This qualitative, single-center study studied how older adults perceive the ethical opportunities, risks, and limitations of introducing an AI-based clinical decision support system (CDSS) in surgical wards, specifically in the context of geriatric comanagement and perioperative care. Researchers conducted five focus groups (n = 30) with adults aged 65 years or older from southern Germany between June and July 2024, stratified by gender and level of technical understanding. They used a semi-structured discussion guide organized into thematic categories, including data use, patient–AI–physician interaction, patient care, resources, and implementation framework. Transcripts were analyzed through qualitative content and thematic analysis, followed by ethical evaluation using Beauchamp and Childress’s four biomedical principles: autonomy, beneficence, nonmaleficence, and justice. The study found that participants viewed CDSS quality as dependent on data foundations and data protection but expressed concerns about cybersecurity, privacy breaches, and manipulation risks. While participants recognized the potential for AI to improve diagnostic accuracy, streamline processes, and reduce language barriers, they also voiced apprehension about overdiagnosis, diminished patient–physician communication, blind trust in automation, and loss of clinical intuition. Across themes, participants emphasized the importance of preserving shared decision-making, transparency, and equitable access to prevent harm and uphold patient autonomy.