In their proof-of-concept, Meier and colleagues (Citation2022) describe the purpose and programming decisions underpinning Medical Ethics Advisor (METHAD), an automated decision support (ADS) system used to guide treatment interventions. The authors themselves note they are not the first to propose that machines could help humans make better, if not more ethical, decisions. Indeed, Alan Turing commented during a 1951 talk broadcast by the BBC that an “attempt to make a thinking machine will help us greatly in finding out how we think ourselves.” Like the authors, we are among a growing community of ‘computational bioethicists’ interested in how thinking machines may be leveraged to yield faster, more consistent, and potentially fairer decisions in clinical and research contexts. Unlike Meier and colleagues, however, we reject the notion that developers can sidestep justice and the impacts that competing justice claims have on decisional outcomes at the ADS design stage, pilot testing, or implementation. In this Open Peer Commentary, we engage with three central ideas about justice: (i) ADS should be used to support, not supplant human decision-making as a matter of algorithmic justice; (ii) gains in procedural justice are among the strongest rationales to pursue research and development of ADS for ethical decision-making, and finally (iii) the values and priorities of stakeholders, e.g., patients, families, and communities actually affected by decisions should comprise the data inputs upon which ADS are ultimately trained. We draw on our collective work developing and implementing ADS for responsible data access management as members of the Global Alliance for Genomics and Health (GA4GH), and propose an agenda for future empirical work needed to advance the subdiscipline of computational bioethics with justice at the forefront.