这篇论文揭示了AI医疗建议中隐藏的价值偏见问题，做医疗AI开发或临床决策支持的团队值得关注——它提醒我们，模型不只是输出答案，还在无声地传递伦理立场。
医学伦理天然具有多元性，但大型语言模型在提供医疗建议时可能隐含单一的价值偏好。研究者提出了一个审计框架，包含临床验证的伦理困境基准和从决策中恢复价值优先级的方法。前沿模型在讨论伦理冲突时能展现观点多元性，但个体决策几乎确定，无法复现医生群体的分布性多元。多数模型的价值优先级在医生变异范围内，但部分模型显著低估患者自主权。若不加干预，单一模型可能将自身价值偏好大规模强加给所有患者，取代临床伦理的多元性。
What Does the AI Doctor Value? Auditing Pluralism in the Clinical Ethics of Language Models
Medicine is inherently pluralistic. Principles such as autonomy, beneficence, nonmaleficence, and justice routinely conflict, and such ethical dilemmas often sharply divide reasonable physicians. Good clinical practice navigates these tensions in concert with each patient's values rather than imposing a single ethical stance. The ethical values that large language models bring to medical advice, however, have not been systematically examined. We present a framework for auditing value pluralism in medical AI, comprising a benchmark of clinician-verified dilemmas and an attribution method that recovers value priorities directly from decisions. The ecosystem of frontier models spans physician-level value heterogeneity, and models discuss competing values in their reasoning (Overton pluralism) before committing to a decision. However, individual model decisions are near-deterministic across repeated sampling and semantic variations, failing to reproduce the distributional pluralism of the physician panel. Across benchmark cases, these consistent decisions reflect committed, systematic value preferences. While most model priorities fall within the natural range of inter-physician variation, some significantly underweight patient autonomy. A single LLM deployed without regard for its value priorities could amplify those priorities at scale to every patient it serves. Without explicit efforts to balance ethical perspectives with one or multiple models, these tools risk replacing clinical pluralism with a deployment monoculture.