arXiv:2608.05583cs.CYcs.AI2026-08中稿 · AIES 2026被引 1

LLM在医疗资源分配中明知患者有责任,却仍随机分配,与人类差异显著。

The Judgment-Consequence Gap: LLM Moral Reasoning in Healthcare Decisions

论文配图:The Judgment-Consequence Gap: LLM Moral Reasoning in Healthcare Decisions
图 1 · 摘自论文原文
  • 评估多类LLM对医疗情境的责任判断与资源分配
  • 发现责任判断与资源分配间存在明显脱节,多数模型随机分配
  • 能力越强的模型与人类分歧越大,更看重信息可得性

随着大语言模型(LLMs)进入医疗等高风险领域,理解其道德推理至关重要。当医疗资源稀缺时,患者自身行为导致疾病的情况常引发责任判断。我们研究了LLM在行为、疾病后果及治疗拒绝三个层级上的责任推理,评估了多种模型家族和能力水平的LLM在改编自先前研究的临床案例上的表现。结果揭示出‘判断-后果差距’:尽管LLM与人类一致认为患者应对健康危害行为负责,但绝大多数拒绝让此判断影响资源分配,转而采取随机分配;而人类则始终倾向给予责任较轻的患者优先权。相较人类,LLM在缺乏健康风险知识时更显著降低责任判断。这表明,当责任与资源稀缺交织时,LLM采用系统性异于人类的道德框架,且随着推理能力提升,与人类的规范分歧反而加剧。

原文摘要 · Abstract (English)

As large language models (LLMs) enter high-stakes domains such as healthcare, understanding their moral reasoning becomes essential. Decisions about scarce medical resources often hinge on judgments of responsibility, particularly when patients' own actions contribute to illness. We investigate how LLMs reason about responsibility and its consequences, tracing their judgments across successive levels, from the behavior, to the resulting illness, to the denial of care. We evaluate a wide range of LLMs, spanning different model families and capability levels, on various clinical vignettes adapted from prior studies. Our results identify a judgment-consequence gap: LLMs largely agree with humans that patients bear responsibility for health-harming behaviors, yet overwhelmingly refuse to let that judgment influence how they allocate scarce resources. Specifically, LLMs default to random allocation, whereas humans consistently favor the less-culpable patient. Compared to humans, LLMs also place greater emphasis on access to information, reducing responsibility judgments when health-risk knowledge is unavailable. These findings reveal that LLMs apply a systematically different moral framework than humans when responsibility and resource scarcity intersect, surprisingly often amplifying normative disagreement with humans as reasoning capability increases.

大模型医疗决策道德推理责任判断

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