Futures Before Failures: Design Fictions for Anticipatory Fairness in Surgical AI

Surgical AI is no longer a promise on the horizon. Platforms combining robotic assistance, mixed reality navigation, and real-time decision support are entering operating rooms. Yet the values embedded in these systems, the choices about whose data they train on, whose bodies they optimise for, and whose autonomy they quietly override, are rarely considered before deployment or revisited as these systems evolve. We present VIRTUES (Values and Impact for Responsible Technological Use in Environments of Surgery), a framework for anticipatory fairness evaluation in surgical AI. VIRTUES was developed through a focus group, thematic analysis, and design fictions following a fictional surgical AI platform across three temporal horizons, then evaluated by ten independent raters using structured valence coding. Across these horizons, we find that the most consequential design decisions are neither clearly beneficial nor harmful, but Mixed, simultaneously advancing some values while eroding others. Left unresolved, these tensions accumulate until they become the structural conditions of care. By surfacing these tensions before they become embedded in practice, VIRTUES supports anticipatory fairness evaluation throughout the surgical AI lifecycle.

Recommended citation: El-Mufti, N., Drouin, S., Jannin, P., & Kersten-Oertel, M. (2026). Futures Before Failures: Design Fictions for Anticipatory Fairness in Surgical AI. Joint FAIMI-BRIDGE-EPIMI Workshop, MICCAI 2026.
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