houston psychological association presentation on emerging ethical challanges in a changing...
TRANSCRIPT
Emerging Ethical Challenges in a Changing Landscape
Michael Winters, PhD & Kristin Scheel, JD
Technology and Ethics
Is there guidance?Emerging Ethical Challenges in a Changing
Landscape
What is the Internet?US Supreme Court, Reno v. American Civil Liberties Union, (paraphrase): “The internet is an international network of interconnected computers.”“Email enables an individual to send an electronic message - generally akin to a note or letter.”“Cyberspace is located in no particular geographic location but available to anyone, anywhere in the world.”
What is the Legal Test?Client’s Reasonable ExpectationFactors to Consider:
Customary Practices in Your ProfessionYour Pattern of ConductDisclaimersInformed ConsentPlain Language
What technology?Telephone
TeleconferencingVoicemailsText MessagesPDAs: Calendaring + Email
InternetSkypeFacebook, LinkedIn, TwitterWebsites, Blogs and Forums
Have I considered?Type of Communication
Jurisdiction / Licensing
Patient Privacy / Confidentiality
Quality of Care / Duty
Informed Consent / Capacity
Nature of Relationship
Types of Communication
Administrative Communications
Administering Psychological Services or Treatment
Marketing (Advertising, Platform for Public Statements, Display of Credentials)
Jurisdiction / LicensingUnder the laws governing personal jurisdiction, a psychologist who travels beyond the borders of his/her home state to provide services to out-of-state residents may be subject to suit in those states’s courts. US Supreme Court says this applies even if someone has never physically been in a particular state.
Rules of Texas Board of Examiners of Psychologists: An individual physically located in another state is considered practicing psychology in Texas if a recipient of psychological services in located in Texas. Texas license is required.
Duty to Warn: Texas vs. California (and Other States)
Limited knowledge of distant community resources, cultural norms, local traumatic events.
Particularly helpful for clients prematurely terminating therapy due to relocation, childcare difficulties, or post-surgical restrictions.
Patient Privacy / ConfidentialityProviding mental health care services online and transferring client data electronically clearly implicates HIPAA’s privacy requirements.
Access to electronically stored health information must be limited to those who have a legitimate business need to access data.
Psychologists must obtain a client’s authorization prior to allowing anyone to use or disclose the information.
Psychologists must insure the integrity of the data.
Psychologists must confirm identities of people with whom they communicate.
Health information transmitted over open networks must be protected from interception.
Involuntary disclosures. Privilege is limited to protection from disclosure of confidential information during course of treatment.
Quality of Care / DutyCan you give competent advice through the internet?
Lack of vocal, visual and other sensory cues
Potential for equipment failures leading to undue client anxiety, especially in crisis situation
Periodic face to face encounters are helpful
Duty to Protect
Imminent Harm
24 Hour Hotline or Forums
Informed ConsentOnly competent adults can give informed consent.
How to verify age, affect, demeanor and legal mental capacity of anonymous online user.
Use of language that is reasonably understandable to the clientTimeShifts in the relationship
Nature of the Relationship
Mutually Established Therapeutic Relationship
Client’s Community
Advertising Prior to Establish Relationship
Peers
Anonymous Internet Users
When providing comments via internet, or electronic transmission, ensure that statements are (1) based on your professional knowledge, training or experience; (2) consistent with Ethics Code; and (3) do not indicate that a professional relationship has been established with the recipient.
Consider generic responses, suggesting community resources or follow up.
TakeawaysTechnology is rapidly changing.
Can’t rely on law and ethical codes to provide guidance.
We have to use discretion. A good practice is to rely on a thoughtful process for evaluating ethical considerations and legal liabilities in the use of modern technology.
ResourcesBehnke, S. (2008). Ethics in the age of the internet. APA monitorhttp://www.apa.org/monitor/2008/07-08/ethics.aspx
Clay, R. A. (2010) Expanding your reach: Facebook, Twitter and other social media tools bring new advocacy opportunities but also new challenges. APA Monitorhttp://www.apa.org/monitor/2010/05/slc-social-media.aspx
DeAngelis, T. (2012) Practicing distance therapy, legally and ethically. APA Monitorhttp://www.apa.org/monitor/2012/03/virtual.aspx
Degusta, M. (2012) Are smart phones spreading faster than any technology in human history? Technology Reviewhttp://www.technologyreview.com/news/427787/are-smart-phones-spreading-faster-than-any/
ResourcesDraft of APA Guidelines on Telepsychology
http://apacustomout.apa.org/commentcentral/commentcentralPDF/Site26_Telepsychology%20Guidelines%20Draft_July2012_posted.pdf
Holland, C. (date not given) The Psychologists Legal Update 14: Psychology in the Electronic Age. http://www.e-psychologist.org/index.iml?mdl=exam/show_article.mdl&Material_ID=16
Spottd-Dr Lazzer, A. (2012) Losing your “mind”: What would you do in your mobile device went missing? Psychotherapy Networker, July/August p 17-18
Zur, O. (2012). Therapeutic ethics in the digital age. Psychotherapy Networker July/August, 26 -33.