医疗人工智能临床应用的伦理思考  

Ethical reflections on the clinical application of medical artificial intelligence

作　　者：崔芳芳 李中琳[3] 何贤英[1,2] 王文超 初云天 石小兵 赵杰 CUI Fangfang;LI Zhonglin;HE Xianying;WANG Wenchao;CHU Yuntian;SHI Xiaobing;ZHAO Jie(National Engineering Laboratory for Internet Medical Systems and Application,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Institute of Intelligent Medicine,Henan Academy of Medical Sciences,Zhengzhou 451162,China;Research Center for Medical Humanities Education,Zhengzhou University,Zhengzhou 450001,China;Shanghai Artificial Intelligence Laboratory,Shanghai 200030,China)

机构地区：[1]郑州大学第一附属医院互联网医疗系统与应用国家工程实验室,河南郑州450052 [2]河南省医学科学院智能医学研究所,河南郑州451162 [3]郑州大学医学人文教育研究中心,河南郑州450001 [4]上海人工智能实验室,上海200030

出　　处：《中国医学伦理学》2025年第2期159-165,共7页Chinese Medical Ethics

基　　金：科技创新2030-(浦江国家实验室)新一代人工智能重大专项子课题“自适应智能辅助诊疗开放平台”(2022ZD0160704);国家超级计算郑州中心创新生态系统建设科技专项“基于多模态数据的肺癌智能诊疗关键技术研究与示范应用”(201400210400);河南省医学科技攻关计划省部共建重点项目“基于多模态特征融合的乳腺癌超声智能筛查技术研究”(SBGJ202402097)。

摘　　要：医疗人工智能是机器学习、计算机视觉、自然语言处理等技术与临床医疗结合形成的一类新型应用,随着相关技术不断迭代、发展,医疗人工智能在提高诊疗效率、服务质量方面展现出巨大潜力,但同时也增加了引发伦理问题的可能性。分析了医疗人工智能临床应用可能导致的伦理问题,包括医疗人工智能的算法可解释性和透明度不足,导致信息不对称和认知差异;医疗数据的安全性和隐私保护状况堪忧;由于医疗人工智能在临床应用中的多主体协同参与,责任划分复杂、不明确,导致医疗事故鉴定和责任厘清的难度增加等,提出应遵循的不伤害患者利益原则、医生主体原则、公正包容原则和快速响应原则,并从多个角度探讨了应对医疗人工智能伦理问题的策略及实现路径,包括规范环境与流程、明确责任归属,持续进行数据保护影响评估、保障数据安全性,确保模型透明与可解释性、开展多主体协作,以及以伦理价值为驱动、坚持“以人的健康为中心”的原则等,旨在为医疗人工智能的健康发展提供指导,确保技术进步同时,能够有效管理和缓解伴随的伦理风险,从而推动医疗人工智能技术的良性发展,更好地服务于医患双方。Medical artificial intelligence(AI) is a new type of application formed by the combination of machine learning,computer vision,natural language processing,and other technologies with clinical medical treatment.With the continuous iteration and development of relevant technologies,medical AI has shown great potential in improving the efficiency of diagnosis and treatment,and service quality,but it also increases the possibility of triggering ethical issues.Ethical issues resulting from the clinical application of medical AI were analyzed,including the lack of algorithmic interpretability and transparency of medical AI,leading to information asymmetry and cognitive discrepancies;the concerning status of security and privacy protection of medical data;and the complex and unclear division of responsibilities due to the collaborative participation of multiple subjects in the clinical application of medical AI,resulting in increased difficulty in the identification of medical accidents and clarification of responsibilities.The paper proposed the principles of not harming patients' interests,physician's subjectivity,fairness and inclusiveness,and rapid response.It also explored the strategies and implementation paths for responding to the ethical issues of medical AI from multiple perspectives,including standardizing the environment and processes,clarifying responsibility attribution,continuously assessing the impact of data protection,guaranteeing data security,ensuring model transparency and interpretability,carrying out multi-subject collaboration,as well as the principles of being driven by ethical values and adhering to the “human health-centeredness.” It aimed to provide guidance for the healthy development of medical AI,ensuring technological progress while effectively managing and mitigating accompanying ethical risks,thereby promoting the benign development of medical AI technology and better serving the healthcare industry and patients.

关 键 词：医疗人工智能 临床应用 伦理原则 科技伦理治理 

分 类 号：R-052[医药卫生]