Associate Professor Lena Sanci is the Deputy Head of the
Department of General Practice at the University of Melbourne and a
Research Program Leader for the Cooperative Research Centre for
Youth Technology and Wellbeing . In this article she discusses
ethical challenges that using technologies with young people poses
from a GP's perspective.
Part of the clinical approach to caring for young people is
gaining an insight into their life's context, in order to
understand their risk and protective factors more clearly and to
address these in a holistic management plan. Social media and new
technologies are now an integral part of young people's worlds, and
it has become increasingly important to understand the role these
technologies play in their lives, to better address risk factors.
However there are some ethical challenges to resolve for
professionals to feel comfortable communicating with young people
through the new technologies or viewing a young patient's social
networking site. In a sense the challenges are not new and exist in
the current way we communicate with young people - but the very
public, immediate and permanent nature of communication via new
technologies adds new ethical considerations.
One issue is the establishment and maintenance of appropriate
boundaries between a treating health professional and a young
person. Professionals need to consider how they negotiate rules of
engagement with young patients before they give out contact details
such as email, mobile phone numbers or social media profiles such
as Facebook. Consider - what times can young people contact a
professional and expect a response, and with what sorts of issues?
Do professionals use private numbers or practice specific ones?
Should professionals ever accept to be a patient's 'friend' on
social media sites? If so how are expectations managed? What if a
risky behaviour that a young person is engaging in occurs when the
health professional is off duty and unable to respond in a timely
and objective manner? None of these issues are irresolvable - they
need to be discussed and clarified with a young person in the same
way we would normally set expectations and rules around
communication.
A key issue in engaging online is the privacy of the young
person - or other young people who may also be linked to the online
profile of the young person who is the patient of the health
professional. Potential threats to privacy must be discussed from
the outset if a professional considers viewing a young person's
site.
A third issue for the health professional using new technologies
instead of face-to-face consultations are the potential limitations
of this for adequately dealing with certain types of health issues.
When would the health professional recommend a visit in person? Is
any therapeutic effect lost with electronic communication or is
there a greater gain? There are many problems or issues for which
young people might consult a GP which are conducive to 'discussion'
via new technologies, particularly for those requesting information
or advice. However problems requiring a diagnostic process are
better dealt with in person where there is option to conduct an
examination or investigations.
Further ethical and legal issues arise if health professionals
consult via the new technologies with youth who are legally minors
(under 18 years in some states or under 16 years in others). As
with face to face consultations, GPs must judge whether the young
person is a mature minor who can consult without permission from
parents or guardians on certain matters or whether parental consent
is necessary. How does the professional judge mature minor status
online? How does the GP involve parents or guardians if necessary?
What if mandatory reporting issues arise (eg. sexual or physical
abuse) and require a response, how would these be identified and
handled in an online world?
Using technologies to benefit the health and well being of all
young people is the subject of the new Cooperative Research Centre (CRC) on young people,
technology and wellbeing. The CRC will be investigating the
potential and challenges of virtual clinics where professionals
consult in an online world.
On balance there seem to be great advantages in using new
technologies to increase access to health care for young people.
These can help us achieve better outcomes with our patients, if we
resolve challenges such as managing patient expectations, risk,
patient and professional privacy, mature minor assessments,
mandatory reporting and involving parents/guardians
appropriately.
What are the key ethical and professional boundaries
that you find to be barriers using technology in practice? How do
you resolve them?
For professional development resources on managing some of the
ethical and professional boundaries raised here, visit the
ReachOutPro.com.au Education
Module.