The COVID-19 pandemic has necessitated a rapid escalation in the use of telepsychiatry. Herein we revisit some of the ethical issues regarding its use, including patient benefice, distributive justice, privacy, and autonomy. Based on these considerations we would hold that telepsychiatry is a vital aspect of providing psychiatric care, and ethically should be offered as a format for treatment, likely beyond the pandemic period. Investigative and advocacy efforts will need to continue to determine its exact role within psychiatric care, and (...) expand its availability for those most in need. (shrink)

This article investigates the conceptual foundations of technological innovation and development projects that aim to bring ethical and social issues into the design stage. Focusing on the ethics and social impact of technological innovation and development has been somewhat of a trend lately, for instance in ELSA research and in such initiatives as the Dutch Responsible Innovation programme. I argue that in order to succeed in doing social responsible and ethical sound design, a proper understanding of the relation between technology (...) and society is required. I propose to move away from an externalist framework, in which technology and society are depicted as being defined independently, towards an interdependent framework, where technology and society are regarded to be mutually defining. This move is necessary in order for such innovation projects not to reinforce outdated concepts about technology, which in the longer run will prove counterproductive to the actual aims of the projects themselves. (shrink)

Telepsychiatry has long been discussed as a supplement to or substitute for face-to-face therapeutic consultations. The current pandemic crisis has fueled the development in an unprecedented way. More and more psychiatric consultations are now carried out online as video-based consultations. Treatment results appear to be comparable with those of face-to-face care in terms of clinical outcome, acceptance, adherence and patient satisfaction. However, evidence on videoconferencing in a variety of different fields indicates that there are extensive changes in the communication behaviour (...) in online conversations. We hypothesise that this might impact ethically relevant aspects of the therapeutic relationship, which plays a prominent role in psychiatry. In this paper, we review effects of video-based consultations on communication between therapists and patients in psychiatry. Based on a common understanding of video-based consultations as changing the lived experience of communication, we categorise these effects according to sensory, spatial and technical aspects. Departing from a power-based model of therapeutic relationships, we then discuss the ethical significance of this changed communication situation, based on dimensions of respect for autonomy, lucidity, fidelity, justice and humanity. We conclude that there is evidence for ethically relevant changes of the therapeutic relationship in video-based telepsychiatric consultations. These changes need to be more carefully considered in psychiatric practice and future studies. (shrink)