Respecting formerly autonomous persons: clarifying the role of the Personalised Patient Preference Predictor (P4) in substituted judgement

Introduction

In a recent paper,1 we proposed a Personalised Patient Preference Predictor (P4), building on earlier work by Rid and Wendler.2 The P4 is a hypothetical computer program that would, in the context of surrogate decision-making (eg, following a substituted judgement standard), use generative artificial intelligence (AI) models to infer a patient’s underlying values and preferences and, on that basis, predict which treatment option they would choose in the current situation. Such AI models, we suggested, could be ‘fine-tuned’ on various pre-existing data or materials produced by, or otherwise pertaining to (eg, including information about), the patient considered as a unique individual.1 3

Annoni has offered a thoughtful critique of this proposal, challenging what he (implicitly) characterises as assumptions underlying our work.4 In his critique, in addition to advancing the negative claim that the P4 would not, as we had suggested,

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