Brain stimulation for ‘enhancement’ in children: An ethical analysis

By Hannah Maslen, Brian D Earp, Roi Cohen-Kadosh and Julian Savulescu
Frontiers in Human Neuroscience
Revised on November 6, 2014

Abstract

Davis (2014) called for "extreme caution" in the use of non-invasive brain stimulation (NIBS) to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child's future options. The distinction between treatment and enhancement has some normative force here. As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests (as judged by the parents) diminish, and the need to protect the child's (future) autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are (themselves) justified on a best interests standard.

The entire article is here.

The Use of Telepsychology in Clinical Practice: Benefits, Effectiveness, and Issues to Consider

By Nicole Godine and Jeffrey Barnett
International Journal of Cyber Behavior, Psychology and Learning
DOI: 10.4018/ijcbpl.2013100105

Abstract

The use of various technologies in the practice of psychology has increased greatly in recent years in concert with increases in the use of these technologies in the lives of most individuals. E-mail, text messaging, chat rooms, and the Internet have greatly changed how many individuals communicate and maintain relationships. The psychotherapy relationship is no exception. The scope and practice of telepsychology, the use of the Internet and other technologies in the provision of psychological services, is reviewed along with relevant research that supports their use in the treatment of a wide range of conditions and disorders. Clinical, ethical, and legal issues and challenges are addressed and recommendations for the effective and appropriate use of these technologies in psychological practice are provided.

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Mental health services can be delivered by e-mail, real-time chat, telephones, videoconferencing, cell phones, and websites (Grohol, 2003; Smith & Allison, 1998; Stamm, 2003; VandenBos & Williams, 2000). Synchronous modalities of communication, in which participants communicate in real time, include online chat, telephones, cell phones, and videoconferencing. Videoconferencing is a “technological procedure that allows individuals to see and hear each other on a computer monitor or video screen in real time” (Germain, Marchand, Bouchard, Drouin, & Guay, 2009, p. 42). It is different from real-time chat, telephone conversations, and cell phone conversations in that videoconferencing allows users to view and speak to each other in real time, whereas chat, telephones, and cell phones only allow the users to speak to each other (not view each other) in real time. Asynchronous forms of communication, in which there is a delayed response time, include e-mail, websites (which might be simply informational, or might offer contact with a mental health professional through e-mail), and text messaging via cell phones.

The entire article is here, behind a paywall.

When Your Therapist Is Only a Click Away

By Jan Hoffman
The New York Times

THE event reminder on Melissa Weinblatt’s iPhone buzzed: 15 minutes till her shrink appointment.

She mixed herself a mojito, added a sprig of mint, put on her sunglasses and headed outside to her friend’s pool. Settling into a lounge chair, she tapped the Skype app on her phone. Hundreds of miles away, her face popped up on her therapist’s computer monitor; he smiled back on her phone’s screen.

She took a sip of her cocktail. The session began.

Ms. Weinblatt, a 30-year-old high school teacher in Oregon, used to be in treatment the conventional way — with face-to-face office appointments. Now, with her new doctor, she said: “I can have a Skype therapy session with my morning coffee or before a night on the town with the girls. I can take a break from shopping for a session. I took my doctor with me through three states this summer!”

And, she added, “I even e-mailed him that I was panicked about a first date, and he wrote back and said we could do a 20-minute mini-session.”

Since telepsychiatry was introduced decades ago, video conferencing has been an increasingly accepted way to reach patients in hospitals, prisons, veterans’ health care facilities and rural clinics — all supervised sites.

But today Skype, and encrypted digital software through third-party sites like CaliforniaLiveVisit.com, have made online private practice accessible for a broader swath of patients, including those who shun office treatment or who simply like the convenience of therapy on the fly.

One third-party online therapy site, Breakthrough.com, said it has signed up 900 psychiatrists, psychologists, counselors and coaches in just two years. Another indication that online treatment is migrating into mainstream sensibility: “Web Therapy,” the Lisa Kudrow comedy that started online and pokes fun at three-minute webcam therapy sessions, moved to cable (Showtime) this summer.

“In three years, this will take off like a rocket,” said Eric A. Harris, a lawyer and psychologist who consults with the American Psychological Association Insurance Trust. “Everyone will have real-time audiovisual availability. There will be a group of true believers who will think that being in a room with a client is special and you can’t replicate that by remote involvement. But a lot of people, especially younger clinicians, will feel there is no basis for thinking this. Still, appropriate professional standards will have to be followed.”

The pragmatic benefits are obvious. “No parking necessary!” touts one online therapist. Some therapists charge less for sessions since they, too, can do it from home, saving on gas and office rent. Blizzards, broken legs and business trips no longer cancel appointments. The anxiety of shrink-less August could be, dare one say ... curable?

Ms. Weinblatt came to the approach through geographical necessity. When her therapist moved, she was apprehensive about transferring to the other psychologist in her small town, who would certainly know her prominent ex-boyfriend. So her therapist referred her to another doctor, whose practice was a day’s drive away. But he was willing to use Skype with long-distance patients. She was game.

Now she prefers these sessions to the old-fashioned kind.

But does knowing that your therapist is just a phone tap or mouse click away create a 21st-century version of shrink-neediness?

The entire story can be read here.