Outsourcing Virtue

Essay by  L. M. Sacasas: “To take a different class of example, we might think of the preoccupation with technological fixes to what may turn out to be irreducibly social and political problems. In a prescient essay from 2020 about the pandemic response, the science writer Ed Yong observed that “instead of solving social problems, the U.S. uses techno-fixes to bypass them, plastering the wounds instead of removing the source of injury—and that’s if people even accept the solution on offer.” There’s no need for good judgment, responsible governance, self-sacrifice or mutual care if there’s an easy technological fix to ostensibly solve the problem. No need, in other words, to be good, so long as the right technological solution can be found.

Likewise, there’s no shortage of examples involving algorithmic tools intended to outsource human judgment. Consider the case of NarxCare, a predictive program developed by Appriss Health, as reported in Wired in 2021. NarxCare is “an ‘analytics tool and care management platform’ that purports to instantly and automatically identify a patient’s risk of misusing opioids.” The article details the case of a 32-year-old woman suffering from endometriosis whose pain medications were cut off, without explanation or recourse, because she triggered a high-risk score from the proprietary algorithm. The details of the story are both fascinating and disturbing, but here’s the pertinent part for my purposes:

Appriss is adamant that a NarxCare score is not meant to supplant a doctor’s diagnosis. But physicians ignore these numbers at their peril. Nearly every state now uses Appriss software to manage its prescription drug monitoring programs, and most legally require physicians and pharmacists to consult them when prescribing controlled substances, on penalty of losing their license.

This is an obviously complex and sensitive issue, but it is hard to escape the conclusion that the use of these algorithmic systems exacerbates the same demoralizing opaqueness, evasion of responsibility and cover-your-ass dynamics that have long characterized analog bureaucracies. It becomes difficult to assume responsibility for a particular decision made in a particular case. Or, to put it otherwise, it becomes too easy to claim “the algorithm made me do it,” and it becomes so, in part, because the existing bureaucratic dynamics all but require it…(More)”.