This chapter examines the fundamental challenges that artificial intelligence-enabled predictive neuroscience poses to traditional frameworks of informed consent and patient autonomy. AI algorithms increasingly generate probabilistic forecasts about neurological conditions, disease progression, and treatment responses from brain imaging data. This development means that established bioethical principles require substantial reconsideration. This chapter identifies four critical areas of ethical tension. First, informed consent processes struggle with the probabilistic, temporally distant, and technically opaque nature of AI-generated neurological predictions. This necessitates innovative approaches such as layered consent, dynamic consent, and process consent models. Second, AI-enhanced neuroimaging dramatically expands the scope and complexity of incidental findings. These systems detect subtle patterns invisible to human observers and create novel categories of predictive findings with unclear clinical significance. These developments require new management frameworks. Third, algorithmic predictions threaten patient autonomy in multiple ways. These include epistemic opacity, influential risk framing, potential disruption of temporal self-understanding, and risks of algorithmic determinism that may create self-fulfilling prophecies. Fourth, cultural variations in privacy conceptions, disclosure preferences, decision-making authority, and brain-related stigma complicate the global implementation of neurotechnology, demanding culturally responsive approaches rather than universalized Western models. This chapter presents detailed case studies from clinical research demonstrating how these theoretical challenges manifest in practice, from managing unexpected predictive findings in multiple sclerosis research to implementing cross-cultural Alzheimer’s prediction studies. The analysis reveals that effective ethical practice requires moving beyond standardized procedures toward contextual responsiveness, balancing scientific rigor with respect for diverse values, and maintaining longitudinal engagement rather than one-time procedural compliance. This chapter concludes that preserving human dignity and self-determination in the age of predictive neuroscience demands the proactive development of adaptive ethical frameworks that evolve alongside technological capabilities while protecting fundamental human values.