Telemedicine practice: Review of the current ethical and legal challenges
Open accessAbstract
Background: Telemedicine involves medical practice and information and communications technology. It has been proven to be very effective for remote health care, especially in areas with poor provision of health facilities. However, implementation of these technologies is often hampered by various issues. Among these, ethical and legal concerns are some of the more complex and diverse ones. In this study, an analysis of scientific literature was carried out to identify the ethical and legal challenges of telemedicine. Materials and Methods: English literature, published between 2010 and 2019, was searched on PubMed, Scopus, and Web of Science by using keywords, including “Telemedicine,” “Ethics,” “Malpractice,” “Telemedicine and Ethics,” “Telemedicine and Informed consent,” and “telemedicine and malpractice.” Different types of articles were analyzed, including research articles, review articles, and qualitative studies. The abstracts were evaluated according to the selection criteria, using the Newcastle–Ottawa Scale criteria, and the final analysis led to the inclusion of 22 articles. Discussion: From the aforementioned sample, we analyzed elements that may be indicative of the efficacy of telemedicine in an adequate time frame. Ethical aspects such as informed consent, protection data, confidentiality, physician's malpractice, and liability and telemedicine regulations were considered. Conclusions: Our objective was to highlight the current status and identify what still needs to be implemented in telemedicine with respect to ethical and legal standards. Gaps emerged between current legislation, legislators, service providers, different medical services, and most importantly patient interaction with his/her data and the use of that data.
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Many countries were unprepared for teletherapy due to lacking legal frameworks, lacking prior approval, and lacking clarity concerning cost coverage or reimbursement.
“Although teletherapy generally seems to be beneficial (35, 36), many countries were unprepared for it due to lacking legal frameworks, lacking prior approval on the conductance of teletherapy by legal authorities and professional organizations, and lacking clarity concerning cost coverage or reimbursement (22).”
From Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study (2022) · cites this paper as [22]
The Conclusions say telemedicine legislation is lacking or absent in many cases, and the Summary of Article Pool reports gaps in insurance coverage and reimbursement guidance. These findings concern telemedicine broadly rather than teletherapy specifically. The cited paper does not establish that many countries lacked prior approval for teletherapy from legal authorities or professional organizations. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA review of 2010-2020 literature indicated that a twelve-year-old observation still held: current measures often ignore ethical issues concerning professional conduct and relationships, patient autonomy and safety, cultural diversity, and human values.
“However, this review indicated that a twelve year old observation still held: “Current measures often ignore ethical issues linked to professional conduct and relationships, protection of patient autonomy, patient safety, cultural diversity, and the human value system [42].””
From REVISITING HEALTH INFORMATION TECHNOLOGY ETHICAL, LEGAL, and SOCIAL ISSUES and EVALUATION: TELEHEALTH/TELEMEDICINE and COVID-19 (2020) · cites this paper as [42]
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- Authors
- Nittari, G., Khuman, R., Baldoni, S., Pallotta, G., Battineni, G., Sirignano, A., Amenta, F., & Ricci, G.
- Affiliations
- Università di Camerino (IT)
- Corresponding author
- Nittari, Giulio
- ORCID
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2020-12
- Volume
- 26
- Issue
- 12
- Pages
- 1427-1437
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- PMC
- PMC7757597
- OpenAlex
- W3006523342
- Cited by
- 471
- References
- 38
- Citations by year
- 2026: 34 · 2025: 80 · 2024: 87 · 2023: 83 · 2022: 90 · 2021: 62 · 2020: 34
- FWCI
- 50.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Telemedicine Journal and e-Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Unicam Scientific Publications (University of Camerino) (submittedVersion, other-oa)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Medical and Health Sciences Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- telemedicine, medical ethics, legal challenges, malpractice, informed consent, patient data confidentiality, data protection, physician liability, telemedicine regulation, remote care
- MeSH terms
- Information Technology, Confidentiality, Female, Humans, Informed Consent, Male, Malpractice, Telemedicine
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