Fiske Amelia, Henningsen Peter, Buyx Alena
Institute for History and Ethics of Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany.
Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar at Technical University of Munich, Munich, Germany.
J Med Internet Res. 2019 May 9;21(5):e13216. doi: 10.2196/13216.
Research in embodied artificial intelligence (AI) has increasing clinical relevance for therapeutic applications in mental health services. With innovations ranging from 'virtual psychotherapists' to social robots in dementia care and autism disorder, to robots for sexual disorders, artificially intelligent virtual and robotic agents are increasingly taking on high-level therapeutic interventions that used to be offered exclusively by highly trained, skilled health professionals. In order to enable responsible clinical implementation, ethical and social implications of the increasing use of embodied AI in mental health need to be identified and addressed.
This paper assesses the ethical and social implications of translating embodied AI applications into mental health care across the fields of Psychiatry, Psychology and Psychotherapy. Building on this analysis, it develops a set of preliminary recommendations on how to address ethical and social challenges in current and future applications of embodied AI.
Based on a thematic literature search and established principles of medical ethics, an analysis of the ethical and social aspects of currently embodied AI applications was conducted across the fields of Psychiatry, Psychology, and Psychotherapy. To enable a comprehensive evaluation, the analysis was structured around the following three steps: assessment of potential benefits; analysis of overarching ethical issues and concerns; discussion of specific ethical and social issues of the interventions.
From an ethical perspective, important benefits of embodied AI applications in mental health include new modes of treatment, opportunities to engage hard-to-reach populations, better patient response, and freeing up time for physicians. Overarching ethical issues and concerns include: harm prevention and various questions of data ethics; a lack of guidance on development of AI applications, their clinical integration and training of health professionals; 'gaps' in ethical and regulatory frameworks; the potential for misuse including using the technologies to replace established services, thereby potentially exacerbating existing health inequalities. Specific challenges identified and discussed in the application of embodied AI include: matters of risk-assessment, referrals, and supervision; the need to respect and protect patient autonomy; the role of non-human therapy; transparency in the use of algorithms; and specific concerns regarding long-term effects of these applications on understandings of illness and the human condition.
We argue that embodied AI is a promising approach across the field of mental health; however, further research is needed to address the broader ethical and societal concerns of these technologies to negotiate best research and medical practices in innovative mental health care. We conclude by indicating areas of future research and developing recommendations for high-priority areas in need of concrete ethical guidance.
具身人工智能（AI）研究在心理健康服务的治疗应用中具有越来越高的临床相关性。从“虚拟心理治疗师”到用于痴呆症护理和自闭症治疗的社交机器人，再到用于性功能障碍治疗的机器人，人工智能虚拟和机器人代理越来越多地承担起过去仅由训练有素、技术娴熟的健康专业人员提供的高级治疗干预措施。为了实现负责任的临床应用，需要识别并解决在心理健康领域越来越多地使用具身AI所带来的伦理和社会影响。
本文评估了在精神病学、心理学和心理治疗等领域将具身AI应用转化为心理健康护理所带来的伦理和社会影响。基于这一分析，本文就如何应对具身AI当前和未来应用中的伦理和社会挑战提出了一系列初步建议。
基于主题文献检索和既定的医学伦理原则，对精神病学、心理学和心理治疗领域中当前具身AI应用的伦理和社会方面进行了分析。为了进行全面评估，分析围绕以下三个步骤展开：评估潜在益处；分析总体伦理问题和担忧；讨论干预措施的具体伦理和社会问题。
从伦理角度来看，具身AI在心理健康领域的重要益处包括新的治疗模式、接触难以触及人群的机会、更好的患者反应以及为医生腾出时间。总体伦理问题和担忧包括：预防伤害和各种数据伦理问题；缺乏关于AI应用开发、其临床整合以及健康专业人员培训的指导；伦理和监管框架存在“空白”；存在被滥用的可能性，包括使用这些技术取代现有服务，从而可能加剧现有的健康不平等。在具身AI应用中识别并讨论的具体挑战包括：风险评估、转诊和监督问题；尊重和保护患者自主权的必要性；非人类治疗的作用；算法使用的透明度；以及这些应用对疾病理解和人类状况的长期影响的具体担忧。
我们认为具身AI在心理健康领域是一种有前景的方法；然而，需要进一步研究以解决这些技术更广泛的伦理和社会问题，以便在创新的心理健康护理中协商最佳研究和医疗实践。我们通过指出未来研究领域并为需要具体伦理指导的高优先领域制定建议来得出结论。
