Professionalism/The Hippocratic Oath for Technologists

Introduction

The Hippocratic Oath for Technologists is an "ethical creed" written in 2018 by Ali Abbas of USC, Max Senges of Stanford, and Ronald Howard of Google, Inc. The Oath is to be taken by students as they graduate universities, to be discussed by technology firms, and to lay a foundation for ethical use of technology. The Oath is written in response to unethical use of technology, such as inappropriate AI use by social media platforms, biased software, and other issues. The goal is that if technologists abide by the oath, these issues can be prevented. The Pillars of the Oath focus on considering "ethical, legal and prudential" factors, and the overarching goal is to "promote technology for human progress."

Pillars

The three pillars of the Hippocratic Oath are easily compared to the traditional Hippocratic Oath for the medical field, highlighting how consideration of ethics in technology is essential in human well-being as well.

Pillar 1: I will seek to understand the ethical implications of the use of technology when making decisions.

Pillar 1 echoes themes of responsibility, sympathy, understanding and care. A 2017 Nature article published a AI software for skin cancer diagnosis that was trained on a biased dataset, a case of artificial intelligence in healthcare. Of the 129,450 images used, less than 5% of those imaged were dark-skinned patients. This was a large miss by the research group, showing a lack of consideration for Pillar 1 of the Hippocratic Oath for Technologists. Errors such as this can have widespread impacts on the health of patients, especially since skin cancer is the most common form of cancer in America. Had the researchers thought more carefully about the context that their product would work within, they would have noticed just how many people they failed to reach with their design.

In the medical field's oath, similar themes are mentioned. Doctors pledge to remain humble in the face of a great duty, remember that each patient is a human being deserving of consideration, and fulfill their obligation as a member of society. This commitment allows practitioners to treat patients as more than just ailments, and think with care about the impact their decisions have.

Pillar 2: I will tell the truth.

Pillar 2 encompasses the importance of professionalism in a technological career, asserting that even if it may be a hard conversation, an ethical technologist will tell the truth and put their profession before their career. In the case of the Boeing 737 Max, engineers did not alert clients or regulators of their failed technology. They knew that the new system was dangerous, and that it was being sold with lies to pilots who would be unprepared when things went wrong. All engineers needed to do was share their information with the FAA or a similar regulatory body, and further investigation into the issue would have been highly likely. If those engineers adhered to the Hippocratic Oath for Technologists, many needless deaths would have been avoided. Instead, lives were lost, charges and fines were issued, and Boeing lost the trust of many after selling a failed product.

In the medical field's oath, the virtues of telling the truth are also highlighted. Doctors pledge to communicate with colleagues when they don't know an answer, respect patient privacy, and acknowledge their reliance on the scientific gains of others. These principles create an environment where doctors can all work together to better humanity and healthcare.

Pillar 3: I will act responsibly.

Pillar 3 reflects the idea of prevention rather than cure. In the Bhopal gas tragedy of 1984, civilians were exposed to toxic methyl isocyanate (MIC) after a storage vessel containing the toxic chemical ruptured. The tank was a deadly hazard that had multiple systems in place to prevent a catastrophic release of gas, but the plant's impending shutdown paralyzed all maintenance of those systems. There was an air scrubbing tower meant to trap harmful gas, but it was down to save money. The flare system intended to burn off the gas as it escaped had a corroded pipe that wasn't replaced. Finally, water hoses could have been used to trap the gas and remove it from the air, but the hoses were too weak to reach the leak. Preventative maintenance could have been performed in accordance with the Hippocratic Oath for Technologists. If it had, this disaster that impacted tens of thousands could have been avoided.

In the medical field's oath, acting responsibly is a central theme. In particular, doctors pledge not to overprescribe, nor give in to nihilism, and commit to seek prevention of disease whenever possible. Doctors following this pillar will seek to avoid merely prescribing pharmaceuticals as a solution to patient problems. Instead, doctors will use tools like drugs carefully to aid their patient's health.

BetterHelp: a case study in technological ethics

Respondent BetterHelp, Inc. (BetterHelp) is an online counseling platform that connects clients with licensed mental health professionals. Founded in September of 2013, it self-identifies as the world’s largest counseling organization, employing over 23,000 licensed therapists and serving more than 3.8 million patients. As detailed in a complaint submitted to the Federal Trade Commission (FTC) on March 3rd, 2023, BetterHelp was cited for 8 violations of the Federal Trade Commission Act of 1914 which outlaws unjust practices that affect commerce. The complaint details evidence of privacy practices in which BetterHelp illegally used and sold visitors' and users' data such as emails and IP addresses to third parties including Facebook, Snapchat, and Pinterest. Third parties used the information to target and optimize advertisements for both BetterHelp and their own platforms.

Important Events

BetterHelp launched in September 2013. At the time, its website displayed a seal incorrectly implying compliance with the Health Insurance Portability and Accountability Act (HIPAA), and its privacy policy claimed that visitor and users data was only accessible by BetterHelp itself. There was no mention of third-party involvement.

In 2017, BetterHelp wanted to improve its marketing strategy and began by delegating almost unilateral authority over the use of Facebook's advertising services to one of its Junior Marketing Analysts—a recent college graduate with no prior marketing experience. Consequently, BetterHelp's marketing practices became increasingly deceitful in the following years. In January, the company began selling user data to third-party platforms, providing over 170,000 user emails to Facebook, thereby violating its own privacy policy. Facebook used this data to target new and existing users with advertisements. In August, BetterHelp published an "Intake Questionnaire" to which users could submit information about their mental health histories for treatment advice. The questionnaire falsely stated that any user-provided information was kept confidential between patient and counselor. In October, the email addresses of all existing and former users—over 2 million individuals—were given to Facebook to optimize advertising practices.

Between January 2018 and October 2021, BetterHelp continued to supply sensitive user data to third parties, primarily Facebook, Snapchat, and Pinterest. This data included information on a user's relative financial status, previous therapy history, email, and IP address. At least 10 million visitors and users had their data given away. During that period, BetterHelp also revised the Intake Questionnaire privacy statement four separate times. Each revision made minor changes to wording that gave the company more freedom with its users' information, but never mentioned third-party involvement. The statement was removed completely in October 2021.

In December 2020, a Civil Investigative Demand was issued by the FTC. Prior to then, no government agency or third party has been brought in to review BetterHelp's information policies for HIPAA compliance. In addition, BetterHelp never recorded which of its providers were subject to HIPAA, meaning an unknown number of patients were unprotected while using the platform. In turn, BetterHelp was forced to remove the seal of HIPAA compliance from its website.

In March 2023, the FTC issued BetterHelp a $7.8 million fine and an official ban on disclosing user data for targeted advertisements.

Conclusion

Ethical consideration highlights shared principles between medicine and technology, such as professional responsibility, incident prevention and open communication. Medical ethics are a fairly familiar and well accepted concept to many, but technology impacts lives just as medicine impacts lives, only in different ways. It is important for professionals to consider how their technology may help or harm others, and follow the Hippocratic Oath for Technologists just as doctors follow their own Oath. Profound negative consequences are observed when the Hippocratic Oath for Technologists is not followed, such as the case of BetterHelp, Boeing 737, and the Bhopal gas tragedy. Technologies can have society-wide effects that should be treated with the all the reverence of a medical intervention. Following the ethics of the oath can help to prevent a repeat of historical issues with unethical technological uses. Furthermore, an oath is the basis for a professional society that upholds certain standards for everyone. Lone technologists with well defined principles will be discouraged from standing out amidst others who have no concern for ethics. A community with an ethical culture would reward those who uphold the standards, and allow ethical professionals to thrive without having to fight the system.