians and patients.