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Ethical Challenges of Telemedicine and Telehealth

  • BONNIE KAPLAN and SERGIO LITEWKA
Extract

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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1 Wyatt JC, Sullivan F. Ehealth and the future: Promise or peril? British Medical Journal 2005;331:1391–3.

2 Eysenbach G. What is e-health? Journal of Medical Internet Research 2001;3(2):c20.

3 McCubbin CN. Legal and ethico-legal issues in e-healthcare research projects in the UK. Social Science and Medicine 2006;62:2768–73.

4 Bauer KA. Home-based telemedicine: A survey of ethical issues. Cambridge Quarterly of Health Care Ethics 2001;10:137–46; Layman E. Health informatics: Ethical issues. Health Care Manager 2003;22(1):2–15.

5 Nykänen P. E-health systems: Their use and visions for the future. In: Spil TAM, Schuring RW, eds. E-Health Systems Diffusion and Use: The Innovation, the User and Use IT Model. Hershey, PA: Idea Group Publishing; 2006:281–93.

6 Kaplan B, Brennan PF. Consumer informatics supporting patients as co-producers of quality. Journal of the American Medical Informatics Association 2001;8(4):309–16.

7 Bernhardt JM. Health education and the digital divide: Building bridges and filling chasms. Health Education Research 2000;15(5):528-31; see note 1, Wyatt 2005.

8 See note 4, Bauer 2001.

9 Whitten PS, Mair FS, Haycox A, May CR, Williams TL, Hellmich S. Systematic review of cost effectiveness studies of telemedicine intervention. British Medical Journal 2002;324:1434–37; see note 1, Wyatt, Sullivan 2005.

10 See note 5, Nykänen 2006.

11 See note 3, McCubbin 2006; see note 2, Eysenbach 2001.

12 See note 7, Bernhardt 2000.

13 Cornford T, Klecun-Dabrowska E. Ethical perspectives in evaluation of telehealth. Cambridge Quarterly of Health Care Ethics 2001;10:161–9; Kaplan B, Shaw NT. People, organizational, and social issues: Future directions in evaluation research. Methods of Information in Medicine 2004;43(3–4):215–31; Lehoux P. Introduction: Is chronic illness solved through health technology, or is it one of its consequences? Chronic Illness 2008 (in press).

14 Iserson KV. Telemedicine: A proposal for an ethical code. Cambridge Quarterly of Healthcare Ethics 2000;9:404–6.

15 See note 4, Bauer 2001.

16 See note 4, Layman 2006.

17 See note 4, Bauer 2001; see note 6, Kaplan, Brennan 2001; see note 5, Nykänen, 2006; Goodman KW. Bioethics and health informatics: An introduction. In: Goodman KW, ed. Ethics, Computing, and Medicine: Informatics and the Transformation of Health Care. Cambridge: Cambridge University Press; 1998:1–31; Anderson JG, Goodman KW, eds. Ethics and Information Technology: A Case-Based Approach to a Health Care System in Transition. New York: Springer; 2002.

18 Hensel BK, Demiris G, Courtney KL. Defining obtrusiveness in home telehealth technologies: A conceptual framework. Journal of the American Medical Informatics Association 2006;13(4):428–31.

18a See note 13, Lehoux (in press).

19 See note 2, Eysenbach 2001:c20.

20 Preller SA. Desafios eticos planteados por la ciencia, la tecnica y la innovacion: Una mirada desde la ciencia. In: Stepke FL, ed. Ética E Innovación Tecnológica. N.p.: Centro Interdisciplinario de Estudios en Bioética, Universidad de Chile; 2006:84.

21 See note 13, Lehoux in press; Palen L, Aaløkke S. Of pill boxes and piano benches: “Home-made” methods of managing medication. In: Proceedings of the 2006 20th Anniversary Conference on Computer Supported Cooperative Work, 4–8 November 2006, Banff, Alberta, Canada. New York: ACM Press; 2006:79–886.

22 Grasso D, Martinelli D. Holistic engineering. The Chronicle Review: The Chronicle of Higher Education, Section B 2007;Mar 16:B8–B9.

