International Journal of Chinese & Comparative Philosophy of Medicine

前言：AI科技與生命倫理學

穎張 — 2024-09-27

人工智慧 (AI) 對醫學－生命倫理學的影響是當今不可忽視的話題，亦是頗有爭議的話題。自2007年以來，美國IBM的華生醫生(Dr. Watson) 通過認知運算 (Cognitive Computing)，從事疾病的早期發現、治療方法及新藥研發等工作。近幾年，AI科技得到突飛猛進的發展，其機器學習演算法 (machine learning algorisms) 持續對人類社會帶來前所未有的改變。AI工具如OpenAI公司的ChatGPT、Sora，微軟的“必應”(Bing)，穀歌的“巴德”(Bard) 以及醫療大模型 (PaLM2)。高級自然語言處理模型的出現，掀起了通過人工智慧聊天機器人收集資訊、回答醫療問題的新浪潮。美國加州大學聖地亞哥分校神經生物學教授泰倫斯．塞諾夫斯基 (Terrence J. Sejnowski) 在一次有關人工智慧未來展望的會議上明確指出，“人工智慧的最新進展似乎是革命性的，但我們才剛剛起步——未來超出了我們有限的想像範圍。”(Sejnowski,“GPT: From Brains to the Talking Dog”)。目前人工智慧在中國的發展亦是與日俱增，其未來的發展問題以及其背後的倫理思考愈來愈受到學者的關注，是否運用AI技術建構的人工智慧系統的問題已經轉向如何運用AI技術建構的人工智慧系統的問題。(撮要取自內文首段)

“仁術”概念與“仁”的價值實現——醫用護理機器人倫理設計反思

子瑜陳 — 2024-09-27

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

當前醫用護理機器人的倫理設計存在現實局限，而“仁術”概念則能為突破這些局限提供新的思路。在“仁術”概念中，“仁”是“仁術”得以存在的根源，並決定了“術”作為“仁術”的價值指向，而在現實實踐中不斷擴充的“仁”也意味著“仁術”最終會成為更高層面的“仁政”。“仁術”概念對醫用護理機器人倫理設計的啟示是：倫理設計的目標應當以價值為優先，在關注醫護工作者具體專業實錢的同時，也應兼顧面向社會成員的公共衛生事業。

The ethical design of healthcare robots has practical limitations in current design practice, but these can be addressed by the concept of “benevolence.” The value orientation of “art” can be regarded as benevolence, as the meaning of the concept is constantly expanding in practice. Benevolence can eventually attain the higher level of “benevolent government.” The concept of benevolence can inform the ethical design of healthcare robots. Ethical design should take value as the priority, take into account the specific professional practices of medical personnel, and consider the health of the general public.

人工智慧助力抑鬱症治療：道家視角

禹平何 — 2024-09-27

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

近些年，全球抑鬱症患者顯著增加，傳統線下心理治療面臨可及性、便利性和社會污名化等挑戰，已成為全球公共術生領域的關注焦點。在此背景下，人工智慧(AI)聊天機器人的快速發展為其提供了新的解決方案，但AI聊天機器人仍面臨患者隱私信息保護、算法偏見、人機過度依賴及責任歸屬等倫理問題。因此，本文借用道家哲學思想對AI醫學倫理進行反思，並引用心理健康、人工智慧和機器學習等多領域知識。通過探討AI聊天機器人治療抑鬱症可能出現的人機過度依賴和責任歸屬的倫理問題，以期AI技術發展的同時，亦能維護人的自由與本真狀態，實現技術創新與人文闋懷的和諧統一。

The current rapid increase in the number of people suffering from depression globally has presented traditional offline psychotherapies with various challenges, such as regarding accessibility, convenience of treatment, and social stigma, which have become focal areas in the global public health domain. In this context, the rapid development of artificial intelligence (AI) chatbots has provided new solutions. However, AI chatbots still face ethical issues regarding patient privacy information protection, algorithmic bias, human–machine overdependence, and responsibility attribution. Therefore, this paper draws on the philosophical ideas of Daoism to reflect on the ethics of AI medicine and references the knowledge of multiple fields such as mental health, AI, and machine learning. We explore the ethical issues of human–machine overdependence and responsibility attribution that may arise in the use of AI chatbots to treat depression. The goal should be to ensure that human freedom and authenticity are protected alongside the development of AI technology, thus achieving harmony between technological innovation and humanistic care.

