Redistributing Voice and Responsibility: AI in Relationship-Centred Care

2026-04-15

AI Summary

This study investigates how artificial intelligence reshapes the distribution of voice, decision-making authority, and moral responsibility among patients, caregivers, and providers in highly subjective clinical contexts—such as advance care planning and peer support. Integrating qualitative empirical inquiry with human-AI interaction design, the work posits that AI’s central role in relationally oriented care lies not in optimizing efficiency but in redistributing relational dynamics, identifying three key dimensions: authority, temporality, and visibility. The research reveals that users prioritize AI’s relational consequences over its technical accuracy, leading to four design principles for responsible AI in care: relational legibility, bounded agency, accountability traceability, and non-substitutive support. These principles offer both a theoretical foundation and practical pathways for developing ethically grounded AI systems in healthcare.

Abstract

Relationship-centred care (RCC) recognises that healthcare quality depends not only on outcomes, but on how voice, responsibility, and emotional labour are negotiated among patients, caregivers, and providers. As AI systems enter sensitive care contexts, they introduce a new participant into these negotiations. Drawing on empirical work in Advance Care Planning (ACP) and peer support, we argue that AI's primary impact in high-subjectivity domains is not optimisation but redistribution: it reorganises who speaks, who decides, and who bears moral responsibility. Across both settings, participants were less concerned with technical accuracy than with relational consequences: whether AI would appropriately represent their decision, reduce burden, or blur accountability, scaffold connection, or subtly displace it. We identify three relational dimensions: authority, temporality, and visibility, through which AI reshapes care relationships, and propose design provocations centred on relational legibility, bounded agency, responsibility traceability, and non-substitutive scaffolding.

Problem

• relationship-centred care
• artificial intelligence
• moral responsibility
• voice redistribution
• care relationships

Innovation

• relationship-centred care
• AI redistribution
• relational legibility
• bounded agency
• responsibility traceability