Ethics, Guidelines, Standards, and Policy: Telemedicine, COVID-19, and Broadening the Ethical Scope
Open accessAbstract
The coronavirus crisis is causing considerable disruption and anguish. However, the COVID-19 pandemic and consequent explosion of telehealth services also provide an unparalleled opportunity to consider ethical, legal, and social issues (ELSI) beyond immediate needs. Ethicists, informaticians, and others can learn from experience, and evaluate information technology practices and evidence on which to base policy and standards, identify significant values and issues, and revise ethical guidelines. This paper builds on professional organizations’ guidelines and ELSI scholarship to develop emerging concerns illuminated by current experience. Four ethical themes characterized previous literature: quality of care and the doctor–patient relationship, access, consent, and privacy. More attention is needed to these and to expanding the scope of ethical analysis to include health information technologies. An applied ethics approach to ELSI would addresses context-specific issues and the relationships between people and technologies, and facilitate effective and ethical institutionalization of telehealth and other health information technologies.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
For telemedicine to stay incorporated into routine care as responsibly and ethically as possible, this broader view of ELSI is necessary.
“For telemedicine to remain incorporated into routine care as responsibly and ethically as possible, this broader view of ELSI is necessary [49].”
From REVISITING HEALTH INFORMATION TECHNOLOGY ETHICAL, LEGAL, and SOCIAL ISSUES and EVALUATION: TELEHEALTH/TELEMEDICINE and COVID-19 (2020) · cites this paper as [49]
Combined into an applied ethics approach that examines practice, these would address context-specific issues along with the situations and relations that people and technologies co-create.
“These, combined into an applied ethics approach that examines practice would address context-specific issues together with the situations and relations people and technologies co-create [49,59].”
From REVISITING HEALTH INFORMATION TECHNOLOGY ETHICAL, LEGAL, and SOCIAL ISSUES and EVALUATION: TELEHEALTH/TELEMEDICINE and COVID-19 (2020) · cites this paper as [49]
Those questions also apply to evaluating other healthcare information technologies and to broadening the scope and understanding of ELSI.
“They also are applicable to evaluating other healthcare information technologies and for broadening the scope and understanding of ELSI [49].”
From REVISITING HEALTH INFORMATION TECHNOLOGY ETHICAL, LEGAL, and SOCIAL ISSUES and EVALUATION: TELEHEALTH/TELEMEDICINE and COVID-19 (2020) · cites this paper as [49]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19)
Smith, A. C., Thomas, E., Snoswell, C. L., Haydon, H., Mehrotra, A., Clemensen, J., & Caffery, L. J. (2020) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x20916567 · Cited by 1,828 · see citing works
Telemedicine practice: Review of the current ethical and legal challenges
Nittari, G., Khuman, R., Baldoni, S., Pallotta, G., Battineni, G., Sirignano, A., Amenta, F., & Ricci, G. (2020) · Telemedicine and e-Health · doi:10.1089/tmj.2019.0158 · Cited by 471 · see citing works
Ethical practice in telehealth and telemedicine
on behalf of the Council on Ethical and Judicial Affairs American Medical Association, Chaet, D., Clearfield, R., Sabin, J. E., & Skimming, K. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4082-2 · Cited by 323 · see citing works
Kaplan, B. (2020) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2020.104239 · Cited by 303 · see citing works
Self-citationDaniel, H., & Sulmasy, L. S. (2015) · Annals of Internal Medicine · doi:10.7326/m15-0498 · Cited by 202 · see citing works
Ethical challenges of telemedicine and telehealth
KAPLAN, B., & LITEWKA, S. (2008) · Cambridge Quarterly of Healthcare Ethics · doi:10.1017/s0963180108080535 · Cited by 167 · see citing works
Self-citationAdvancing health equity and access using telemedicine: A geospatial assessment
Khairat, S., Haithcoat, T., Liu, S., Zaman, T., Edson, B., Gianforcaro, R., & Shyu, C.-R. (2019) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocz108 · Cited by 165 · see citing works
Mort, M., Roberts, C., Pols, J., Domenech, M., Moser, I., & The EFORTT investigators (2015) · Health Expectations · doi:10.1111/hex.12109 · Cited by 130 · see citing works
Parimbelli, E., Bottalico, B., Losiouk, E., Tomasi, M., Santosuosso, A., Lanzola, G., Quaglini, S., & Bellazzi, R. (2018) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2018.01.012 · Cited by 110 · cited 1× · see citing works
“69,70,71 Such considerations were recognized as possibly impeding the expansion of telehealth services.”
BackgroundKluge, E.-H. W. (2011) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2010.10.002 · Cited by 90 · see citing works
Telecare, Surveillance, and the Welfare State
Sorell, T., & Draper, H. (2012) · The American Journal of Bioethics · doi:10.1080/15265161.2012.699137 · Cited by 76 · see citing works
Leaving patients to their own devices? Smart technology, safety and therapeutic relationships
Ho, A., & Quick, O. (2018) · BMC Medical Ethics · doi:10.1186/s12910-018-0255-8 · Cited by 74 · see citing works
Ethical Considerations Regarding the Use of Technology for Older Adults: The Case of Telehealth
Demiris, G., Doorenbos, A. Z., & Towle, C. (2009) · Research in Gerontological Nursing · doi:10.3928/19404921-20090401-02 · Cited by 57 · see citing works
Towards an ethics for telehealth
Botrugno, C. (2019) · Nursing Ethics · doi:10.1177/0969733017705004 · Cited by 45 · cited 1× · see citing works
“…impact, and “ situate the ethical analysis in real-world practices and specific contexts, ” 2 a call reminiscent of arguments for “ an ethics of telehealth, ” 3 and for applied ethics related to health information technologies, 4 points similarly made by medical informaticians working on ELSI.”
