Designing AI for Real Users -- Accessibility Gaps in Retail AI Front-End

Ethical discourse on AI in healthcare has focused predominantly on back-end concerns such as bias, fairness and explainability, while the front-end interface, where patients and clinicians actually encounter AI outputs, remains under explored. This paper identifies imbalanced user-AI relationships as a distinct class of front-end ethical failure: patients are rendered highly visible to AI systems through data inference, yet cannot understand, question or influence how they are represented. Through the concept of asymmetric legibility and a chat-based telemedicine case, we show how design choices e.g., default recommendations, restricted inputs and suppressed uncertainty, undermine agency, clinician judgment and human oversight even where systems are technically accurate. We propose reciprocity as a design orientation and offer interventions for more balanced, participatory user-AI relationships in healthcare.

Ethical debates in AI have primarily focused on back-end issues such as data governance, model training, and algorithmic decision-making. Less attention has been paid to the ethical significance of front-end design choices, such as the interaction and representation-based elements through which users interact with AI systems. This gap is particularly significant for Conversational User Interfaces (CUI) based on Natural Language Processing (NLP) systems, where humanizing design elements such as dialogue-based interaction, emotive language, personality modes, and anthropomorphic metaphors are increasingly prevalent. This work argues that humanization in AI front-end design is a value-driven choice that profoundly shapes users' mental models, trust calibration, and behavioral responses. Drawing on research in human-computer interaction (HCI), conversational AI, and value-sensitive design, we examine how interfaces can play a central role in misaligning user expectations, fostering misplaced trust, and subtly undermining user autonomy, especially in vulnerable contexts. To ground this analysis, we discuss two AI systems developed by Chayn, a nonprofit organization supporting survivors of gender-based violence. Chayn is extremely cautious when building AI that interacts with or impacts survivors by operationalizing their trauma-informed design principles. This Chayn case study illustrates how ethical considerations can motivate principled restraint in interface design, challenging engagement-based norms in contemporary AI products. We argue that ethical front-end AI design is a form of procedural ethics, enacted through interaction choices rather than embedded solely in system logic.

Assistive agents for Blind and Visually Impaired (BVI) users require accessibility alignment as a first-class design objective. Despite rapid progress in agentic AI, most systems are designed and evaluated under assumptions of sighted interaction, low-cost verification, and tolerable trial-and-error, leading to systematic failures in assistive scenarios that cannot be resolved by model scaling or post-hoc interface adaptations alone. Drawing on an analysis of 778 assistance task instances from prior work, we show that current agentic AI remain prone to failure in assistive scenarios due to mismatches between sighted-user design assumptions and the verification, risk, and interaction constraints faced by BVI users. We argue that accessibility should be treated as an alignment problem rather than a peripheral usability concern. To this end, we introduce accessibility alignment and propose a lifecycle-oriented design pipeline for accessibility-aligned assistive agents, spanning user research, system design, deployment and post-deployment iteration. We conclude that BVI-centered assistive tasks provide a critical stress test for agentic AI and motivate a broader shift toward inclusive agent design.