Paediatric Preference Prediction: the Future of Decision-Making for Children?

Abstract Adolescents sometimes express firm views about high-stakes medical decisions that conflict with those of their caregivers or clinicians, raising difficult questions about how much weight their wishes should carry. A recurring concern is whether such decisions will later be regretted, although the normative significance of future potential regret remains hotly debated. Recent work in adult bioethics has proposed using artificial intelligence–based Personalized Patient Preference Predictors (P4s) to estimate what current treatment incapacitated adults would have chosen based on their known or inferred preferences when last autonomous. This paper explores whether, and with what ethical significance, a parallel ‘Paediatric Personalized Patient Preference Predictor’ (P5) could be applied to children and young people. We analyse how predicted future preferences might bear on questions of substituted judgment or proxy consent, best-interests assessments, resistance to treatment, and adolescents’ own deliberation. We distinguish different groups of paediatric patients based on current and future decision-making capacity, and identify both where a P5 might have greatest promise and where it is least defensible. We identify challenges for a P5 including that of self-reinforcing or self-negating preferences as well as of deciding which future preferences are relevant to current decisions. We argue that, in paediatrics, predicted future preferences cannot ground substituted judgment in the adult sense, but may nonetheless play a supportive role in best-interests reasoning and shared decision-making, subject to significant epistemic and ethical constraints.