Redistributing Voice and Responsibility: AI in Relationship-Centred Care
For healthcare designers and ethicists, this work highlights the need to consider relational dynamics when integrating AI into sensitive care contexts.
The paper argues that AI in relationship-centred care primarily redistributes voice, responsibility, and emotional labour among patients, caregivers, and providers, rather than optimizing outcomes. Based on empirical work in Advance Care Planning and peer support, participants prioritized relational consequences over technical accuracy.
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.