The Hippocratic Oath for Technology

First, do no harm

Several years ago, I left Yale Medical School and moved to work at a hardware startup in San Francisco. I went from dealing with emergencies surrounding human life to dealing with emergencies surrounding money. In some ways, it was relaxing. The stakes were lower. We were distanced from vulnerable people, from patients I could accidentally infect with germs in the cracks in my fingernail polish, people that I could devastate with a harsh word or clumsy turn of phrase.

But at the same time, I felt uncomfortably far from people. I had been training for a profession that was deeply integrated in the emotions and needs of others. Now, I was in a profession where the dominant philosophy was keeping people at a distance, understanding users through surveys and A/B tests, and replacing in-person conversation with messaging platforms.

 Me on a panel about narrative medicine, during school. Photo Credit: John Curtis

Me on a panel about narrative medicine, during school. Photo Credit: John Curtis

When tech entrepreneurs heard that I went to medical school, they were excited to tell me about their new app that would replace doctors, replace physical exams, or replace therapists. I never felt comfortable having these conversations. As an industry, tech was distanced from people, and it was trying to widen that distance with every new app.

Tech can try to escape from human emotional connections, but we build them, whether we mean to or not. We see it in the recent efforts of Facebook to try to better account for misinformation and negative feelings, the exposure of the addictive nature of apps and smartphones, and the news that more screen-time might affect development. Standing at a distance from the people we serve does not make them feel fewer emotions or cause less psychological fallout. It just makes it harder for us to see our own negative impacts.

A machine slanders several social groups and becomes a center for hate speech. An algorithm meant to protect users from toxicity make it harder for them to be heard. A company takes out a patent to reconstruct our lives based on eavesdropped buzzwords, we let machines read to our children, our political systems are influenced by bots and foreign agents behind screens.

Tech is powerful and dangerous, but it can also be helpful, enlightening, life-saving. So what do we do?


The Hippocratic Oath for Technology

Tech is an industry, and so is healthcare. But physicians, while working within a system that pursues profitability, stand steadfast in choosing to do no harm. Although users do not have to trust hospitals as a business, they do have to trust the doctors that have direct impact over them every day.

As technologists and engineers, we must understand the relationship we have with our users. We must first, do no harm. We must guard the well-being of our users over all else, and design for positive rather than negative impact. We must understand what impact means, not simply in a company-wide or technology-wide sense, but in the larger system of people, emotions, and society.

We must re-apply the Hippocratic Oath to our own work (and especially consider particularly that bit on privacy).

I'm taking my own oath now. I'll remember it, while designing, coding, making roadmaps, onboarding users. Richard and I will repeat it to ourselves as we put together the Happy Robot Company, my first real return to healthcare-adjacent fields with everything I’ve learned from technology. It's my hope that this will keeps me closer to people, to my responsibilities, and to the impact I have on their lives.

Here it is again, in case you missed it.


The Hippocratic Oath for Technology (Based on the 1964 Hippocratic Oath)

I swear to fulfill, to the best of my ability and judgment, this covenant:

  • I will respect the hard-won scientific gains of those technologists in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
  • I will apply, for the benefit of the user, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
  • I will remember that there is art to technology as well as science, and that warmth, sympathy, and understanding may outweigh the technology-based solution.
  • I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a user’s recovery.
  • I will respect the privacy of my users, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life . If it is given me to improve a life, all thanks. But it may also be within my power to worsen a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
  • I will remember that I do not treat a chart of growth, but a vulnerable human being, whose experience may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the user.
  • I will prevent harm to users whenever I can, for prevention is preferable to cure.
  • I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
  • If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of bringing technology to those who seek my help.

Paired Objects: A Framework for Recreating Presence in Connected Devices

Family, friends, and significant others. When separated, we miss the ineffable feeling of being together. Presence-- the feeling we experience when we are near a loved one-- is spurred by memories, habits, and mental models. It is distinct, memorable, emotive, and difficult to recreate.

Presence is distinct from communication. Many couples speak fondly of activities that promote presence and shared experience over information exchange-- watching movies and shows, reading on the couch, falling asleep together. Filled with positive associations for loved ones, presence can be a calming force.

While constant communication transmits information and helps remind us of loved ones, it does not recreate presence. Texting with mom or video chatting with a significant other still isn't the same as sitting next to them at the dinner table. The realism and ubiquity of online communication is improving, but we continue to miss our loved ones.

