Your Robot Therapist Will See You Now: Ethical Implications of Embodied Artificial Intelligence in Psychiatry, Psychology, and Psychotherapy.

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

The Ethical Principles of the Portuguese Psychologists: An Empirical Approach.

One thousand four-hundred thirty Portuguese psychologists answered a questionnaire that had been designed in order to ascertain the level of acceptability of a set of proposed ethical principles, which subsequently served as a basis for the Portuguese Psychologists' Ethics Code. On the one hand, the results show that, as expected, the ethical principles rated high on the evaluation scale. On the other hand, the results also highlighted the need for a formal regulation of the practice of psychology in Portugal, especially in view of participants' noticeable failure to recognize the importance of the principle of professional integrity. The responsibility of psychologists in modern societies is huge. As such, the large number of different training programs in Portugal, and the implied lack of a strong professional identity, is a cause of concern. The creation of a professional association allows an external identification of the profession in terms of aims and methods. The main goal of such an association is to promote public trust and enhance public demand. The results also indicate that training and experience lead to a higher valorization of ethical principles, and this is an insight that will be of great importance to the professional practice of psychology.

Ethical behaviour of physicians and psychologists: similarities and differences.

OBJECTIVE: To compare the coping patterns of physicians and clinical psychologists when confronted with clinical ethical dilemmas and to explore consistency across different dilemmas. POPULATION: 88 clinical psychologists and 149 family physicians in Israel. METHOD: Six dilemmas representing different ethical domains were selected from the literature. Vignettes were composed for each dilemma, and seven possible behavioural responses for each were proposed, scaled from most to least ethical. The vignettes were presented to both family physicians and clinical psychologists. RESULTS: Psychologists' aggregated mean ethical intention score, as compared with the physicians, was found to be significantly higher (F(6, 232)=22.44, p<0.001, η2=0.37). Psychologists showed higher ethical intent for two dilemmas: issues of payment (they would continue treating a non-paying patient while physicians would not) and dual relationships (they would avoid treating the son of a colleague). In the other four vignettes, psychologists and physicians responded in much the same way. The highest ethical intent scores for both psychologists and physicians were for confidentiality and a colleague's inappropriate practice due to personal problems. CONCLUSIONS: Responses to the dilemmas by physicians and psychologists can be categorised into two groups: (1) similar behaviours on the part of both professions when confronting dilemmas concerning confidentiality, inappropriate practice due to personal problems, improper professional conduct and academic issues and (2) different behaviours when confronting either payment issues or dual relationships.

Ethics and Confidentiality for Psychologists in Academic Health Centers.

Psychologists in academic health centers (AHC) face important ethical issues including confidentiality when working with a multidisciplinary team, sharing of information through the electronic health record, obtaining informed consent in a fast-paced healthcare environment, cultural competency in the medical setting, and issues related to supervision and training. The goal of this paper is to describe ethical issues for psychologists in AHCs in the context of case examples, and to consider ethical decision-making tools to enhance clinical care. Considerations for best practices in integrated care settings will be discussed, and the APA Ethical Standards will be referenced throughout.

Outcomes of Notifications against Psychologists in the New Zealand Health Regulation Context 2004-2015.

Research focusing on disciplined health practitioners is growing though exploring lower level decisions is also important. This study examines the outcomes and characteristics of psychologists subject to formal notifications between 2004 and 2015. Data were extracted from archived notification files (N = 396) held by the New Zealand Psychologists Board alongside publically available decisions of the Health Practitioners Disciplinary Tribunal (N = 13). Annually, <2% of practising psychologists were subject of a notification. Outcomes varied by type of notification but the vast majority resulted in no further action either at initial triage or after further investigation. Notifications involving psychologist scope practitioners and those with overseas qualifications prior to New Zealand registration were significantly more likely to result in further investigation. All 13 prosecutions resulted in a finding of guilt. Further research is needed to explore risk factors and why female practitioners may be over-represented in cases of sexual boundary transgressions.

Refining moral agency: Insights from moral psychology and moral philosophy.

