Online and Dangerous?
Online and Dangerous?
We live in the age of age of Facebook, Myspace, Twitter, YouTube, WhatsApp, and a seemingly infinite numbers of Blog sites/websites/virtual gaming worlds etc.! We live in a world of self-disclosure. We generate and interact with all sorts of information online. We can create encyclopedic information with no credentials. How does this electronic social media effect the way services are offered to consumers? Can the reach of the Internet be of benefit to society, and if so, at what costs? The following paper is not only relevant to the delivery of online psychology: it is relevant to all service providers – of which should the Church be one?
The Ethics of Online Psychology: The Clashing of Rights and Utility
The Internet is a worldwide networking infrastructure facilitating information exchange between users (Kaplan & Haenlein, 2010) and is increasingly being used as a platform for psychological services (Australian Psychological Society [APS], 2014). However, in taking advantage of this technology there has been little reflection concerning the ethical responsibilities of professional psychologists (Nicholson, 2011). Dilemmas can arise in the provision of Online Psychology (OP), particularly if the benefits of those services come at the cost of competence and confidentiality. This paper presents the ethics of Online Psychology (OP) in terms utility, rights, and the inevitable clashing of rights with utilitarian principles. It will be argued that the Code of Ethics (APS, 2007) is shackled to these (irreconcilable) positions due to Ross’ (1930) theory of prima facie duties. A new perspective must emerge. It is proposed that virtue ethics (that are seminally contained in the Code) be considered the appropriate perspective from which to safeguard the integrity of psychological practice, in the delivery of OP.
Weighing Up the Costs and Benefits of OP
Advancements in Internet-based technologies have made multiple forms of social media available to psychologists (Van Allen, & Roberts, 2011). In Australia, due to Internet infrastructure and standardised frameworks for training, registration and ethics, opportunities have arisen for psychologists to broaden the reach of their services (Gamble, Boyle, & Morris, 2015). The cost however, may be to the expense of confidentiality, consent and competence in the delivery of those services (Gamble et al., 2015). In weighing up these considerations Nicholson (2011), and Koocher and Speigal (2008) claim that as constant, existing ethical principles are adequate to balance competing ethical demands. Conversely, Davis (2014) recommends rethinking ethical codes and guidelines, making them more prescriptive and contextual.
To establish an interpretive framework for this discussion, the phenomena of moral deliberation needs outlining – exposing how ethical principles are employed in moral reasoning. Moral action considered from the perspective of creating the greatest happiness for the greatest number of people (Bentham, 1776) is act consequentialism. Noting that what is considered of utility can vary, the principle itself is readily graspable, i.e., the beneficial consequence of OP is the maximisation of those services, therefore bringing maximum benefit to the majority. For example: a more convenient and flexible delivery of services (particularly for those in remote locations or with mobility issues) (Gamble et al., 2015; Davis, 2014), and benefits for those with special needs such as requirements specific to culture, time-restraints, or anonymity (Davis, 2014).
However, a caveat exists. Kant (1785) argues that persons should be treated as ends in themselves, but in act consequentialism personal rights are not considered. It is this clashing of utility with rights, e.g., the cost of confidentiality, consent and privacy that are the potential negative consequences associated with the increased benefits, that need considering. Confidentiality, privacy and consent are personal rights (APS, 2007) which, from a deontological perspective are moral imperatives (Kant, 1785). Resolving this dilemma, Davidson, Allan, and Love (2010) claim that rights are conditional based on Ross’ (1930) argument that promise keeping—in relation to rights, which he calls prima facie duties—has limits. However, Ross’s attempt to divorce the notion of intrinsic goods from consequence based reasoning, is self-defeating (Oderberg, 2000). Oderberg (2000) restates prima facie duties as rule-based consequentialism, where the rule is defeated if conflicting duties of promise keeping have to be weighed against each other. One must ask whether acting with integrity (i.e., with fidelity and probity) (APS, 2007) is that which actually informs decisions concerning limits to personal rights?
Having established an interpretive framework for assessing the ethics of OP, the issues surrounding the provision of those services can be nuanced (prior to introducing the concept of virtue based ethics, from which perspective ethical deliberation is liberated from both rights and utility focussed reasoning). And having outlined the utility of Internet technologies to broaden the reach of psychology, this paper turns to assessing the ethical concerns these benefits raise.
