Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic.

Renata Solimini,Filippo Gibelli,Ascanio Sirignano,Giovanna Ricci,Francesco Paolo Busardò

doi:10.3390/medicina57121314

Abstract

Background and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. Nevertheless, at present, several ethical and legal issues related to the practice of these services still remain unsolved and need adequate regulation. This narrative review will give a synthesis of the main ethical and legal issues of telemedicine practice during the COVID-19 pandemic. Material and Methods: A literature search was performed on PubMed using MeSH terms: Telemedicine (which includes Mobile Health or Health, Mobile, mHealth, Telehealth, and eHealth), Ethics, Legislation/Jurisprudence, and COVID-19. These terms were combined into a search string to better identify relevant articles published in the English language from March 2019 to September 2021. Results: Overall, 24 out of the initial 85 articles were considered eligible for this review. Legal and ethical issues concerned important aspects such as: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional–patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%). Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality. At present, telemedicine services could be only used as complementary or supplementary tools to the traditional healthcare services. Some indications for medical providers are suggested.

Highlights

In the 1970s, the term “telemedicine” was coined with the meaning of “healing at distance”, i.e., using Information and Communication Technologies (ICT) to improve patient outcomes by increasing access to care and medical information [1]
The following medical fields, clinical routines, or non-urgent care types included in telemedicine/telehealth services emerged: Dermatology, Psychoanalysis and Psychotherapy, Pediatrics including perinatal and neonatal care, Nursing, Radiology, Neurology, Gynecology, Cardiology, Ophthalmology, Otorhinolaryngology, Orthopaedic and Musculoskeletal care, Nephrology, Endocrinology, Sports medicine, Chronic illnesses, COVID-19 care, and Follow-up care
This large list indicated that the application of telemedicine increased with respect to the number of medical fields during the COVID-19 pandemic, due to the risk of contagion and the consequent reduction in face-to-face contacts between patients and physicians

Summary

Introduction

In the 1970s, the term “telemedicine” was coined with the meaning of “healing at distance”, i.e., using Information and Communication Technologies (ICT) to improve patient outcomes by increasing access to care and medical information [1]. According to the World Medical Association Statement on the Ethics of Telemedicine, “Face-to-face consultation between physician and patient remains the gold standard of clinical care” [4], in recent years, telemedicine has been increasingly practiced It provides several benefits, the most important of which include simplified access to health facilities and a reduction in the distance between patient and doctor, especially in geographical areas where the medical services are difficult to reach or in the case of seafarers, who are remote individuals [5]. Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality.

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Results

Discussion

Conclusion