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DYSWIS operates a platform that allows i) certain healthcare professionals to share video excerpts, including those showing interactions with patients, and ii) professional users of the platform to consult and comment on these video excerpts.
The DYSWIS platform aims to globally improve the professional abilities of its users through exchanges on real clinical situations or through the sharing of training material proposed by experts. Despite this commendable goal, the DYSWIS platform may give rise to concerns among some clinicians as to their ethical obligations, especially given the fact that publishing video excerpts of real clinical situations is not part of the daily practice for many professionals today.
This document is meant to be a statement with regard to certain questions related to respecting the ethical obligations of users of the DYSWIS platform who are members of professional orders of speech therapists and audiologists, occupational therapists and physiotherapists of Quebec, as well as general guidelines applicable across Canada.
The ethical rules that apply to healthcare professionals vary according to the profession, the jurisdiction and even to some extent to how the respective officials within a professional order apply the rules. That being said, there are common practices that healthcare clinicians must follow, especially as concerns professional confidentiality and in relation to the circumstances in which confidential information on a patient might be shared.
All professionals who might use the DYSWIS platform must keep all patient information of a clinical nature confidential. Many of the video excerpts likely to be shared through the platform will clearly contain information to which confidentiality rules apply. As professionals already know, respecting confidentiality in term of confidential information on a patient’s state of health is not absolute. Patients are regularly asked to consent to the sharing of information of a medical nature, through consent forms or other means, despite the fact that this kind of consent occurs in a different context than the consent on the DYSWIS platform.
Professionals must, in most cases, obtain permission (often known as consent) from the concerned person before sharing confidential information. This particular type of consent is unique in that it implies the patient renouncing the fundamental right to maintain his / her privacy and the professional confidentiality from which he / she benefits. This aspect does not make consent any less valid, but it does require that it be clearly stated and given with full knowledge of the cause, in other words, that the patient’s consent be freely given and informed.
Applicable ethical rules for professionals are not limited specifically to the extent of consent that patients can give to the sharing of confidential information, some ethical codes even explicitly allow confidential information to be, in some circumstances, used for teaching without preserving anonymity. Nevertheless, the extent of the use of confidential information, even when authorised by the patient, is not unlimited and is truly restricted, namely by professional obligations that prohibit anything that undermines the dignity and honour of the professions. The goals of the DYSWIS platform appears to align with the responsibility which is incumbent on the targeted professionals to advancing their profession. The use of the Platform is thus part of this development process.
The DYSWIS platform offers tools that allow professional users to easily obtain free and informed written consent 2 from their patients before sharing confidential information about them.
The consent process put in place by DYSWIS maintains a written record, clearly explains the implications of the consent given by the patient, requires the consent of parents of minors and encourages the patient to pay attention to the different means of consent. The DYSWIS platform has also taken measures to allow a patient to easily withdraw consent. All these elements favour free and informed consent on the part of the person as well as conform to professional ethical obligations.
Only the clinician is in a position to judge the patient’s level of understanding and free choice to consent to the sharing of video excerpts in which the patient is seen / heard. Ethical obligations are the responsibility of the professionals and not of the company operating the DYSWIS platform; the company’s role being limited to its obligations to its users and to offering users tools to help them respect their obligations. In this context, the professional cannot rely on a technological tool instead of their proper judgement when it is necessary to judge the patient’s understanding of the effects and consequences of giving consent. As a user, you take it upon yourself to see that you obtain your patients’ free and informed consent, specifically by giving them all the required explanations.
We hope that this document will further your understanding of the ethical issues surrounding the use of the DYSWIS platform.