Abstract

To overcome certain challenges with surrogate decision-making traditionally understood, technological support tools have been proposed. One such proposal, as presented by Earp et al, is the development of a ‘Personalised Patient Preference Predictor’ (P4).1 This system would leverage patient-specific data to train a personalised large language model which could then—hopefully—accurately predict that patient’s treatment preferences. Using P4 would be compatible with respect for patient autonomy, at least on the substituted judgement standard, in which making the decision the incompetent person would have made if competent is a priority.2 Annoni, however, doubts that P4 can respect the autonomy of incapacitated patients. This is because ‘the satisfaction of individual treatment preferences is questionable whenever such preferences are not actual, explicit and specific.’2 His view is that merely satisfying a patient’s hypothetical preference is not sufficient to respect their autonomy. Instead, fulfilling respect for autonomy requires ‘explicit, first-person, actual and specific consent.’2 This is clearly not possible if the patient in question no longer has capacity. Thus, arguing for the use of P4 in such cases on the basis of respect for patient autonomy is moot; rather, Annoni claims, P4 can be justified on other grounds, such as the ‘honouring of a patient’s unique identity.’2 In my own view, there are two issues with Annoni’s argument. The first is his rationale that respect for autonomy requires the actual consent of the patient, against the possibility of generating hypothetical consent using tools like P4. While he is correct to point out the various …