cs.AIOct 28, 2026

Disparity Laundering: Consensus Without Fairness in Clinical Multi-Agent Systems

Authors: Xiaoyang Wang, Tianrui Wang, Christopher C. Yang

Organizations: Drexel University · University of Michigan

Abstract

Clinical large language models are increasingly fielded as multi-agent teams, on the assumption that deliberation averages out individual error. It does not average out bias. Across a full factorial of five model families and four aggregation topologies on 120 real MIMIC-IV emergency cases under counterfactual demographic swaps, no configuration neutralizes the disparity: all 20 cells commit the direction of their agents' independent answers, giving Black patients more acute triage. Every model has a topology that amplifies its baseline gap, but which one varies by model, so no design is reliably safe or reliably amplifying: the disparity is relocated, never removed. Late-stage fixes fail: fairness instructions and demographic masking leave the gap untouched, and per-agent self-debiasing widens it, because the bias is already encoded in the agents' ordinary clinical numbers. We call this disparity laundering; the audits now applied to clinical AI, per model, per output, per version, can certify the parts but never the committed decision. Interventions close the gap exactly when they make counterfactual versions visible inside the system and pool them, through deliberation, into the committed decision. A diverse-perspective ensemble does both while keeping the team, with no retraining or architectural change: the disparity falls by 67 to 94% where all five perspectives pool at every round, and the one topology that never pools them is the one it cannot reliably repair. Medical multi-agent systems do not filter demographic bias; they launder it into plausible decisions no single-version audit can catch, and the only defense is to make the bias visible.

Figures & tables

Appendix figures & tables20 assets

Supplementary material from the paper’s appendix.

Appendix

Explore similar work

Aug 7, 2026

Does Splitting a Triage Decision Across Agents Hide Bias or Help Catch It? A Multi-Agent Simulation Study of LLM-Based Resource Allocation Under Audit Capacity Constraints

Prior benchmarking work has shown that a single large language model (LLM), forced to make life-or-death resource-allocation decisions, exhibits measurable demographic bias. Real deployments, however, rarely use a single agent: they use pipelines, with review steps meant to catch exactly this kind of failure. We study what happens to bias when the same decision is distributed across a role-differentiated multi-agent pipeline (assessment, allocation, independent audit) instead of made and checked by one model alone. Using a synthetic disaster-triage simulator with paired cases that are clinically identical except for one demographic attribute, we run 192 episodes (2,304 resolved case pairs) on GPT-4o-mini comparing a single-agent control condition to a nine-agent pipeline under three independently varied pressure dimensions. We find no measurable difference in how often biased outcomes occur between the two conditions (6.9% vs. 6.1%, p = 0.498). We do find a large and significant effect of audit capacity on whether bias is caught: 30.0% of biased outcomes go entirely undetected, rising to 43.8% when the auditor is overloaded and falling to 18.4% when it is not. Decomposing this effect shows it is driven almost entirely by coverage (whether a case is reviewed at all, which collapses from 100.0% to 65.6% under load, p < 0.001) rather than by degraded judgment on the cases that are reviewed (81.6% vs. 85.7%, p = 1.000, direction reversed). A follow-up experiment shows that reordering the audit queue by estimated risk, rather than first-come-first-served, recovers most of the lost coverage under the same capacity constraint (65.6% to 91.7%, p = 0.028). We discuss the implications for any system that adds independent oversight to an LLM agent pipeline under resource constraints, and report the study's limitations honestly: one model, modest sample sizes, and no adversarial replication.
Apr 15, 2026

Beyond Arrow's Impossibility: Fairness as an Emergent Property of Multi-Agent Collaboration

Fairness in language models is typically studied as a property of a single, centrally optimized model. As large language models become increasingly agentic, we propose that fairness emerges through interaction and exchange. We study this via a controlled hospital triage framework in which two agents negotiate over three structured debate rounds. One agent is aligned to a specific ethical framework via retrieval-augmented generation (RAG), while the other is either unaligned or adversarially prompted to favor demographic groups over clinical need. We find that alignment systematically shapes negotiation strategies and allocation patterns, and that neither agent's allocation is ethically adequate in isolation, yet their joint final allocation can satisfy fairness criteria that neither would have reached alone. Aligned agents partially moderate bias through contestation rather than override, acting as corrective patches that restore access for marginalized groups without fully converting a biased counterpart. We further observe that even explicitly aligned agents exhibit intrinsic biases toward certain frameworks, consistent with known left-leaning tendencies in LLMs. We connect these limits to Arrow's Impossibility Theorem: no aggregation mechanism can simultaneously satisfy all desiderata of collective rationality, and multi-agent deliberation navigates rather than resolves this constraint. Our results reposition fairness as an emergent, procedural property of decentralized agent interaction, and the system rather than the individual agent as the appropriate unit of evaluation.
Jun 15, 2026

AgentFairBench: Do LLM Agents Discriminate When They Act?

Large language model (LLM) agents increasingly take actions (screening applicants, recommending credit, triaging patients), yet fairness for LLMs is still measured by grading answers. We introduce AgentFairBench, a cheap, reproducible, multi-domain benchmark for demographic disparity in the actions of LLM agents. Grounded in a companion framework, the Bias Conduction Framework (BCF, restated here), it spans three regulator-anchored domains: hiring, lending, and medical triage. Synthetic, demographic-neutral profiles are evaluated in counterfactual matched sets that vary only a name-coded race x gender signal (in the Bertrand Mullainathan tradition), under four agent scaffolds of increasing agency (direct, chain-of-thought, multi-agent deliberation, tool-augmented). A NumPy-only harness computes counterfactual flip rate, mean absolute score difference (MASD), action-rate disparity, and tool-invocation disparity, with bootstrap confidence intervals, paired tests, and false-discovery-rate control, for single-digit dollars per model. A live leaderboard with a held-out private split and a contamination canary admits external models by submission. Our pilot (864 decisions plus a test-retest replication) carries a methodological lesson: comparing a six-group score spread against a two-run noise difference overstates disparity by ~ 2.4X through statistic arity alone. Against an arity matched noise floor and an omnibus group test, claude haiku 4 5 shows no demographic effect above sampling noise (0 of 120 pairwise and 0 of 9 omnibus contrasts survive correction); a planted-bias test confirms the instrument detects disparity when present. The contribution is a sound, sensitive, adoption-ready instrument, the arity matched null methodology, and open artifacts to scale it. Code, data, and harness are released under open licenses, with an anonymized review artifact.