LW - How Emergency Medicine Solves the Alignment Problem by StrivingForLegibility

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Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: How Emergency Medicine Solves the Alignment Problem, published by StrivingForLegibility on December 27, 2023 on LessWrong.
Emergency medical technicians (EMTs) are not licensed to practice medicine. An EMT license instead grants the authority to perform a specific set of interventions, in specific situations, on behalf of a medical director. The field of emergency medical services (EMS) faces many principal-agent problems that are analogous to the principal-agent problem of designing an intelligent system to act autonomously on your behalf. And many of the solutions EMS uses can be adapted for AI alignment.
Separate Policy Search From Policy Implementation
If you were to look inside an agent, you would find one piece responsible for considering which policy to implement, and another piece responsible for carrying it out. In EMS, these concerns are separated to different systems. There are several enormous bureaucracies dedicated to defining the statutes, regulations, certification requirements, licensing requirements, and protocols which EMTs must follow.
An EMT isn't responsible for gathering data, evaluating the effectiveness of different interventions, and deciding what intervention is appropriate for a given situation. An EMT is responsible for learning the rules they must follow, and following them.
A medical protocol is basically an if-then set of rules for deciding what intervention to perform, if any. If you happen to live in Berkeley California, here are the EMS documents for Alameda County. If you click through to the 2024 Alameda County EMS Field Manual, under Field Assessment & Treatment Protocols, you'll find a 186 page book describing what actions EMS providers are to take in different situations.
As a programmer, seeing all these flowcharts is extremely satisfying. A flowchart is the first step towards automation. And in fact many aspects of emergency medicine have already been automated. An automated external defibrillator (AED) measures a patient's heart rhythm and automatically evaluates whether they meet the indications for defibrillation. A typical AED has two buttons on it: "On/Off" and "Everyone is clear, go ahead and shock." A ventilator ventilates a patient that isn't breathing adequately, according to parameters set by an EMS provider.
A network router isn't a consequentialist agent. It isn't handed a criteria for evaluating the consequences of different ways it could route each packet, and then empowered to choose a policy which optimizes the consequences of its actions. It is instead what I'll suggestively call a mechanism, a system deployed by an intelligent agent, designed to follow a specific policy which enforces a predictable regularity on the environment. If that policy were to be deficient in some way, such as having a flaw in its user interface code that allows an adversary to remotely obtain complete control over the router, it's up to the manufacturer and not the router itself to address that deficiency.
Similarly, EMS providers are not given a directive of "pick interventions which maximize the expected quality-adjusted life years of your patients." They are instead given books that go into 186 pages of detail describing exactly which interventions are appropriate in which circumstances. As the medical establishment gathers more data, as technology advances, and as evidence that another off-policy intervention is more effective, the protocols are amended accordingly.
Define a Scope of Practice
A provider's scope of practice defines what interventions they are legally allowed to perform. An EMT has a fixed list of interventions which are ever appropriate to perform autonomously. They can tell you quickly and decisively whether an intervention is in their scope of practice, because being able to answer those questions is a big part...