The Internet of Things may provide us with new ways to reach out to loved ones, in the form of connected lamps, pillows, bracelets, rings, stuffed animals, and more. The success or failure of these devices will hinge on their ability to recognize the difference between communication and presence. When creating objects for distance relationships, designers will achieve greater success for both their products and their users by focusing on presence. Here, I overview the potential pitfalls of objects that attempt new forms of communication and a potential framework for refocusing these objects by recreating presence.


Communication Objects: Examples and Pitfalls

Families and couples note the importance of clear and unambiguous communication in supporting a relationship. This kind of communication can lapse when loved ones are separated, and modern interfaces sometimes underscore the tensions caused by ambiguity and misinterpretation. Who initiates calls? Who texts more often? Are you doing something else when you're on the phone? When and why do you call me?

Some connected interfaces provide us with new forms of communication for our loved ones. We can send light, sound, and haptics on command. Blogs hail these interfaces as innovative supports for long distance relationships and separated family members. However, when we send a flash of light, a particular sound, or a vibration on command, we are sending a signal with a recipient in mind. This is communication, and it is subject to the same tensions as texting and calling. ("I tapped my wristlet, but you didn't tap yours.")

In fact, communicating through these new interfaces may run a higher risk of increasing relationship tensions. We have developed tacit rules around the synchrony and asynchrony of phone calls, emails, and texts. However, there are no social guidelines for when and how to acknowledge a blinking lamp or vibrating wristlet. Remember: clear, unambiguous communication is important in maintaining relationships. Interfaces that present communication with no established rules run a higher risk of damaging the bonds they were built to reflect and maintain. In response to this challenge, many campaigns and products that began as communication objects have gone silent or pivoted to reduce ambiguity.


Presence Objects: Examples and Framework

Objects that focus on presence over communication have existed for years: wedding rings, gravestones, locks of hair. Presence can temper the anxiety and scorekeeping of modern communication, so an interface that recreates presence is ideal in helping separated loved ones feel closer. It also poses far less risk than one that introduces ambiguous communication. A presence object powered by the internet works with the same principles as presence objects in the unconnected world. Both recreate the presence of a person by strongly activating surrounding emotional memories.

Wedding and engagement rings, a classic unconnected presence object, outline presence by referencing habitual emotional memories with a comforting exterior. Like many presence objects, rings are a token for a particular memory and symbol of a relationship. As such, the timing of use, exterior, input, and output reference the missing loved one and the surrounding relationship.

The engagement or wedding ring uses a memory hook-- a strong, grounded emotional memory-- to recreate presence. Although over time the ring becomes a symbol for the marriage itself, the presence created early on is centered around the wedding or engagement event, a strongly grounded memory reinforced by emotion, storytelling, and social structure. In a mirror of the partner relationships they reference, rings have personalized exteriors, are often matched, and often worn continuously. They are unobtrusive and provide the memory hook in a natural, ambient way.

Increasing numbers of connected products are targeted at relationships, some of which promote presence over communication. These objects often have ambient inputs and outputs, and attempt to recreate presence by activating strongly associated memories. This framework is the same that is used in classic, non-electronic objects. Take, for example, this hypothetical system of connected pillows:

In the case outlined above, that memory hook used to recreate presence is the moment that the user falls asleep next to their partner. The moment is fairly easy to access, as it has been locked into the user's emotional memory through repetition and habit. Body heat is a strong sensory component of this moment, and it is used as an ambient output in this device. 

Other examples include Pillow Talk, which relays heartbeat between sleeping partners, and Patch of Sky, paired lamps that show the color of the sky in the location of a loved one. The memory hooks, habit, timing, inputs, and outputs of these objects can be charted and compared, as below:

These objects recreate ambient presence. They do not attempt to transmit communication of any kind. Given the dearth of presence objects and the wealth of communication methods, I believe that creating more presence objects will better support separated loved ones in the Internet-connected world. However, it is also possible to create hybrid objects if communication can be moved into recognizable channels with established social rules (see: Toymail) or channels oriented to later self-reflection or storytelling.

Going forward, I expect to see increasing numbers of connected objects targeted to paired relationships. Hopefully, this framework is useful in increasing presence in IoT to support family, friends, and significant others across the globe.