Ethical Risk and Governance Analysis of Medical Robots: Based on the 'Doctor-Patient-Robot' Analytical Framework
-
摘要: 基于“医−患−机”分析框架,医疗机器人的不断发展面临主体资质复杂、责任认定困难等责任伦理风险,医患关系重构、医患信任危机等医患伦理风险,数据质量与数据隐私等数据伦理风险,算法安全与算法偏见等算法伦理风险以及医疗资源分配正义风险。医疗机器人的伦理治理要以医学伦理和机器人伦理准则为依据,建立多元伦理治理体制,推动学术共同体的构建,探索自愿型、调节型与管制型等伦理治理工具的组合运用,加快医疗机器人伦理治理的法治化发展。Abstract: Based on the "doctor-patient-robot" analytical framework, the continuous development of medical robots faces ethical risks related to complex qualifications of subjects, difficulties in accountability, risks in the reconstruction of doctor-patient relationships, trust crises in doctor-patient relationships, data quality, data privacy, algorithm security, algorithm bias, and ethical risks related to the distributive justice of medical resources. The ethical governance of medical robots should be based on principles of medical ethics and robot ethics, establishing a diverse ethical governance system, promoting the construction of academic community, and exploring the combined use of voluntary, regulatory, and control-oriented ethical governance tools, accelerating the legal development of ethical governance for medical robots.
-
[1] 中共中央办公厅, 国务院办公厅. 关于加强科技伦理治理的意见[N]. 人民日报, 2022-03-21(1).
[2] 王 豫, 樊瑜波. 医疗机器人: 产业未来新革命[M]. 北京: 机械工业出版社, 2020: 39-92.
[3] 王 豫, 徐 岩, 方 林. AI+医疗健康: 智能化医疗健康的应用与未来[M]. 北京: 机械工业出版社, 2021: 105-108.
[4] 贾计东, 张明路. 人机安全交互技术研究进展及发展趋势[J]. 机械工程学报, 2020, 56(3): 16-30.
[5] 刘文勇, 刘亚军. 2019年医用机器人研发热点回眸[J]. 科技导报, 2020, 38(1): 188-195.
[6] 宋国立, 韩建达, 赵忆文. 骨科手术机器人及其导航技术[J]. 科学通报, 2013, 58(S2): 8-19.
[7] 张学高, 周恭伟. 人工智能+医疗健康: 应用现状及未来发展概论[M]. 北京: 电子工业出版社, 2019: 177-179.
[8] WENG Y H. Beyond robot ethics: On a legislative consortium for social robotics[J]. Adv Robot, 2010, 24(13): 1919-1926. doi: 10.1163/016918610X527220
[9] LICHOCKI P, KAHN P H, BILLARD A. The ethical landscape of robotics[J]. IEEE Robot Automat Mag, 2011, 18(1): 39-50. doi: 10.1109/MRA.2011.940275
[10] SAEIDI H, OPFERMANN J D, KAM M, et al. Autonomous robotic laparoscopic surgery for intestinal anastomosis[J]. Sci Robot, 2022, 7(62): eabj2908. doi: 10.1126/scirobotics.abj2908
[11] ETZIONI A, ETZIONI O. Incorporating ethics into artificial intelligence[J]. J Ethics, 2017, 21(4): 403-418. doi: 10.1007/s10892-017-9252-2
[12] BIGMAN Y E, WAYTZ A, ALTEROVITZ R, et al. Holding robots responsible: The elements of machine morality[J]. Trends Cogn Sci, 2019, 23(5): 365-368. doi: 10.1016/j.tics.2019.02.008
[13] LIN P, ABNEY K, BEKEY G. Robot ethics: Mapping the issues for a mechanized world[J]. Artif Intell, 2011, 175(5/6): 942-949.
[14] 杜严勇. 论机器人权利[J]. 哲学动态, 2015(8): 83-89.
[15] 杜严勇. 机器人伦理中的道德责任问题研究[J]. 科学学研究, 2017, 35(11): 1608-1613.
[16] LOH J. Responsibility and robot ethics: A critical overview[J]. Philosophies, 2019, 4(4): 58. doi: 10.3390/philosophies4040058
[17] SAND M, DURÁN J M, JONGSMA K R. Responsibility beyond design: Physicians' requirements for ethical medical AI[J]. Bioethics, 2022, 36(2): 162-169. doi: 10.1111/bioe.12887
[18] GELHAUS P. Robot decisions: On the importance of virtuous judgment in clinical decision making[J]. J Eval Clin Pract, 2011, 17(5): 883-887. doi: 10.1111/j.1365-2753.2011.01720.x
[19] ROYAKKERS L, VAN EST R. A literature review on new robotics: Automation from love to war[J]. Int J Soc Robot, 2015, 7(5): 549-570. doi: 10.1007/s12369-015-0295-x
[20] PALMER A, SCHWAN D. Beneficent dehumanization: Employing artificial intelligence and carebots to mitigate shame-induced barriers to medical care[J]. Bioethics, 2022, 36(2): 187-193. doi: 10.1111/bioe.12986
[21] GREBENSHCHIKOVA E G, TISHCHENKO P D. Bioethical challenges of artificial intelligence in surgery[J]. Clin Exp Surg Petrovsky J, 2021, 9(3): 7-15. doi: 10.33029/2308-1198-2021-9-3-7-15
[22] BIGMAN Y E, GRAY K. People are averse to machines making moral decisions[J]. Cognition, 2018, 181: 21-34. doi: 10.1016/j.cognition.2018.08.003
[23] 李晓洁, 丛亚丽. 健康医疗大数据公平问题研究[J]. 自然辩证法通讯, 2021, 43(8): 8-13.
