Youth as Underrepresented Stakeholders in AI-Mediated Health Environments: A Bioethical Analysis of Regulatory Gaps.

Abstract

The integration of artificial intelligence (AI) into digital media and health information ecosystems-including large language model chatbots, AI-enabled mHealth applications, and algorithmically curated social media-is reshaping how adolescents encounter and interpret health-related content. While regulatory debates emphasize innovation and efficiency, insufficient attention has been paid to youth as stakeholders whose interests and perspectives are rarely represented in AI governance. This article offers a bioethical analysis of federal and state regulatory approaches to AI in the United States, arguing that frameworks insufficiently address adolescents' developmental interests and exposure to algorithmic risk. Adolescents navigate digital health ecosystems shaped by algorithmic curation and inconsistent credibility signals yet have little voice in governance decisions shaping these environments. Drawing on bioethical principles, including respect for developing autonomy, distributive justice, and nonmaleficence, this analysis demonstrates how disclosure-based models place interpretive burdens on users while carrying developmental stakes for adolescents, and how vulnerability emerges relationally from interactions among developmental, technological, and social factors rather than from deficits within young people. These limitations are compounded by gaps in transparency and accountability across AI-generated and commercially influenced health content. Addressing these challenges requires developmentally responsive, equity-oriented governance, including youth-specific AI impact assessments and mechanisms for youth participation.