Beyond presumed autonomy: AI-assisted patient preference predictors and the personalised living will

Annoni’s critique of Personalized Patient Preference Predictors (P4) highlights a fundamental flaw in their current design: they fail to meaningfully respect patient autonomy.1 His argument that P4 risks reducing decision-making to the presumed preferences of incapacitated individuals underscores the need for a better approach. To address this, we introduce the concept of the Personalized Patient Preference Predictor-Assisted Living Will (P4-LW)—a mechanism that allows individuals, while still capacitated, to formally consent to the use of P4 and subsequently validate that their living will aligns with their personal values and evolving preferences. Unlike static living wills or surrogate decision-makers, the P4-LW has the potential to provide clinicians with real-time, patient-specific guidance from individuals who have proactively endorsed its use. In this commentary, we extend the discussion by examining the ethical and practical implications of this model, arguing that it offers a more nuanced and ethically sound alternative to conventional surrogate…

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