人工智慧時代醫患關係的“關懷”倫理構建

巍肖 — 2024-09-27

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

隨著21世紀以來的科技發展進步，人類正在進入一個“人機物”三元融合的萬物智能互聯時代。人工智慧（AI）和大數據已經對人們對醫患關係的傳統認知提出挑戰。在生命倫理學領域，如何闡釋醫患關係問題已不是簡單的概念討論和爭辯，而關乎到AI時代醫生職業精神的塑造、醫學發展向善的價值導向與實錢，以及醫學人文精神與和諧社會的追求。國内學者一直對醫患關係性質問題爭論不休，美國倫理學家雅克．蒂洛等人也概括出醫患倫理關係的三個形式。然而，這些討論和形式都存在某種程度的不足。儒家和女性主義關懷倫理學都屬於“關懷”倫理，基於這兩種理論資源，醫患關係可以理解為一種關懷關係，並可以通過關係自主性和生命共同體理念進行構建。

The rapid progress of science and technology in the 21st century has ushered humanity into an era characterized by the intelligent interconnectedness of all entities through the tripartite integration of humans, machines, and objects. The emergence of artificial intelligence (AI) and big data has posed challenges to conventional perceptions of physician–patient relationships. Within bioethics discourse, interpreting such relationships is now more important than mere conceptual deliberation, as it can help to shape the professionalism of physicians in an AI-driven age. In addition, such interpretation can align medical development with ethical values aimed at fostering a humanistic spirit within healthcare practices to help build a harmonious society. Domestic scholars have been engaged in debates concerning this issue, and the American ethicist Jacques Paul Thiroux and others have proposed three models for the ethical interactions between physicians and patients. However, these discussions exhibit some limitations. Confucian ethics alongside the feminist ethics of care can contribute to what can be termed “care” ethics. Leveraging these theoretical foundations allows us to perceive physician–patient relations as inherently caring and as able to be cultivated through notions such as relational autonomy within communal living.

數字復活——記億哲學的審視

慶峰楊 — 2024-09-27

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

數位復活是利用數位技術、大資料和人工智慧等技術實現的同一性的再現式行為，數位人是一種特殊的數位記憶形式。從語言維度看，語言再現能夠將逝者的聲音和言語方式再現，但是數位語言存在如無法呈現世界經驗，數位主體的語言與理解呈現出分裂、無法再生意義以及非言語行為的單向交流等問題；從影像維度看，圖像再現能夠將逝者的影像呈現，數位圖像數能夠確保整體性的構建，但是卻無法實現道德責任的建構。面對數位影像，我們無法實現對數位親者和數位他者的道德責任。從復活主體看，復活自我、復活他者和復活親者是數位復活基本的三種形式。復活自我的本質是增強意義上的做法，而復活他者則是懷念意義上的做法；復活親者是悼念意義上的做法。

Digital resurrection refers to a representational act involving digital technology, big data, or artificial intelligence in which the digital agent offers a specific form of digital memory. From the linguistic dimension, although language reproduction can imitate the voice and speech styles of the departed, digital reproduction cannot present a lived experience of them. The digital subject, which exhibits a split between language and understanding, may fail to regenerate a clear meaning or unidirectional communication from the animated image of the departed. In terms of the digital agent, ambivalent relationships exist among the three entities of the departed, the self, and the other. Digital resurrection can offer three forms of meaning: an enhanced meaning from the self, the memorial meaning of the other, and a condoling meaning from the departed. Who is the resurrected agent? Who has the digital memory? Who is ethically responsible for the digital data used to create the digital memory? All of these questions should be addressed and discussed.