Research in moral psychology has recently raised questions about the impact of context and the environment on the way the human mind works. In a 2012 call to action, Paley wrote: "If some of the conclusions arrived at by moral psychologists are true, they are directly relevant to the way nurses think about moral problems, and present serious challenges to favoured concepts in nursing ethics, such as the ethics of care, virtue, and the unity of the person" (p. 80). He urges nurse ethicists and scholars to evaluate the impact these findings may have for moral theory. In this paper, I review some of Paley's (Nursing Philosophy, 13, 2012, 80) critique, focusing on the argument that theories of nursing ethics have failed to account for the role of context; both in terms of its impact on the way nurses make moral judgements and in terms of the environment's influence on the way the mind works. I then examine nursing literature on moral agency, and focus on the role of the environment and context play within existing theory. I argue that theories of moral agency have often accounted for the role of context on the way nurses make decisions; however, less attention has been paid to its impact on the mind. With this background, I use insights from the fields of moral philosophy and moral psychology to refine the conceptualization of nurse moral agency in a way that is reflective of current cognitive, philosophical and nursing practice-based science.

The Stories We Tell: Introduction to the Special Issue on Ethical Challenges in Community Psychology Research and Practice.

This Special Issue examines ethical challenges in community psychology research and practice. The literature on ethics in community psychology has remained largely abstract and aspirational, with few concrete examples and case studies, so the goal of this Special Issue was to expand our written discourse about ethical dilemmas in our field. In these articles, researchers and practitioners share stories of specific ethical challenges they faced and how they sought to resolve them. These first-person narratives examine how ethical challenges come about, how community psychology values inform ethical decision making, and how lessons learned from these experiences can inform an ethical framework for community psychology.

Inside-Out: Representational Ethics and Diverse Communities.

The purpose of this paper is to write about insights and special considerations for researchers who are, to some degree, "insiders" to the communities they study by expanding on the concept of representational ethics as applied to research in community psychology with diverse and marginalized groups. Representational ethics refers to the ways that researchers, artists, or corporations represent the identities of the people they portray in their communications. As community psychologists we generate and disseminate knowledge about the communities we work with, and in that process, create narratives about the people who participate in our studies. In preparing a report on psychological issues among Evangelical Christian refugees from the former Soviet Union, Dina Birman struggled with her portrayal of this group and her own status of being both an insider and an outsider to this community. When investigating academic aspirations and psychological distress among Muslim high school students, Ashmeet Oberoi was forced to acknowledge the one-sidedness of the discourse on autonomy and cultural socialization of Muslim adolescents. In her research with Cuban-educated doctors in Miami, Florida, Wendy Moore encountered similar issues as she considered how to represent gender dynamics among her participants.

Community Power Structure Analysis and the Ethical Considerations of "Studying Up".

This narrative outlines our challenges in studying power and power structures within an individual-level ethical framework. Taking a social ethics perspective, we share the story of our "sticky situation" (Campbell, ) that transpired during a multi-year community partnership. We were asked, by our community partners, to help collect interview data without informed consent. As a team of community-engaged university researchers, we were faced with a seemingly easy ethical situation (no consent, no research) that had unexpectedly complicated and long-lasting consequences. This experience revealed to us how community-engaged research and action, under a traditional ethics framework, can often work to protect those in positions of power and offer little to disrupt the status quo. Reflecting on the tension between individual and social ethics, we discuss the limitations of an individual-level framework, including the definitions for respect for persons, justice, and beneficence, on our ability as a field to understand, critique, and contribute to the dismantling of oppressive power structures.

Reflexivity in Counterspaces Fieldwork.

Reflexivity is an important tool for navigating ethically important moments in fieldwork. It may be particularly useful in situations where the researcher has the potential to undermine the conduct of the study and/or the well-being-enhancing role of counterspaces. In this article, I explore my use of reflexivity to traverse ethically important moments I encountered while investigating a counterspace for African-American youth who had been incarcerated. The ethical challenge concerned whether and how to continue this study in light of realizing that I held implicit biases toward the research participants. I describe my process for arriving at a decision and propose key considerations for the use of reflexivity in supporting ethical fieldwork within counterspaces.

Ethical Challenges of Personal Disclosure in Gaining Entry with Religious Congregations.

This is a story about learning how to navigate my social identities as a non-religious gay man attempting to conduct data-based consultation with a religious congregation. Beyond my own growth in knowing myself better, this story speaks to the larger ethical challenge of how we build trust in community relationships, and in particular how much of our personal selves we need to disclose in the process of an individual or group deciding to work with us. Individuals and groups make decisions to work with us based on who they perceive us to be; thus, what is our ethical obligation to disclose aspects of who we are to promote full informed consent? To illustrate this ethical challenge of personal disclosure, I tell the story of discussions I had with three different religious leaders and a congregational committee about potentially working together. Throughout these stories, I reflect on my own messy process of growth as a window into the more general question of how we navigate our identities and values as community psychologists in the work we do with communities.

