Towards abundant intelligences: Considerations for Indigenous perspectives in adopting artificial intelligence technology

The Silicon Valley doctrine

The composition of the technology workforce dominated by affluent male engineers of European descent influences the development of AI technology. ¹¹ The Silicon Valley perspective refers to a set of values, attitudes, and approaches to technology, entrepreneurship, and innovation that have emerged and become associated with a renowned tech innovation region in California. ⁵ The Silicon Valley doctrine embodies a Western perspective that regards both humans and non-humans as exploitable resources, ¹² a perspective deeply intertwined with the legacies of colonization, capitalism, and slavery. ¹³ Moreover, humans may need to develop an understanding of the ethical considerations or algorithmic biases that AI technologies may endow from their creators. Algorithmic bias has been defined as the application of algorithms exacerbating existing inequities in socioeconomic status, race, ethnicity, religion, gender, disability, or sexual orientation, particularly within health systems.^14,15 For example, algorithms employed by prominent health systems have exhibited racial bias for marginalized populations, including Black, ¹⁶ LGBTQ2S+, Asian, ¹⁷ and Indigenous populations. ¹⁸ Bias and underrepresentation in the creation of AI technologies have a trickle-down effect, exacerbating social inequalities and potentially causing patient harm through the misinterpretation of personal health data. ¹⁹ Ultimately, the peril in Silicon Valley may lie in its exclusive incorporation of the dominant Western worldview in the development of conscious machines.

The breath of AI

Kinship-based knowledge systems emphasize the collective, holistic, and relational aspects of Indigenous ways of knowing to promote human flourishing. ²⁰ This belief is core to many Indigenous epistemologies. If Western philosophical and scientific traditions lack “relational” understanding of humanity’s place in the world, conversely, many Indigenous cultures place importance on relationships with inanimate and animate objects.^20,21 For example, in Lakota ontologies, non-human relationships are prioritized, especially those with stones. ²² In essence, non-humans are viewed as having volition and decision-making. ²³ These epistemologies form the foundation for ways of knowing and communicating that recognize the interconnected relationships that extend to wildlife, plants, the elements, water, and land. ²⁴ Similarly, AI is an extension of personhood to an inanimate object such as a technological device, software code or algorithm. ²¹ It is essential to highlight that there is no singular Indigenous epistemology. This article will use the terms Indigenous epistemology and perspective to describe frameworks originating from Indigenous nations in North America and the Pacific Ocean, which hold commonalities in their perspectives on human to non-human kin relationships. ²² When considering the development of more ethical, sustainable, and culturally sensitive AI applications that can serve the well-being of both individuals and the broader ecosystem, ultimately contributing to a more balanced society. ²⁵

Two-Eyed AI

Two-Eyed AI represents an AI approach that encompasses both IK and Western scientific perspectives. This concept of Two-Eyed AI is rooted in the Two-Eyed Seeing principle, championed by prominent Mi’kmaw Elders, Albert and Murdena Marshall. ¹⁹ Two-Eyed Seeing entails the art of perceiving the strengths inherent in Indigenous wisdom balanced with the strengths found in Western knowledge and ways of understanding. ¹⁹ This approach involves one eye focused on human ethics concerns and the other on recognizing the technological potential.^10,19 For example, in Canada, AI is being used to help preserve polysynthetic Indigenous languages like Mohawk, Algonquin, and Michif through speech- and text-based applications. ²⁶ In essence, Two-Eyed AI is a practical manifestation of decolonization theory in the realm of AI. It promotes a seamless fusion of AI technologies with Indigenous culture, with the goal of empowering Indigenous communities in the digital era while preserving their culturally rich heritage.

Case study: Co-creation of AI technology with Indigenous communities

Abundance over singularity

“Abundant intelligences” encapsulates the notion of diverse and thriving knowledge practices within specific environments. ³⁰ Drawing on the AIP framework, health leaders and AI working groups may actively embrace strategies within their organizations to ensure a culturally sensitive and inclusive approach. The term “abundant” signifies not only the richness of these practices but also their potential to shape numerous futures and challenge narrow perceptions of intelligence. ³⁵ Health leaders who understand the importance of incorporating Indigenous worldviews into AI development are better positioned to manage culturally sensitive, equitable, and inclusive organizations. As emphasized by the 2015 TRC Calls to Action, ³⁶ the praxis of the AIP can guide healthcare leaders to ensure the inclusion, respect, and empowerment of Indigenous communities during this technological transformation. By lowering the predominant Western viewpoint and incorporating alternative paradigms, the more adept AI developers may become at achieving social and ethical objectives.

Health leadership towards abundantly intelligent organizations

There is potential for infusing Indigenous worldviews into the integration of AI at multiple levels within healthcare organizations. At the development level, designers, engineers, and computer scientists can incorporate diverse perspectives to inform the creation process. ³⁵ This may involve developing adaptable, modular systems customized to fit specific contexts while maintaining core elements that respect Indigenous cultural identities, histories, and worldviews. Creating wider gender identification spectra to include Two Spirit is one example. ³⁷ At the management tier, tools such as end-to-end AI development frameworks that allow for recurring audits enable managers to better mediate the implementation of new technology in conjunction with Indigenous stakeholders. ³⁸ Such tools can enable development teams to assess how an AI model performs under various conditions, including its effectiveness across diverse human health datasets.^10,39 Moreover, culturally diverse AI development teams are crucial for designing and developing inclusive AI applications. ⁴⁰ An emphasis should also be made on recruiting and retaining Indigenous talent in both healthcare and AI fields to further enhance the creation and uptake of abundantly intelligent software.

Providing cultural competency training for healthcare staff, including AI developers and users, enables more culturally sensitive care and the culturally appropriate use of AI technologies. Participatory exercises such as the “KAIROS Blanket Exercise” lead by Indigenous elders or educators promote truth, understanding, and reconciliation among both Indigenous and non-Indigenous communities alike.^41,42 Creating shared spaces, coined “pods” by the AIP, whereby Indigenous community members facilitate deep learning and IK sharing practices, such as talking circles and smudge ceremonies reflect culturally sensitive approach.^29,43

Establishing ethical oversight committees with Indigenous representation to review AI technologies in tandem with current and novel government policies can help to ensure better alignment with Indigenous ethical principles. Furthermore, sharing best practices and successful case studies related to integrating Indigenous perspectives into AI in healthcare contributes to interdisciplinary and cross-sector knowledge sharing. ⁴² Without widespread understanding of the impacts of singular AI systems, healthcare equity challenges as seen in differential outcomes during the COVID-19 pandemic in Canada will persist. ³⁹

Although an exhaustive discussion of decolonization is beyond the scope of the article, this brief overview is a catalyst for practically merging Two-Eyed Seeing principles into healthcare organizational change strategies. At the heart of this discussion is the need for health leaders to honour the ethical imperative of, “nothing about us without us” through ongoing consultation with Indigenous Peoples. ⁴⁴ In the same vein, as health leaders understand the issues within AI systems, lines of accountability can become more clearly defined within the healthcare organizations that they serve.