Telemonitoring: ethical lessons from the COVID-19 pandemic

Abstract

BackgroundThe COVID-19 pandemic accelerated the development and application of telemonitoring, enabling health care providers to continue to provide medical care. Telemonitoring oftentimes replaced face-to-face health care services instead of as being offered as a supplement to regular medical care. Given that pressure on hospitals is expected to remain, telemonitoring is seen as an important means of alleviating those pressures. In this paper, we consider the intensified deployment of telemonitoring during the pandemic as an excellent opportunity to learn how telemonitoring can be implemented in a morally responsible way.ResultsIn order to gain concrete, contextual and in-depth knowledge of the ethical issues raised by telemonitoring during the corona pandemic, we explore telemonitoring for two conditions: COVID-19 and Idiopathic pulmonary fibrosis. We conducted interviews with patients and professionals on five important ethical themes: 1. a shift in responsibilities, 2. empowerment and self-management, 3. the value of face-to-face consultations, 4. inclusivity and equal access, and 5. privacy and big data. Based on the findings of this empirical study and medical ethical principles, we formulate lessons for responsible implementation and upscaling: 1. ensure explicit and realistic allocation of responsibilities and avoid expectations that monitoring is more direct and continuous than it actually is; 2. create opportunities for an optimal form of self-management—in particular for patients with chronic conditions—and for meaningful conversations; 3. integrate telemonitoring within an established HCP – patient trust relation and stimulate research on the conditions for face-to-face consultations; 4. take vulnerability into account in inclusion & exclusion criteria and involve patients in design and implementation processes; 5. concerns of collection of data are beyond privacy and identify the risks of dependency on commercial companies.ConclusionsOur findings show that offering patients choices for telemonitoring will not necessarily result in increased and equal accessibility, good quality of care and patient autonomy. Whether or not these aims and promises will be fulfilled, and the ethical challenges adequately met, is highly dependent on choices regarding the design of specific monitoring systems, the development process and the embeddedness in a trusting physician–patient relationship.