Metric-Fair Prompting: Treating Similar Samples Similarly

We introduce \emph{Metric-Fair Prompting}, a fairness-aware prompting framework that guides large language models (LLMs) to make decisions under metric-fairness constraints. In the application of multiple-choice medical question answering, each {(question, option)} pair is treated as a binary instance with label $+1$ (correct) or $-1$ (incorrect). To promote {individual fairness}~--~treating similar instances similarly~--~we compute question similarity using NLP embeddings and solve items in \emph{joint pairs of similar questions} rather than in isolation. The prompt enforces a global decision protocol: extract decisive clinical features, map each \((\text{question}, \text{option})\) to a score $f(x)$ that acts as confidence, and impose a Lipschitz-style constraint so that similar inputs receive similar scores and, hence, consistent outputs. Evaluated on the {MedQA (US)} benchmark, Metric-Fair Prompting is shown to improve performance over standard single-item prompting, demonstrating that fairness-guided, confidence-oriented reasoning can enhance LLM accuracy on high-stakes clinical multiple-choice questions.