Ethical Ramifications of Medicine and Psychiatry in Cyberspace - Case Study Example

Ethical Ramifications of Medicine and Psychiatry in Cyberspace Introduction The fields of medicine and psychology are not exempt in any from the practice of ethics and there is an entirely different branch of ethics connected with the actions of mental health professionals and medical professionals who have to follow medical and psychological ethics. In fact, psychological researchers also have to follow bioethics concerning how they can perform research on animals and accept the legal guidelines that govern how research can be done on any particular topic (APA, 2002). Despite the strict application of ethics, the field itself is so broad that it often becomes difficult to define it in any particular shape or form (Fisher, 2003). The matter is even more complicated when it comes to ethics in cyberspace where they may be different questions with regard to privacy and confidentiality. Therefore, to fully understand the ethical ramification of medicine and psychiatry in cyberspace, it is important to understand what ethics are and then to see how various ethical issues in cyberspace can be tackled by psychiatrists as well as medical practitioners. Ethics The word ethics comes from the Greek language word ethikos which means ‘based on habit’. In scientific terminology, ethics is a branch of philosophy which discusses individual and collective behavior as being right, wrong, good or evil. In business and professional fields such as finance, public relations, advertising and many others, the application of ethical principles is said to be a part of the good practices which establish and increase the credibility of an organization or an individual (Wikipedia, 2006). When it comes to medicine and psychiatry, the world today is very much concerned with ethics since media attention as well as professional organization focus has come to ethics in a very significant way. Velasquez et. al. (1987) report that when people on the street were inquired about the meaning of ethics, they came up with very different answers. Some said that ethics have to do with internal feelings of what is right and wrong while others suggested that ethics are religious beliefs or that ethics are legal requirements. People also considered ethics to be acceptable behavior as given by the rules of society and some people simply did not know what the term ‘ethics’ means. While the responses stated above may come naturally due to the way the word is used, it must be clarified that ethics have nothing to do with internal feelings (Fisher, 2003). In fact, personal feelings and individual emotions about something may lead a person to do what is wrong rather than what is right. A doctor who ‘feels’ that a patient’s case history can be put online to warn others of dangerous drug use may have the interest of the public at heart, but s/he is conducting a serious breach of ethics in terms of confidentiality in cyberspace. Moreover, religion has nothing to do with ethics because if ethics were based on religion then every person might be free to follow their own set of ethics which are based on their own religious practices. Additionally, those who have no religious beliefs may consider themselves to be free of ethical demands while every medical professional has to accept the given ethical guidelines for his or her field (Velasquez et. al., 1987). Similarly, laws regarding cyberspace can not be seen as ethics alone because all laws may not be ethical at all times. If we take ethics to mean whatever is acceptable to society then it would be ethically acceptable to be anti-Semitic if a person were living in Nazi Germany and to deny them medical treatment or to even conduct medical experiments on them. Moreover, it is almost impossible to accurately judge what is ‘acceptable’ to a given society since the acceptance level of certain things may change dynamically (Velasquez et. al., 1987). Ethics in Cyberspace Therefore, ethics as they apply to psychologists and medical professionals cover the professionally established standards of right and wrong supported by reasonable arguments given by experts in the field that explain how psychologists and medical professionals ought to perform (Fisher, 2003). These mandated standards are the exact ethical values which these professionals are supposed to follow as they perform their duties and render their services to the public in cyberspace or in the real world. The American Psychological Association (APA) has created a code of conduct for psychologists which states that: “This Ethics Code is intended to provide specific standards to cover most situations encountered by psychologists. It has as its goals the welfare and protection of the individuals and groups with whom psychologists work and the education of members, students, and the public regarding ethical standards of the discipline (APA, 2002, Pg.1).” Clearly, there can be situations in cyberspace which demand a deeper exploration of commonly applied ethics. However, to better come to terms with those issues, a professional can develop and improve his/her ethics by studying and understanding the rules which are applicable in the real world (Fisher, 2003). Being an ethical professional requires the continued practice of good ethical standards and the ability to recognize ethical issues as well as their recommended solutions (Velasquez et. al., 1987). While these solutions may not be always obvious in the cyber world, an ethical psychologist would try to be comfortable with various principles and practices of the profession including knowing about the code of conduct, ethical decision making, understanding client welfare, knowing about the principles of confidentiality and getting informed consent (Smith, 2003). Of these issues, the principles of confidentiality come across as being the most important one in cyberspace (Horan, 2006). While electronic records in cyberspace have the same confidentiality requirements as paper based records, there are additional security concerns which must be addressed by medical practitioners. The assurance of confidentiality concerning electronic records encourages and strengthens the integrity of the caregiver-patient relationship and thus helps the process of patient care and successful recovery. The principle of respect for the patient’s autonomy furthers the right of a patient to have control over deciding who should have access to his/her personal information which is stored on a computer. That is why, confidentiality is seen as a fundamental ethical principal in cyberspace