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240603P - THE ETHICAL CHALLENGE OF HUMAN CONTROL LOSS IN THE USE OF ARTIFICIAL INTELLIGENCE (AI) IN MEDICINE

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Presented at the 17th World Congress of Bioethics in Qatar by Professor Omar Hasan Kasule MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and bioethics, Chairman of the Human and Research Ethics Committees at King Abdullah bin Abdulaziz University Hospital in Riyadh, former chairman of ethics committees at King Fahad Medical City, Riyadh. and former professor of medicine at the International University in Malaysia and the University of Brunei Darussalam.


The key concepts: human control, moral choices, Fiqh = law + morality (ethics). 


HUMAN ETHICAL SUPERIORITY

Allah gave humans superiority over all other creations in the cosmos through the 5 enablers. 

  • Istikhlaf 
  • Haml al amanat
  • Taskhir 
  • Isti’mar 
  • akhlaq

 

VISCEGERANCY

  • Istikhlaf (Baqara:30)
  • وَإِذْ قَالَ رَبُّكَ لِلْمَلَائِكَةِ إِنِّي جَاعِلٌ فِي الْأَرْضِ خَلِيفَةً ۖ قَالُوا أَتَجْعَلُ فِيهَا مَن يُفْسِدُ فِيهَا وَيَسْفِكُ الدِّمَاءَ وَنَحْنُ نُسَبِّحُ بِحَمْدِكَ وَنُقَدِّسُ لَكَ ۖ قَالَ إِنِّي أَعْلَمُ مَا لَا تَعْلَمُونَ. البقرة ٣٠  


RESPONSIBILITY

  • Haml al amanat (Ahzab:72)

  •  إِنَّا عَرَضْنَا الأَمَانَةَ عَلَى السَّمَوَاتِ وَالأَرْضِ وَالْجِبَالِ فَأَبَيْنَ أَنْ يَحْمِلْنَهَا وَأَشْفَقْنَ مِنْهَا وَحَمَلَهَا الإِنْسَانُ إِنَّهُ كَانَ ظَلُومًا جَهُولًا. الأحزاب ٧٢

 

CONTROL

  • Taskhiir (Jathiyah:13)

  • وَسَخَّرَ لَكُم مَّا فِي السَّمَاوَاتِ وَمَا فِي الْأَرْضِ جَمِيعًا مِّنْهُ ۚ إِنَّ فِي ذَٰلِكَ لَآيَاتٍ لِّقَوْمٍ يَتَفَكَّرُونَ﴾ [ الجاثية: 13]

  • Under the Qur’anic paradigm of taskhiir (14:32-33, 31:20, 45:13) the human was endowed with special intellectual power in the form of the largest cerebral cortex area/body volume to control and the rest of creation (living and non-living).
  • In addition, the human was given a flexible figure that enables him to make tools like computers that must remain under human control according to the doctrine of taskhiir.

 

CIVILIZATION

  • Building civilization, isti’mar (Hud:61)

  • وَإِلَىٰ ثَمُودَ أَخَاهُمْ صَٰلِحًا ۚ قَالَ يَٰقَوْمِ ٱعْبُدُواْ ٱللَّهَ مَا لَكُم مِّنْ إِلَٰهٍ غَيْرُهُۥ ۖ هُوَ أَنشَأَكُم مِّنَ ٱلْأَرْضِ وَٱسْتَعْمَرَكُمْ فِيهَا فَٱسْتَغْفِرُوهُ ثُمَّ تُوبُوٓاْ إِلَيْهِ ۚ إِنَّ رَبِّى قَرِيبٌ مُّجِيبٌ (هود ٦١)

  • Because of taskhiir the human can build a civilization which is good or bad.

 

MORALITY 

  • Moral judgment to distinguish the right from the wrong highway, najdain (Balad:10). وَهَدَيْنَاهُ النَّجْدَيْنِ ]البلد:10]

HUMAN-MACHINE INTERACTION

  • Before recent developments of autonomous artificial intelligence, the computer was a decision support system under the programmer who could predict all its decisions.
  • In the modern AI era, the computer has some ability to learn on its own, to think and to decide solutions to some problems creatively such as disease diagnosis, disease drug treatment and surgical procedures as well also control other computers and machines producing goods and services.

 

THE ISSUE OF CONTROL AS IT RELATES TO TASKHIR

  • The debate is still open whether the human has lost control or worse whether the human is under machine control.
  • Can the human envisage or predict all what the machine may decide and do?
  • Can the human be completely surprised by the conclusions and decisions of the machine?

