Torous John, Roberts Laura Weiss
*Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and †Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
J Nerv Ment Dis. 2017 Jan;205(1):4-8. doi: 10.1097/NMD.0000000000000596.
The rapid rise of mobile health technologies, such as smartphone apps and wearable sensors, presents psychiatry with new tools of potential value in caring for patients. Novel diagnostic and therapeutic applications of these technologies have been developed in private industry and utilized in mental health, although these methods do not yet constitute standard of care. In this article, we provide an ethical perspective on the practical use of this novel modality by psychiatrists. We propose that in the present context of limited scientific research and regulatory oversight, mobile technologies should serve to enhance the psychiatrist-patient relationship, rather than replace it, to minimize potential clinical and ethical harm to vulnerable patients. We analyze areas of possible ethical tension between clinical practice and the consumer-driven mobile industry, and develop a decision-tree model for implementing ethical safeguards in practice, focused on managing risk to the therapeutic relationship, informed consent, confidentiality, and mutual alignment of treatment goals and expectations.
移动健康技术的迅速崛起，如智能手机应用程序和可穿戴传感器，为精神病学提供了在照顾患者方面具有潜在价值的新工具。这些技术的新型诊断和治疗应用已在私营行业得到开发，并应用于心理健康领域，尽管这些方法尚未成为标准治疗手段。在本文中，我们从伦理角度对精神科医生实际使用这种新型方式提供见解。我们提出，在目前科学研究和监管监督有限的背景下，移动技术应有助于加强医患关系，而不是取代它，以尽量减少对脆弱患者的潜在临床和伦理伤害。我们分析了临床实践与消费者驱动的移动行业之间可能存在伦理冲突的领域，并开发了一个决策树模型，用于在实践中实施伦理保障措施，重点是管理对治疗关系、知情同意、保密以及治疗目标和期望相互协调的风险。