and a breach of confidentiality in cyberspace could be a reason for disciplinary action (Horan, 2006). The confidentiality of electronic records has been given such high importance that even if a patient does not know that his/her information has been disclosed by a caregiver to someone else, even then it can be considered as a breach of confidence. Fundamentally, the relationship between the medical practitioner and the patient in cyberspace can be seen as having elements of an implied legal contract and this includes a promise from the side of the caregiver which ensures that any confidential information about his/her patients will be kept secure regardless of the nature of information i.e. digital or analog (Stuttle, 2006). The primary means of securing digital information in cyberspace are to restrict access to computer systems to authorized personnel and to create records which allow for some level of anonymity for the patient. If either of the two means is not employed when it comes to record keeping in cyberspace, the results can lead to hearings, disciplinary actions and even a cancellation of the medical practitioner’s license (Castledine, 2006). Castledine (2006) discusses such a case where a nurse’s inability to handle information securely led to her dismissal. In the case described, the nurse had a bad habit of leaving patients records screen open on her terminal when she went for a break or went away from her computer to engage in other nursing related activities. In the real world, she was found to have left patient records in her car which allowed anyone to peer through the window of her car and take a look at those records. The result of these two indiscretions was dismissal from clinical duties which highlights the need for the confidentiality of records in the real world and the cyber world. In some cases, doctors may need to share information with the patient digitally to help the diagnostic process or for discussing treatment options. For such situations, Norwell (2006) goes as far as to suggest that even the arrangement of the consulting room computer screens can become a confidentiality hazard. There were cases where unconcerned and unauthorized individuals could see through large glass panes in a clinic and observe display screens where patients’ records were clearly to them. When this situation was brought to the notice of other doctors, the arrangements of the screens was quickly changed and the large glass windows were immediately given a dark tint to reduce visibility. In some situations, digital information may need to be shared with others for research concerning the treatment of a disease or a particular accident the patient was involved in. Norwell (2006) recommends that in such situations, a research ethics committee should clear any proposals involving access to patient records. The committee must be satisfied that the arrangements to safeguard disclosure of patient related information for research needs can be justified with patient consent and such consent is ethically essential before the publication of any individually identifiable personal information. Regardless of how safe we consider electronic records and the systems that store electronic records to be, it must be understood that no information system (electronic or paper-based) can ever be considered as foolproof. While the digital records may be far more secure than printed data, they can not be taken as unbreakably secure and medical practitioners are ethically bound to show that they have taken all reasonable steps in order to establish and maintain the security of patient records in cyberspace. To minimize the slight remaining chances of unauthorized information disclosure, medical caregivers are ethically obligated to not leave patients records in any form, i.e. paper or electronic, anywhere that allows them to be viewed by others. These ‘others’ include other patients, unauthorized staff members and the general public who have come to a given health provision facility (Norwell, 2006). In addition, it must be noted that many civil groups and privacy advocates are continually fighting for more privacy rights for the patients in cyberspace. This means that new laws and new regulations are bound to come which can make the rules concerning privacy more stringent as technology and the means for security improve (DoBias, 2006). However, we also live in a time where governments may consider the need for privacy a hindrance for security. Rogers (2006) suggests that the right to keep information secure and the right to privacy is being threatened with a loss of liberties that were previously taken for granted by the public. In conclusion, working in cyberspace and dealing with the digital variety of information creates interesting scenarios and some important questions for psychologists as well as other medical practitioners. However, the questions often come with the same answers as they would apply in the real world. Therefore, an understanding and appreciation of ethical issues in the real world would be most helpful in logically applying the same principles to ethical dilemmas in the cyber world. While this may make things difficult for those who do not pay much heed to ethics, the job of an ethical practitioner is certainly not made very difficult. Works Cited APA. 2002, Ethical principles of psychologists and code of conduct. [Online] Available at: http://www.apa.org/ethics/code2002.html Castledine, G. 2006, ‘The importance of keeping patient records secure and confidential’, British Journal Of Nursing, vol. 15, no. 8, pp. 466-467. DoBias, M. 2006, ‘Fighting for privacy. Protect patients in rush to health IT coalition’, Modern Healthcare, vol. 36, no. 15, pp. 14-15. Fisher, C. 2003, Decoding the Ethics Code: A Practical Guide for Psychologists. Sage Publications. Horan, S. 2006, ‘Confidentiality must come first’, Occupational Health, vol. 58, no. 4, pp. 10-11. Norwell, N. 2006, ‘Confidentiality risks for electronic patient data’, General Practitioner, 21 Apr., p. 60-61. Rogers, W. 2006, ‘Pressures on confidentiality’, Lancet, vol. 367, no. 9510, pp. 553-4. Smith, D. 2003, ‘10 ways practitioners can avoid frequent ethical pitfalls’, Monitor on Psychology, vol. 34, no. 1, pp. 50-51. Stuttle, B. 2006, ‘Independent Nurse: The wider issues around confidentiality’, General Practitioner, 10 Feb., p. 94. Velasquez, M. et. al. 1987, What is Ethics? [Online] Available at: http://www.scu.edu/ethics/practicing/decision/whatisethics.html Wikipedia. 2007. Ethics. [Online] Available at: http://en.wikipedia.org/wiki/Ethics Word Count: 2,064 Read More