[24] HAMET P, TREMBLAY J. Artificial intelligence in medicine[J]. Metabolism, 2017, 69S: S36-S40.
[25] GEIS J R, BRADY A P, WU C C, et al. Ethics of artificial intelligence in radiology: Summary of the joint European and North American multisociety statement[J]. Can Assoc Radiol J, 2019, 70(4): 329-334. doi: 10.1016/j.carj.2019.08.010
[26] FLORIDI L, TADDEO M. What is Data Ethics?[J]. Philos Transactions, 2016, 374(2083): 20160360.
[27] FLORIDI L, COWLS J, BELTRAMETTI M, et al. AI4People: An ethical framework for a good AI society: Opportunities, risks, principles, and recommendations[J]. Mines Mach, 2018, 28(4): 689-707. doi: 10.1007/s11023-018-9482-5
[28] NYRUP R, ROBINSON D. Explanatory pragmatism: A context-sensitive framework for explainable medical AI[J]. Ethics Inf Technol, 2022, 24(1): 13. doi: 10.1007/s10676-022-09632-3
[29] KUNDU S. AI in medicine must be explainable[J]. Nat Med, 2021, 27(8): 1328. doi: 10.1038/s41591-021-01461-z
[30] MARTIN K. Ethical implications and accountability of algorithms[J]. J Bus Ethics, 2019, 160(4): 835-850. doi: 10.1007/s10551-018-3921-3
[31] HOWARD A, BORENSTEIN J. The ugly truth about ourselves and our robot creations: The problem of bias and social inequity[J]. Sci Eng Ethics, 2018, 24(5): 1521-1536. doi: 10.1007/s11948-017-9975-2
[32] VAN WYNSBERGHE A. A method for integrating ethics into the design of robots[J]. Ind Robot, 2013, 40(5): 433-440. doi: 10.1108/IR-12-2012-451
[33] OBERMEYER Z, POWERS B, VOGELI C, et al. Dissecting racial bias in an algorithm used to manage the health of populations[J]. Science, 2019, 366(6464): 447-453. doi: 10.1126/science.aax2342
[34] GEIGER J D, HIRSCHL R B. Innovation in surgical technology and techniques: Challenges and ethical issues[J]. Semin Pediatr Surg, 2015, 24(3): 115-121. doi: 10.1053/j.sempedsurg.2015.02.008
[35] 王晓娣, 方旭红. 医疗机器人伦理风险探析[J]. 自然辩证法研究, 2018, 34(12): 64-69.
[36] 王 硕, 王 珏, 文侃骁. 国际精准医学伦理研究: 知识基础与热点前沿[J]. 自然辩证法通讯, 2022, 44(7): 83-93.
[37] 樊春良. 科技伦理治理的理论与实践[J]. 科学与社会, 2021, 11(4): 33-50.
[38] MURPHY R, WOODS D D. Beyond Asimov: The three laws of responsible robotics[J]. IEEE Intell Syst, 2009, 24(4): 14-20. doi: 10.1109/MIS.2009.69
[39] 雷瑞鹏, 张 毅. 机器人学科技伦理治理问题探讨[J]. 自然辩证法研究, 2022, 38(4): 108-114.
[40] GUNDERSEN T, BÆRØE K. The future ethics of artificial intelligence in medicine: Making sense of collaborative models[J]. Sci Eng Ethics, 2022, 28(2): 17. doi: 10.1007/s11948-022-00369-2
[41] 于 雪, 李 伦. 人工智能的设计伦理探析[J]. 科学与社会, 2020, 10(2): 75-88.
[42] BENDEL O. Surgical, therapeutic, nursing and sex robots in machine and information ethics[M]//VAN RYSEWYK S, PONTIER M. Machine Medical Ethics. Cham: Springer, 2015: 17-32.
[43] PERSAUD P, VARDE A S, WANG W. Can robots get some human rights?: A cross-disciplinary discussion[J]. J Robot, 2021, 2021: 5461703.
[44] 刘鸿宇. 机器人道德决策进路与模型研究[J]. 自然辩证法研究, 2021, 37(9): 28-34.
[45] HAGENDORFF T. The ethics of AI ethics: An evaluation of guidelines[J]. Mines Mach, 2020, 30(1): 99-120. doi: 10.1007/s11023-020-09517-8
[46] MCLENNAN S, FISKE A, TIGARD D, et al. Embedded ethics: A proposal for integrating ethics into the development of medical AI[J]. BMC Med Ethics, 2022, 23(1): 6. doi: 10.1186/s12910-022-00746-3
[47] TZAFESTAS S. Roboethics: Fundamental concepts and future prospects[J]. Information, 2018, 9(6): 148. doi: 10.3390/info9060148