23 Kaplan B, Farzanfar R, Friedman RH. Personal relationships with an intelligent interactive telephone health behavior advisor system: A multimethod study using surveys and ethnographic interviews. International Journal of Medical Informatics 2003;71(1):33–41.

24 See note 17, Goodman 1998; see note 13, Cornford, Klecun-Dabrowska 2001; see note 6, Kaplan, Brennan 2001; see note 13, Kaplan, Shaw 2004; May C. Mobilising modern facts: Health technology assessment and the politics of evidence. Sociology of Health and Illness 2006;28(5):513–32; Banta D. The development of health technology assessment. Health Policy 2003;63(2):121–32; Leys M. Health care policy: Qualitative evidence and health technology assessment. Health Policy 2003;65(3):217–26.

25 See note 13, Cornford, Klecun-Dabrowska 2001; see note 13, Kaplan, Shaw 2004.

26 Kaplan B. Objectification and negotiation in interpreting clinical images: Implications for computer-based patient records. Artificial Intelligence in Medicine 1995;280:439–54; Kaplan B, Elkin PL, Gorman P, Koppel R, Sites F, Talmon J. Virtual patients: Virtuality and virtualization in health care. In: Crowston K, Sieber S, Wynn E, eds. Virtuality and Virtualization. Boston: Springer; 2007:397–401.

27 Nicolini D. The work to make telemedicine work: A social and articulative view. Social Science and Medicine 2006;62:2754–67.

28 Anderson JG, Aydin CE. Evaluating medical information systems: Social contexts and ethical challenges. In: Goodman KW, ed. Ethics, Computing, and Medicine: Informatics and the Transformation of Health Care. Cambridge: Cambridge University Press; 1998:57–74; see note 4, Bauer 2001; see note 13, Cornford, Klecun-Dabrowska 2001; Lehoux P, Blume S. Technology assessment and the sociopolitics of health technologies. Journal of Health Politics, Policy, and Law 2000;25(6):1083–120.

29 See note 13, Kaplan, Shaw 2004.

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

31 Lolas SF. Bioetica y Medicina: Aspectos de Una Relacion. N.p.: Biblioteca Latinoamericana Editores; 2002.

32 Demiris G, Oliver DP, Courtney KL. Ethical considerations for the utilization of telehealth technologies in home and hospice care by the nursing profession. Nursing Administration Quarterly 2006;30(1):56–66.

33 See note 4, Bauer 2001.

34 See note 23, Kaplan et al. 2003.

35 Berdichevsky D, Neunschwander E. Toward an ethics of persuasive technology. Communications of the ACM 1999;42(5):51–59.

36 Resnick DB. Patient access to medical information in the computer age: Ethical concerns and issues. Cambridge Quarterly of Health Care Ethics 2001;10:147–56.

37 Lolas SF. Escritos Sobre Vejez, Envejecimiento y Muerte. N.p.: Universidad Arturo Prat; 2000; Del Aguila M, Cox L, Lee L. Functional interdependence. Australasian Journal on Aging 2006;25(3):134–9.

38 White AM, Groves MA. Interdependence and the aged stereotype. Australian Journal on Ageing 1997;16:83–9.

39 See note 13, Lehoux in press.

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

41 DiMaggio P, Hargittai E, Celeste C, Shafer S. From unequal access to differentiated use: A literature review and agenda for research on digital inequality. In: Neckerman K, ed. Social Inequality. New York: Russell Sage Foundation; 2004:355–400; Seale C, Ziebland S, Charteris-Black J. Gender, cancer experience and Internet use: A comparative keyword analysis of interviews and on-line cancer support groups. Social Science and Medicine 2006;62:2577–90.

42 Reeves B, Nass C. The Media Equation: How People Treat Computers, Television, and New Media Like Real People and Places. Cambridge: Cambridge University Press; 1996; Nass C, Brave S. Wired for Speech: How Voice Activates and Advances the Human-Computer Relationship. Cambridge, MA: MIT Press; 2005.

43 Weizenbaum J. Computer Power and Human Reason: From Judgment to Calculation. San Francisco, CA: W.H. Freeman and Company; 1976.

