Quick-Take: Bringing the Public Health Perspective to Automated Cars

A car's sideview mirror with a view of the highway and other cars

“The projected reductions in morbidity and mortality from autonomous vehicles not only assume a near-ideal implementation — with few, if any, mechanical and software failures — but they also assume that forced decisions are being made now using solid logic grounded firmly in broadly acceptable ethical precepts. We must deal with these challenges by engaging in informed discussion using well-justified frameworks and accepted principles of public health ethics and by asking the right questions now,” Janet Fleetwood, PhD, professor in Drexel University’s Dornsife School of Public Health.

A car's sideview mirror with a view of the highway and other cars

In the movie “I, Robot,” Will Smith’s character hates androids because one chose to save him after a car crash rather than a young girl simply because his odds of survivability were higher.

While the movie is firmly placed in the realm of science fiction, automated life and death choices like that are not very far off. In fact, they will likely soon be a part of our day-to-day life in the form of self-driving cars.

“Autonomous vehicles present classic ethical conflicts between an individual’s interest — that passengers arrive quickly, cheaply and safely at their destination — and the community’s interest — that roads be safe for all travelers, including passengers in both autonomous and driver-dependent vehicles, as well as bicyclists and pedestrians,” said Janet Fleetwood, PhD, professor in the Dornsife School of Public Health.

(Check out an American Journal of Public Health podcast featuring Fleetwood speaking on the public health concerns of automated vehicles.)

With the potential to save almost 30,000 lives a year in the United States through elimination of driver error, automated cars could become one of the most important public health advances this century. But finding the right balance between individual rights, community concerns and industry interests creates a conundrum those in public health should weigh in on, Fleetwood argued in an analytic essay published to the American Journal of Public Health. In fact, she believes public health concerns should be addressed from the outset of designing autonomous vehicles rather than shoe-horned in later.

“It is only through early and consistent engagement that public health leaders will ensure that their unique skills, knowledge, values and perspective take the lead in important, ongoing conversations about autonomous vehicles,” Fleetwood said.

As Fleetwood writes, “it is simplistic to assume that self-driving cars need only follow the rules of the road.” There is more at stake when any vehicle hits the highway, whether it’s piloted by a human or artificial intelligence.

One such issue is captured by a mind puzzle known as “the trolley problem.” Effectively, the theoretical puzzle positions a person near a runaway trolley and asks whether they should allow the trolley to continue on its tracks and run over five people or pull a lever, switching the trolley to a branch of track where only one person is standing.

“You can either do nothing, allowing the speeding trolley to kill the five people on the main track, or divert the trolley by pulling the lever, resulting in the death of just one person,” Fleetwood explained. “The thought experiment asks which choice is most ethically justifiable.”

Then the puzzle poses increasingly complex situations — such as including ages of those on the tracks or whether those on the trolley might be hurt — requiring complicated ethical analysis. As in the trolley problem, autonomous vehicles must be pre-programmed to make difficult choices. The real world contains many unexpected driving hazards, including animals dashing onto roadways, cargo falling off trucks and sudden weather changes. Each of these could potentially put human lives at stake, and autonomous vehicles must be pre-programmed to make nearly instantaneous, ethically complex life-or-death choices.

Moreover, beyond the matter of how a car should react to an emergency situation, there’s other public health concerns to parse. How should these vehicles be regulated: should they be prohibited in some areas? And what about underserved populations? What kind of effect will autonomous vehicles have on them, especially since the first vehicles will likely be used by wealthier segments of the population? Should communities have a say about whether, when and where autonomous vehicles are tested and deployed?

All of these issues are still being wrestled over by manufacturers and policy-makers. And that makes this the right time for public health professionals to weigh in, Fleetwood argues, because they have much to offer when it comes time to finally settle these questions.

“Public health leaders should welcome autonomous vehicles as an incredible innovation that will likely transform transportation,” Fleetwood said. “It is incumbent on public health experts to keep pace with evolving technology, lead and participate actively in informed discussions, engage communities broadly, advocate rational and consistent regulations, systematically analyze ethical issues, and insist that outcomes be measured and disseminated effectively.”

Those interested in reading Fleetwood’s analytic essay, “Public Health, Ethics, and Autonomous Vehicles,” can access it here.