Computer as plug-puller: Fate by software

How would you feel if your fate was in the "hands" of a computer? The idea may not be as far-fetched as you think: A new study by the National Institutes of Health (NIH) says that computers, using a mathematical formula, could determine the wishes of incapacitated patients as accurately as—if not better than—their family members or close friends.

"We thought with the surrogate decisions, is that the best we got? And are we stuck with it?" says NIH bioethicist David Wendler, co-author of the study published in this week's PLoS Medicine. "Or could we do better? So we started working on what alternatives could be better."

In the study, Wendler and his colleagues proposed this scenario: a 70-year-old Native American male, with a PhD and severe Alzheimer's, develops a life-threatening infection. If the patient's treatment or non-treatment preference is unknown, doctors would typically turn to his designated next of kin surrogate for guidance. But under Wendler's plan, a proposed computer software program, dubbed the "population-based treatment indicator," would make the choice by locating the profiles of similar patients—in terms of age, race, education, illness and other factors—and matching the most popular treatment choice for that group with one of the current patient's options.