44 Shneiderman B. Designing trust into online experiences. Communications of the ACM 2000;43(12):57–9; Parasuraman R, Miller CA. Trust and etiquette in high-criticality automated systems. Communications of the ACM 2004;47(4):51–5.

45 Picard RW. Affective Computing. Cambridge, MA: MIT Press; 1997; Breazeal CL. Designing Sociable Robots. Cambridge, MA: MIT Press; 2002.

46 Turkle S. Authenticity in the age of digital companions. Interaction Studies 2007;8(3):501–17.

47 Cook DJ. Providing for older adults using smart environment technologies. IEEE USA's-Today Engineer On-Line, 05.07, available at http:/www.todaysengineery.org/2007/May/smart_homes.asp (accessed 27 May 2008).

48 Intel. Proactive health; available at http://www.Intel.Com/Research/Prohealth/ (accessed 18 Mar 2007).

50 See note 4, Bauer 2001; see note 13, Cornford, Klecun-Dabrowska 2001; see note 32, Demiris et al. 2006.

51 Brin D. The Transparent Society: Will Technology Force Us to Choose between Privacy and Freedom? Reading, MA: Perseus Books; 1998.

52 See note 36, Resnick 2001; Iserson KV. Commentary: The (partially) educated patient: A new paradigm? Cambridge Quarterly of Health Care Ethics 2001.

53 See note 27, Nicolini 2006; Radin P. “To me its my life”: Medical communication, trust, and activism in cyberspace. Social Science and Medicine 2006;62:591–601.

54 Shortliffe EH. Dehumanization of patient care—Are computers the problem or the solution? Journal of the American Medical Informatics Association 1994;1:76–8.

54a See note 31, Lolas 2002; see note 37, Lolas 2002.

55 Zuboff S. In the Age of the Smart Machine: The Future of Work and Power. New York: Basic Books; 1984.

56 See note 4, Bauer 2001; see note 27, Nicolini 2006.

57 See note 32, Demiris et al. 2006.

58 Qavi T, Corley L, Kay S. Nursing staff requirements for telemedicine in the neonatal intensive care unit. Journal of End User Computing 2001;13(3):5–13; May C, Ellis NT. When protocols fail: Technical evaluation, biomedical knowledge and the social production of ‘facts’ about a telemedicine clinic. Social Science and Medicine 2001;53(8):989–1002; Lehoux P, Sicotte C, Denis JL, Berg M, Lacroix A. The theory of use behind telemedicine: How compatible with physicians' clinical routines? Social Science and Medicine 2002;54(6):889–904.

59 Turner JW. Telemedicine: Generating the virtual office visit. In: Eder LB, ed. Managing Healthcare Information Systems with Web-Enabled Technologies. Hershey, PA and London: Idea Group Publishing; 2000:59–68; Balas EA, Jaffrey F, Kuperman GJ, Boren SA, Brown GD, Pinciroli F, et al. Electronic communication with patients. Evaluation of distance medicine technology. Journal of the American Medical Informatics Association 1997;278(2):152–9; Finkelstein J, Cabrera MR, Hripcsak G. Internet-based home asthma telemonitoring: Can patients handle the technology? Chest 2000;117(1):148–55.

60 Sandelowski M. Visible humans, vanishing bodies, and virtual nursing: Complications of life, presence, place, and identity. Advances in Nursing Science 2002;24(3):58–70; See note 26, Kaplan et al. 2007.

61 Kaplan B, Lundsgaarde HP. Toward an evaluation of a clinical imaging system: Identifying benefits. Methods of Information in Medicine 1996:221–9.

62 See note 4, Layman 2003.

63 See note 13, Cornford, Klecun-Dabrowska 2001; May C, Finch T, Mair FS, Mort M. Towards the wireless patient: Chronic illness, scarce care, and technological innovation in the NHS. Social Science and Medicine 2005;61(7):1485–94.

64 Cameron D. Good to Talk. London, Thousand Oaks, New Delhi: Sage; 2000.

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. http://www.medicalnewstoday.com/articles/44592.php (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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