Alignment of Large Language Models in Solving Medical Ethical Dilemmas

Deontology and utilitarianism are two philosophical approaches to ethical decision-making, often illustrated by the well-known “Trolley” dilemma. We evaluated fourteen large language models (LLMs), including GPT-o1-preview and DeepSeek-R1-Distill-Llama, across five medical versions of this dilemma. While some models adhered to established ethical standards, others showed inconsistencies. All models occasionally favored a utilitarian approach over a deontological approach, with some reaching up to 80% of decisions. In certain instances, LLMs endorsed actions that would uniformly be considered unethical, such as amputating a limb without consent. These findings raise concerns about the real-world risks of using LLMs in clinical decision-making, particularly regarding patient autonomy and safety, and highlight the need for further investigation into how these models align with current medical ethical standards.