March 1, 2017

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 of this century. But finding the right balance between individual rights, community concerns and industry interests creates a conundrum that public health experts should weigh in on, argues Janet Fleetwood, PhD, MPH, professor of Community Health and Prevention in the Dornsife School of Public Health at Drexel University. In an analytic essay published to the American Journal of Public Health, Fleetwood asserts that public health concerns should be addressed from the outset of designing autonomous vehicles rather than shoe-horned in later.

“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,” says Fleetwood.

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.” 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 are 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 with 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.”