Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label chatbots. Show all posts
Showing posts with label chatbots. Show all posts

Sunday, June 9, 2024

Artificial Intelligence Feedback on Physician Notes Improves Patient Care

NYU Langone Health
Research, Innovation
Originally posted 17 APR 24

Artificial intelligence (AI) feedback improved the quality of physician notes written during patient visits, with better documentation improving the ability of care teams to make diagnoses and plan for patients’ future needs, a new study finds.

Since 2021, NYU Langone Health has been using pattern-recognizing, machine-learning AI systems to grade the quality of doctors’ clinical notes. At the same time, NYU Langone created data informatics dashboards that monitor hundreds of measures of safety and the effectiveness of care. The informatics team over time trained the AI models to track in dashboards how well doctors’ notes achieved the “5 Cs”: completeness, conciseness, contingency planning, correctness, and clinical assessment.

Now, a new case study, published online April 17 in NEJM Catalyst Innovations in Care Delivery, shows how notes improved by AI, in combination with dashboard innovations and other safety initiatives, resulted in an improvement in care quality across four major medical specialties: internal medicine, pediatrics, general surgery, and the intensive care unit.

This includes improvements across the specialties of up to 45 percent in note-based clinical assessments (that is, determining diagnoses) and reasoning (making predictions when diagnoses are unknown). In addition, contingency planning to address patients’ future needs saw improvements of up to 34 percent.

Last year, NYU Langone added to this long-standing effort a newer form of AI that develops likely options for the next word in any sentence based on how billions of people used language on the internet over time. A result of this next-word prediction is that generative AI chatbots like GPT-4 can read physician notes and make suggestions. In a pilot within the case study, the research team supercharged their machine-learning AI model, which can only give physicians a grade on their notes, by integrating a chatbot that added an accurate written narrative of issues with any note.


The article is linked above.  Here is the abstract:

Abstract

Electronic health records have become an integral part of modern health care, but their implementation has led to unintended consequences, such as poor note quality. This case study explores how NYU Langone Health leveraged artificial intelligence (AI) to address the challenge to improve the content and quality of medical documentation. By quickly and accurately analyzing large volumes of clinical documentation and providing feedback to organizational leadership and individually to providers, AI can help support a culture of continuous note quality improvement, allowing organizations to enhance a critical component of patient care.

Monday, April 15, 2024

On the Ethics of Chatbots in Psychotherapy.

Benosman, M. (2024, January 7).
PsyArXiv Preprints
https://doi.org/10.31234/osf.io/mdq8v

Introduction:

In recent years, the integration of chatbots in mental health care has emerged as a groundbreaking development. These artificial intelligence (AI)-driven tools offer new possibilities for therapy and support, particularly in areas where mental health services are scarce or stigmatized. However, the use of chatbots in this sensitive domain raises significant ethical concerns that must be carefully considered. This essay explores the ethical implications of employing chatbots in mental health, focusing on issues of non-maleficence, beneficence, explicability, and care. Our main ethical question is: should we trust chatbots with our mental health and wellbeing?

Indeed, the recent pandemic has made mental health an urgent global problem. This fact, together with the widespread shortage in qualified human therapists, makes the proposal of chatbot therapists a timely, and perhaps, viable alternative. However, we need to be cautious about hasty implementations of such alternative. For instance, recent news has reported grave incidents involving chatbots-human interactions. For example, (Walker, 2023) reports the death of an eco-anxious man who committed suicide following a prolonged interaction with a chatbot named ELIZA, which encouraged him to put an end to his life to save the planet. Another individual was caught while executing a plan to assassinate the Queen of England, after a chatbot encouraged him to do so (Singleton, Gerken, & McMahon, 2023).

These are only a few recent examples that demonstrate the potential maleficence effect of chatbots on-fragile-individuals. Thus, to be ready to safely deploy such technology, in the context of mental health care, we need to carefully study its potential impact on patients from an ethics standpoint.


Here is my summary:

The article analyzes the ethical considerations around the use of chatbots as mental health therapists, from the perspectives of different stakeholders - bioethicists, therapists, and engineers. It examines four main ethical values:

Non-maleficence: Ensuring chatbots do not cause harm, either accidentally or deliberately. There is agreement that chatbots need rigorous evaluation and regulatory oversight like other medical devices before clinical deployment.

Beneficence: Ensuring chatbots are effective at providing mental health support. There is a need for evidence-based validation of their efficacy, while also considering broader goals like improving quality of life.

Explicability: The need for transparency and accountability around how chatbot algorithms work, so patients can understand the limitations of the technology.

Care: The inability of chatbots to truly empathize, which is a crucial aspect of effective human-based psychotherapy. This raises concerns about preserving patient autonomy and the risk of manipulation.

Overall, the different stakeholders largely agree on the importance of these ethical values, despite coming from different backgrounds. The text notes a surprising level of alignment, even between the more technical engineering perspective and the more humanistic therapist and bioethicist viewpoints. The key challenge seems to be ensuring chatbots can meet the high bar of empathy and care required for effective mental health therapy.

Thursday, December 21, 2023

Chatbot therapy is risky. It’s also not useless

A.W. Ohlheiser
vox.com
Originally posted 14 Dec 23

Here is an excerpt:

So what are the risks of chatbot therapy?

There are some obvious concerns here: Privacy is a big one. That includes the handling of the training data used to make generative AI tools better at mimicking therapy as well as the privacy of the users who end up disclosing sensitive medical information to a chatbot while seeking help. There are also the biases built into many of these systems as they stand today, which often reflect and reinforce the larger systemic inequalities that already exist in society.

