• Decision Making
• Personal Autonomy
• Moral Status

Artificial intelligence preference predictors, such as the personalised patient preference predictor (P4), are designed to forecast patients’ decision-making preferences and thereby function as a form of substituted judgement. Annoni advocates for both advance directives and substituted judgement, arguing that medical decisions should reflect the values and preferences held by patients when they are capable of deciding for themselves.1 However, he contends that the ethical justification for substituted judgement should not rest on respect for patient autonomy, since basing decisions on a person’s preferences does not necessarily equate to genuinely respecting their autonomy. Annoni illustrates this point with the example of deceiving a patient into using a placebo. Although the placebo produces effects that align with the patient’s desires, this approach fails to respect their autonomy. We further note that Buchanan and Brock distinguish between two dimensions of autonomy. The first is its instrumental value—the idea that individuals are generally best positioned to determine what is in their own interests—while the second is its non-instrumental value, which concerns the intrinsic worth of engaging in the process of decision-making itself.2 For example, if P4 indicates that individual B prefers apples and individual A subsequently provides an apple to B, then P4 has respected B’s autonomy …