미국의 의료 분야 차별금지법: 인공지능의 편향에 대한 대응과 시사점 = U.S. Antidiscrimination Law in Healthcare & Algorithmic Bias: Its Lessons for South Korean Legislation

다국어 초록 (Multilingual Abstract)

Antidiscrimination law in U.S. healthcare began with the Civil Rights Act of 1964 and has since expanded under Section 1557 of the Patient Protection and Affordable Care Act. The protected characteristics under Section 1557 include race, color, national origin, sex, age, and disability. As in other sectors, machine learning-based algorithms present a challenge in applying antidiscrimination law due to their opaque, black-box nature. At the practical level, the tendency of many courts to deny private right of action in a disparate impact claim under Section 1557 acts as a disincentive for people in a protected class to seek legal action.
In Korea, the challenges in preventing or mitigating algorithmic bias in healthcare are compounded. First and foremost, no antidiscrimination law exists in the healthcare sector yet. Notwithstanding, the artificial intelligence bills proposed to the National Assembly and the ethical guidelines published by the medical community stipulate that preventing discrimination or bias is essential in developing artificial intelligence, leaving in the vacuum which characteristics should be protected. In addition, health disparity has not been a significant issue in Korean healthcare in general. For Korea, the initial efforts should lay down the necessary first step by defining the protected characteristics that reflect public health research while being compatible with other sectoral antidiscrimination laws.

참고문헌 (Reference)

1 성중탁, "직장내 여성 차별에 관한 최신 미연방대법원 판례와 우리 법제에 대한 시사점" 27 (27): 2016

2 고학수 ; 정해빈 ; 박도현, "인공지능과 차별" (171) : 2019

3 이슬아, "인공지능 판사 앞의 7가지 숙제-재범위험성 예측 알고리즘을 둘러싼 과학기술적․법적 논의 분석" (64) : 2023

4 박도현, "인공지능 공정성의 이론과 실제" 26 (26): 2023

5 문기업 ; 양지현 ; 손유미 ; 최은경 ; 이일학, "보건의료영역 인공지능 윤리 원칙과 고려사항" 26 (26): 2023

6 이인영, "보건의료에서의 인공지능 적용과 관련된 법적 과제에 대한 개관" 27 (27): 2019

7 심재진, "미국의 차별적 영향 이론과 유럽연합의 간접차별 법리" (27) : 2009

8 최윤희, "미국에서의 결과적 차별행위(Disparate Impact)이론에 대한 고찰" (20) : 2006

9 Takshi, S., "Unexpected Inequality : Disparate-Impact from Artificial Intelligence in Healthcare Decisions" 34 (34): 2021

10 Seyyed-Kalantari, L., "Underdiagnosis Bias of Artificial Intelligence Algorithms Applied to Chest Radiographs in Under-Served Patient Populations" 27 (27): 2021

11 Rosenbaum, S., "The Affordable Care Act and Civil Rights: The Challenge of Section 1557 of the Affordable Care Act" 94 (94): 2016

12 Starr, S., "Statistical Discrimination" 58 (58): 2023

13 "State v. Loomis, 881 N.W.2d 749"

14 "Simkins v. Moses H. Cone Memorial Hospital, 323 F. 2d 959"

15 Watson, S.D., "Section 1557 of the Affordable Care Act: Civil Rights, Health Reform, Race, and Equity" 55 : 2012

16 "Ricci v. DeStefano, 557 U.S. 557"

17 Coley, R. Y., "Racial/Ethnic Disparities in the Performance of Prediction Models for Death by Suicide After Mental Health Visits" 78 (78): 2021

18 Smith, D. B., "Racial and Ethnic Health Disparities And The Unfinished Civil Rights Agenda" 24 (24): 2005

19 Kupke, A., "Pulse Oximeters and Violation of Federal Antidiscrimination Law" 329 (329): 2023

20 Shachar, C., "Prevention of Bias and Discrimination in Clinical Practice Algorithms" 329 (329): 2023

21 "NM Ass’n for Retarded Citizens v. State of NM, 678 F. 2d 847"

22 "NAACP v. Medical Ctr., Inc., 657 F. 2d 1322"

23 Cary, M. P., "Mitigating Racial and Ethnic Bias And Advancing Health Equity In Clinical Algorithms : A Scoping Review" 42 (42): 2023

24 Kostick-Quenet, K. M., "Mitigating Racial Bias in Machine Learning" 50 (50): 2022

25 "McWright v. Alexander, 982 F. 2d 222"

26 "McDonnell Douglas Corp. v. Green, 411 U.S. 792"

27 "Linton by Arnold v. Carney by Kimble, 779 F. Supp. 925"

28 Khazanchi, R., "Leveraging Affordable Care Act Section 1557 To Address Racism In Clinical Algorithms" 2022

29 Frankel, T., "Implied Rights of Action" 67 (67): 1981

30 Schwarcz, D., "Health-Based Proxy Discrimination, Artificial Intelligence, and Big Data" 21 (21): 2021

31 "Griggs v. Duke Power Co., 401 U.S. 424"

32 "Griffin v. General Electric Co., 752 Fed. Appx. 947"

33 Barocas, S., "Fairness and Machine Learning : Limitations and Opportunities" MIT Press 2023

34 Gallifant, J., "Equity Should Be Fundamental to the Emergence of Innovation" 2 (2): 2023

35 "Doe v. CVS Pharmacy, Inc., 982 F. 3d 1204"

36 "Doe v. BlueCross BlueShield of Tennessee, Inc., 926 F. 3d 235"

37 Obermeyer, Z., "Dissecting Racial Bias in an Algorithm Used to Manage the Health of Populations" 366 (366): 2019

38 Daneshjou, R., "Disparities in Dermatology AI Performance on a Diverse, Curated Clinical Image Set" 2022

39 Murray, S. G., "Discrimination By Artificial Intelligence In A Commercial Electronic Health Record—A Case Study" 2020

40 "Cummings v. Premier Rehab Keller, Pllc, 142 S. Ct. 1562"

41 Goodman, K. E., "Clinical Algorithms, Antidiscrimination Laws, and Medical Device Regulation" 329 (329): 2023

42 Hahn, R. A., "Civil Rights as Determinants of Public Health and Racial and Ethnic Health Equity : Health Care, Education, Employment, and Housing in the United States" 4 : 2018

43 "Bryan v. Koch, 627 F. 2d 612"

44 "Briscoe v. Health Care Service Corp., 281 F. Supp. 3d 725"

45 Gilboa, M., "Biased but Reasonable : Bias Under the Cover of Standard of Care" 57 (57): 2023

46 Nazer, L. H., "Bias in Artificial Intelligence Algorithms and Recommendations for Mitigation" 2 (2): 2023

47 Gates, S. W., "Automated Underwriting in Mortgage Lending : Good News for the Underserved?" 13 (13): 2002

48 Kim, P. T., "Auditing Algorithms for Discrimination" 166 : 2017

49 Hoffman, S., "Artificial Intelligence and Discrimination in Health Care" 19 (19): 2020

50 Kelley, S., "Antidiscrimination Laws, Artificial Intelligence, and Gender Bias : A Case Study in Nonmortgage Fintech Lending" 24 (24): 2022

51 "Alexander v. Sandoval, 532 U.S. 275"

52 Kroll, J. A., "Accountable Algorithms" 165 (165): 2017

53 이병규, "AI의 예측능력과 재범예측알고리즘의 헌법 문제 - State v. Loomis 판결을 중심으로" 21 (21): 2020