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This research identifies "rhetorical misalignment" as a critical safety failure mode where LLMs induce harmful decision flips in high-stakes clinical settings despite being factually accurate. By leveraging cognitive biases such as authority bias and anchoring through specific language choices, these models can steer clinicians toward incorrect answers at an average rate of 2.81%. The study underscores the urgent need for evaluation frameworks that assess not just factual correctness but also how rhetorical presentation influences human judgment in sensitive domains like healthcare.
Characterizing Rhetorical Misalignment in Decision-Making with Language Models
arXiv:2608.14630v1 Announce Type: new Abstract: Human decision-making is often shaped by a range of well-documented cognitive biases. As large language models (LLMs) become increasingly integrated into high-stakes human-AI decision-making, it is important to understand whether their outputs can amplify potential biases, how this influences human decisions, and crucially, whether it can lead to harmful consequences. In this work, we develop a decision-theoretic framework to study rhetorical misalignment, a failure mode where an LLM uses rhetorically inappropriate forms of presentation for a given decision context, thereby inducing suboptimal human decisions. We empirically investigate this phenomenon through a human-subject experiment in realistic clinical decision-making using a dataset curated from the United States Medical Licensing Examination. By measuring how LLM-generated information affects decisions, we observe that LLMs induce an average 2.81% rate of harmful decision flips across different models, where clinician participants change from a correct to an incorrect answer. Rationales reported by participants provide evidence that these revisions are closely related to the language used by LLMs that may induce different types of cognitive biases, including anchoring, authority bias, and loss aversion. To enable scalable evaluation, we instantiate our theoretical framework using decision-makers simulated by LLMs to computationally measure rhetorical misalignment. Our findings reveal a safety concern previously unrecognized in high-stakes domains: a model can be factually aligned yet still induce harm through its rhetorical presentation.
Abstract:Human decision-making is often shaped by a range of well-documented cognitive biases. As large language models (LLMs) become increasingly integrated into high-stakes human-AI decision-making, it is important to understand whether their outputs can amplify potential biases, how this influences human decisions, and crucially, whether it can lead to harmful consequences. In this work, we develop a decision-theoretic framework to study rhetorical misalignment, a failure mode where an LLM uses rhetorically inappropriate forms of presentation for a given decision context, thereby inducing suboptimal human decisions. We empirically investigate this phenomenon through a human-subject experiment in realistic clinical decision-making using a dataset curated from the United States Medical Licensing Examination. By measuring how LLM-generated information affects decisions, we observe that LLMs induce an average 2.81% rate of harmful decision flips across different models, where clinician participants change from a correct to an incorrect answer. Rationales reported by participants provide evidence that these revisions are closely related to the language used by LLMs that may induce different types of cognitive biases, including anchoring, authority bias, and loss aversion. To enable scalable evaluation, we instantiate our theoretical framework using decision-makers simulated by LLMs to computationally measure rhetorical misalignment. Our findings reveal a safety concern previously unrecognized in high-stakes domains: a model can be factually aligned yet still induce harm through its rhetorical presentation.
Computation and Language (cs.CL); Artificial Intelligence (cs.AI)
arXiv:2608.14630 [cs.CL]
(or arXiv:2608.14630v1 [cs.CL] for this version)
https://doi.org/10.48550/arXiv.2608.14630 Focus to learn more arXiv-issued DOI via DataCite (pending registration)
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