Key Words: Ethics, electronic publishing
You are asked to submit a manuscript to an electronic journal, or perhaps as a reader of an electronic journal, you are moved to write a letter to the editor about a topic. As you contemplate writing either the article or the letter, you may experience some anxiety and uncertainty. How are letters and manuscripts reviewed and is the journal peer reviewed? Do I submit my work electronically and how will the editorial staff communicate with me? Who will read my work? Underlying these questions are ethical issues about quality, security, and access. Let's now examine how these ethical issues could manifest themselves.
Quality is closely related to the ethical principle of "do no harm" and to the virtues of honesty and integrity. The ethical issue about the quality of electronic publishing that is raised most often is whether articles submitted to electronic journals are peer reviewed or not (e.g., Dougherty, 1999; Kassirer & Angell, 1995; Relman, 1999; Sparks, 1999). Ideally, peer review is one mechanism that helps to ensure that ideas are sound, thinking is logical, scholarly details are attended to, and appropriate revisions are made when requested. According to Relman (1999),
The best way to protect the public interest is through the existing system of carefully monitored peer review, revision, and editorial commentary in journals . . . A system that allowed immediate electronic publication of new clinical studies without the usual careful process of peer review and revision would be risky at best and might well fill the clinical data bases with misleading and inadequately evaluated information. (p. 1828)
Relman's quote raises the issue that is heard over and over again with web based information. Is the content valid and true? Peer review is one way to help ensure and let readers know that standards have been met. Whether one is talking about new clinical studies or any other type of online (or printed) material, the issue of quality as manifested through peer review is paramount.
At present in nursing there is a rush to initiate new electronic journals. If you plan to submit to one of these journals, you need to ask yourself some important questions: Who is the editor? Who constitutes the Editorial Review Board? Is the journal peer reviewed? If so, how does the peer review process work? If inadvertent errors occur, how does the journal handle this problem? Does the journal allow for reader response? Although these are valid questions to ask of new print journals as well, the guidelines for print journals are, overall, well established. In electronic publishing, however, editors and publishers are "breaking new ground" where traditional publication practices may not fit or be relevant. You, as a potential author for an electronic journal, must assume ethical responsibility for assessing the quality of the journal and for the honesty and integrity of your work.
Security is closely related to the ethical tenets of privacy and confidentiality. Privacy can be thought of as a person's area of individual freedom that governs when, and under what conditions, that person is willing to allow others to intrude or not intrude upon that freedom. Since privacy belongs to a person, it cannot be taken away from that person without his/her consent. If consent has not been given, invasion of privacy may occur. Confidentiality, as opposed to privacy, can be thought of as non-disclosure of information to others without a legitimate "need to know."
Electronic journal editors carry the responsibility to their readers and to their authors to guarantee confidentiality and to be sensitive to privacy issues in many of the same ways that print journal editors must. For example, the process of peer review is often blind, so that bias may be reduced. In addition, reviewers' comments may be edited by the editor before they are distributed to the author. However, with electronic journals, editors may face an additional challenge to security from electronic communication. Editorial policy may dictate that all articles and letters be submitted, reviewed, and corrected electronically through e-mail and attachments, thus, introducing additional threats to security. According to Gannon-Leary (1997),
It is important that companies be up-front about their policy and intentions. It would also be helpful if employees were aware of just how far down the road technology has gone and what its capabilities are. Corporate computer systems may save and store data automatically for a number of years, partly to ensure against data loss if a system crashes. Sophisticated retrieval programs mean that even deleted files may be reconstructed. It's also possible to divert incoming e-mail messages to another account. (p.221)
Although the preceding quote is directed toward corporations, the implications are clear for editors, Editorial Review Boards/peer reviewers, authors, and electronic journal readers. A motto for these persons could be: Let the users of e-mail beware! Someone beside yourself may be reading your e-mail, reconstructing your deleted e-mail files, or diverting your e-mail to other persons. Under such circumstances, if no morally justified reason can be given for such intrusions, the ethics of privacy and confidentiality have been severely compromised.
