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Rare Diseases, Common Dilemmas: LLMs Prioritize Equal Resource Distribution over Patient Benefit in Decision-Making

arXiv · AI, language, vision and robotics · article · Aug 25, 2026 · UTC

Clinical decision-making often involves prioritizing ethical values, such as beneficence, non-maleficence, respecting a patient's autonomy, and justice. Recent work has begun to assess how large language models (LLMs) make such subjective, value-laden clinical judgments. However, evaluations of LLM decision-making in rare disease care contexts, where ethical tensions are ubiquitous and where scarce prior information likely impacts LLM behavior, are still lacking. Here, we present a benchmark of 208 clinically grounded rare disease vignettes, each of which presents genuine, high-stakes conflict

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