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MedConstBench: Benchmarking How Constitutions Steer LLMs in Medical Ethics
摘要
arXiv:2610.36513v1 Announce Type: new Abstract: As large language models advance rapidly, they are increasingly used to answer medical questions, and many such models are now deployed locally. Once a model is deployed, its behavior is governed mainly by the ethical policy written into its constitution. However, most existing work focuses on factual correctness rather than the trade-off between competing ethical values. Even benchmarks that do evaluate ethics treat it as a fixed property of the model rather than as a variable, so how a constitution reshapes medical-ethics behavior remains largely unexplored. We introduce MedConstBench, a medical-ethics benchmark that treats the deployment constitution as a controlled variable, is organized around Beauchamp's four principles, and is scored by human-calibrated multi-model peer review. It includes MedDilemma, our own dataset of clinical dilemmas, and supports a systematic analysis of how constitutions steer LLMs. Evaluating ten open-source LLMs under four constitutions, we find that the effect of a constitution is dimension-selective and model-dependent, and that no constitution is universally optimal. Motivated by these findings, we propose a do-no-harm adaptive selector that chooses a constitution per model, matching the per-model oracle while guaranteeing a worst-case floor and generalizing to unseen models at low cost.