AI preference prediction beyond substituted judgement: enhancing best interest decision-making

Tracking patient preferences is vital to medical decision-making, but evidence suggests that the standard method for tracking the preferences of incapacitated or incompetent patients (ie, surrogates) is inaccurate. Recent proposals suggest that artificial intelligence preference predictors (AIPPs) can improve preference tracking for these patients, but have faced significant objections. While many of these objections depend on unsettled empirical or technical assumptions, one prominent objection—that AIPPs rely inappropriately on impersonal information—seems to be an in-principle challenge to AIPPs. In this paper, we show that even granting an implausibly strong version of this objection, AIPPs may provide value to clinical decision-making. To show this, we develop suggestions that AIPPs may support best interest decision-making (BIDM) by improving the accuracy, consistency and speed of BIDM, and show that the prevalence of BIDM in the intensive care unit (ICU) grants this application of AIPPs significant moral and practical consequence. This not only clears a path to improve BIDM but also establishes a safe harbour—a relatively uncontroversial yet impactful space—in which proponents may develop AIPPs sufficently to resolve empirical and technical questions about their potential. We conclude by highlighting key questions for the application of AIPPs to BI determinations, setting an agenda for the deeper examination of a largely overlooked application of these tools.