Cited by 51Artificial Intelligence in Healthcare and EducationEthics and Social Impacts of AIArtificial Intelligence in Law

How AI can learn from the law: putting humans in the loop only on appeal

Open access
Cohen, I. Glenn, Babic, Boris, Gerke, Sara, Xia, Qiong, Evgeniou, Theodoros, Wertenbroch, Klaus·2023·npj Digital Medicine

Abstract

While the literature on putting a “human in the loop” in artificial intelligence (AI) and machine learning (ML) has grown significantly, limited attention has been paid to how human expertise ought to be combined with AI/ML judgments. This design question arises because of the ubiquity and quantity of algorithmic decisions being made today in the face of widespread public reluctance to forgo human expert judgment. To resolve this conflict, we propose that human expert judges be included via appeals processes for review of algorithmic decisions. Thus, the human intervenes only in a limited number of cases and only after an initial AI/ML judgment has been made. Based on an analogy with appellate processes in judiciary decision-making, we argue that this is, in many respects, a more efficient way to divide the labor between a human and a machine. Human reviewers can add more nuanced clinical, moral, or legal reasoning, and they can consider case-specific information that is not easily quantified and, as such, not available to the AI/ML at an initial stage. In doing so, the human can serve as a crucial error correction check on the AI/ML, while retaining much of the efficiency of AI/ML’s use in the decision-making process. In this paper, we develop these widely applicable arguments while focusing primarily on examples from the use of AI/ML in medicine, including organ allocation, fertility care, and hospital readmission.

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  • In aligned situations, contestability consistently leads to better decisions.

    “Such situations are ideal, as contestability then consistently leads to better decisions (Cohen et al. 2023).”

    From Explainable AI Isn't Enough! Rethinking Algorithmic Contestability (2026) · cites this paper as Cohen et al. 2023

    In “The case for human appeals of medical AI/ML decisions” (page unavailable), the paper says appeals may reveal overlooked information and improve an AI system. It describes appeals as particularly useful when parties’ incentives are not clearly aligned. The “Best of both worlds” section (page unavailable) makes improved outcomes conditional on proper design; neither section supports the claim that contestability consistently produces better decisions in aligned situations. (LLM, conf=0.86)

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Authors
Cohen, I. G., Babic, B., Gerke, S., Xia, Q., Evgeniou, T., & Wertenbroch, K.
Affiliations
  • Harvard University (US)
  • University of Toronto (CA)
  • Pennsylvania State University (US)
  • INSEAD (FR)
Corresponding author
Cohen, I. Glenn
Venue
npj Digital Medicine
Published
2023-08-25
Volume
6
Issue
1
Pages
160-160
ISSN
2398-6352 (ISSN-L)
OpenAlex
W4386162831
Cited by
51
References
8
Citations by year
2026: 22 · 2025: 17 · 2024: 10 · 2023: 2
FWCI
1.89
Type
journal article
Language
en
Open access
Locations
  • npj Digital Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • eYLS (Yale Law School) (submittedVersion, cc-by)
  • bepress Legal Repository (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • University of Pennsylvania
  • Pennsylvania State University
  • European Commission (101057099, 101057321)
  • University of Toronto
  • Novo Nordisk (NNF17SA0027784)
  • Connaught Fund
  • Novo Nordisk Fonden (NNF17SA0027784)
  • National Institutes of Health
  • National Institute of Biomedical Imaging and Bioengineering (R01EB027650)
Topics
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
  • Social Sciences › Safety Research › Ethics and Social Impacts of AI
  • Social Sciences › Political Science and International Relations › Artificial Intelligence in Law
Keywords
human-in-the-loop decision making, appeal procedure, human oversight of AI, algorithmic transparency, human-AI collaboration, error correction, artificial intelligence in healthcare, organ allocation, fertility care, hospital readmission, legal reasoning

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