BackgroundInformation technologies in healthcare: Enhancing or dehumanising doctor–patient interaction?
Botrugno, C. (2019) · Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine · doi:10.1177/1363459319891213 · Cited by 45 · see citing works
Goodman, K. W. (2020) · Yearbook of Medical Informatics · doi:10.1055/s-0040-1701966 · Cited by 38 · see citing works
Kuziemsky, C. E., Hunter, I. M., Gogia, S. B., lyenger, S., Kulatunga, G. G., Rajput, V. K., Subbian, V., John, O., Kleber, A., Brieux, H. F. M., et al. (2020) · Yearbook of Medical Informatics · doi:10.1055/s-0040-1701976 · Cited by 35 · see citing works
Kaplan, B. (2020) · Journal of Law and the Biosciences · doi:10.1093/jlb/lsaa062 · Cited by 30 · see citing works
Self-citationFour Ethical Issues of “E-Health”
Kleinpeter, É. (2017) · IRBM · doi:10.1016/j.irbm.2017.07.006 · Cited by 26 · see citing works
Ethical aspects of eHealth - systematic review of open access articles
Miesperä, A., Ahonen, S., & Reponen, J. (2013) · Finnish Journal of eHealth and eWelfare · Cited by 11 · see citing works
Digital Medicine: An Opportunity to Revisit the Role of Bioethicists
Jongsma, K. R., Bredenoord, A. L., & Lucivero, F. (2018) · The American Journal of Bioethics · doi:10.1080/15265161.2018.1498952 · Cited by 11 · see citing works
Alzheimer’s and mHealth: Regulatory, Privacy and Ethical Considerations
Kaplan, B., & Ranchordás, S. (2019) · CRC Press eBooks · doi:10.1201/9781351032186-3 · Cited by 10 · see citing works
Self-citationLegal, Regulatory, and Ethical Issues in the Use of Telemedicine
Zubrow, M. T., Witzke, A. K., & Reynolds, H. N. (2015) · Springer eBooks · doi:10.1007/978-3-319-22285-1_10 · Cited by 7 · see citing works
Application of Ethics for Providing Telemedicine Services and Information Technology
Moghbeli, F., & Langarizadeh, M. (2017) · Acta Informatica Medica · doi:10.5455/aim.2017.25.208-212 · Cited by 6 · see citing works
Grebenshchikova (2019) · doi:10.21860/j.10.1.12 · Cited by 6 · see citing works
Big Data, HIPAA, and the Common Rule
Riley, M. F. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108147972.023 · Cited by 3 · see citing works
The Common Rule and Research with Data, Big and Small
Dawson, L. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108147972.022 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 8
- American Medical Association. Telehealth Implementation Playbook; 2020; available at https:// www.ama-assn.org/system/files/2020-04/ama-telehealth-playbook.pdf (last accessed 5 May 2020).
- Jack CL, Mars M. Telemedicine a need for ethical and legal guidelines in South Africa. South African Family Practice 2008;50(2):60a-d.
- American Medical Association Council on Medical Service. Established patient relationships and telemedicine: CMS Report 1-i-19; 2019; available at https://www.ama-assn.org/system/files/2019- 12/i19-cms-report1-patient-relations-telemedicine.pdf (last accessed 7 May 2020).
- American Medical Association. Code of medical ethics opinion 1.2.12; 2019; available at https:// www.ama-assn.org/delivering-care/ethics/ethical-practice-telemedicine (last accessed 5 May 2020).
- Mehta SJ. Telemedicine's potential ethical pitfalls. Virtual Mentor 2014;16(12):1014-7.
- Mars M, Jack C. Why is telemedicine a challenge to the regulators? South African Journal of Bioethics and Law 2010;3(2):55-8.
- Young JD, Borgetti SA, Clapham PJ. Telehealth: Exploring the ethical issues. DePaul Journal of Health Care Law Spring, 2017;19(3; Symposium):Article 2.
- Razon AKAR. The threatened erosion of privacy in healthcare and the search for a "cure:" Pursuing a legal framework for health information privacy in ehealth and telemedicine. Phillipine Law Journal 2017;90:768.
Cited by
Sorted by citations
Kaplan, B. (2020) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2020.104239 · Cited by 303 · see citing works
Self-citation
- Authors
- Kaplan, B.
- Affiliations
- Yale University (US)
- Corresponding author
- Kaplan, Bonnie
- Venue
- Cambridge Quarterly of Healthcare Ethics
- Publisher
- Cambridge University Press (CUP)
- Published
- 2022-01
- Volume
- 31
- Issue
- 1
- Pages
- 105-118
- ISSN
- 0963-1801 (ISSN-L)
- 1469-2147
- OpenAlex
- W4205354942
- Cited by
- 32
- References
- 27
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 11 · 2023: 4 · 2022: 6 · 2020: 1
- FWCI
- 6.19
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Cambridge Quarterly of Healthcare Ethics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- University of Cambridge
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Medical and Health Sciences Research
- Keywords
- telemedicine, COVID-19 pandemic, ethical, legal and social issues, health information technology, professional ethics guidelines, quality of care, physician-patient relationship, health care access, informed consent, privacy, applied ethics
- MeSH terms
- COVID-19, SARS-CoV-2, Humans, Physician-Patient Relations, Telemedicine, Policy, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
