RESUMO
BACKGROUND: Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. METHODS: A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom (UK)-based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites (cancer, liver, renal, cystic fibrosis and mental health) were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. RESULTS: Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician's duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. CONCLUSIONS: The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to.
Assuntos
Atitude , Temas Bioéticos , Comunicação , Correio Eletrônico/ética , Assistência de Longa Duração/ética , Relações Médico-Paciente/ética , Adolescente , Adulto , Doença Crônica , Compreensão , Confidencialidade , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido , Masculino , Obrigações Morais , Autonomia Pessoal , Inquéritos e Questionários , Confiança , Reino Unido , Adulto JovemRESUMO
PURPOSE OF REVIEW: Internet and social media use continue to expand rapidly. Many patients and psychiatrists are bringing digital technologies into the treatment process, but relatively little attention has been paid to the ethical challenges in doing this. This review presents ethical guidelines for psychiatry in the digital age. RECENT FINDINGS: Surveys demonstrate that patients are eager to make digital technologies part of their treatment. Substantial numbers search for professional and personal information about their therapists. Attitudes among psychiatrists about using digital technologies with patients range from dread to enthusiastic adoption. Digital technologies create four major ethical challenges for psychiatry: managing clinical boundaries; maintaining privacy and confidentiality; establishing realistic expectations regarding digital communications; and upholding professional ideals. Traditional ethical expectations are valid for the evolving digital arena, but guidance must be adapted for actual application in practice.
Assuntos
Ética Médica , Internet/ética , Relações Médico-Paciente/ética , Privacidade , Psiquiatria/ética , Confidencialidade/ética , Correio Eletrônico/ética , Humanos , Psiquiatria/métodos , Psicoterapia/ética , Psicoterapia/métodos , Ferramenta de Busca/ética , Mídias Sociais/éticaRESUMO
This is the first of two essays written to consider several important trends in dental practice that result from innovations in digital and social media. This essay reviews ethical and legal implications of the use of websites, Facebook, review sites, email and other digital innovations in dental practice. The second essay provides ethical tools for analysis, illuminates areas of ethical concern in today's practice environment and offers recommendations for future practice.
Assuntos
Ética Odontológica , Mídias Sociais/ética , Correio Eletrônico/ética , Humanos , Internet/ética , Marketing de Serviços de Saúde/ética , Fotografia Dentária/ética , Mídias Sociais/legislação & jurisprudênciaAssuntos
American Medical Association , Códigos de Ética , Ética Médica , Publicidade/ética , Pessoal Técnico de Saúde/ética , Confidencialidade/ética , Conflito de Interesses , Correio Eletrônico/ética , Emprego/ética , Ética nos Negócios , Ética em Enfermagem , Ética Profissional , Honorários Médicos/ética , Acessibilidade aos Serviços de Saúde/ética , Experimentação Humana/ética , Humanos , Consentimento Livre e Esclarecido/ética , Reembolso de Seguro de Saúde/ética , Internet/ética , Relações Interprofissionais/ética , Licenciamento em Medicina/ética , Relações Médico-Paciente/ética , Médicos/ética , Prática Profissional/ética , Relações Públicas , Encaminhamento e Consulta/ética , Alocação de Recursos/ética , Estados UnidosRESUMO
There is currently limited direct evidence of how sponsorship of scientific conferences fits within the food industry's strategy to shape public policy and opinion in its favour. This paper provides an analysis of emails between a vice-president of The Coca-Cola Company (Coke) and prominent public health figures in relation to the 2012 and 2014 International Congresses of Physical Activity and Public Health (ICPAPH). Contrary to Coke's prepared public statements, the findings show that Coke deliberated with its sponsored researchers on topics to present at ICPAPH in an effort to shift blame for the rising incidence of obesity and diet-related diseases away from its products onto physical activity and individual choice. The emails also show how Coke used ICPAPH to promote its front groups and sponsored research networks and foster relationships with public health leaders in order to use their authority to deliver Coke's message. The study questions whether current protocols about food industry sponsorship of scientific conferences are adequate to safeguard public health interests from corporate influence. A safer approach could be to apply the same provisions that are stipulated in the Framework Convention on Tobacco Control on eliminating all tobacco industry sponsorship to the food industry.
