生成式人工智能对于医患关系的伦理重构

基于对生成式人工智能医学能力、风险以及第三者效应的综合考量，分析生成式人工智能介入医患关系可能构成的四种伦理转向：即“医−人工智能−患”共同决策模式（可能Ⅰ）、“患−人工智能”深度协作与医生保守立场（可能Ⅱ）、恢复传统“医−患”关系（可能Ⅲ）以及“医−人工智能”深度协作与患者保守立场（可能Ⅳ）。其中“医−人工智能−患”共同决策模式的交互本质可能进一步形成两种相互背离的发展取向：一是以患者为中心的医疗实践模式，二是计算机主义的医疗家长主义。

Ethical Reconstruction of Doctor-patient Relationships through Generative Artificial Intelligence

Based on a comprehensive assessment of the medical capabilities, risks, and third-party effects of generative artificial intelligence (AI), this paper analyzes four potential ethical shifts in doctor-patient relationships resulting from the intervention of generative AI: "Doctor-AI-Patient" shared decision-making model (possibility Ⅰ), "Patient-AI" deep collaboration with a conservative doctor's stance (possibility Ⅱ), the restoration of the traditional "Doctor-Patient" relationship (possibility Ⅲ), and "Doctor-AI" deep collaboration with a conservative patient's stance (possibility Ⅳ). The interactive nature of "Doctor-AI-Patient" shared decision-making model may lead to the development of two mutually exclusive orientations: the patient-centered medical practice model or the computational medical paternalism.