What's an editor, peer reviewer, or author to do? The answer is security. Security addresses how privacy and confidential data can be protected from accidental or purposeful intrusions. Here are some tips:
- The editor, working in concert with the publisher and the Editorial Review Board/peer reviewers, must establish policies that clearly delineate acceptable usage of e-mail for electronic journals. The editor should ensure that these policies are online and easily accessible by all interested authors and readers. A written disciplinary action plan that addresses breaches in security related to privacy and confidentiality should be part of the preceding established policies and also should be placed online.
- E-mail should be viewed as a record, better yet, a permanent record. Although you may delete an e-mail message, remember that it can be reconstructed by other persons. Therefore, editors, peer reviewers, and authors should be professional in their correspondence with one another. In addition, care should be taken whenever names other than the sender and the receiver are involved. In highly sensitive matters (e.g., an author's work has been plagiarized and the plagiarist's name is known), encryption can be used. If that mechanism is not available, use a pseudonym. The editor can then keep the plagiarist's real name in a secure place to protect her/his privacy until and after due process is complete.
- Fraud and computer viruses are becoming a major problem with the use of e-mail and the Internet. It is not hard to imagine a computer "hacker" who causes havoc with an author's manuscript by introducing intentional errors or who changes a peer reviewer's rejection of a manuscript to an acceptance. Therefore, systems of security must be put into place to verify that whoever sends an e-mail message is indeed that person and not somebody else. Again, encryption can be used since it electronically identifies users, thus guarding against fraudulent e-mail messages that have the potential to do great harm to all persons involved with electronic journals. In addition, electronic signatures and "cyber notaries" are on the horizon to prevent unauthorized access to e-mail (Spielberg, 1998). More practical at present are the use of complex access codes to deter unauthorized e-mail use and the use of audit trails to scrutinize e-mail access (Styffe, 1997).
Access is related to the ethical principle of justice. Justice can be defined as fairness or as giving person(s), group(s), or society(ies) what is due or owed them. In keeping with this definition, what does access have to do with the ethics of electronic publishing? Everything! For any journal to be successful, it must have a loyal readership. For an electronic journal to be successful, it must not only have a loyal readership but also a readership that has the means by which to access the information. How is the publication disseminated? Is the journal a dual publication (i.e. print and journal)? Is the publication free? Is registration required if the journal is free? Is the journal subscription based? Is the journal a benefit open only to members? (See Jones & Cook, 2000 for a review of electronic journals).
Immediately, the ethics of justice manifests itself. The first question to answer is who has access? Not every person or nurse has a computer or access to one. Although this problem may not be a major one for professional nurses in the United States, it is a problem for consumers of health care knowledge who are poor in the United States and for virtually all third-world countries. According to Mandl, Kohane, and Brandt (1998), inequitable access to new technologies causes social disparities. It also causes "immediate access" knowledge disparities. (See Ludwick & Glazer, 2000 for a review of access to computers, www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume52000/No1Jan00/ElectronicPublishing.aspx and Budd, 2000 for a review of free access to scholarly information, www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume52000/No1Jan00/EconomicsofElectronicJournals.aspx).
The preceding inequities are ones that presently are inherent in electronic journals. Since both health care providers and consumers can benefit from access to new technologies, editors and publishers of electronic journals must reflect on this issue. Given that an electronic journal has a potential worldwide audience, careful records should be kept about who the online users are and who the journal editor wants them to be. Efforts can then be made to target offerings to underserved areas through more traditional methods of dissemination until access becomes more egalitarian. This is a lofty goal, but justice demands it.
In summary, three critical areas related to the ethics of electronic publishing have been addressed: quality, security, and access. While we introduced this column with questions for authors to consider, it is apparent that not only authors but also editors or publishers who are considering the start-up of a new electronic journal should consider both the logistics and the ethics involved. (See West, 2000 for a review of how to develop an online publication, www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume52000/No1Jan00/DosandDontsinEstablishingElectronicJournal.aspx). Lastly, readers too must consider ethical questions as they reflect on the materials they read and use in their professional work. For in the final analysis, attention to ethics is the best quality control measure we have.
Ruth Ludwick, PhD, RN, C
Mary Cipriano Silva, PhD, RN, FAAN
Related issue: Electronic Publishing
Spielberg, A. R. (1998). On call and online: Sociohistorical, legal, and ethical implications of e-mail for the patient-physician relationship. JAMA: The Journal of the American Medical Association, 280, 1353-1359.