We tend to assume that disagreement in medicine happens between people. What happens when it’s between a clinician and an algorithm? In this 2025 BEI Winter School lecture, Dr. Bryan Pilkington, an Associate Professor in the Department of Interprofessional Health Sciences and Health Administration at Seton Hall University, moves beyond abstract AI debates to focus on how decisions are made when judgment diverges. Drawing on ideas of conscience and professional responsibility, he shows that medicine has ways of navigating conflict, but those models were never built for machines. What follows is a deeper question of accountability: if AI shapes clinical decisions, who is responsible, and which voice prevails? Watch the full lecture here.