Conversational Artificial Intelligence in Psychotherapy: A New Therapeutic Tool or Agent?

Conversational artificial intelligence (CAI) presents many opportunities in the psychotherapeutic landscape-such as therapeutic support for people with mental health problems and without access to care. The adoption of CAI poses many risks that need in-depth ethical scrutiny. The objective of this paper is to complement current research on the ethics of AI for mental health by proposing a holistic, ethical, and epistemic analysis of CAI adoption. First, we focus on the question of whether CAI is rather a tool or an agent. This question serves as a framework for the subsequent ethical analysis of CAI focusing on topics of (self-) knowledge, (self-)understanding, and relationships. Second, we propose further conceptual and ethical analysis regarding human-AI interaction and argue that CAI cannot be considered as an equal partner in a conversation as is the case with a human therapist. Instead, CAI's role in a conversation should be restricted to specific functions. Keywords: Artificial intelligence; agency; ethics; psychotherapy; therapeutic alliance

How to Strengthen Patients' Meaning Response by an Ethical Informed Consent in Psychotherapy.

Healthcare professionals including psychotherapists are legally and ethically obliged to ensure informed consent for the provided treatments comprising type and duration or potential benefits and possible risks (e.g., side effects) among others. In the present contribution, we argue that as potential benefit, informed consent can foster the patient's meaning response. Moerman's notion of the meaning response as the physiological or psychological effects of meaning in the course and treatment of an illness is a useful concept in explaining the effects of communicating a treatment rationale as part of the informed consent procedure. The more compelling the rational explanation of the targeted treatment effects including an explanatory model and a model of unique and common change mechanisms, the stronger the meaning response is expected to be resulting in increased hope and positive expectations with regard to the treatment

Ethical and Practical Issues in Video Surveillance of Psychiatric Units

Objectives: Video surveillance is used in inpatient psychiatry in many countries and institutions. However, its use varies considerably because of a lack of research, discussion, and agreement on best practice. This review provides an overview of current issues in the use of video surveillance in psychiatry, with a focus on ethical questions and their practical implications. Methods: A narrative review of literature on video surveillance in psychiatry was conducted. References were identified through searches of PubMed, CINAHL, MEDLINE, PsycINFO, and Google Scholar for articles published before December 2018. Sixteen articles in English and German were reviewed. Results: The ethical challenges and practical implications differ between surveillance of public spaces versus private areas, such as bedrooms or seclusion rooms. The most common reason for video surveillance was to increase security and safety. However, empirical evidence suggests that it is not useful in increasing security of shared spaces on psychiatric wards. Some evidence exists for clinical benefits of video surveillance in private spaces (e.g., allowing patients to sleep undisturbed). Video surveillance can increase patients’ choices regarding monitoring options. The main ethical conflict lies in balancing patients’ autonomy and privacy versus patient and staff security and safety. Conclusions: Whether video monitoring is used in the most effective and ethical manner needs to be reconsidered. Available evidence does not support its use as a security measure. More research is needed to evaluate the benefits, risks, and best practices of using video monitoring for patient observation, with consideration given to increasing the role of patient consent

Ist die fürsorgerische Unterbringung von Urteilsfähigen zulässig?

Mit dem Inkrafttreten des neuen Erwachsenenschutzrechts per 1. Januar 2013 wurde die fürsorgerische Freiheitsentziehung (FFE) in fürsorgerische Unterbringung (FU) umbenannt. Bei der Frage, ob eine solche auch bei diesbezüglich urteilsfähigen Personen zulässig ist, gehen die juristischen und medizinethischen Meinungen jedoch auseinander

Testing a German Adaption of the Entrapment Scale and Assessing the Relation to Depression

The construct of entrapment is used in evolutionary theory to explain the etiology of depression. The perception of entrapment can emerge when defeated individuals want to escape but are incapable. Studies have shown relationships of entrapment to depression, and suicidal tendencies. The aim of this study was a psychometric evaluation and validation of the Entrapment Scale in German (ES-D). 540 normal subjects completed the ES-D along with other measures of depressive symptoms, hopelessness, and distress. Good reliability and validity of the ES-D was demonstrated. Further, whereas entrapment originally has been regarded as a two-dimensional construct, our analyses supported a single-factor model. Entrapment explained variance in depressive symptoms beyond that explained by stress and hopelessness supporting the relevance of the construct for depression research. These findings are discussed with regard to their theoretical implications as well as to the future use of the entrapment scale in clinical research and practice

Urteilsfähigkeit, Zurechnungsfähigkeit und Schuldfähigkeit

Ärztinnen und Ärzte (aber teilweise auch RichterInnen, StaatsanwältInnen und VerteidigerInnen) verwenden die Begriffe Urteilsfähigkeit, Zurechnungsfähigkeit und Schuldfähigkeit oft praktisch synonym. Welche der oben genannten Fähigkeiten ist jedoch relevant, damit eine Person sich selbstbestimmt für oder gegen eine ärztlich indizierte Behandlungsoption entscheiden kann? Bei Vorliegen welcher Fähigkeit muss die Patientenentscheidung respektiert und umgesetzt werden