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A new ethical guidance from the American Medical Association focuses on how the physician’s fundamental responsibilities play out differently with the use of telemedicine. Some considerations include the following:
A patient asks her physician, whom she’s never seen previously, a particularly sensitive medical question. How does this interaction differ if the patient is at home, viewing the doctor’s response on a computer screen?
“Telemedicine services can change communication and power relationships between clinicians, between patients and clinicians, and between family members,” says Bonnie Kaplan, PhD, FACMI, Yale Interdisciplinary Bioethics Center Scholar and faculty in the Yale Center for Medical Informatics at the School of Medicine at Yale University in New Haven, CT.1
A telemedicine physician may never meet the patient or others involved in caring for that person. “So physicians may not get to know the patient’s situation, and that can affect care,” Kaplan says.
New ethical guidance from the American Medical Association (AMA) aims to help physicians understand how their fundamental responsibilities may play out differently when patient interactions occur through telemedicine instead of in-person.2
BJ Crigger, PhD, the AMA’s director of ethics policy and secretary for the AMA’s Council on Ethical and Judicial Affairs (CEJA), explains, “As the public becomes increasingly fluent in utilizing novel technologies in all aspects of daily life, evolving applications in healthcare are altering the contours of when, where, and how patients and physicians engage with one another.”
Crigger describes the practice of medicine as “inherently a moral activity.” This is founded in a covenant of trust between patient and physician. “No matter what the model for care, physicians’ fundamental ethical responsibilities do not change,” she says.
The ability to maintain privacy and confidentiality is one oft-cited ethical concern with telemedicine. “Others ‘off-camera’ at the patient site and unknown to the physician may be able to hear or observe the interaction taking place,” says David A. Fleming, MD, MA, MACP, director of University of Missouri’s Center for Health Ethics in Columbia.
Fleming names the following three issues as other central ethical concerns:
Kaplan says that ethical policies for the use of telemedicine should include the following:
Fleming says that bioethicists can offer education for providers who will be using telehealth about its potential ethical pitfalls. Bioethicists can also make themselves available if questions arise during clinical encounters, or if there are questions about appropriate telehealth utilization.
“The ethics team can provide an invaluable service to systems that are establishing telehealth services,” says Fleming.
Consulting Editor Arthur R. Derse, MD, JD, Nurse Planner Susan Solverson BSN, RN, CMSRN, Managing Editor Jill Drachenberg, Associate Managing Editor Dana Spector, and Contributing Editor Stacey Kusterbeck report no consultant, stockholder, speakers’ bureau, research, or other financial relationships with companies having ties to this field of study.