Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-30T12:46:30.332Z Has data issue: false hasContentIssue false

9 - Ethical implications in the use of telehealth and teledermatology

Published online by Cambridge University Press:  29 September 2009

David A. Fleming
Affiliation:
MU Center for Health Ethics, University of Missouri, School of Medicine, Columbia, Missouri, USA
Hon S. Pak
Affiliation:
Brooke Army Medical Center, San Antonio, Texas
Karen E. Edison
Affiliation:
University of Missouri, Columbia
John D. Whited
Affiliation:
Duke University Medical Center, Durham
Get access

Summary

There's no going back. We are headed for a future where healthcare will be dominated by information and communication technologies, and like it or not we must learn how to adapt and use it skillfully and effectively for the good of our patients. In so many ways, healthcare is improved by technological innovations that allow us to effectively diagnose and treat illness and relieve suffering. However, as technology evolves and as the skills necessary to use that technology become increasingly difficult and selective to attain, so grows the risk that healthcare will become technology centric rather than patient centric.

Multiple forms of informational technology are rapidly being developed and deployed. Electronic medical records, telephone intervention and triage centers, email diagnosis and prescribing, transmission of medical images, remote monitoring, and videoconferencing are all inundating the healthcare field. For healthcare providers to remain focused on their primary goal, a studied and balanced approach must be taken that will allow the introduction of innovative interventions without losing sight of the patient as having unique needs, recognizing that there is potential for harm and abuse, and that “one size does not fit all” in the application of new forms of treatment and technology. Stanberry argues that telehealth presents us with unique and ethically appropriate opportunities for both the patient and the clinician when it is implemented in direct response to clear clinical needs, but warns against excessive reliance upon technology to the detriment of traditional provider-patient relationships and cautions against complacency regarding the risks and responsibilities that distant medical intervention, consultation, and diagnosis carry.

