Life,Death, and Monopoly Rights in a Democratic Society

This Report examines the ethical implications of electronic communication, focusing on the use of electronic mail (e-mail), considers its impact on a previously established patient-physician relationship, and the limitations in using e-mail to create a new patient-physician relationship. In its recommendations, this report offers guidance to physicians who use electronic mail to communicate with patients and online users. These guidelines maintain that e-mail should not be used to establish a patient-physician relationship, but rather to supplement personal encounters. When using e-mail, physicians hold the same ethical responsibilities to their patients as they do during other encounters and that information must be presented in a manner that meets professional standards. The report requires that physicians notify patients of e-mail's inherent limitations and that patients be given the opportunity to accept these limitations prior to the communication of privileged information. Finally, physicians should be aware of privacy and confidentiality concerns when using e-mail to communicate with patients.     

Ethical and legal issues in e-mail therapy

Psychologists and psychiatrists recently started using electronic mail (e-mail) to conduct therapy. This article explores relevant ethical and legal issues including, among others, the nature of the professional relationship, boundaries of competence, informed consent, treating minors, confidentiality, and the duty to warn and protect. To illustrate these complex issues, two services currently operating are discussed. To address potential hazards to clients and the profession, a new ethical standard for e-mail therapists is offered.     

Ethical and Legal issues in E-Mail Therapy

Psychologists and psychiatrists recently started using electronic mail (e-mail) to conduct therapy. This article explores relevant ethical and legal issues including, among others, the nature of the professional relationship, boundaries of competence, informed consent, treating minors, confidentiality, and the duty to warn and protect. To illustrate these complex issues, two services currently operating are discussed. To address potential hazards to clients and the profession, a new ethical standard for e-mail therapists is offered.     

Egocentrism over e-mail: can we communicate as well as we think?

Without the benefit of paralinguistic cues such as gesture, emphasis, and intonation, it can be difficult to convey emotion and tone over electronic mail (e-mail). Five experiments suggest that this limitation is often underappreciated, such that people tend to believe that they can communicate over e-mail more effectively than they actually can. Studies 4 and 5 further suggest that this overconfidence is born of egocentrism, the inherent difficulty of detaching oneself from one's own perspective when evaluating the perspective of someone else. Because e-mail communicators "hear" a statement differently depending on whether they intend to be, say, sarcastic or funny, it can be difficult to appreciate that their electronic audience may not.     

Patient and Family Descriptions of Ethical Concerns

Abstract

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants (N?=?196) described 219 unique ethical experiences that spanned many of the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting.     

The Confluence of Technology and Narrative Approaches in Group Work

Abstract

This article illustrates procedures for using e-journals as a creative and adjunctive approach in group work. Incorporating e-mail based journaling as an ancillary form of group interaction allows members to communicate via written channels, and creates new ways for clients to relate in the group. This article outlines how leaders can use narrative theory to construct e-mail based writing exercises in group settings. Borrowing from established narrative techniques, specific interventions are provided for using interactive e-mails in each group stage. Finally, detailed instructions for establishing encrypted and confidential e-mail communications are provided, and implications and limitations for establishing e-mail based communication systems are overviewed.     

Electronic performance appraisals: The effects of e-mail communication on peer ratings in actual and simulated environments

Across three empirical studies, this paper explores the effect of using e-mail as a communication medium (versus pen-and-paper) when conducting performance appraisals of peers. The notion put forth by Media Richness Theory that paper-form and e-mail media should be considered identical for conveying this information was theoretically challenged and differences were empirically supported. Using two different settings, results demonstrate that evaluators offered more negative appraisals of their peers when using e-mail than when using traditional paper-form methods. Reduced feelings of social obligation in the e-mail condition were found to mediate this relationship, indicating that social psychological processes can influence the effects of different media on peer ratings.     

