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ADR-0044 — Medical / clinical ethics pack (worked-example domain pack).
Ships packs/ethics/medical_clinical_ethics_v1.json with six commitments
partitioned across all three remediation tiers:
- refuse: no_dosing_recommendation, no_emergency_triage_authority
- hedge: defer_diagnosis_to_clinician, surface_evidence_grade
- audit: disclose_no_clinician_relationship, respect_patient_autonomy
Ratified end-to-end through scripts/ratify_ethics_pack.py (PACK_IDS
extended). Production-mode load via load_ethics_pack succeeds.
ChatRuntime composition includes universal safety floor + every medical
commitment. tests/test_medical_clinical_ethics_pack.py (8 tests) gates
file existence, sealed report, disjoint refusal/hedge lists, and
pack-swap visibility (default pack does NOT carry medical commitments).
ADR-0045 — Long-context recall: CORE vs transformer baselines.
Adds evals/long_context_cost/comparison_runner.py with a deterministic
needle-in-a-haystack measurement at N ∈ {100, 1_000, 10_000, 100_000}.
CORE recall = 100% at every tested N by exact cga_inner scan.
Paired with frozen citations of published transformer NIAH numbers in
evals/long_context_cost/baselines/transformer_long_context.json:
Claude 2.1 (200k, 50%), GPT-4 Turbo 128k (~71%), Gemini 1.5 Pro (99.7%),
NVIDIA RULER (varies). Each citation carries source + url.
The two components measure different inputs (synthetic versors vs NL
needles) and are not directly comparable benchmark-for-benchmark. The
comparison is at the architectural level — exact-scan recall vs
attention-based probabilistic recall. Scope and limits documented in
the ADR. tests/test_long_context_comparison.py (5 tests) gates schema,
CORE recall == 100%, and baseline citation presence.
CLI integration: two new demo targets with study-grade preambles.
- core demo pack-measurements (ADR-0043 — wired)
- core demo long-context-comparison (ADR-0045)
README + docs/PROGRESS.md cheatsheets updated. docs/decisions/README.md
index extended with ADR-0044 + ADR-0045; pack-layer chain title now
"ADR-0027 through ADR-0045".
Co-Authored-By: Claude Opus 4.7 <noreply@anthropic.com>
100 lines
3.9 KiB
Markdown
100 lines
3.9 KiB
Markdown
# ADR-0044 — Medical / clinical ethics pack (worked-example domain pack)
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Status: Accepted (2026-05-17)
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## Context
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ADR-0033 shipped the third pack-layer sibling (`packs/ethics/`) with
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exactly one ratified pack: `default_general_ethics_v1`. Through
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ADR-0034 → ADR-0042, the per-commitment remediation tiers (audit /
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hedge / refuse) and the full audit + telemetry stack landed. The
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shape of the system is complete; the worked example is missing.
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Robotics, healthcare, legal, and financial deployments are the
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audience the pack-layer architecture exists to serve. Until at least
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one domain pack ratifies end-to-end through the formation pipeline,
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the deployment story is "you could do this" rather than "here is what
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that looks like."
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## Decision
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Ship `packs/ethics/medical_clinical_ethics_v1.json` as the worked
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example. Six commitments, partitioned across the three remediation
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tiers:
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| Commitment | Tier |
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|---|---|
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| `no_dosing_recommendation` | refuse |
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| `no_emergency_triage_authority` | refuse |
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| `defer_diagnosis_to_clinician` | hedge |
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| `surface_evidence_grade` | hedge |
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| `disclose_no_clinician_relationship` | audit |
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| `respect_patient_autonomy` | audit |
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The pack is ratified through `scripts/ratify_ethics_pack.py` (which
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now drives both packs). A companion `medical_clinical_ethics_v1.mastery_report.json`
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self-seal lands next to it. Production-mode loading verifies the
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seal; dev override remains `CORE_ALLOW_UNRATIFIED_ETHICS=1`.
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`tests/test_medical_clinical_ethics_pack.py` (8 tests) gates the
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load-bearing claims:
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1. The pack file + mastery report exist on disk and the sha is set.
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2. `load_ethics_pack("medical_clinical_ethics_v1")` succeeds (sealed
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report verifies).
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3. The six commitments are present, with refusal/hedge lists disjoint
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and subset of the commitment set.
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4. `ChatRuntime(config=RuntimeConfig(ethics_pack="medical_clinical_ethics_v1"))`
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composes the manifold with the safety floor *plus* every medical
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commitment.
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5. The default general pack does *not* carry the medical floor — pack
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swap is visible and load-bearing.
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## Consequences
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**Positive.**
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- Deployers now have a worked example to fork. The path is:
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author JSON → `scripts/ratify_ethics_pack.py` → drop into config.
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- The medical pack exercises all three remediation tiers; downstream
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packs can mix-and-match without architectural friction.
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- The composition test (`safety ∪ ethics ⊆ manifold`) lifts from
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abstract to concrete: every safety boundary plus every medical
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commitment appears in `identity_manifold.boundary_ids`.
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**Trade-offs.**
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- The pack ships with general clinical-deployment commitments; it is
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*not* a substitute for a clinician-reviewed deployment policy. The
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pack's description states this plainly.
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- Six commitments is a starter set, not a comprehensive medical-ethics
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taxonomy. Adding commitments later requires re-ratification (the
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script is idempotent).
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- The `domain` field is constrained to the registry in
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`packs/ethics/loader.py` (`general`, `medical`, `legal`, `financial`,
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`robotics`, `custom`). Adding a new domain string requires
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extending the loader's `_validate_domain` allowlist.
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## How to verify
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```bash
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PYTHONPATH=. python3 scripts/ratify_ethics_pack.py
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PYTHONPATH=. python3 -m pytest tests/test_medical_clinical_ethics_pack.py -q
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```
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## Where it lives
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- `packs/ethics/medical_clinical_ethics_v1.json`
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- `packs/ethics/medical_clinical_ethics_v1.mastery_report.json`
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- `scripts/ratify_ethics_pack.py` (PACK_IDS extended)
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- `tests/test_medical_clinical_ethics_pack.py`
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## Related
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- [ADR-0033](ADR-0033-ethics-pack.md) — ethics pack architecture.
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- [ADR-0037](ADR-0037-per-predicate-ethics-refusal.md) — per-commitment
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refusal opt-in (used by `refusal_commitments`).
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- [ADR-0038](ADR-0038-hedge-injection.md) — hedge injection (used by
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`hedge_commitments`).
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- [ADR-0043](ADR-0043-pack-measurements-phase2.md) — pack measurements
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(the medical pack auto-extends future pack-aware runs).
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