Clinical AI evaluation benchmarks embed normative judgments: what constitutes good reasoning, appropriate caution, and justified confidence. These judgments are not purely technical; they reflect values about patient autonomy, clinician responsibility, and the nature of medical evidence. This paper examines the philosophical foundations of clinical AI safety evaluation. We explore how rubrics—the scoring frameworks used to evaluate AI outputs—instantiate implicit ethical commitments. We ask whether consensus rubrics reflect genuine moral agreement or suppressed value pluralism. We analyze the role of human oversight: if an AI system achieves high benchmark scores, does human clinician review remain necessary? We argue that this is a normative question, not merely an efficiency question. Finally, we examine the authority question: who decides whether an AI system is safe? Clinical expertise alone is insufficient; legitimacy requires input from patients, clinicians, and ethicists. The paper illustrates these philosophical dimensions through analysis of ClinMAP-VOI v0 rubric design, arguing for greater reflexivity about the values embedded in clinical AI benchmarks.
Tarek Ahmed Ibrahim Etman (Sun,) studied this question.