Assuntos
Bebidas Gaseificadas , Congressos como Assunto , Correio Eletrônico , Exercício Físico , Indústria Alimentícia , Bebidas Gaseificadas/economia , Bebidas Gaseificadas/estatística & dados numéricos , Congressos como Assunto/economia , Congressos como Assunto/ética , Congressos como Assunto/legislação & jurisprudência , Congressos como Assunto/estatística & dados numéricos , Correio Eletrônico/ética , Correio Eletrônico/estatística & dados numéricos , Indústria Alimentícia/ética , Indústria Alimentícia/legislação & jurisprudência , Indústria Alimentícia/estatística & dados numéricos , Humanos , Saúde Pública/normas , Saúde Pública/tendências , Indústria do Tabaco/legislação & jurisprudênciaRESUMO
Decisions that we make about email legitimacy can result in a pernicious threat to security of both individuals and organisations. Yet user response to phishing emails is far from uniform; some respond while others do not. What is the source of this diversity in decision-making? From a psychological perspective, we consider cognitive and situational influences that might explain why certain users are more susceptible than others. Alongside an email judgment task employed as a proxy for fraud susceptibility, 224 participants completed a range of cognitive tasks. In addition, we manipulated time pressure for email legitimacy judgments. We identify cognitive reflection and sensation seeking as significant, albeit modest, predictors of susceptibility. Further to this, participants asked to make quicker responses made more judgment errors. We conclude there are cognitive signatures that partially contribute to email fraud susceptibility, with implications for efforts to limit online security breaches and train secure behaviors.
Assuntos
Tomada de Decisões/ética , Correio Eletrônico/ética , Julgamento/ética , Adolescente , Adulto , Cognição , Segurança Computacional , Correio Eletrônico/tendências , Feminino , Previsões/métodos , Fraude/tendências , Humanos , Masculino , Fatores de Tempo , Adulto JovemRESUMO
Core ethical principles for the conduct of psychotherapy with children and adolescents transcend times, trends, and jurisdictions. Advances in technology, variations in state law, and the evolution of federal law should stimulate consideration of how these ethical principles apply to new situations; however, the guiding compass remains the psychotherapist's obligation to create and protect the integrity of the psychotherapeutic space to provide the child or adolescent the freedom to identify, examine, explore, and hopefully resolve the issues that bring one to treatment. Boundaries, privacy, confidentiality, and the patient's autonomy are components of this space. Together, they reflect a basic respect for the patient central to professional conduct and essential to any effective treatment process.
Assuntos
Psiquiatria do Adolescente/ética , Psiquiatria Infantil/ética , Psicoterapia/ética , Adolescente , Criança , Confidencialidade/ética , Contratransferência , Correio Eletrônico/ética , Humanos , Autonomia Pessoal , Relações Médico-Paciente/ética , Psicoterapia Múltipla/ética , Telefone/éticaRESUMO
In child and adolescent psychiatry, medical records and professional communications raise important ethical concerns for the treating or consulting clinician. Although a distinction may be drawn between internal records (eg, medical records and psychotherapy notes) and external communications (eg, consultation reports and correspondence with pediatricians), several ethical principles apply to both types of documentation; however, specific considerations may vary, depending upon the context in which the records or communications were produced. Special care is due with regard to thoroughness and honesty, collaboration and cooperation, autonomy and dignity of the patient, confidentiality of the patient and family members, maintaining objectivity and neutrality, electronic communications media, and professional activities (eg, political advocacy). This article reviews relevant ethical concerns for child and adolescent psychiatrists with respect to medical records and professional communications, drawing heavily from forensic and legal sources, and offers additional recommendations for further reading for clarification and direction on ethical dilemmas.
