# The Clinician's Veto: Navigating Trust, Liability, and Uncertainty in Autonomous AI Prescribing

arXiv: https://arxiv.org/abs/2606.25108 · HTML: https://mlsanity.com/paper/2606.25108/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 9 of its 45 references that are in the map.
- First posted on arXiv 23 Jun 2026.

## Builds on (most cited first, 9 of 9)

- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Uncertainty as a Form of Transparency: Measuring, Communicating, and Using Uncertainty](https://mlsanity.com/paper/2011.07586/) (2020)
- [Superintelligent Agents Pose Catastrophic Risks: Can Scientist AI Offer a Safer Path?](https://mlsanity.com/paper/2502.15657/) (2025)
- [Trustworthy clinical AI solutions: a unified review of uncertainty quantification in deep learning models for medical image analysis](https://mlsanity.com/paper/2210.03736/) (2022)
- [Estimating Epistemic and Aleatoric Uncertainty with a Single Model](https://mlsanity.com/paper/2402.03478/) (2024)
- [Quantifying Uncertainty in Natural Language Explanations of Large Language Models](https://mlsanity.com/paper/2311.03533/) (2023)
- [Quantifying Aleatoric and Epistemic Uncertainty with Proper Scoring Rules](https://mlsanity.com/paper/2404.12215/) (2024)
- [Regulating AI Agents](https://mlsanity.com/paper/2603.23471/) (2026)
- [The Role of Model Confidence on Bias Effects in Measured Uncertainties for Vision-Language Models](https://mlsanity.com/paper/2506.16724/) (2025)

## Abstract (arXiv)

Autonomous AI systems are transitioning from advisory roles to autonomous ones for medication prescriptions. Recent U.S. bill H.R. 238 and Utah's prescription-renewal pilot program both authorize AI to prescribe medications in an agentic capacity. While many regulatory guidelines suggest aggregate model performance metrics at the point of clearance, they do not require i) calibrated per-prediction confidence for action-gated thresholds, ii) differentiated communication between uncertainty arising from model ignorance (epistemic) from genuine clinical ambiguity (aleatoric), and iii) inferential transparency at the moment of decision enabling liability allocation. Here, we argue these three architectural features are minimum conditions for safe autonomous prescribing, and validate them with a survey of 136 U.S. prescribing clinicians. Our results suggest prescribing clinicians i) would not permit autonomous prescribing without a confidence-based escalation mechanism, ii) preferred a competing-options summary for aleatoric uncertainty but preferred abstention for epistemic uncertainty, and iii) were only willing to accept liability when inferential transparency enabled them to make a decision under acknowledged uncertainty. These findings indicate that our recommended architectural features would encourage higher rates of clinician adoption of autonomous AI prescribing, largely through collapsing much of what "autonomy" conventionally means.