Martinez-Martin Nicole, Kreitmair Karola
Stanford Center for Biomedical Ethics, Stanford, CA, United States.
JMIR Ment Health. 2018 Apr 23;5(2):e32. doi: 10.2196/mental.9423.
This paper focuses on the ethical challenges presented by direct-to-consumer (DTC) digital psychotherapy services that do not involve oversight by a professional mental health provider. DTC digital psychotherapy services can potentially assist in improving access to mental health care for the many people who would otherwise not have the resources or ability to connect with a therapist. However, the lack of adequate regulation in this area exacerbates concerns over how safety, privacy, accountability, and other ethical obligations to protect an individual in therapy are addressed within these services. In the traditional therapeutic relationship, there are ethical obligations that serve to protect the interests of the client and provide warnings. In contrast, in a DTC therapy app, there are no clear lines of accountability or associated ethical obligations to protect the user seeking mental health services. The types of DTC services that present ethical challenges include apps that use a digital platform to connect users to minimally trained nonprofessional counselors, as well as services that provide counseling steered by artificial intelligence and conversational agents. There is a need for adequate oversight of DTC nonprofessional psychotherapy services and additional empirical research to inform policy that will provide protection to the consumer.
本文关注的是直接面向消费者（DTC）的数字心理治疗服务所带来的伦理挑战，这些服务不涉及专业心理健康提供者的监督。DTC数字心理治疗服务有可能帮助改善许多原本没有资源或能力联系治疗师的人获得心理健康护理的机会。然而，这一领域缺乏适当监管，加剧了人们对这些服务如何解决安全、隐私、问责制以及在治疗中保护个人的其他伦理义务等问题的担忧。在传统治疗关系中，存在着保护客户利益并提供警示的伦理义务。相比之下，在DTC治疗应用程序中，没有明确的问责界限或相关伦理义务来保护寻求心理健康服务的用户。带来伦理挑战的DTC服务类型包括使用数字平台将用户与训练不足的非专业咨询师联系起来的应用程序，以及由人工智能和对话代理指导的咨询服务。需要对DTC非专业心理治疗服务进行充分监督，并开展更多实证研究，为能保护消费者的政策提供依据。