Considering the global reach of the Internet, the provision of OP must comply with the jurisdiction in which those services are provided (APS, 2014). This leads to the broader question of competent (not merely lawful) delivery of those services. Competency is binding upon psychologists because they are obliged to cause no harm (APS, 2007), or at least minimise potential harms (Fitzgerald, Hunter, Hadjistavropoulos, & Koocher, 2010). Herein lies the tension between utility and rights, as non-maleficence is an unconditional good according to Kant’s ethics of duty (Omonzejel, 2005). A psychologist’s duty/obligation to provide this good is best safeguarded by providing services within the limits of their competence (APS, 2007). This means maintaining an awareness of the strengths, limitations, scope and appropriate ethical use of all the modes of Internet-based OP, inclusive of client/practice management, and evaluating the effectiveness interventions (APS, 2014).
Efficacy is therefore related to competency. Internet treatments, which are largely differentiated by the asynchronous nature of online communication (APS, 2014), have been found to be effective, inexpensive, and flexible (Fitzgerald et al., 2010) - although having methodological limitations (Davis, 2014). Additionally, they are innovative, e.g., Black Dog Institute’s suicide prevention iBobbly app for Indigenous people (Black Dog Institute, 2016). The APS (2014) cites studies supporting the effectiveness of online therapies for panic disorder, social phobia, depression, posttraumatic stress disorder and substance abuse (APS, 2014). Andersson (2016) issues a caution however, regarding security, the robustness of assessment procedures, the proper formatting (i.e., text based) of treatment contents, and allowances for differences in the therapist’s role (i.e., not face-to-face).
Competent online practice is predicated on the duty of non-maleficence. Discussed next are harms to interrelated rights to confidentiality, privacy and consent. Privacy concerns a client’s privilege to be left alone and to be in control of their personal information, hence privacy and informed consent are predicated on the right to autonomy (Davidson et al., 2010). The associated duty of confidentiality, that is of the greatest relevance to the ethical practice of OP (Gamble et al., 2015), binds psychologists to keep professional secrets (Davidson et al., 2010). These secrets are threatened because the Internet is designed to be an open environment (Gamble et al., 2015).
Accordingly breaches of confidentiality (through breaches in online security) constitute breaches of client’s rights to autonomy, i.e., to privacy and informed consent (Davidson et al., 2010). Here the centrality of confidentiality emerges along with the realisation that breaches to confidentiality, privacy and consent are possible across all domains of OP inclusive of record keeping, consensual participation in online research (APS, 2014) and communication via electronic mediums. Due to the openness of the Internet absolute rights to confidentiality, consent and privacy are unreasonable. And as the benefits exceed these potential harms, best practice occurs through maintaining Internet technologies, and knowing the conditions under which service providers may view online information, including deleted material (APS, 2014).
The Internet also creates opportunities for the inappropriate disclosure of information which may impact therapeutic relationships such as the unregulated (no use of privacy settings) sharing of personal information on Facebook or Myspace about past holidays. This seems innocuous but may be inappropriate, resulting in the degrading of professional boundaries (Taylor, McMinn, Bufford, & Chang, 2010). Another example is accidentally disclosing inappropriate (or confidential) information by emailing the incorrect person. Interactive/smart technology makes this easy and information cannot be unsent.
A Better Way
Although limited, this paper has reflected on benefits of OP weighed against infractions to competency and confidentiality, meaning that the increased delivery of services may come at the expense of personal rights and/or a duty of care. As no balance exists between utilitarian and deontological moral reasoning in pursuing autonomy, justice benefice, integrity (Davidson et al., 2010), a better way is proposed. MacIntyre (2007) argues for the ethics of virtue, where virtues function to unify personal practices with the wholeness/integrity of that person’s tradition. Virtues are human qualities and habits that orient/dispose persons towards intrinsic goods internal to their community’s practices (MacIntyre, 2007). Unfortunately, the virtues identified within the Code are minimal: integrity, fidelity, probity and honest conduct (APS, 2007). This is a starting point from which to construct a positive account of right and virtuous conduct, and that which constitutes integrity of practice for professional psychologists.
The perspective of virtue transcends both rights and utility focussed reasoning, is prescribed by tradition, and forms part of one’s character. Only virtue will safeguard deliberations of promise keeping concerning rights—as has been discussed—and possibly the online conduct (character) of psychologists, and a psychologist’s navigation of conflicting interests, exploitation, authorship issues, financial arrangements, and handling of complaints (C.3.-7.) (APS, 2007), that require integrity of practice.
