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ENGLISH ABSTRACT
人工智能在临床实践中的创新应用和伦理挑战
于兰亦
翟晓梅
作者及单位信息
·
DOI： 10.3760/cma.j.cn101909-20231127-00073
Innovative applications and ethical challenges of artificial intelligence in clinical practice
Yu Lanyi
Zhai Xiaomei
Authors Info & Affiliations
Yu Lanyi
Chinese Academy of Medical Sciences and Peking Union Medical College; School of Population Medicine and Public Health, Beijing 100730, China
Zhai Xiaomei
Chinese Academy of Medical Sciences and Peking Union Medical College; School of Population Medicine and Public Health, Beijing 100730, China
·
DOI： 10.3760/cma.j.cn101909-20231127-00073
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摘要

人工智能（AI）在医学与健康领域被广泛视为具有巨大潜力，将可能从根本上改变医疗方式和决策模式。尽管诸如基于规则的专家系统、机器学习和自然语言模型等技术已在临床实践中有所应用，但广泛部署医疗AI仍面临诸多技术难题和伦理挑战。当前，AI在临床医学领域的应用处于早期阶段，尚未对临床诊疗产生重大影响，但随着医学领域AI的迅猛发展，这个“机会窗口”正在逐渐关闭。本文旨在探讨AI在临床实践中的应用进展和新兴潜力，重点分析其应用所面临的伦理挑战，包括数据隐私安全与偏倚、数字鸿沟与健康不公平、可解释AI与自主决策，以及错误风险与责任转移问题，并提出相应对策，以期为我国医学AI相关政策的制定提供理论依据和决策支持。

人工智能;机器学习;临床应用;新兴技术;伦理
ABSTRACT

Artificial intelligence (AI) is widely seen as having great potential in the field of medicine and health, with the possibility to fundamentally transform medical care and clinical decision-making. Despite technologies such as rule-based expert systems, machine learning, and natural language models being applied in clinical practice, the widespread deployment of AI in healthcare still faces numerous technical challenges and ethical debates. Still, in its early stage of development, it has not had a significant impact on clinical diagnostics and treatment. However, with the rapid progression of AI in medicine, this"window of opportunity"is gradually closing. This study aims to explore the application progress and emerging potential of AI in clinical practice; analyze the ethical challenges, including data privacy and bias, digital divide and health inequities, explainable AI and autonomous decision-making and the incorrect risk and responsibility shift; put forward corresponding countermeasures; to provide theoretical groundwork and evidence for the policy-making related to medical AI in China.

Artificial intelligence;Machine learning;Clinical application;Emerging technologies;Ethics
Zhai Xiaomei, Email: nc.defudabe.cmupiahzmx
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引用本文

于兰亦,翟晓梅. 人工智能在临床实践中的创新应用和伦理挑战[J]. 数字医学与健康,2024,02(02)：108-112.

DOI:10.3760/cma.j.cn101909-20231127-00073

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人工智能（artificial intelligence，AI）被视为工业革命的第四次浪潮，是一场类似于人类历史中蒸汽机、电气和数字技术革命的新一轮产业、社会和文明的全球性变革 ［ 1 ］ 。AI驱动的科学研究也被称为是继经验范式、理论范式、计算范式、数据驱动范式后的“第五范式”，并将从根本上改变医疗方式和决策模式 ［ 2 ］ 。2020年11月，一篇发表在 Nature杂志上的文章表明，AI已经能够以92%的准确率预测蛋白质的结构 ［ 3 ］ 。这不仅意味着科学挑战的革命性进展，也标志着生命科学领域将迎来更多的突破。可以说，人脸识别和自动驾驶技术仅是AI应用领域的冰山一角，而在生命医学领域，AI的应用将掀起更为汹涌的浪潮。
近年来，AI和机器学习在医学领域的应用，以及这些应用的伦理学研究都受到广泛关注 ［ 4 ］ 。虽然AI在医学和健康领域仍处于验证和实施的早期阶段，相对来说尚未在临床一线的诊疗工作中产生重大的影响，但随着医学和健康领域AI的迅猛发展，这个“机会窗口”正在迅速关闭 ［ 5 ］ 。在颠覆性新兴技术的实践中，伦理可辩护性是技术可行的决定性因素。对于医学这一直接关乎人们生命健康和尊严的领域来说，伦理的重要性不言而喻。在AI真正大范围应用于真实世界和临床实践前，伦理规制至关重要 ［ 6 ］ 。
目前，我国对AI的监管分布在多个法律法规和规范性文件之中，如《网络安全法》《数据安全法》《个人信息保护法》，以及《互联网信息服务算法推荐管理规定》《生成式人工智能服务暂行管理办法》等。此外，AI领域的伦理治理也备受关注。2022年3月中共中央办公厅、国务院办公厅印发《关于加强科技伦理治理的意见》，提出将AI、生命科学、医学作为国家“十四五”期间的3个重点领域。2023年9月科技部等十部门联合印发的《科技伦理审查办法（试行）》也将AI相关开发部署列入专家复核清单。这一系列规制对于引导AI健康发展具有重要意义。但需要指出的是，现有规范对于医学AI的直接规范价值仍十分有限，尚不足以规制和监管AI在临床实践的创新应用。
正是在这种背景下，我们探讨了AI在临床实践中的研究进展和新兴应用，重点分析了临床实践中AI应用的伦理挑战，以期支持决策讨论，进而引导更为完善的政策制定和负责任的战略部署。
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A
翟晓梅，Email： nc.defudabe.cmupiahzmx
B
于兰亦, 翟晓梅. 人工智能在临床实践中的创新应用和伦理挑战[J]. 数字医学与健康, 2024, 2(2): 108-112. DOI: 10.3760/cma.j.cn101909-20231127-00073.
C
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