College students' use of electronic communication with parents: links to loneliness, attachment, and relationship quality

Despite the ubiquitous use of new communication technologies, gaps in our knowledge remain regarding who is likely to rely on particular technologies and potential ramifications of these forms of communication on individuals' relationships and adjustment. In an online survey, 211 college students reported on their use of electronic communication with a parent who they identified as their closest family member. Results indicated that students who report more frequent phone conversations with parents also report more satisfying, intimate, and supportive parental relationships, but those students who use a social-networking site to communicate with parents report higher levels of loneliness, anxious attachment, as well as conflict within the parental relationship. The findings offer new evidence on how electronic communication technology with parents is related to adjustment in college students. Our study also suggests that further research is needed using longitudinal designs to understand better young adults' use of technology to communicate in today's society.     

The Persistence of Status Differentials in Computer Conferencing

One feature of electronic communication media is its potential to remove the effects of occupational role identity. For better or for worse, electronic communication technologies may reduce occupational status differentials and allow individuals to communicate as equals. This article reports results from a study of health-care professionals engaged in an educational program using computer conferences over a five-month period. Results show that the content and network of communication among health-care professionals using the computer conference were significantly related to occupational roles. Specifically, physicians and hospital administrators were afforded higher status in computer conferences than nurses. The effects of occupational status differentials were manifest and became more established with greater use of the computer conferencing system. Status characteristics derived from the educational task also appeared to affect communication patterns. The importance of considering multiple social contexts when implementing information technology is discussed.     

Improving the Scientist/Journalist Conversation

How well do scientists communicate to members of the mass media? A communication scholar reviews potential barriers to the essential dialogue necessary between those in the sciences and journalists who report science to the public. Suggestions for improving communication within this relationship, in spite of professional process differences, are offered, emphasizing adherence to shared ethical standards.     

Organizational media choice in performance feedback: a multifaceted approach

This study was designed to examine media choice in performance feedback, an organizational communication process that has been overlooked in the literature. Specifically, we adopted a multifaceted approach and examined how contextual variables in feedback, variables identified from media choice theories, and individual differences in media perception influenced selection of a medium to communicate performance information. A policy‐capturing survey was administered to 178 full‐time employees in Hong Kong. Participants read feedback scenarios and provided media preference ratings of face‐to‐face, telephone, electronic mail, and written communication. Results showed that the three facets jointly influenced media choice. Given that communication quality is partly determined by the medium selected, the present work sheds light on the understanding of initiation process in performance feedback.     

Computer Communication and Organizational Commitment: Tracing the Relationship in a City Government

Various theories and management policies suggest that there should be a positive relationship between communication and commitment to the organization. However, support for that relationship remains equivocal. We report the results of a questionnaire on communication and commitment filled out by 376 employees of a mid-sized city government. They were asked about the mode and frequency of their communications within the organization and about their commitment to the city government. Consistent with our hypotheses about the nature of computer-mediated communication, use of computer mail and bulletin boards predicted organizational commitment, but use of the telephone and paper modes of communication did not. In addition, those most likely to benefit from the immediacy and memory of computer communication—shift workers—evidenced a stronger relationship between computer mail use and commitment than did regular employees. Two mechanisms for mediating the relationship between communication and commitment were evaluated. Evidence supports active participation in communication as a mediating mechanism in the relationship between communication and commitment. The informational value of communication does not appear to be important in this regard.     

The patient-physician relationship and the allocation of scarce resources: a law and economics approach

Patients with insufficient financial resources place physicians in a conflict of interest between the patients' needs and the financial interests of the physician, other patients, and society. Not only must physicians act ethically, but they must avoid liability for violating their legal duties to their patients. The traditional rules of contract and malpractice law that govern the patient-physician relationship do not provide satisfactory guidelines. Better answers are found in the rules of fiduciary law, but only with regard to direct conflicts between patients and physicians and only at the risk of reducing patient access to care. Certain types of legislative action can resolve these conflicts by altering the traditional legal rules, but care must be taken to preserve patient-physician trust, which the legal rules were designed to enhance.     