But the biggest risk of chatbot therapy — whether it’s poorly conceived or provided by software that was not designed for mental health — is that it could hurt people by not providing good support and care. Therapy is more than a chat transcript and a set of suggestions. Honos-Webb, who uses generative AI tools like ChatGPT to organize her thoughts while writing articles on ADHD but not for her practice as a therapist, noted that therapists pick up on a lot of cues and nuances that AI is not prepared to catch.

Stade, in her working paper, notes that while large language models have a “promising” capacity to conduct some of the skills needed for psychotherapy, there’s a difference between “simulating therapy skills” and “implementing them effectively.” She noted specific concerns around how these systems might handle complex cases, including those involving suicidal thoughts, substance abuse, or specific life events.

Honos-Webb gave the example of an older woman who recently developed an eating disorder. One level of treatment might focus specifically on that behavior: If someone isn’t eating, what might help them eat? But a good therapist will pick up on more of that. Over time, that therapist and patient might make the connection between recent life events: Maybe the patient’s husband recently retired. She’s angry because suddenly he’s home all the time, taking up her space.

“So much of therapy is being responsive to emerging context, what you’re seeing, what you’re noticing,” Honos-Webb explained. And the effectiveness of that work is directly tied to the developing relationship between therapist and patient.


Here is my take:

The promise of AI in mental health care dances on a delicate knife's edge. Chatbot therapy, with its alluring accessibility and anonymity, tempts us with a quick fix for the ever-growing burden of mental illness. Yet, as with any powerful tool, its potential can be both a balm and a poison, demanding a wise touch for its ethical wielding.

On the one hand, imagine a world where everyone, regardless of location or circumstance, can find a non-judgmental ear, a gentle guide through the labyrinth of their own minds. Chatbots, tireless and endlessly patient, could offer a first step of support, a bridge to human therapy when needed. In the hushed hours of isolation, they could remind us we're not alone, providing solace and fostering resilience.

But let us not be lulled into a false sense of ease. Technology, however sophisticated, lacks the warmth of human connection, the nuanced understanding of a shared gaze, the empathy that breathes life into words. We must remember that a chatbot can never replace the irreplaceable – the human relationship at the heart of genuine healing.

Therefore, our embrace of chatbot therapy must be tempered with prudence. We must ensure adequate safeguards, preventing them from masquerading as a panacea, neglecting the complex needs of human beings. Transparency is key – users must be aware of the limitations, of the algorithms whispering behind the chatbot's words. Above all, let us never sacrifice the sacred space of therapy for the cold efficiency of code.

Chatbot therapy can be a bridge, a stepping stone, but never the destination. Let us use technology with wisdom, acknowledging its potential good while holding fast to the irreplaceable value of human connection in the intricate tapestry of healing. Only then can we mental health professionals navigate the ethical tightrope and make technology safe and effective, when and where possible.

Tuesday, May 30, 2023

Are We Ready for AI to Raise the Dead?

Jack Holmes
Esquire Magazine
Originally posted 4 May 24

Here is an excerpt:

You can see wonderful possibilities here. Some might find comfort in hearing their mom’s voice, particularly if she sounds like she really sounded and gives the kind of advice she really gave. But Sandel told me that when he presents the choice to students in his ethics classes, the reaction is split, even as he asks in two different ways. First, he asks whether they’d be interested in the chatbot if their loved one bequeathed it to them upon their death. Then he asks if they’d be interested in building a model of themselves to bequeath to others. Oh, and what if a chatbot is built without input from the person getting resurrected? The notion that someone chose to be represented posthumously in a digital avatar seems important, but even then, what if the model makes mistakes? What if it misrepresents—slanders, even—the dead?

Soon enough, these questions won’t be theoretical, and there is no broad agreement about whom—or even what—to ask. We’re approaching a more fundamental ethical quandary than we often hear about in discussions around AI: human bias embedded in algorithms, privacy and surveillance concerns, mis- and disinformation, cheating and plagiarism, the displacement of jobs, deepfakes. These issues are really all interconnected—Osama bot Laden might make the real guy seem kinda reasonable or just preach jihad to tweens—and they all need to be confronted. We think a lot about the mundane (kids cheating in AP History) and the extreme (some advanced AI extinguishing the human race), but we’re more likely to careen through the messy corridor in between. We need to think about what’s allowed and how we’ll decide.

(cut)

Our governing troubles are compounded by the fact that, while a few firms are leading the way on building these unprecedented machines, the technology will soon become diffuse. More of the codebase for these models is likely to become publicly available, enabling highly talented computer scientists to build their own in the garage. (Some folks at Stanford have already built a ChatGPT imitator for around $600.) What happens when some entrepreneurial types construct a model of a dead person without the family’s permission? (We got something of a preview in April when a German tabloid ran an AI-generated interview with ex–Formula 1 driver Michael Schumacher, who suffered a traumatic brain injury in 2013. His family threatened to sue.) What if it’s an inaccurate portrayal or it suffers from what computer scientists call “hallucinations,” when chatbots spit out wildly false things? We’ve already got revenge porn. What if an old enemy constructs a false version of your dead wife out of spite? “There’s an important tension between open access and safety concerns,” Reich says. “Nuclear fusion has enormous upside potential,” too, he adds, but in some cases, open access to the flesh and bones of AI models could be like “inviting people around the world to play with plutonium.”


Yes, there was a Black Mirror episode (Be Right Back) about this issue.  The wiki is here.