Telemedicine Needs Ethical Guidelines

The Hastings Center Forum, October 26, 2016

2 Pages Posted: 13 Mar 2019

See all articles by Bonnie Kaplan

Bonnie Kaplan

Yale University; Yale University - Yale Information Society Project; Department of Biostatistics (Health Informatics); Yale Interdisciplinary Center for Bioethics; Yale Law School

Date Written: October 26, 2016

Abstract

Telemedicine is becoming more widespread. This is care at a distance, where patient and clinician are connected by information technology that may include video, audio, and monitoring equipment linked by computer. Telemedicine has many advantages. It can bring expert care and support to people in remote locations. It can help empower patients by giving them more independence and letting them stay where they are comfortable while still getting good care. It can lower health care costs while providing service that may be even better than what would be available in person. It is convenient – freeing both patient and clinician from in-person visits for routine follow-ups or simple cases in which the diagnosis and treatment are clear.

States are enacting legislation to regulate telemedicine and allow telemedicine encounters to be billed. Codes of ethics are being updated. In June, the AMA adopted new guidance for physicians in telemedicine encounters. It states that “while new technologies and new models of care will continue to emerge, physicians’ fundamental ethical responsibilities do not change.” Telemedicine is a new model of care in which physicians’ responsibilities may play out differently from traditional patient interactions at a medical office or hospital. Under these circumstances, Jack Resneck, an AMA board member, explained, “What matters is that physicians have access to the relevant information they need to make well-grounded recommendations for each patient.”

These measures are not enough. More attention to legal and ethical issues is needed. Aetna, Anthem, Cigna, and UnitedHealthcare have telemedicine services, raising questions about licensing when clinicians are not licensed where the patients are located, and about the fiduciary relationship between clinicians and patients. Telemedicine services that cross national boundaries further complicate these issues. Court cases are establishing legal precedents. For example, Teledoc v. Texas Medical Board is an antitrust case that concerns the Texas Medical Board’s stipulation that physicians have a “proper professional relationship” that includes a face-to-face examination of a patient before prescribing “dangerous” drugs.

To address these ethical responsibilities, hospital, clinics, and insurers should develop policies for telemedicine that reflect the ethical guidance of organizations such as the AMA, the American and International Medical Informatics Associations, and the American Telemedicine Association. Policies should entail a variety of additional considerations.

Suggested Citation

Kaplan, Bonnie, Telemedicine Needs Ethical Guidelines (October 26, 2016). The Hastings Center Forum, October 26, 2016, Available at SSRN: https://ssrn.com/abstract=3338907

Bonnie Kaplan (Contact Author)

Yale University ( email )

New Haven, CT CT 06520
United States

HOME PAGE: http://https://medicine.yale.edu/profile/bonnie-kaplan/

Yale University - Yale Information Society Project ( email )

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Department of Biostatistics (Health Informatics) ( email )

Yale School of Public Health
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Yale Interdisciplinary Center for Bioethics ( email )

238 Prospect Street
New Haven, CT 06515
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Yale Law School ( email )

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New Haven, CT 06510
United States

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