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Ethical Challenges of Telemedicine and Telehealth



As healthcare institutions expand and vertically integrate, healthcare delivery is less constrained by geography, nationality, or even by institutional boundaries. As part of this trend, some aspects of the healthcare process are shifted from medical centers back into the home and communities. Telehealth applications intended for health promotion, social services, and other activities—for the healthy as well as for the ill—provide services outside clinical settings in homes, schools, libraries, and other governmental and community sites. Such developments include health information web sites, on-line support groups, automated telephone counseling, interactive health promotion programs, and electronic mail exchanges. Concomitant with these developments is the growth of consumer health informatics, in which individuals seeking medical care or information are able to find various health information resources that take advantage of new information technologies.



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12 See note 7, Bernhardt 2000.

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29 See note 13, Kaplan, Shaw 2004.

30 See note 13, Cornford, Klecun-Dabrowska 2001.

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34 See note 23, Kaplan et al. 2003.

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57 See note 32, Demiris et al. 2006.

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62 See note 4, Layman 2003.

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65 See note 4, Bauer.

66 See note 41, DiMaggio et al. 2004:72; see note 41, Seale et al. 2006.

67 See note 7, Bernhardt 2000.

68 See note 17, Goodman 1998; see note 4, Bauer; see note 13, Cornford, Klecun-Dabrowska 2001; see note 32, Demiris et al. 2006.

69 See note 28, Anderson, Aydin 1998; see note 13, Cornford, Klecun-Dabrowska 2001; see note 27, Nicolini 2006.

70 See note 53, Radin 2006.

71 See note 5, Nykänen 2006; see note 36, Resnick 2001.

72 See note 27, Nicolini 2006.

73 Braverman H. Labor and Monopoly Capital: The Degradation of Work in the Twentieth Century. New York: Monthly Review Press; 1974; Attewell P. The deskilling controversy. Work and Occupations 1987;14(3):323–46; see note 55, Zuboff 1984.

74 See note 27, Nicolini 2006.

75 Steinbrook R. Imposing personal responsibility for health. New England Journal of Medicine 2006;355(8):753–6; West Virginia Medicaid reform plan likely illegal, center of budget and policy priorities says. Medical News Today, 6 Jun 2006. (accessed 23 July 2007).

76 See note 17, Goodman 1998.

77 See note 4, Bauer; see note 13, Cornford, Klecun-Dabrowska 2001.

78 See note 13, Kaplan, Shaw 2004.

Bonnie Kaplan gratefully thanks the participants in discussions following her presentations of some of this material at the Kay-Claremont Graduate University Symposium on Pacific Edge E-Health Innovations, December 2006; University of Miami and VA Health care System Dialogues in Research Ethics, January 2007; and at the Conference on Education and Health Professionals in the New Millenium: Technological Advances, Multicultural Competence, Documented Outcomes and Evidence-Based Practice, in Celebration of the Tenth Anniversary of the College of Education and Health Professions, Sacred Heart University, March 2007.

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Cambridge Quarterly of Healthcare Ethics
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