Type
Chapter
Information
Teledermatology
A User's Guide
, pp. 97 - 108
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Stanberry, B.Telemedicine: Barriers and opportunities in the 21st century, J Int Med 2000;247:615–28.CrossRefGoogle ScholarPubMed
Fleming, D.The ethical challenges of new technology. Eur J Med Res 2002;7(Suppl 1):25.Google Scholar
Comford, T, Klecun-Debrowska, E.Ethical perspectives in evaluation of telehealth. Camb Q Healthc Ethics 2001;10(2):161–9.CrossRefGoogle Scholar
Bauer, K.Home based telemedicine: A survey of ethical issues. Camb Q Healthc Ethics 2001;10(2):137–46.CrossRefGoogle ScholarPubMed
Bauer, K.The ethical and social dimensions of home-based telemedicine. Crit Rev Biomed Eng 2000;28(3 and 4):541–4.CrossRefGoogle ScholarPubMed
Ashley, R.Telemedicine: Legal, ethical and liability considerations. J Am Dietetic Assoc 2002;102(2):267–9.CrossRefGoogle ScholarPubMed
Grigsby, J, Sanders, J.Telemedicine: Where it is and where it's going. Ann Int Med 1998;129(2):123–7.CrossRefGoogle ScholarPubMed
Butler, D.Informed consent and patient videotaping. Acad Med 2002;77(2):184–91.CrossRefGoogle ScholarPubMed
Stanberry, B.The legal and ethical aspects of telemedicine. 3: Telemedicine and malpractice. J Telemed Telecare 1998;4(2):72–9.CrossRefGoogle ScholarPubMed
Irvine, R.Mediating telemedicine: Ethics at a distance. Int Med J 2005;35:56–8.CrossRefGoogle ScholarPubMed
Silverman, J.Would a virtual office visit cut long waits, paperwork? An end to true “medicine”?Fam Pract News 2003;33:53.Google Scholar
Evans H. “High tech vs high touch”: The impact of medical technology on patient care. In Clare, J, Allman, R (eds), Sociomedical perspectives on patient care. Lexington, Kentucky: University Press of Kentucky, 1993, pp. 83–95.Google Scholar
Finnish Medical Association. Ethical guidelines in telemedicine. 1997. www://laakarilitto.fi/e/ethics/telemed/html Last accessed on July 11, 2003.
Bredfeldt, R, Ripani, A, Cuddeback, G.The effect of touch on patients' estimates of time in the waiting and examination rooms. Fam Med 1987;19(4):299–302.Google ScholarPubMed
Fleming, D, Boren, S, Alber, S, et al. Internal medicine telehealth training and evaluation project (IMTTEP). Telemed eHealth 2006;12(2):210.Google Scholar
Miller, E.Telemedicine and doctor-patient communication: An analytical survey of the literature. J Telemed Telecare 2001;7:1–17.CrossRefGoogle ScholarPubMed
Demiris, G, Oliver, D, Fleming, D, Edison, K.Hospice staff attitudes towards telehospice. Am J Hospice Palliat Care. 2004;21(5):343–7.CrossRefGoogle ScholarPubMed
U.S. Bureau of Census. Income, poverty, and health insurance coverage in the United States: 2005. Current Population Reports Series P 60-231. Washington, DC: U.S. Printing Office, 2006.
Marmot, M.Inequalities in health care. NEJM 2001;345(2):134–6.CrossRefGoogle Scholar
Hart, LG, Salsberg, E, Phillips, DM, Lishner, DM.Rural health care providers in the United States. J Rural Health 2002;18 Suppl:211–32.CrossRefGoogle ScholarPubMed
Resneck, J.Too few or too many dermatologists?Arch Dermatol 2001;137:1293–301.CrossRefGoogle ScholarPubMed
Rosenthal, T, Fox, C.Access to health care for the rural elderly. JAMA 2000;284:2034–6.CrossRefGoogle ScholarPubMed
Fleming, D, Demiris, G, Edison, K.The value of Telehomecare for the frail elderly. Telemed E Health 2003;9 (Suppl 1):S-102.Google Scholar
U.S. Bureau of the Census. Decennial census of population, 1900–1980 and projections of populations of the United States: 1982–2050. Current Population Reports Series P-25, no. 922. Washington, DC: U.S. Bureau of the Census, 2006.
Hoover, D, Crystal, S, Kumar, , Sambamoorthi, U, and Cantor, J.Medical expenditures during the last year of life: Findings from the 1992–1996 Medicare Current Beneficiary Survey. Health Serv Res 2002;37(6):1625–42.CrossRefGoogle ScholarPubMed
Kosmadaki, M, Gilchrest, B.The demographics of aging the United States. Arch Dermatol 2002;138:1427–8.CrossRefGoogle ScholarPubMed
Beauregard, S, Gilchrest, B.A survey of skin problems and care regimens in the elderly. Arch Dermatol 1987;123(12):1638–43.CrossRefGoogle ScholarPubMed
Gabrel, C, Jones, A.The National Nursing Home Survey: 1995 summary. Vital Health Stat 13. 2000;146:1–83.Google Scholar
Zedlewski, SR, Barnes, RO, Burt, MK, McBride, TD, Meyer, J.The needs of the elderly in the 21st century. Washington, DC: The Urban Institute, 1989.Google Scholar
Doty PJ. The oldest old and the use of institutional long-term care from an international perspective. In Suzman, R, Willis, DP, Manton, KG (eds), The oldest old. New York: Oxford University Press, 1992, pp. 251–67.Google Scholar
Kemper, P, Murtaugh, CM.Lifetime use of nursing home care. NEJM 1991;324:595–600.CrossRefGoogle ScholarPubMed
Ersek, M, Wilson, S.The challenges and opportunities in providing end-of-life care in nursing homes. J Palliat Med 2003;6(1):45–57.CrossRefGoogle ScholarPubMed
65+ in the United States: 2005. U.S. Census Bureau Report. Issued December 2005.
Demiris, G, Edison, K, Sridhar, S, Patrick, T, Fleming, D.Human factors in implementing telemedicine programs: Part 2. Telemed eHealth 2004;10(Suppl 1):S-58.Google Scholar
Qureshi, A, Kvedar, J.Patient knowledge and attitude toward information technology and teledermatology: Some tentative findings. Telemed J E Health 2003;9(3):259–64.CrossRefGoogle ScholarPubMed
Buckley K, Tran B, Prandoni C. Receptiveness, use and acceptance of telehealth by caregivers of stroke patients in the home. Online J Issues Nurs 2004; 9(3). http://nursingworld.org/ojin/topic16/tpc16_6.htm
Whitten, P, Doolittle, G, Mackert, M.Telehospice in Michigan: Use and patient acceptance. Am J Hospice Palliat Med 2004;21(3):191–5.CrossRefGoogle ScholarPubMed
Rasool, A, Xue, L.Variations in the utilization of medical technology as influenced by socio-economic factors in the case of magnetic resonance imaging (MRI). Int J Healthc Tech Mgmt 2000;2(1–4):337–57.Google Scholar
Iserson, K.Telemedicine: A proposal for an ethical code. Camb Q Healthc Ethics 2000:9:404–6.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×