Entre Autonomia e Risco: Análise Sociotécnica do Uso de LLMs por Pacientes na Interpretação de Laudos Psicológicos
Resumo
Pacientes têm utilizado Modelos de Linguagem de Grande Escala (LLMs) para interpretar laudos psicológicos, ampliando sua autonomia, mas também gerando riscos clínicos, éticos e sociais. Este artigo realiza uma análise sociotécnica desse fenômeno, examinando como a mediação algorítmica reconfigura práticas de cuidado e responsabilidade. Propõe-se o Manifesto de Contextualização como mecanismo leve para orientar respostas de LLMs em contextos sensíveis. A avaliação em cenários simulados sobre orientação vocacional, com apoio de especialistas, indica redução de aconselhamento inadequado. Contribui-se para o debate sobre as implicações sociais do uso de LLMs em contextos clínicos sensíveis.Referências
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Chandra, M., Pataranutaporn, P., Bickmore, T., & Maes, P. (2025). From lived experience to insight: Unpacking the psychological risks of using AI conversational agents. Proceedings of the ACM on Human-Computer Interaction, 9(CSCW), Article 34. DOI: 10.1145/3715275.3732063
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Floridi, L., Cowls, J., Beltrametti, M., Chatila, R., Chazerand, P., Dignum, V., Luetge, C., Madelin, R., Pagallo, U., Rossi, F., Schafer, B., Valcke, P. and Vayena, E. (2018). “AI4People—An Ethical Framework for a Good AI Society: Opportunities, Risks, Principles, and Recommendations”, Minds and Machines, vol. 28, no. 4, p. 689–707. DOI: 10.1007/s11023-018-9482-5
Fitzpatrick, K. K., Darcy, A. and Vierhile, M. (2017). “Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial”, JMIR Mental Health, vol. 4, no. 2, e19. DOI: 10.2196/mental.7785
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Iftikhar, Z., Xiao, A., Ransom, S., Huang, J. and Suresh, H. (2025). “How LLM Counselors Violate Ethical Standards in Mental Health Practice: A Practitioner-Informed Framework”, Proceedings of the AAAI/ACM Conference on AI, Ethics, and Society, vol. 8, no. 2, p. 1311–1323. DOI: 10.1609/aies.v8i2.36632
Ji, Z., Lee, N., Frieske, R., Yu, T., Su, D., Xu, Y., Ishii, E., Bang, Y., Madotto, A. and Fung, P. (2023). “Survey of Hallucination in Natural Language Generation”, ACM Computing Surveys, vol. 55, no. 12, p. 1–38. DOI: 10.1145/3571730
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Milella, F. and Cabitza, F. (2026). “Perceiving AI as an Epistemic Authority or Algority: A User Study on the Human Attribution of Authority to AI”, Machine Learning and Knowledge Extraction, vol. 8, no. 2, p. 36. DOI: 10.3390/make8020036
Norman, C. D. and Skinner, H. A. (2006). “eHealth Literacy: Essential Skills for Consumer Health in a Networked World”, Journal of Medical Internet Research, vol. 8, no. 2, e9. DOI: 10.2196/jmir.8.2.e9
Orlikowski, W. J. (2007). “Sociomaterial Practices: Exploring Technology at Work”, Organization Studies, vol. 28, no. 9, p. 1435–1448.
Ranisch, R. and Meier, L. J. (2026). “The Potential Harms of AI Psychotherapy: A Fear as Old as ELIZA”, The American Journal of Bioethics, vol. 26, no. 2, p. 69–71. DOI: 10.1080/15265161.2025.2608640
Rousmaniere, T., Zhang, Y., Li, X. and Shah, S. (2025). “Large language models as mental health resources: Patterns of use in the United States”, Practice Innovations, Advance online publication. DOI: 10.1037/pri0000292
Salmi, L., Lewis, D. M., Clarke, J. L., Dong, Z., Fischmann, R., McIntosh, E. I., Sarabu, C. R. and DesRoches, C. M. (2025). “A proof-of-concept study for patient use of open notes with large language models”, JAMIA Open, vol. 8, no. 2, p. ooaf021. DOI: 10.1093/jamiaopen/ooaf021
Scholich, T., Barr, M., Wiltsey Stirman, S. and Raj, S. (2025). “A Comparison of Responses from Human Therapists and Large Language Model–Based Chatbots to Assess Therapeutic Communication: Mixed Methods Study”, JMIR Ment Health, vol. 12, p. e69709. DOI: 10.2196/69709
Selbst, A. D., Boyd, D., Friedler, S. A., Venkatasubramanian, S. and Vertesi, J. (2019). “Fairness and Abstraction in Sociotechnical Systems”, In: Proceedings of the 2019 Conference on Fairness, Accountability, and Transparency (FAT ’19)*, ACM, New York, p. 59–68. DOI: 10.1145/3287560.3287598
Sharkey, A. and Sharkey, N. (2012). “Granny and the Robots: Ethical Issues in Robot Care for the Elderly”, Ethics and Information Technology, vol. 14, no. 1, p. 27–40.