Assuntos
Psiquiatria do Adolescente/ética , Psiquiatria Infantil/ética , Comunicação , Ética Médica , Prontuários Médicos , Adolescente , Criança , Confidencialidade/ética , Comportamento Cooperativo , Correio Eletrônico/ética , Humanos , Equipe de Assistência ao Paciente/ética , Participação do Paciente , Autonomia Pessoal , Relações Profissional-Família , Encaminhamento e Consulta/éticaRESUMO
In this paper, we consider the use of e-mail in psychotherapy and its impact on the experience of therapy for both patient and clinician. We discuss in detail the potential for boundary compromise by e-mail use and consider how e-mail may undermine the therapeutic alliance and the cultivation of empathy. Case studies illustrate the possible positive aspects of e-mail and elucidate several fundamental problems with any use of e-mail in psychodynamic treatment.
Assuntos
Correio Eletrônico , Relações Médico-Paciente , Terapia Psicanalítica , Psicoterapia , Adolescente , Adulto , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Correio Eletrônico/ética , Empatia , Feminino , Soropositividade para HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente/ética , Terapia Psicanalítica/ética , Psicoterapia/ética , Comportamento Autodestrutivo/psicologiaRESUMO
Occupational health nurses' ability to use email efficiently and effectively enhances their professionalism, responsiveness, and overall communications. Poorly written emails can damage the reputations of nurses and their organizations. Knowing when not to communicate by email is as important as being able to write effective emails. Many safeguards can be employed to prevent or minimize confusion and strengthen email communications. Names and addresses must be checked, appropriate subject lines used, and humor applied conscientiously. All emails should be proofread prior to sending, and replies must be carefully considered. Simple, colorless email backgrounds make downloading quicker. Sharp, clear fonts are easier on the eyes. Direct and defined requests and confirmations augment communication. Once "Send" is pressed, the email is out of the sender's control. Lack of network security, forwarding by others, and potential confidentiality breaches can lead to legal or public relations controversies. Email is an important business tool. Occupational health nurses must be competent in the skills of effective email communication, as it is an integral part of business and health care.
Assuntos
Segurança Computacional , Confidencialidade , Correio Eletrônico/organização & administração , Enfermagem do Trabalho/organização & administração , Competência Profissional , Redação , Segurança Computacional/ética , Segurança Computacional/legislação & jurisprudência , Confidencialidade/ética , Confidencialidade/legislação & jurisprudência , Correio Eletrônico/ética , Health Insurance Portability and Accountability Act/legislação & jurisprudência , Humanos , Papel do Profissional de Enfermagem , Competência Profissional/legislação & jurisprudência , Competência Profissional/normas , Estados Unidos , Redação/normasRESUMO
Electronic communications are an increasingly important part of people's lives, and much information is accessible through such means. Anecdotal clinical reports indicate that mental health professionals are beginning to use information from their patients' electronic activities in treatment and that their data-gathering practices have gone far beyond simply searching for patients online. Both academic and private sector researchers are developing mental health applications to collect patient information for clinical purposes. Professional societies and commentators have provided minimal guidance, however, about best practices for obtaining or using information from electronic communications or other online activities. This article reviews the clinical and ethical issues regarding use of patients' electronic activities, primarily focusing on situations in which patients share information with clinicians voluntarily. We discuss the potential uses of mental health patients' electronic footprints for therapeutic purposes, and consider both the potential benefits and the drawbacks and risks. Whether clinicians decide to use such information in treating any particular patient-and if so, the nature and scope of its use-requires case-by-case analysis. But it is reasonable to assume that clinicians, depending on their circumstances and goals, will encounter circumstances in which patients' electronic activities will be relevant to, and useful in, treatment.
Assuntos
Correio Eletrônico/ética , Internet/ética , Serviços de Saúde Mental/ética , Pessoas Mentalmente Doentes , Relações Profissional-Paciente/ética , HumanosRESUMO
E-mail communication is pervasive. Since many forensic psychiatrists have their e-mail addresses available online (either on personal websites, university websites, or articles they have authored), they are likely to receive unsolicited e-mails. Although there is an emerging body of literature about exchanging e-mail with patients, there is little guidance about how to respond to e-mails from nonpatients. Therefore, we used a Delphi technique to develop a consensus about salient points for the forensic psychiatrist to consider regarding responding to e-mails from nonpatients and the risks entailed. Four scenarios are described, including e-mails from nonpatients and unknown others requesting advice or help. The potential ethics-related, legal, moral, and practical concerns for forensic psychiatrists are discussed. Finally, potential pitfalls for forensic psychiatrists are described.
