It is not about autonomy
Realigning the ethical debate on substitute judgement and AI preference predictors in healthcare
Bibliographic Data
| ID | 21515407 |
|---|---|
| Authors | Marco Annoni (0000-0003-3259-1856, Interdepartmental Center for Research Ethics and Integrity (CID Ethics), National Research Council, Rome, Italy, corresponding author) |
| Year | 2025 |
| Volume | 51 |
| Issue | 7 |
| Pages | 450-455 |
| Publication date | 2025-07-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Journal of Medical Ethics (JOURNAL) |
| Journal identifiers | ISSN: 0306-6800 • E-ISSN: 1473-4257 |
| Publisher | BMJ (PUBLISHER • GB) |
| DOI | 10.1136/jme-2024-110343 |
| PMID | 39603800 |
| OpenAlex | W4404791479 |
| Language | EN |
| Citations received | 9 |
| References cited | 23 |
This article challenges two dominant assumptions in the current ethical debate over the use of algorithmic Personalised Patient Preference Predictors (P4) in substitute judgement for incapacitated patients. First, I question the belief that the autonomy of a patient who no longer has decision-making capacity can be meaningfully respected through a P4-empowered substitute judgement. Second, I critique the assumption that respect for autonomy can be reduced to merely satisfying a patient’s individual treatment preferences. Both assumptions, I argue, are problematic: respect for autonomy cannot be equated with simply delivering the ‘right’ treatments, and expanding the normative scope of agency beyond first-person decisions creates issues for standard clinical decision-making. I suggest, instead, that the development of these algorithmic tools can be justified by achieving other moral goods, such as honouring a patient’s unique identity or reducing surrogate decision-makers’ burdens. This conclusion, I argue, should reshape the ethical debate around not just the future development and use of P4-like systems, but also on how substitute judgement is currently understood and justified in clinical medicine
Autonomy · Clinical judgement · Economics · Epistemology · Health care · Judgement · Microeconomics · Normative · Paternalism · Political science · Preference · Artificial Intelligence in Healthcare and Education · Computer Science · Law · Medicine · Organ Donation and Transplantation · Palliative Care and End-of-Life Issues · Philosophy · Psychology · Social Psychology
AI-powered psychotherapy as a model for improving disclosure and substitute judgment
Respecting formerly autonomous persons
Is the use of personalised patient preference predictors consistent with autonomy
Keeping the humans in the loop
Beyond presumed autonomy
AI preference prediction beyond substituted judgement
Autonomy, self-determination and substitute judgement
Ethical consideration of the limitation of substitute judgement and AI preference predictors in medical decision-making
P4s Are Either Unhelpful or Unnecessary. Proposing a Better AI‐Powered Solution to Predict Patients' Preferences
| Citations per year | 9 |
|---|---|
| Citation span | 2025 - 2026 (2) |
| Highly cited | No |