生成式人工智能对于医患关系的伦理重构

Ethical Reconstruction of Doctor-patient Relationships through Generative Artificial Intelligence

基于对生成式人工智能医学能力、风险以及第三者效应的综合考量,分析生成式人工智能介入医患关系可能构成的四种伦理转向:即“医-人工智能-患”共同决策模式(可能Ⅰ)、“患-人工智能”深度协作与医生保守立场(可能Ⅱ)、恢复传统“医-患”关系(可能Ⅲ)以及“医-人工智能”深度协作与患者保守立场(可能Ⅳ)。其中“医-人工智能-患”共同决策模式的交互本质可能进一步形成两种相互背离的发展取向:一是以患者为中心的医疗实践模式,二是计算机主义的医疗家长主义。

Based on a comprehensive assessment of the medical capabilities,risks,and third-party effects of generative artificial intelligence(AI),this paper analyzes four potential ethical shifts in doctor-patient relationships resulting from the intervention of generative AI:"Doctor-AI-Patient"shared decision-making model(possibilityⅠ),"Patient-AI"deep collaboration with a conservative doctor's stance(possibilityⅡ),the restoration of the traditional"Doctor-Patient"relationship(possibilityⅢ),and"Doctor-AI"deep collaboration with a conservative patient's stance(possibilityⅣ).The interactive nature of"Doctor-AIPatient"shared decision-making model may lead to the development of two mutually exclusive orientations:the patient-centered medical practice model or the computational medical paternalism.