Eileanor LaRocco, Sarah Tan, Adarsh Subbaswamy +4cs.AI cs.HC
Autonomous AI systems are transitioning from advisory roles to autonomous ones for medication prescriptions. Recent U.S. bill H.R. 238 and Utah's prescription-renewal pilot program both authorize AI to prescribe medications in an agentic capacity. While many regulatory guidelines suggest aggregate model performance metrics at the point of clearance, they do not require i) calibrated per-prediction confidence for action-gated thresholds, ii) differentiated communication between uncertainty arising from model ignorance (epistemic) from genuine clinical ambiguity (aleatoric), and iii) inferential transparency at the moment of decision enabling liability allocation. Here, we argue these three architectural features are minimum conditions for safe autonomous prescribing, and validate them with a survey of 136 U.S. prescribing clinicians. Our results suggest prescribing clinicians i) would not permit autonomous prescribing without a confidence-based escalation mechanism, ii) preferred a competing-options summary for aleatoric uncertainty but preferred abstention for epistemic uncertainty, and iii) were only willing to accept liability when inferential transparency enabled them to make a decision under acknowledged uncertainty. These findings indicate that our recommended architectural features would encourage higher rates of clinician adoption of autonomous AI prescribing, largely through collapsing much of what "autonomy" conventionally means.
Policy-oriented agent-based models are increasingly used to study regulatory interventions in complex adaptive socio-technical systems. Recent adaptive ABM frameworks distinguish between static and adaptive agents, fixed and adaptive policies, and alternative controller designs. However, most diagnostic workflows remain ex post: trajectories are analysed after simulation, but the resulting evidence is not systematically fed back into the policy controller. This paper proposes a lightweight machine-coached policy-revision layer for adaptive agent-based regulation. The layer represents policy decisions as defeasible rules with explicit conflicts and priorities, generates explanations for controller actions, and allows diagnostic failures to be translated into rule additions, removals, or priority changes. The contribution is not a new optimal controller and does not claim formal guarantees for unrestricted machine coaching. Instead, it provides a simulation-compatible operationalization of controller-level contestability: policy decisions can be explained, challenged, revised, and re-evaluated in held-out simulation runs. A stylized emissions-regulation ABM is used as the experimental component. A controlled simulation experiment focuses on an over-conservatism failure in the VPVA regime. The predefined coaching template adds a relaxation rule to the symbolic controller, reducing over-conservatism recurrence under held-out seeds while preserving violation, overshoot, and volatility guardrails. The paper argues that machine coaching is best understood as a controller-level extension of explainable adaptive ABM, complementary to causal, information-theoretic, and trajectory-based diagnostics.