ethics

The Challenge of Modern Technology

 

Reprinted and Adapted with the permission of Social Work Today ©. Great Valley Publishing, Co.

“The Challenge of Modern Technology” by Dr Frederic G. Reamer, Social Work Today, published on 1 October 2001

 

COMMUNICATION RISK

Perhaps the most obvious ethical issues involve confidentiality and privacy. Ever since the profession’s inception, social workers have embraced strict standards designed to protect clients. Practitioners have long understood how privacy and confidentiality are essential ingredients in trusting relationships between social workers and clients. Several technological innovations used widely by social workers pose unique threats to client privacy and confidentiality.

• Computer-based Client Records

Most social service agencies and independent practitioners would not bat an eyelid at using computer-based client records due to the ease at which it helps for clinical or billing purposes. Although firewalls and passwords provide considerable protection, these mechanisms are not infallible.

• Mobile Phones

The telephone’s portability sometimes means that we social workers may carry on conversations within earshot of people who should not be pricy to hearing the identifying information mentioned by the social worker during the calls (for example, conversations conducted in public spaces such as on buses or trains, and in hallways). In one notorious case, a social worker’s client was shopping in an electronics store and overheard a wireless phone call that their social worker was having concerning another client.

• Email

In one case, a social worker intended to send a confidential message to a colleague about a mutual client. Unfortunately when the social worker scrolled through her electronic address book to find her colleague’s email address, she inadvertently clicked on and sent the message to a different friend’s address that was adjacent to the colleague’s name, thereby disclosing intimate details concerning her client’s life.

 

SERVICE DELIVERY

Internet communications has led the way to a wide array of Web-based social services. Among them are clinical services offered by mental health professionals, including social workers who provide psychotherapy exclusively via e-mail communication. Under this arrangement, the social worker and client do not meet in person. Rather, the social worker relies on this type of communication to conduct an assessment and offer follow-up help. Pertinent ethical issues concern the adequacy of such computer-based services i.e., the extent to which clients’ mental health needs can be met adequately through this counseling medium and the challenge of informed consent. Key questions include the following:

 

• Do clients fully understand the nature of the clinical services they will be provided via the Internet, including their advantages and limitations? Namely, that the convenience and anonymity of email consultation may result in the absence of us picking up on certain clinically significant nonverbal cues.

• Do clients understand possible privacy and confidentiality risks in case security of this communication is accidentally breached?

• Have we as social workers taken reasonable steps to encrypt their communications and to ensure secure storage of electronic records and put in place adequate measures to ensure quality and respond to clinical emergencies?

 

Other non-computer limited technologies also pose ethical challenges in the delivery of social services. For example, many social workers employed as parole officers are attaching electronic bracelets to clients to monitor their whereabouts in the community. Social workers in psychiatric facilities may use strategically placed cameras and one-way mirrors to monitor patients’ movement, therapy, and recreational activities. And for many years now, social workers have participated in programs that make extensive use of pharmacological technology (i.e., neuroleptic and psychotropic medications) to treat emotional and behavioral symptoms. Clearly, these and other forms of technology can be helpful and constructive; at the same time, their use forces us to think seriously about potential ethical trade-offs related primarily to privacy, exploitation, coercion, and civil liberties.