Robot Surrogates: AI’s Growing Role in Both Guiding and Making Healthcare Decisions for Unrepresented and Other Incapacitated Patients

Join me at the International Conference on Clinical Ethics and Consultation (ICCEC) from June 10-13, 2026 for Robot Surrogates: AI’s Growing Role in Both Guiding and Making Healthcare Decisions for Unrepresented and Other Incapacitated Patients.

My presentation shows how to use "robot surrogates" for unrepresented and other incapacitated patients.   

Surrogates. Substantial evidence shows that surrogates exercise substitute judgment unsatisfactorily. They are poor at making the same treatment decisions for incapacitated patients that those patients would have made for themselves. In response, clinical ethicists have engaged in substantial discussion about Patient Preference Predictors and similar models. Proponents argue that PPPs can guide surrogates to make decisions that better accord with the incapacitated patient’s goals, preferences, and values. Now, pervasive use of AI and large language models in healthcare has exponentially expanded these discussions. Using both personal and demographic data, robot surrogates can predict how this patient would decide in this situation.

Unrepresented Patients. Using robot surrogates can be even more helpful with one of the biggest and most persistent problems in clinical ethics: decision making for unrepresented patients. Different jurisdictions and different healthcare systems take variable approaches. For example, the decision maker for an unrepresented patient might be a hospital committee, a single physician, or a public guardian. But as strangers to the patient, all are even less likely than an appointed agent or default surrogate to make value congruent treatment decisions. Consequently, the relative value of AI/LLM robot proxies is even greater for unrepresented patients than for incapacitated patients with surrogates. And we confront even bigger questions. Should robot proxies merely “guide” the decision maker? Can they establish default choices? Or even “be” the decision maker.

How to Use Robot Surrogates. This presentation describes and illustrates three new roles for robot surrogates: (1) resolving conflicts between family members, (2) resolving surrogate uncertainty about what the patient would want, and (3) guiding decision making for unrepresented patients. This presentation summarizes the extent to which robot surrogates are already being used for these roles and obstacles to wider implementation.