by Judith Maginnis Kuster - Mankato State University (firstname.lastname@example.org).
Phenomenal growth of Internet resources has produced major changes in the professional world which may force re-definition of what is considered ethical behavior and may also expand professional obligations. For instance, our Code of Ethics says that we should use every appropriate resource to provide high quality service. Does the Internet expand professional obligations if the best resources for services (or most realistically available services due to physical distance from services) are available through the Internet? E-mail makes consultation available to persons in remote areas. For example the parents of a child who stutters, living hundreds of miles away from any clinician specializing in stuttering are now able to consult through email and video tapes, with one of the nation's top specialists in child stuttering.
Technology already exists to provide some direct treatment services through email, live video exchange, or through virtual reality programs on Web pages. Can Internet technology at times provide advantages over face-to-face treatment? Could virtual environments on the World Wide Web provide a variety of simulated practice situations? Can interactive journalling prepare a client for face-to-face treatment or be an acceptable adjunct to treatment? Do clinicians have an ethical responsibility to know about and provide clients with Internet resources?
Although using the Internet supports the development of services designed to fulfill unmet needs, some may wonder if the use email could be considered a type of treating by correspondence, which our Code of Ethics prohibits? And would state licensure bodies allow speech-language pathologists or audiologists licensed in one state to provide services via the internet in other states where they are not licensed?
At least one other professional association (American Psychological Association) is beginning to grapple with these issues and has placed online a statement by their Ethics Committee regarding Services by Telephone, Teleconferencing, and Internet
Using email is like sending postcards where anyone between the sender and receiver can read the message, leading to confidentiality and professional courtesy concerns. Email is not a behind-a-closed-office-door consultation. This also needs to be clear in any client-clinician interaction or any sharing of client reports on the Internet.
On open discussion lists there is the potential for clients or former clients to actually be on the list and be able to recognize themselves. In a discussion on Stutt-L about confidentiality issues, William Rosenthal wrote (April 13, 1995), "The result could range from embarrassment or discomfort about having one's personal life displayed for all to read about, to feelings of betrayal and loss of trust for his therapist."
Some discussion forums are closed (only open to subscribers that are approved by the list owner). Closed discussion lists, may be developed appropriately such as the ones listed below.
SID4@VM.TEMPLE.EDU is a mailing list for members of the ASHA Special Interest Division 4 on Stuttering and other fluency disorders. Subscribing to the mailing list can be accomplished by sending the message subscribe sid4 yourfirstname yourlastname to email@example.com This message will be automatically forwarded to the list owner.
CLEFTSERVE is intended for use only by members of the American Cleft Palate-Craniofacial Association (ACPA) who are devoted to advancing research and clinical management of cleft palate, craniofacial anomalies, and related disorders. Requests for Cleftserve subscriptions as well as requests for information about ACPA should be forwarded to Nancy Smythe, Executive Director of ACPA,
WORDFREE@VM.TEMPLE.EDU is a mailing list for young persons, under the age of 20, who stutter. To join send the message sub wordfree firstname lastname to firstname.lastname@example.org
Even designing Internet resources raises ethical issues. For example, the World Wide Web opens global access to information previously unavailable in many remote areas. At this point it may be best to design Web Pages without extensive graphics which create an expensive barrier to many people trying to access the information, especially in developing countries with limited access to the Internet.
Sometimes Internet users have made embarrassing mistakes when they accidentally address a private email message to an entire mailing. It's also easy to forward mail even when it's marked private. Best not to post anything that you would not write to your best friend and your worst enemy.
How do rules of "informed consent" apply when you describe actual case studies on mailing lists or on Web sites, whether for teaching purposes, research, or general interest? Clients in university clinics typically sign a consent form allowing their therapy to be viewed and discussed for educational purposes in our own programs. Putting information online for a global community, academic or otherwise, is a different matter.
Researchers may soon study the communication differences displayed on the Internet by persons with communication disorders. One list for people with high-functioning autism expressly forbids the use of the list for gathering research subjects or research data. Is it ethical to gather data from mailing lists and archives using people for research or teaching purposes without their written consent?,
Finally, professionals have a responsibility to continue development throughout their careers. Books, journals, continuing education, additional coursework and conference/convention attendance are traditional ways to stay current. Using the Internet may soon prove essential to staying current. It does, however, require honing critical skills. Traditional methods all provide peer review or professional endorsement before information reaches an audience. However, any Internet user can publish material, good, bad or indifferent.
The Internet provides many resources for learning and teaching about ethical issues, including: