Big Data and the “Small X” : Patient Autonomy in the Age of AI

Patient autonomy has become a cornerstone of contemporary medical ethics, reshaping the doctor–patient relationship through the practices of informed consent and shared decision-making. The integration of artificial intelligence (AI) into healthcare introduces new challenges to this principle. While AI promises improved efficiency and personalized care, it also risks entrenching systemic biases, diminishing clinical transparency, and disrupting the relational foundations of care. These concerns are particularly acute for patients from minoritized and culturally diverse backgrounds, whose needs are often excluded from AI training data and system design. Algorithmic opacity, in turn, may threaten the dialogical conditions necessary for meaningful consent, potentially fostering a new form of “double paternalism” where both physicians and patients defer to inscrutable machine authority. This chapter argues that safeguarding autonomy in the age of AI requires more than technical oversight or regulatory safeguards. Drawing on the frameworks of cultural and narrative humility, it proposes a relational and reflexive approach to care, which foregrounds critical self-awareness and a sustained commitment to co-constructing meaning across difference: algorithmic humility. Only by cultivating these ethical dispositions can clinicians resist reductive models of identity, counterbalance algorithmic influence, and affirm patient autonomy as a dynamic, socially embedded process.