Assuntos
Aconselhamento/ética , Correio Eletrônico/ética , Psiquiatria Legal , Técnica Delphi , Humanos , Medição de RiscoRESUMO
What is the place of vulnerability in our lives? The current debate about the ethics of enhancement technologies provides a context in which to think about this question. In my view, the current debate is likely to be fruitless, largely because we bring the wrong ethical resources to bear on its questions. In this article, I recall an important, but currently neglected, role that moral concepts play in our thinking, a role they should especially play in relation to the introduction of new technologies. I call this the 'contemplative role of moral concepts'. I then contrast two approaches to the contemplative role of moral concepts which are found in the current literature, and show why it is important to keep in mind both of these approaches when thinking about human vulnerability.
Assuntos
Melhoramento Genético/ética , Princípios Morais , Identificação Social , Pensamento , Confiança , Populações Vulneráveis , Melhoramento Biomédico/ética , Formação de Conceito , Correio Eletrônico/ética , Correio Eletrônico/tendências , Análise Ética , Teoria Ética , Fertilização in vitro/ética , Fertilização in vitro/métodos , Humanos , Casamento , Privacidade , Cônjuges/psicologiaRESUMO
OBJECTIVE: The purpose of the review is to assess frequencies of reporting adherence to professional practice standards and research ethics in studies of technology-based home health care programs. METHODS: Key databases were searched to yield 2,866 abstracts that were independently rated by two reviewers using inclusion-exclusion criteria, resulting in 107 articles that were then reviewed for reports of practice standards and research ethics. RESULTS: Issues related to professional practice standards and research ethics were not well reported. When reported, adherence to practice standards included preintervention training, use of intervention protocols, supervision, and mechanisms for risk management. Research ethics most commonly reported were informed consent, REB/IRB approval, and protection of privacy. DISCUSSION: The results raise questions as to whether practice standards and research ethics are addressed sufficiently when health service delivery occurs in technology-based environments. Guidelines for professional accountability in e-health service delivery are needed.
Assuntos
Idoso , Ética em Pesquisa , Fidelidade a Diretrizes/ética , Fidelidade a Diretrizes/normas , Serviços de Assistência Domiciliar/ética , Serviços de Assistência Domiciliar/normas , Pesquisa/normas , Telemedicina/ética , Telemedicina/normas , Confidencialidade , Correio Eletrônico/ética , Correio Eletrônico/normas , Humanos , Internet/ética , Internet/normas , Privacidade , Competência Profissional/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/normas , Estados UnidosRESUMO
BACKGROUND: The use of information and communication technologies (ICTs) in the health service is increasing. In spite of limitations, such as lack of time and experience, the deployment of ICTs in the healthcare system has advantages which include patient satisfaction with secure messaging, and time saving benefits and utility for patients and health professionals. ICTs may be helpful as either interventions on their own or as complementary tools to help patients stop smoking. OBJECTIVES: To gather opinions from both medical professionals and smokers about an email-based application that had been designed by our research group to help smoking cessation, and identify the advantages and disadvantages associated with interventions based on the utilization of ICTs for this purpose. METHODS: A qualitative, descriptive-interpretative study with a phenomenological perspective was performed to identify and interpret the discourses of the participating smokers and primary healthcare professionals. Data were obtained through two techniques: semi-structured individual interviews and discussion groups, which were recorded and later systematically and literally transcribed together with the interviewer's notes. Data were analyzed with the ATLAS TI 6.0 programme. RESULTS: Seven individual interviews and four focal groups were conducted. The advantages of the application based on the email intervention designed by our research group were said to be the saving of time in consultations and ease of access for patients who found work timetables and following a programme for smoking cessation incompatible. The disadvantages were thought to be a lack of personal contact with the healthcare professional, and the possibility of cheating/ self-deception, and a greater probability of relapse on the part of the smokers. CONCLUSIONS: Both patients and healthcare professionals viewed the email-based application to help patients stop smoking as a complementary aid to face-to-face consultations. Nevertheless, ICTs could not substitute personal contact in the smoking cessation programme.