Machine learning in the EU health care context: exploring the ethical, legal and social issues
Machine learning in the EU health care context: exploring the ethical, legal and social issues
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DOI：
10.1080/1369118x.2020.1719185
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发表时间：
2020-07-02
影响因子：
4.2
通讯作者：
Lazcoz, Guillermo
中科院分区：
文献类型：
--
作者：
de Miguel, Inigo;Sanz, Begona;Lazcoz, Guillermo
基于机器学习技术的诊断和临床决策显示出重大进步，可能会改变我们医疗保健系统的功能。它们承诺以更低的成本提供更有效和高效的医疗保健。尽管有证据表明，所有这些承诺尚未在临床实践中得到证明，但不可否认的是，这些技术已经重新定义了医疗保健领域的关系，特别是在医患关系中，我们已经可以将其重新定义为“医生-计算机-患者关系”。这种新情况无疑是有希望的，但它也提出了一些急需解决的基本问题。机器学习的不当使用可能会导致患者知情同意权的严重丧失，或者可能反映他们个人情况的歧视。不幸的是，医疗法所包含的传统原则不足以应对这一挑战。我们最新的监管框架是由《数据保护通用条例》定义的，它可能有助于避免这种情况，因为它包括不受完全基于自动化处理的决策约束的权利。然而，在本文中，我们认为这种法律工具是足够的，但不足以解决机器学习技术对患者权利和医疗保健提供者能力构成的法律、伦理和社会挑战。因此，有必要进一步制定关于这一主题的条例，并发展新的行为者，如卫生信息顾问。
Diagnosis and clinical decision-making based on Machine Learning technologies are showing significant advances that may change the functioning of our health care systems. They promise more effective and efficient healthcare at a lower cost. Even though evidence suggests that all these promises have yet to be demonstrated in clinical practice, it is undeniable that these technologies are already re-signifying the relationships on the health care landscape, particularly in the physician-patient relationship, which we can already redefine as a 'physician-computer-patient relationship'. This new scenario is undoubtedly promising, but it also poses some fundamental issues that need an urgent answer. An inappropriate use of Machine Learning might involve a dramatic loss in the patients' rights to informed consent or possible discrimination reflecting their personal circumstances. Unfortunately, the traditional principles incorporated by medical law are insufficient to face this challenge. Our most recent regulatory framework, defined by the General Regulation on Data Protection, might be useful in order to avoid this scenario since it includes the right not to be subject to a decision based solely on automated processing. In this paper, however, we argue that this legal tool is adequate but not sufficient to address the legal, ethical and social challenges that Machine Learning technologies pose to patients' rights and health care givers' capacities. Therefore, further development of the regulation on this topic and the development of new actors such as the Health Information Counsellors, will be necessary.