Public Health and the Ethics of Self-Driving Cars: Developing a Framework



One of the most persistent struggles in public health and safety in America over the past century has been the burden placed on the healthcare system by motor vehicle fatalities and injuries. While the numbers of deaths and injuries have been reduced since their peak in the late 1960s and early 1970s, when deaths averaged more than 50,000 people per year, motor vehicles are still responsible for more than 30,000 deaths and more than two million injuries per year in the United States.

Unfortunately, as long as there are cars on the road and human beings behind the wheel there is going to be a limit to how far fatalities and injuries can be reduced. Raising the drinking age from 18 to 21 in 1984 had an overwhelmingly positive effect in reducing fatalities, yet even with more active anti-drunk driving campaigns, the United States has struggled to reduce fatalities below 30,000. It is worth noting that drunk driving is only a part of the problem: around 50% of all traffic fatalities in 2015 were accidents in which the drivers involved had not been drinking or had blood alcohol content (BAC) within the legal limit.

Human error is still a major cause for concern among safety and public health experts, which is why new technologies that would limit such factors are particularly promising.

Self-driving cars offer new possibilities that were unthinkable just a few decades ago. Most famously, Google began developing a self-driving car in 2009 and Uber began testing its self-driving cars in Pittsburgh last year. Google in particular is well aware of the human factor involved in motor vehicle fatalities, which is why it markets its self-driving car as a potential solution on the program website. Public health professionals are equally optimistic about the possibilities for self-driving cars, with some experts estimating that these vehicles can save as many as 29,000 lives per year in the United States alone.

To be clear, in order to see these kinds of benefits the majority of drivers would need to own or have access to self-driving cars. While companies like Google are optimistic about the future, there are still some technical problems that need to be worked out before such cars are anywhere near mass production readiness. Entire industries would need to make adjustments, and some of those adjustments are likely to be costly in the initial stages. Laws governing self-driving cars would also need to be created and passed, which is not an easy thing given the current political landscape.

A new article in the American Journal of Public Health entitled “Public Health, Ethics, and Autonomous Vehicles” offers new possibilities for evaluating self-driving cars from a public health perspective. Rather than focusing on the insurance or legal ramifications of self-driving cars, the author chooses to focus on the ethical concerns surrounding these vehicles. The author is optimistic that self-driving cars have the potential to be one of the most important breakthroughs in terms of public health benefits that have been seen so far in the 21st century.

However, self-driving cars will still be forced to make split-second ethical decisions that are difficult enough for human beings to make, let alone machines that rely on algorithms programmed into their systems. How, for example, will self-driving cars decide between swerving to avoid a pedestrian if it means placing the vehicle’s own passenger at risk and striking the pedestrian while keeping its passenger safe?

This kind of decision is extremely difficult and subjective- most people will swerve out of principle or self-interest (to avoid criminal or civil penalties), but self-driving cars would need to weigh the safety of two lives at once and make a decision that will likely involve at least one person getting hurt. The article’s author advocates for public health input into these kinds of ethical issues when companies are designing decision-making algorithms, as well as input from individuals and communities that will ultimately be most affected by self-driving cars.

While it is unlikely that a unanimous consensus will ever be reached when it comes to ethics, an inclusive process is more likely to ease the public’s concerns about the future of autonomous vehicles.

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