Isn't this what talking to the artist and having them design something for you is for? They have years of practice in listening to clients describe what they want and turning them into an image that works well as a tattoo. If you're cheap they also usually have a ton of pre-made designs known as "flash".
What kind of world do you live in where someone with "artist" in their job title can't work with you to create an image?
1) Sometimes I just don't really know what I want. I have an area X big and most of my body is in the style of Y. AI lets me iterate hundreds of design ideas quickly. My artist books a few months out minimum. It's hard to iterate.
2) References really streamline the process. I absolutely agree that my tattoo artist is an artist, so I don't go to them and say "I want this exact thing". However, most of my (and my artists) most enjoyable tattoos have been when I come with solid references and say "this, but put your touch on it" or "here's two ideas, can you combine them into something cool?".
Same!
>Beyond that I don't need AI slop
I don't share the same hatred of AI. If something is cool looking, it's cool. I bring it to my artist as a reference and we work something out. I don't really care about the provenance.