Obligations arise from moderating, placebos

Ethics Forum. Aug. 5, 2002.

Scenario: Does a doctor-patient relationship arise from online moderating?

We asked a physician who is an online moderator to a patient support group on the Internet to comment on the professional obligation to intervene when a posting suggests pending or immediate harm to the patient.

Reply:

As the public increasingly turns to the Internet for information and support, clinicians increasingly have the opportunity to incorporate the Internet into their work.

This is a new role for clinicians, and the obligations that attach may be unclear for them as well as the public. A significant concern with an Internet support group that is moderated by a physician is that individuals may expect and therefore wait for the moderator to intervene. If the moderator believes he or she is under no obligation to intervene and does not act, there could be an adverse health outcome and the moderator could conceivably be held liable for damages.

Moderating a group generally means maintaining the supportiveness of the group milieu. A moderator also may take on other roles, from which other obligations could flow.

As highlighted in an earlier Ethics Forum column (See column, Aug. 6, 2001), a key question is whether moderating an Internet support group creates a clinician-patient relationship. Such a relationship may exist if (a) the moderator offers and a group member requests diagnostic, prognostic, or therapeutic services or (b) even if not explicitly offered, the moderator actually does provide such services. Providing general information does not by itself create a clinician-patient relationship. [...]