|
New for November 2007:
Issue of the Month
November 2007- Ethics of Telemedicine
For several decades physicians have been using telecommunication
technologies to provide services to physician colleagues, other
health providers and patients, especially in remote areas where
normal health care services are not available. Telemedicine is
a general term that includes services such as the following:
- Transmission of patient data via the Internet, for example,
reports of symptoms and diagnostic data such as X-rays, and
monitoring of physiological functioning.
- Email exchange of consultation requests and responses; email
communication between physician and patient.
- Remote real-time examination of a patient in one location
by a physician in another.
- Remote real-time assistance in medical or surgical treatment
of a patient, when the treatment is being performed by a lesser-skilled
practitioner with the advice of a physician in another location.
- Remote robotic surgery.
Although telemedicine has become an essential tool for the practice
of medicine, it raises important ethical and legal issues. Notably,
by eliminating a common site and face-to-face consultation, telemedicine
challenges some of the traditional principles that govern the
patient-physician relationship. The need for specific ethical
guidelines for telemedicine has been widely recognized. These
guidelines should address the following topics:
- Responsibility for the patient - when practising telemedicine
directly with a patient, the physician assumes responsibility
for the patient. This includes diagnosis, advice, treatment
plans and direct medical interventions. The physician should
have both the qualifications and the authorization for the telemedicine
activity. Special attention is necessary when the telemedicine
activity crosses international or other jurisdictional borders.
- Informed consent - the physician must ensure that the patient
has consented to the intervention.
- Confidentiality - patient data must be transmitted and stored
securely in order to prevent access by unauthorized persons.
The WMA, National Medical Associations and other organizations
have developed guidelines and other resources dealing with the
ethics of telemedicine:
- The 2007 WMA General Assembly in Copenhagen adopted a Statement
on the Ethics of Telemedicine that includes a list of
principles governing the patient-physician relationship and
confidentiality, responsibilities of the physician, and quality
of care.
- The American Medical Association policy statement, The
Promotion of Quality Telemedicine, "emphasizes
to physicians their responsibility to ensure that their legal
and ethical requirements with respect to patient confidentiality
and data integrity are not compromised by the use of any particular
telemedicine modality."
- The Australian Medical Association statement, On-line
and other Broadband Connected Medical Consultations,
"does not support the provision of on-line consultations
between medical practitioners and patients where no established
relationship exists. The only exceptions should be where there
is no practical alternative available, for example, remote emergency
treatment of a previously healthy individual or where it provides
access to medical services in areas where such services would
otherwise be unavailable."
- According to the Finnish Medical Association statement, Ethical
Guidelines in Telemedicine, "The use of telemedicine
must not adversely affect the individual patient-doctor relationship
which, as in all fields of medicine, must be based on mutual
respect, the independence of judgement of the doctor, autonomy
of the patient and professional confidentiality…. Normal
rules of confidentiality and security also apply to telemedicine
documentations. Storing or transmission methods may be used
only where confidentiality and security can be guaranteed. Patient
data and other information may only be transmitted to a doctor
or other health professional on the request or with the informed
consent (permission) of the patient and to the extent approved
by him/her. The data transmitted must be relevant to the problem
in question."
- The International Society for Telemedicine & eHealth website
contains a section on Good
Practice Models, some of which deal with ethical issues.
- A Canadian National Initiative for Telehealth has developed
a Framework
of Guidelines that deal with ethical issues such as duty
of care, communication with patients/clients, standards of practice/quality
of clinical care, clinical outcomes, patient/client confidentiality
and informed consent. The framework includes a recommendation
that "Health professionals' bodies and organizations providing
telehealth services should review existing codes of ethics to
determine if they include telehealth specific ethical considerations."
|
