临床决策支持系统应用中的伦理思考

基于人工智能技术的临床决策支持系统(clinical decision support system, CDSS)是可以辅助临床医护人员进行医疗决策的交互式系统。基于知识库和非知识库的两种形式和临床应用情况逐步被熟知。CDSS意在通过解决目前医疗资源不足、配置不合理和标准化治疗不规范等问题提高医疗质量,但也面临着医疗信任、诊断准确性、诊断标准、责任归属等潜在挑战。在CDSS研发与应用中,只有秉持以患者为中心的理念,提高CDSS安全性、明确其诊断标准,才能提升信任基础,从而真正回归临床并提高患者福利。

     

责任伦理视角下临床决策支持系统的伦理责任考量

从责任伦理的视角,提出临床决策支持系统（clinical decision support system,CDSS）在确保准确性、尊重自主性、保护隐私安全等责任中存在的合作意识缺失、职业责任薄弱、社会责任缺位等伦理责任问题,针对上述问题,通过以人为本、共存共生的责任伦理原则指出CDSS各方承担责任的主要路径,包括增强合作意识提高CDSS准确性、明确医生与开发者职业责任确保CDSS应用的自主性、加强企业社会责任保障隐私保护等,期望为责任相关者更好地承担伦理责任提供思路,为CDSS未来发展提供新的视角。

     

A Multicriteria Spatial Decision Support System Development for Siting a Landfill in the Province of Torino (Italy)

The present paper proposes a spatial multicriteria approach for supporting Decision‐Makers in the siting process of a Municipal Solid Waste landfill in the Province of Torino (Italy). In particular, the contribution illustrates the development of a Multicriteria‐Spatial Decision Support System based on the integration of Geographic Information Systems and a specific Multicriteria Decision Analysis technique, named Analytic Network Process (ANP). This technique, which represents the generalization of the more well‐known Analytic Hierarchy Process to dependences and feedbacks, is particularly suitable for dealing with complex decision problems which are characterized by inter‐relationships among the elements at stake. The application allows the dependence relationships among the criteria to be assessed, and the relative importance of all the elements that play an influence on the final choice to be evaluated. The purpose of the study is to generate a suitability map of the area under analysis for locating a waste landfill, paying particular attention to the contribution that the spatial ANP offers to sustainability assessments of undesirable facilities. To this end, the simple network structure has been used and both exclusionary and non‐exclusionary criteria have been identified and grouped into clusters. The results are obtained in the form of suitability maps analysed through ilwis 3.3 software (52North, ITC, Enschede, The Netherlands) and have been further verified through a sensitivity analysis with reference to the clusters priorities in order to test the robustness of the proposed model. The main findings of this research have proved that the spatial ANP is a useful tool to help technicians to make their decision process traceable and reliable. Moreover, this approach helps Decision‐Makers to undertake a sound reflection of the siting problem. Finally, the implementation of the spatial ANP technique gives an originality value to the present research because it represents one of the first applications at both the national and international level. Copyright © 2011 John Wiley & Sons, Ltd.