Sociedade Brasileira de Computação (SBC). (2025). Grandes Desafios da Computação no Brasil 2025–2035. Sociedade Brasileira de Computação. Disponível em: [link]
Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z. and Brand, H. (2012). “Health Literacy and Public Health: A Systematic Review and Integration of Definitions and Models”, BMC Public Health, vol. 12, article 80.
Topol, E. (2019). Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, Basic Books, New York.
Weidinger, L., Mellor, J., Rauh, M., Griffin, C., Uesato, J., Huang, P.-S., Cheng, M., Glaese, A., McAleese, N., & Irving, G. (2021). Ethical and social risks of harm from language models. arXiv preprint arXiv:2112.04359.
Weizenbaum, J. (1966). “ELIZA—a computer program for the study of natural language communication between man and machine”, Commun ACM, vol. 9, no. 1, p. 36–45. DOI: 10.1145/365153.365168
World Health Organization (WHO). (2023). Ethics and Governance of Artificial Intelligence for Health, WHO Press, Geneva. Disponível em: [link]
Blease, C., Kaptchuk, T. J., Bernstein, M. H., Mandl, K. D., Halamka, J. D., & DesRoches, C. M. (2019). Artificial intelligence and the future of primary care: Exploratory qualitative study of UK general practitioners’ views. Journal of Medical Internet Research, 21(3), e12802. DOI: 10.2196/12802
Chandra, M., Pataranutaporn, P., Bickmore, T., & Maes, P. (2025). From lived experience to insight: Unpacking the psychological risks of using AI conversational agents. Proceedings of the ACM on Human-Computer Interaction, 9(CSCW), Article 34. DOI: 10.1145/3715275.3732063
Design Council. (2005). A study of the design process. Design Council. Disponível em: [link]
Du, D., Paluch, R., Stevens, G. and Müller, C. (2024). “Exploring patient trust in clinical advice from AI-driven LLMs like ChatGPT for self-diagnosis”, arXiv. [link]
Floridi, L., Cowls, J., Beltrametti, M., Chatila, R., Chazerand, P., Dignum, V., Luetge, C., Madelin, R., Pagallo, U., Rossi, F., Schafer, B., Valcke, P. and Vayena, E. (2018). “AI4People—An Ethical Framework for a Good AI Society: Opportunities, Risks, Principles, and Recommendations”, Minds and Machines, vol. 28, no. 4, p. 689–707. DOI: 10.1007/s11023-018-9482-5
Fitzpatrick, K. K., Darcy, A. and Vierhile, M. (2017). “Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial”, JMIR Mental Health, vol. 4, no. 2, e19. DOI: 10.2196/mental.7785
Gao, Y., Liu, Y., Chen, K., Sun, X., Zhang, N., Wang, X., Yan, J. and Zhou, J. (2023). “Retrieval-Augmented Generation for Large Language Models: A Survey”, arXiv preprint arXiv:2312.10997.
Holland, J. L. (1959). A theory of vocational choice. Journal of Counseling Psychology, 6(1), 35–45. DOI: 10.1037/h0040767
Iftikhar, Z., Xiao, A., Ransom, S., Huang, J. and Suresh, H. (2025). “How LLM Counselors Violate Ethical Standards in Mental Health Practice: A Practitioner-Informed Framework”, Proceedings of the AAAI/ACM Conference on AI, Ethics, and Society, vol. 8, no. 2, p. 1311–1323. DOI: 10.1609/aies.v8i2.36632
Ji, Z., Lee, N., Frieske, R., Yu, T., Su, D., Xu, Y., Ishii, E., Bang, Y., Madotto, A. and Fung, P. (2023). “Survey of Hallucination in Natural Language Generation”, ACM Computing Surveys, vol. 55, no. 12, p. 1–38. DOI: 10.1145/3571730
Laranjo, L., Dunn, A. G., Tong, H. L., Kocaballi, A. B., Chen, J., Bashir, R., Surian, D., Gallego, B., Magrabi, F., Lau, A. Y. S., & Coiera, E. (2018). Conversational agents in healthcare: A systematic review. Journal of the American Medical Informatics Association, 25(9), 1248–1258. DOI: 10.1093/jamia/ocy072
Lawrence, H. R., Schneider, R. A., Rubin, S. B., Matarić, M. J., McDuff, D. J. and Jones Bell, M. (2024). “The Opportunities and Risks of Large Language Models in Mental Health”, JMIR Mental Health, vol. 11, p. e59479. DOI: 10.2196/59479
Lewis, P., Perez, E., Piktus, A., Petroni, F., Karpukhin, V., Goyal, N., Küttler, H., Lewis, M., Yih, W., Rocktäschel, T., Riedel, S. and Kiela, D. (2020). “Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks”, In: Proceedings of the 34th International Conference on Neural Information Processing Systems (NeurIPS 2020), Curran Associates Inc.
