SoE-Oct2007
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Handbook of WMA Policies
World Medical Association ½ S-2007-02-2007
WMA STATEMENT
ON
THE ETHICS OF TELEMEDICINE
Adopted by the 58th
WMA General Assembly, Copenhagen, Denmark, October 2007
DEFINITION
Telemedicine is the practice of medicine over a distance, in which interventions, diagno-
stic and treatment decisions and recommendations are based on data, documents and other
information transmitted through telecommunication systems.
PREAMBLE
The development and implementation of information and communication technology are
creating new modalities for providing care for patients. These enabling tools offer dif-
ferent ways of practising medicine. The adoption of telemedicine is justified because of its
speed and its capacity to reach patients with limited access to medical assistance, in ad-
dition to its power to improve health care.
Physicians must respect the following ethical guidelines when practising telemedicine.
PRINCIPLES
Patient-physician relationship and confidentiality
The patient-physician relationship should be based on a personal encounter and sufficient
knowledge of the patient’s personal history. Telemedicine should be employed primarily
in situations in which a physician cannot be physically present within a safe and accepta-
ble time period.
The patient-physician relationship must be based on mutual trust and respect. It is there-
fore essential that the physician and patient be able to identify each other reliably when
telemedicine is employed.
Ideally, telemedicine should be employed only in cases in which a prior in-person relation-
ship exists between the patient and the physician involved in arranging or providing the
telemedicine service.
The physician must aim to ensure that patient confidentiality and data integrity are not
compromised. Data obtained during a telemedical consultation must be secured through
encryption and other security precautions must be taken to prevent access by unauthorized
persons.
S-2007-02-2007½ Copenhagen
Telemedicine
Responsibilities of the physician
A physician whose advice is sought through the use of telemedicine should keep a detailed
record of the advice he/she delivers as well as the information he/she received and on which
the advice was based.
It is the obligation of the physician to ensure that the patient and the health professionals
or family members caring for the patient are able to use the necessary telecommunication
system and necessary instruments. The physician must seek to ensure that the patient has
understood the advice and treatment suggestions given and that the continuity of care is
guaranteed.
The physician asking for another physician’s advice or second opinion remains responsible
for treatment and other decisions and recommendations given to the patient.
A physician should be aware of and respect the special difficulties and uncertainties that
may arise when he/she is in contact with the patient through means of tele-communication.
A physician must be prepared to recommend direct patient-doctor contact when he/she feels
that the situation calls for it.
Quality of care
Quality assessment measures must be used regularly to ensure the best possible diagnostic
and treatment practices in telemedicine.
The possibilities and weaknesses of telemedicine in emergencies must be acknowledged.
If it is necessary to use telemedicine in an emergency situation, the advice and treatment
suggestions are influenced by the level of threat to the patient and the know-how and ca-
pacity of the persons who are with the patient.
RECOMMENDATION
The WMA and National Medical Associations should encourage the development of na-
tional legislation and international agreements on subjects related to the practise of tele-
medicine, such as e-prescribing, physician registration, liability and the legal status of
electronic medical records.