You Can Argue With a Machine, Doctor

In the “Star Trek: The Original Series” episode “The Deadly Years,” Captain Kirk isn’t defeated by an enemy ship. He’s brought down, at least for a while, by medical findings. Radiation poisoning has accelerated his aging. He becomes forgetful, cranky, physically weaker, and less able to lead. During a hearing to determine whether he is still fit for command, the Enterprise computer estimates his actual age. When Spock asks the Chief Medical Officer, McCoy, if he agrees, McCoy snaps, “It’s a blasted machine, Spock! You can’t argue with a machine.”

The line gets a laugh, but the feeling behind it is serious. McCoy faces a judgment that seems cold, objective, and final. The machine has given an answer; the people in the hearing room still have to decide how to weigh it against the fuller human reality the machine cannot capture.

Modern medicine is increasingly in that kind of situation. Computer programs now help with diagnosing, predicting outcomes, interpreting scans, ranking patients by risk, writing notes, determining who is seen first (and last), and even making insurance decisions. These systems can be incredibly fast and adept at spotting patterns. When used wisely, artificial intelligence (AI) can notice what a tired doctor might miss, synthesize scattered information, and help doctors see the bigger picture.

So the real issue is not humans versus machines. The real issue is thoughtful human judgment versus handing over judgment without thinking.

A machine can identify a pattern, but it does not inherit the doctor’s moral duty. It does not truly “know” the patient as a person. It does not feel doubt, loyalty, regret, courage, or responsibility. It cannot sit with a family after harm has occurred and say, “This was my fault” or “This was unforeseeable.” Even if its advice is strong from a heuristic standpoint, the question “What should we do?” remains a human one.

“The Deadly Years” episode also warns about automation bias, our tendency to treat a computer’s result as more trustworthy than it deserves. Kirk is clearly impaired, so requesting a competency hearing is reasonable. But the computer’s guess at his biological age is not equivalent to a thorough, careful assessment of his abilities. Doctors therefore have a duty to challenge AI, not merely because it is AI, but because knee-jerk acceptance is no more sensible than automatic distrust.

A doctor’s job is to push back when a system’s recommendation conflicts with the patient’s best interests, is based on missing or flawed data, is applied beyond its tested scope, obscures its uncertainty, perpetuates unfairness, or cannot be meaningfully questioned or checked. Doctors also need to be skeptical when a machine’s “authority” is used to hide an organization’s true goals, such as fewer admissions, shorter visits, cheaper drugs, fewer staff, or more insurance denials.

So, how can doctors know when to resist? They can ask themselves a few questions. Does this recommendation actually fit this patient? What important information was omitted or inaccurately captured? Is this tool being used for the purpose it was designed and tested for? Can I explain this result to the patient in plain language? Is there a real way to appeal or override this decision? If we follow this advice, who gains and who bears the risk if it’s wrong? Above all: Would I be willing to stand up and defend this choice in my own words, without saying, “The model told me to”? In the age of AI, that may become medicine’s version of Flip Wilson’s “The devil made me do it.“

Current guidance holds that AI can help shape a choice, but it must never serve as an excuse. The American Medical Association deliberately uses the term “augmented intelligence” to underscore that these tools should support and strengthen human thinking rather than replace it. Its principles for AI development, deployment, and use also emphasize oversight, transparency, disclosure, equity, and accountability.

The World Health Organization’s guidance on the ethics and governance of AI for health also places similar principles at the center of how these technologies should be designed and used. The National Institute of Standards and Technology’s AI Risk Management Framework, although voluntary and not specific to medicine, calls for clearly defined human roles, ongoing monitoring, and mechanisms to contest harmful AI outcomes.

These are not merely technical details. They are the basic safeguards that enable physicians to question, challenge, and resist the misuse of AI.

But “The Deadly Years” complicates matters beyond simply following a set of guidelines. McCoy’s intense loyalty to Kirk is moving, yet loyalty can slide into psychological denial. Kirk is impaired. His anger at the hearing does not restore his competence. Doctors must resist machines when machines are wrong, but they must also resist pressure from patients, coworkers, bosses, and even their own feelings when those loyalties skew their judgment. Sometimes the algorithm may be right, and the doctor may be the one who is biased. Human oversight is not inherently kind or fair.

McCoy’s outburst, then, should not be taken as simple hatred of machines. It should be heard as a demand that machines remain under human control. We must be able to question the data they use, test their outputs, show where they fall short, and say no to their advice when necessary. Just as important, patients must have a way to challenge decisions made about them when these tools are used.

“You can’t argue with a machine” is funny because it sounds like giving up. In today’s medicine, it should be a red flag. Doctors do not need to treat AI as a foe, but they need to stop it from becoming a source of authority without responsibility, a ruling with no appeal, or a shield that lets people hide from owning their choices.

The machine may perform the calculations, but the doctor still has to make the ultimate decision. When a patient’s life, dignity, or personal story is reduced to a single line of output, the doctor’s most enduring duty remains unchanged: to stand beside the patient and speak up.

This piece was adapted from the author’s book, “From Starship to Sickbed: Star Trek and the Meaning of Medicine.“