Psychiatric Advance Directives and Artificial Intelligence: A Conceptual Framework for Theoretical and Ethical Principles
The patient's decision-making abilities are often altered in psychiatric disorders. The legal framework of psychiatric advance directives (PADs) has been made to provide care to patients in these situations while respecting their free and informed consent. The implementation of artificial intel...
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Format: | Article |
Language: | English |
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Frontiers Media S.A.
2021-01-01
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Series: | Frontiers in Psychiatry |
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Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2020.622506/full |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Stéphane Mouchabac Stéphane Mouchabac Vladimir Adrien Vladimir Adrien Clara Falala-Séchet Olivier Bonnot Olivier Bonnot Redwan Maatoug Redwan Maatoug Bruno Millet Bruno Millet Charles-Siegfried Peretti Alexis Bourla Alexis Bourla Florian Ferreri Florian Ferreri |
spellingShingle |
Stéphane Mouchabac Stéphane Mouchabac Vladimir Adrien Vladimir Adrien Clara Falala-Séchet Olivier Bonnot Olivier Bonnot Redwan Maatoug Redwan Maatoug Bruno Millet Bruno Millet Charles-Siegfried Peretti Alexis Bourla Alexis Bourla Florian Ferreri Florian Ferreri Psychiatric Advance Directives and Artificial Intelligence: A Conceptual Framework for Theoretical and Ethical Principles Frontiers in Psychiatry psychiatric advance directives artificial intelligence medical ethics joint crisis plan clinical decision support system predictive medicine |
author_facet |
Stéphane Mouchabac Stéphane Mouchabac Vladimir Adrien Vladimir Adrien Clara Falala-Séchet Olivier Bonnot Olivier Bonnot Redwan Maatoug Redwan Maatoug Bruno Millet Bruno Millet Charles-Siegfried Peretti Alexis Bourla Alexis Bourla Florian Ferreri Florian Ferreri |
author_sort |
Stéphane Mouchabac |
title |
Psychiatric Advance Directives and Artificial Intelligence: A Conceptual Framework for Theoretical and Ethical Principles |
title_short |
Psychiatric Advance Directives and Artificial Intelligence: A Conceptual Framework for Theoretical and Ethical Principles |
title_full |
Psychiatric Advance Directives and Artificial Intelligence: A Conceptual Framework for Theoretical and Ethical Principles |
title_fullStr |
Psychiatric Advance Directives and Artificial Intelligence: A Conceptual Framework for Theoretical and Ethical Principles |
title_full_unstemmed |
Psychiatric Advance Directives and Artificial Intelligence: A Conceptual Framework for Theoretical and Ethical Principles |
title_sort |
psychiatric advance directives and artificial intelligence: a conceptual framework for theoretical and ethical principles |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Psychiatry |
issn |
1664-0640 |
publishDate |
2021-01-01 |
description |
The patient's decision-making abilities are often altered in psychiatric disorders. The legal framework of psychiatric advance directives (PADs) has been made to provide care to patients in these situations while respecting their free and informed consent. The implementation of artificial intelligence (AI) within Clinical Decision Support Systems (CDSS) may result in improvements for complex decisions that are often made in situations covered by PADs. Still, it raises theoretical and ethical issues this paper aims to address. First, it goes through every level of possible intervention of AI in the PAD drafting process, beginning with what data sources it could access and if its data processing competencies should be limited, then treating of the opportune moments it should be used and its place in the contractual relationship between each party (patient, caregivers, and trusted person). Second, it focuses on ethical principles and how these principles, whether they are medical principles (autonomy, beneficence, non-maleficence, justice) applied to AI or AI principles (loyalty and vigilance) applied to medicine, should be taken into account in the future of the PAD drafting process. Some general guidelines are proposed in conclusion: AI must remain a decision support system as a partner of each party of the PAD contract; patients should be able to choose a personalized type of AI intervention or no AI intervention at all; they should stay informed, i.e., understand the functioning and relevance of AI thanks to educational programs; finally, a committee should be created for ensuring the principle of vigilance by auditing these new tools in terms of successes, failures, security, and relevance. |