The physician’s role in the protection of human research subjects

Responsibility for the protection of human research subjects is shared by investigators, research ethics committees, sponsors/funders, research institutions, governments and, the focus of this article, physicians who enrol patients in clinical trials. The article describes the general principles of the patient-physician relationship that should regulate the participation of physicians in clinical trials and proposes guidelines for determining when and how such participation should proceed. The guidelines deal with the following stages of the trial: when first considering participation, when deciding whether to enrol patients, when asking patients to participate, when the trial is underway and when it is completed.     

The BlackBerry project: capturing the content of adolescents' text messaging

This article presents an innovative method for capturing the content of adolescents' electronic communication on handheld devices: text messaging, e-mail, and instant messaging. In an ongoing longitudinal study, adolescents were provided with BlackBerry devices with service plans paid for by the investigators, and use of text messaging was examined when participants were 15 years old and in the 10th grade (N = 175; 81 girls). BlackBerries were configured so that the content of all text messages, e-mail messages, and instant messages was saved to a secure server and organized in a highly secure, searchable, online archive. This article describes the technology used to devise this method and ethical considerations. Evidence for validity is presented, including both information on use of text messaging to show that participants used these devices heavily and frequencies of profane and sexual language in a 2-day sample of text messaging to demonstrate that they were communicating openly.     

The on-line voyeur: Promises and pitfalls of observing electronic interaction

Studies that compare objective data on communication activity to data provided in verbal reports have indicated that verbal report data are not as accurate as one might hope. Researchers of communication have used verbal reports as their primary source of data because it presents a cheap and easy way to collect the data. This paper presents an easy alternative involving the study ofelectronic communication: a method that allows the collection of objective information on electronic communication, thus avoiding the problems associated with self-reports. The paper reviews the available literature on the accuracy of self-reports of communication, presents the instrument used to collect the objective electronic communication data, and discusses some of the difficulties and limitations encountered in implementing a study using the instrument.     

Most family physicians report communicating the risks of adverse drug reactions in words (vs. numbers)

Family physicians can communicate to patients the risk of adverse drug reactions using words or numbers, and this format has important implications for patients' ability to make informed decisions. The present study (a) assessed which formats family physicians preferred to communicate the risk of a given side effect, (b) tested whether the severity of this adverse drug reaction affected this preference, and (c) investigated the type of quantifiers physicians preferred to use in general (e.g., ratios, percentages). In a format selection task, a sample of 131 family physicians reported that they mostly use words to communicate to patients the risk of mild and severe adverse drug reactions, but the verbal preference was weaker for severe adverse drug reactions. The quantifier selection task showed that the most common quantifiers were verbal frequencies and verbal probabilities. Family physicians and patients should be aware of the implications of this preference.     

Psychopharmacology and the Power of Narrative

This report offers recommendations to physicians who provide information or services through online sites. The recommendations maintain that physicians responsible for health-related information should ensure that it is accurate, timely, reliable, and scientifically sound. Also, advice to online users with whom physicians do not have preexisting relationships or the use of decision-support programs that generate personalized information directly transmitted to users should be consistent with general and specialty-specific standards. In particular, these standards should address truthfulness, protection of privacy, informed consent, and disclosures including limitations inherent in the technology. Finally, physicians who establish or are involved in health-related online sites must minimize conflicts of interest and commercial biases and, if patient specific information is transmitted, they must provide high-level security protections, as well as privacy and confidentiality safeguards.     

Gender and computer-mediated communication

A case study analyzed employees' attitudes toward, and experiences with, an intraorganizational electronic mail system. Results revealed that females perceived e-mail to be easier to use, more efficient, and more effective than males. They also gave higher ratings of appropriateness for using e-mail to transmit certain types of messages. Females (particularly managers) were more likely than their male counterparts to rely on co-workers to learn how to use e-mail. More females used the computer system for word processing, while more males and whites (who comprised 82.2% of the sample) had off-site connections to the computer system. No other distinctions were found regarding race—ethnicity. Implications for future research are discussed.The author is grateful to Karen Tracy, Robert Craig, and anonymous reviewers for their insights and suggestions.