Luxton, D. D. (2014). “Artificial Intelligence in Psychological Practice: Current and Future Applications and Implications”, Professional Psychology: Research and Practice, vol. 45, no. 5, p. 332–339. [link]
Mendel, T., Singh, N., Mann, D., Wiesenfeld, B. and Nov, O. (2025). “Laypeople’s Use of and Attitudes Toward Large Language Models and Search Engines for Health Queries: Survey Study”, J Med Internet Res, vol. 27, p. e64290. DOI: 10.2196/64290
Milella, F. and Cabitza, F. (2026). “Perceiving AI as an Epistemic Authority or Algority: A User Study on the Human Attribution of Authority to AI”, Machine Learning and Knowledge Extraction, vol. 8, no. 2, p. 36. DOI: 10.3390/make8020036
Norman, C. D. and Skinner, H. A. (2006). “eHealth Literacy: Essential Skills for Consumer Health in a Networked World”, Journal of Medical Internet Research, vol. 8, no. 2, e9. DOI: 10.2196/jmir.8.2.e9
Orlikowski, W. J. (2007). “Sociomaterial Practices: Exploring Technology at Work”, Organization Studies, vol. 28, no. 9, p. 1435–1448.
Ranisch, R. and Meier, L. J. (2026). “The Potential Harms of AI Psychotherapy: A Fear as Old as ELIZA”, The American Journal of Bioethics, vol. 26, no. 2, p. 69–71. DOI: 10.1080/15265161.2025.2608640
Rousmaniere, T., Zhang, Y., Li, X. and Shah, S. (2025). “Large language models as mental health resources: Patterns of use in the United States”, Practice Innovations, Advance online publication. DOI: 10.1037/pri0000292
Salmi, L., Lewis, D. M., Clarke, J. L., Dong, Z., Fischmann, R., McIntosh, E. I., Sarabu, C. R. and DesRoches, C. M. (2025). “A proof-of-concept study for patient use of open notes with large language models”, JAMIA Open, vol. 8, no. 2, p. ooaf021. DOI: 10.1093/jamiaopen/ooaf021
Scholich, T., Barr, M., Wiltsey Stirman, S. and Raj, S. (2025). “A Comparison of Responses from Human Therapists and Large Language Model–Based Chatbots to Assess Therapeutic Communication: Mixed Methods Study”, JMIR Ment Health, vol. 12, p. e69709. DOI: 10.2196/69709
Selbst, A. D., Boyd, D., Friedler, S. A., Venkatasubramanian, S. and Vertesi, J. (2019). “Fairness and Abstraction in Sociotechnical Systems”, In: Proceedings of the 2019 Conference on Fairness, Accountability, and Transparency (FAT ’19)*, ACM, New York, p. 59–68. DOI: 10.1145/3287560.3287598
Sharkey, A. and Sharkey, N. (2012). “Granny and the Robots: Ethical Issues in Robot Care for the Elderly”, Ethics and Information Technology, vol. 14, no. 1, p. 27–40.
Sociedade Brasileira de Computação (SBC). (2025). Grandes Desafios da Computação no Brasil 2025–2035. Sociedade Brasileira de Computação. Disponível em: [link]
Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z. and Brand, H. (2012). “Health Literacy and Public Health: A Systematic Review and Integration of Definitions and Models”, BMC Public Health, vol. 12, article 80.
Topol, E. (2019). Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, Basic Books, New York.
Weidinger, L., Mellor, J., Rauh, M., Griffin, C., Uesato, J., Huang, P.-S., Cheng, M., Glaese, A., McAleese, N., & Irving, G. (2021). Ethical and social risks of harm from language models. arXiv preprint arXiv:2112.04359.
Weizenbaum, J. (1966). “ELIZA—a computer program for the study of natural language communication between man and machine”, Commun ACM, vol. 9, no. 1, p. 36–45. DOI: 10.1145/365153.365168
World Health Organization (WHO). (2023). Ethics and Governance of Artificial Intelligence for Health, WHO Press, Geneva. Disponível em: [link]
Publicado
19/07/2026
Como Citar
CARVALHO, Dárlinton Barbosa Feres; SOUZA, Evaldo de Paula; DIAS, Bárbara Pereira Medeiros; DETOMI, Gustavo Henrique Alves; SOUSA, Paulo Victor Fernandes; DIAS, Wandra Martins; VIANA, Matheus Carvalho.
Entre Autonomia e Risco: Análise Sociotécnica do Uso de LLMs por Pacientes na Interpretação de Laudos Psicológicos. In: WORKSHOP SOBRE AS IMPLICAÇÕES DA COMPUTAÇÃO NA SOCIEDADE (WICS), 7. , 2026, Gramado/RS.
Anais [...].
Porto Alegre: Sociedade Brasileira de Computação,
2026
.
p. 142-156.
ISSN 2763-8707.
DOI: https://doi.org/10.5753/wics.2026.21040.