 

THE PARALLEL OF A TRAINED HUNTING DOG (Sahih Muslim 1929)

  • ثم سأل عَدِيٌّ رضِيَ اللهُ عنه رسولَ الله صلَّى اللهُ عليه وسلَّم عَنِ الصَّيْدِ بالكَلْبِ المُدَرَّبِ والمُعَلَّمِ، فبيَّن له النَّبيُّ صلَّى اللهُ عليه وسلَّم: إذا أرسلْتَهُ وذكَرْتَ اسمَ اللهِ عليه عند إرسالِه، فأَمْسَكَ صَيدًا دونَ أنْ يأكُلَ منه؛ فهو حِلٌّ أكْلُهُ. فسأل عَدِيٌّ رضِيَ اللهُ عنه عن الكَلْبِ إذا أكَلَ مِنَ الصَّيدِ قَبْلَ أنْ يَأتيَ به، فنهاه النَّبيُّ صلَّى اللهُ عليه وسلَّم عن أكلِ الصَّيدِ في هذه الحالةِ؛ لأنَّ الكَلْبَ لم يَحْبِسْهُ ويُوقِعْهُ لك، وإنَّما صاده وحبَسه لنفسِه؛ ليَأكُلَه هو، ولا يَحِلُّ لك.
  • In this case, the human knows what the dog may do or not do: it may hold the animal until the hunter arrives, it may bite at the meat or let another dog catch the animal, etc., but none of these will surprise the human hunter
  • The hunter has in his intellectual repertoire all that the dog may do
  • The hunter knows what is right and what is wrong.
  • The integrity of Taskhiir is in no doubt.

 

ISSUES OF LIABILITY IN THE USE OF AI IN MEDICINE

  • Assuming the human has lost control raises the legal and ethical question of who is liable (machine vs human) in cases of mistakes by AI that result in residual harm for the patient. 
  • Liability for mistakes the diagnosis, the procedures, and the prognostication.
  • Liability also arises in cases of potential criminal manipulation of AI.
  • In case of a medical error who is professionally accountable and liable: the programmer, the seller of the software, the owner of the software, or the physician in closest contact with the patient?
  • If all are liable, how do we portion out the vicarious liability?

 

LOSS OF TASKHIIR

  • If the human loses control, and we pray that this does not happen, then human ethical superiority and the concept of taskhir are jeopardized.
  • The jeopardy is most severe if it involves moral violations because the machine has no moral judgement, only human has.
  • Assuming the human has lost the endowment of taskhiir and is under AI control, we must discuss legislation that will modify or, if necessary, stop unwanted AI developments.

 

LOSS OF VISION

  • Developments in IA are driven by curiosity (scientific and technological) as well as the competitive profit motive to produce newer and more expensive technology.
  • Lack of a forward vision (gha’iyyat) may lead to human disaster – where are we going and why are we going there?
  • With loss of vision, we experience other losses:
    • Loss of khilafat
    • Loss of amanat
    • Loss of the moral compass

 

THE WAY FOREWARD-1

  • These questions need discussion to reach generally acceptable legal rulings by jurists (fuqaha) in consultation with physicians and information technology experts. 
  • Fiqh includes revealed knowledge (’ilm naqli) and human knowledge (‘ilm ‘aqli) and is a combination of positive and moral law. 
  • The paradigm of integration of knowledge, takaamul al ma’arifat, is a judicious balance of application of the two sources of knowledge to solving practical problems. 
  • The bird’s eye view from the maqasid al shari’at.

 

THE WAY FOREWARD-2

  • Should not be rash to judge. 
  • Wait to see actual consequences; benefit from others’ experiments (raises a moral question) 
  • Conservative and prudent

 

THE WAY FOREWARD-3

  • Balance the good and the bad. 
  • If good = bad, then follow the legal maxims, qawa’id fiqhiyyat.

  •  درء المفاسد أولى من جلب المصالح 
  • فإذا تعارضت مفسدة ومصلحة، فدفع المفسدة مقدم في الغالب، إلا أن تكون المفسدة مغلوبة؛ وذلك لأن اعتناء الشرع بترك المنهيات أشد من اعتنائه بفعل المأمورات، لما يترتب على المناهي من الضرر المنافي لحكمة الشارع في النهي.