@inproceedings{hong-etal-2026-principlismqa,
    title = "{P}rinciplism{QA}: A Philosophy-Grounded Approach to Assessing {LLM}-Human Clinical Medical Ethics Alignment",
    author = "Hong, Chang  and
      Wu, Minghao  and
      Xiao, Qingying  and
      Wang, Yuchi  and
      Wan, Xiang  and
      Yu, Guangjun  and
      Wang, Benyou  and
      Hu, Yan",
    editor = "Liakata, Maria  and
      Moreira, Viviane P.  and
      Zhang, Jiajun  and
      Jurgens, David",
    booktitle = "Findings of the {A}ssociation for {C}omputational {L}inguistics: {ACL} 2026",
    month = jul,
    year = "2026",
    address = "San Diego, California, United States",
    publisher = "Association for Computational Linguistics",
    url = "https://preview.aclanthology.org/ingest-acl/2026.findings-acl.1806/",
    pages = "36229--36245",
    ISBN = "979-8-89176-395-1",
    abstract = "As medical LLMs transition to clinical deployment, assessing their ethical reasoning capability becomes critical. While achieving high accuracy on knowledge benchmarks, LLMs lack validated assessment for navigating ethical trade-offs in clinical decision-making where multiple valid solutions exist. Existing benchmarks lack systematic approaches to incorporate recognized philosophical frameworks and expert validation for ethical reasoning assessment. We introduce PrinciplismQA, a philosophy-grounded approach to assessing LLM clinical medical ethics alignment. Grounded in Principlism, our approach provides a systematic methodology for incorporating clinical ethics philosophy into LLM assessment design. PrinciplismQA comprises 3,648 expert-validated questions spanning knowledge assessment and clinical reasoning. Our expert-calibrated pipeline enables reproducible evaluation and models ethical biases. Evaluating recent models reveals significant ethical reasoning gaps despite high knowledge accuracy, demonstrating that knowledge-oriented training does not ensure clinical ethical alignment. PrinciplismQA provides a validated tool for assessing clinical AI deployment readiness."
}