topic |
psychiatric advance directives artificial intelligence medical ethics joint crisis plan clinical decision support system predictive medicine |
url |
https://www.frontiersin.org/articles/10.3389/fpsyt.2020.622506/full |
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doaj-d1399bca90bd49459a775c542b2a0b8d2021-01-22T04:50:31ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402021-01-011110.3389/fpsyt.2020.622506622506Psychiatric Advance Directives and Artificial Intelligence: A Conceptual Framework for Theoretical and Ethical PrinciplesStéphane Mouchabac0Stéphane Mouchabac1Vladimir Adrien2Vladimir Adrien3Clara Falala-Séchet4Olivier Bonnot5Olivier Bonnot6Redwan Maatoug7Redwan Maatoug8Bruno Millet9Bruno Millet10Charles-Siegfried Peretti11Alexis Bourla12Alexis Bourla13Florian Ferreri14Florian Ferreri15Sorbonne Université, AP-HP Department of Psychiatry, Hôpital Saint-Antoine, Paris, FranceSorbonne Université, iCRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain and Spine Institute (ICM), INSERM, CNRS, Paris, FranceSorbonne Université, AP-HP Department of Psychiatry, Hôpital Saint-Antoine, Paris, FranceSorbonne Université, iCRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain and Spine Institute (ICM), INSERM, CNRS, Paris, FranceLaboratory of Psychopathology and Health Processes, EA 4057, Institute of Psychology, University of Paris, Paris, FranceCHU de Nantes, Department of Child and Adolescent Psychiatry, Nantes, FrancePays de la Loire Psychology Laboratory, EA 4638, Nantes, FranceSorbonne Université, iCRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain and Spine Institute (ICM), INSERM, CNRS, Paris, FranceSorbonne Université, AP-HP Department of Psychiatry, Hôpital Pitié-Salpêtrière, Paris, FranceSorbonne Université, iCRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain and Spine Institute (ICM), INSERM, CNRS, Paris, FranceSorbonne Université, AP-HP Department of Psychiatry, Hôpital Pitié-Salpêtrière, Paris, FranceSorbonne Université, AP-HP Department of Psychiatry, Hôpital Saint-Antoine, Paris, FranceSorbonne Université, AP-HP Department of Psychiatry, Hôpital Saint-Antoine, Paris, FranceJeanne d'Arc Hospital, INICEA Group, Saint-Mandé, FranceSorbonne Université, AP-HP Department of Psychiatry, Hôpital Saint-Antoine, Paris, FranceSorbonne Université, iCRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain and Spine Institute (ICM), INSERM, CNRS, Paris, FranceThe patient's decision-making abilities are often altered in psychiatric disorders. The legal framework of psychiatric advance directives (PADs) has been made to provide care to patients in these situations while respecting their free and informed consent. The implementation of artificial intelligence (AI) within Clinical Decision Support Systems (CDSS) may result in improvements for complex decisions that are often made in situations covered by PADs. Still, it raises theoretical and ethical issues this paper aims to address. First, it goes through every level of possible intervention of AI in the PAD drafting process, beginning with what data sources it could access and if its data processing competencies should be limited, then treating of the opportune moments it should be used and its place in the contractual relationship between each party (patient, caregivers, and trusted person). Second, it focuses on ethical principles and how these principles, whether they are medical principles (autonomy, beneficence, non-maleficence, justice) applied to AI or AI principles (loyalty and vigilance) applied to medicine, should be taken into account in the future of the PAD drafting process. Some general guidelines are proposed in conclusion: AI must remain a decision support system as a partner of each party of the PAD contract; patients should be able to choose a personalized type of AI intervention or no AI intervention at all; they should stay informed, i.e., understand the functioning and relevance of AI thanks to educational programs; finally, a committee should be created for ensuring the principle of vigilance by auditing these new tools in terms of successes, failures, security, and relevance.https://www.frontiersin.org/articles/10.3389/fpsyt.2020.622506/fullpsychiatric advance directivesartificial intelligencemedical ethicsjoint crisis planclinical decision support systempredictive medicine |