Whose Community are You Working for? A Change Agent Case Study.

This article explores the role and responsibility of the community psychologist in creating change that could potentially harm the group they are meant to be in solidarity with. Drawing upon a 2-year project with a Latinx Student Union at a public middle school in the Pacific Northwest, I examine the ethical dilemmas that arose when powerful stakeholders (school administration) changed the goals and intention of the research project without the consent of the low-power stakeholders (the students). This narrative seeks to shed light on the dilemmas that come with being an ethical community psychologist (Balcazar, Garate-Serafini, & Keys, 2004; Nelson, Prilleltensky, & MacGillivary, 2001; O'Neill, 1989), how these ethics can be compromised by one's identity, and what it means to work for/with/against one's community when deciding whether to stay with or leave a project.

"It Felt Like Violence": Indigenous Knowledge Traditions and the Postcolonial Ethics of Academic Inquiry and Community Engagement.

In a 2014 presentation at an academic conference featuring an American Indian community audience, I critically engaged the assumptions and commitments of Indigenous Research Methodologies. These methodologies have been described as approaches and procedures for conducting research that stem from long-subjugated Indigenous epistemologies (or "ways of knowing"). In my presentation, I described a Crow Indian religious tradition known as a skull medicine as an example of an indigenous way of knowing, referring to a historical photograph of a skull medicine bundle depicted on an accompanying slide. This occasioned consternation among many in attendance, some of whom later asserted that it was unethical for me to have presented this information because of Indigenous cultural proscriptions against publicizing sacred knowledge and photographing sacred objects. This ethical challenge depends on enduring religious sensibilities in Northern Plains Indian communities, as embedded within a postcolonial political critique concerning the accession of sacred objects by Euro-American collectors during the early 20th century. I complicate these ethical claims by considering competing goods that are valued by community psychologists, ultimately acknowledging that the associated ethical challenge resists resolution in terms that would be acceptable to diverse constituencies.

Complicating Narratives: Defining and Deconstructing Ethical Challenges in Community Psychology.

In this concluding essay, we review the case studies presented in this Special Issue and examine whether community psychology has a distinctive approach to defining and resolving the core ethical canons of the Belmont Report (1979): Respect for Persons, Beneficence, and Justice. For two of these Principles-Respect for Persons and Beneficence-community psychologists elaborate upon and extend their definitions to consider their meaning in community-based, social justice-oriented research. The field's approach to Respect for Persons is multilevel in nature; in addition to respecting individuals and their diverse identities, we also have obligations to respect our community partnerships, the communities with whom we work, and the populations and cultures represented in our work. Similarly, for community psychologists, Beneficence is a multilevel construct that considers risks and benefits at the group, community, and cultural levels of analysis. With respect to Justice, community psychologists' views of our ethical responsibilities are qualitatively different in meaning from the original Belmont Report and from disciplinary-specific interpretations of this principle in ethical guidance documents from psychology, sociology, and evaluation. Our valuing of social change demands that we contribute to individual and group empowerment and liberation, and in so doing, that we avoid collusion with oppressive systems. Thus, we define our ethical responsibilities for promoting Justice as more action-oriented than do other disciplines. The essay closes with an exploration of future directions for developing a comprehensive ethical framework for community psychology.

How Do Our Values Inform Ethical Research? A Narrative of Recognizing Colonizing Practices.

How do you reconcile tensions between ethical research practice, personal values, and disciplinary values? This article focuses on an ethical challenge involving the engagement of rural Indigenous community members that emerged during my PhD fieldwork. The narrative illustrates the necessity to engage in critical reflexive research practice, a process which saw me respond to my own feelings of "wrong" and "right," contemplate a distinction between procedural ethics and virtue ethics in community-based research, explore colonizing research practices, and endeavor to reconcile an instance where the values of community psychology appeared in contest. The "voice" in this narrative is that of the first author; the dual authorship reflects the ongoing collaboration between both authors. When this ethical issue came about, our relationship was one of "student" and "supervisor"; we are now colleagues and friends.

Dating and Sexual Violence Research in the Schools: Balancing Protection of Confidentiality with Supporting the Welfare of Survivors.