Internet-based technologies have great utility in broadening the reach of psychological services (Gamble et al., 2015). The use of these new Internet technologies has raised ethical concerns, particularly in the competent and confidential delivery of OP. Some claim that existing ethical principles are adequate to safeguard the integrity of the profession (Nicholson, 2011; Koocher & Speigal, 2008). However current ethical practice dictates that moral issues be resolved with combined utilitarian and deontological reasoning. The problem is that consequentialism is incompatible with the existence of rights (Oderberg, 2000). The acceptance of Ross’ (1930) theory of prima facie duties has condemned ethical reasoning to deliberation from irreconcilable positions. However, there exists within the tradition of professional psychology the perspective of virtue ethics that transcends both rights and utility focussed reasoning, allowing for a better way towards achieving integrity of practice. Only virtue aligns personal practice with best practice (as contained within the integral tradition of psychological practice in Australia) and forms one’s character in the habitual performance of that practice, irrespective of context. This conclusion is narrow and theoretically limited, but represents an opportunity to develop an ethic of virtue that is positive, aspirational and able to address the most current ethical questions arising in the area/era of OP.
Andersson, G. (2016). Internet-delivered psychological treatments. Annual Review of Clinical Psychology, 12, 157-179. doi.org/10.1146/annurev-clinpsy-021815-093006
Australian Psychological Society. (2007). Code of ethics. Melbourne: Author.
Australian Psychological Society. (2014). Ethical guidelines for providing psychological services and products using the internet and telecommunications technologies. Melbourne: Author.
Bentham, J. (1776). A Fragment on Government. Retrieved from http://www.efm.bris.ac.uk/het/bentham/government.htm
Black Dog Institute. (2016). Overview of the iBobbly trial. Retrieved from http://digitaldog.org.au/programs/ibobbly-black-dog-institute/
Davidson, G. R., Allan, A., & Love, A. W. (2010). Consent, privacy, and confidentiality (pp. 77-91). In A. Allan & A. W. Love (Eds.), Ethical practice in psychology: Reflections from the creators of the APS Code of Ethics. Chichester: Wiley-Blackwell.
Davis, A. (2014). Ethical issues for psychologists using communication technology: An Australian perspective on service provision flexibility. Professional Psychology: Research and Practice, 45, 303–308. doi: dx.doi.org/10.1037/a0037081
Fitzgerald, T. D., Hunter, P. V., Hadjistavropoulos, T. & Koocher, G. P. (2010). Ethical and legal considerations for internet-based psychotherapy. Cognitive Behaviour Therapy, 39, 173-187. doi.org/10.1080/16506071003636046
Gamble, N., Boyle. C., & Morris, Z. A. (2015). Ethical practice in telepsychology. Australian Psychologist, 50, 292-298. doi:10.1111/ap.12133
Kant, I. (1785). Groundwork of the metaphysic of morals. In A. W. Wood (ed.), Rethinking the western tradition (Vols. 1-22, pp. 1-63), New Haven: Yale University Press. Retrieved from http://www.inp.uw.edu.pl/mdsie/Political_Thought/Kant%20-%20groundwork%20for%20the%20metaphysics%20of%20morals%20with%20essays.pdf
Kaplan, A. M., & Haenlein, M. (2010). Users of the world, unite! The challenges and opportunities of Social Media. Business Horizons, 53, 59-68. doi.org/10.1016/j.bushor.2009.09.003
Koocher, G.P. & Keith-Spiegel, P. (2008). Ethics in Psychology and the Mental Health Professions: Standards and Cases (3rd ed.). New York: Oxford University Press.
MacIntyre, A. (2007). After virtue (3rd ed.). London: Duckworth.
Nicholson, I. (2011). New technology, old issues: demonstrating the relevance of the Canadian code of ethics for psychologists to the ever-sharper cutting edge of technology. Canadian Psychology, 52(3), 215-224. doi.org/10.1037/a0024548
Oderberg, D. S. (2000). Moral theory: A non-consequentialist approach. Oxford: Blackwell Publishers.
Omonzejel, P. F. (2005). Obligation of non-maleficence: Moral dilemma in physician-patient relationship. Journal of Medicine and Biomedical Research, 4(1), 22-30.
Ross, W. D. (1930). The Right and The Good. Oxford: Oxford University Press.
Taylor, L., McMinn, M.R., Bufford, R.K. & Chang, K.B.T. (2010). Psychologists’ attitudes and ethical concerns regarding the use of social networking web sites. Professional Psychology: Research and Practice, 41(2), 153-159. doi.org/10.1037/a0017996
Van Allen, J. & Roberts, M. C. (2011). Critical incidents in the marriage of psychology and technology: A discussion of potential ethical issues in practice, education, and policy. Professional Psychology: Research and Practice, 42, 433–439. doi.org/10.1037/a0025278