Rigorous research and program evaluation are needed to understand the experience of dating and sexual violence among youth and the impact of prevention and intervention efforts. Our dilemma in doing this work occurred when youth disclosed dating and sexual violence on a research survey. What responsibility do researchers have to protect survivors' confidentiality as a research participant versus taking steps to ensure the student has the opportunity to access help? In our evaluation of a pilot dating violence prevention program, our protocols employed widely used procedures for providing resources to participants upon their completion of the survey and de-identifying survey data. Upon reviewing preliminary survey results, we became concerned that these established procedures were not sufficient to support research participants who were adolescent survivors of dating and sexual violence. We followed a structured ethical decision-making process to examine legal and ethical considerations, consult with colleagues, consider impacts and alternative solutions, and ultimately find a solution. Through this process, we developed procedures that balance participant confidentiality and the desire to support the welfare of survivors, which other researchers may want to employ when conducting youth sexual and dating violence research in school and community settings.

Accountability, Collaboration, and Social Change: Ethical Tensions in an Action Research Project to Address Untested Sexual Assault Kits (SAKs).

We conducted a collaborative action research project with stakeholders in Detroit, Michigan, to develop long-term policy strategies to resolve ~11,000 untested rape kits that were discovered in a police storage facility in August 2009. In our research, we uncovered overwhelming evidence of victim-blaming behaviors and fundamental disrespect of rape survivors by the police, which directly contributed to their decisions not to submit kits for forensic testing. We had an ethical responsibility to report these negative findings accurately and completely, and in doing so, we were concerned that police stakeholders might disengage from the action research project and hamper our other ethical responsibilities to promote general and public welfare. In this article, we examine the ethical challenges of balancing accountability, collaboration, and social change.

"But We Want to Work": The Movement of Child Workers in Peru and the Actions for Reducing Child Labor.

The program Edúcame Primero (Educate Me First) is an evidence-based practice for eradicating child labor that has been applied with positive results in Colombia, Peru, and several Central American countries. In this article, we describe the difficulties of implementing the program in two poor areas of Lima (Peru) between 2014 and 2016. Specifically, we discuss three ethical challenges faced during the implementation of the program: (a) the existence of a movement of working children that defends the right of children to work; (b) the polarization of some community-based associations and government institutions on how to deal with the problems of working children; and (c) the use of network indicators in the evaluation of the community's level of cohesion. Taking the Code of Ethics of the General Council of Associations of Psychologists in Spain as a guide, we adopted a consensus approach in planning and research design, combining different criteria of value with the participation of different stakeholders. The implementation of the program in Peru gave preference to developing skills in children over changing attitudes in relation to child protection, although the intervention openly declared its aims when engaging institutions and families. Finally, we address how social network research places special ethical demands on conventional ethical standards. Our experience with this project shows the importance of acting as a bridge between different stakeholders and assessing how all of them benefit from the intervention.

To Serve or Not to Serve: Ethical and Policy Implications.

The Institute of Medicine (IOM) is one of the nation's more influential health-related non-profit organizations. It plays a large role in shaping health policy by commissioning panels to develop "white papers" describing research and recommendations on a variety of health topics. These white paper publications are often used to help make policy decisions at the legislative and executive levels. Such a prominent institution might seem like a natural ally for policy-related collaborative efforts. As community psychologists, we strongly endorse efforts to positively influence public policy at the national level. However, while serving on influential panels and commissions like the IOM might seem to be very much part of the ethos of our discipline, there are occasions when such institutions are pursuing a mission that inadvertently has the potential to instigate divisive friction among community activists and organizations. A case study is presented whereby I describe my decision not to accept an invitation to serve on a controversial IOM panel. I explore the ethical challenges regarding maintaining my independence from this institution and its attempt to redefine chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME), as well as the process of searching for alternative avenues for collaborating with community activists to influence policy related to these debilitating illnesses.

Navigating Community Development Conflicts: Contested Visions of Poverty & Poverty Alleviation.

This article explores an ethical dilemma that arose from the author's involvement in a project intended to identify and address the needs of seven batey communities in the Dominican Republic. In the summer of 2014, the author conducted a large-scale needs assessment to inform strategic planning for a foundation that was invested in community development work in those communities. Through a collaborative process, the author worked with the foundation, representatives of the migrant communities, and other researchers to develop survey and focus group tools that were administered to 1,360 and 54 people, respectively. Data collection, analysis, and dissemination proceeded as planned. The conflict and resulting ethical dilemma emerged at the point of data interpretation and strategic planning, processes that revealed that the different parties held conflicting theories of poverty. The ideological conflicts related to why poverty exists, who is responsible for it, and what should be done about it made proceeding with the project ethically tenuous for the author. The author describes the values and theories of ethics on which she relied to navigate this challenge, as well as reflections on her continued participation in the community development process.