JMIR Publications

ABSTRACT

Background:

We undertook a systemic literature review to provide a critical overview of existing research into the incorporation of ethical principles into telehealth practice. As the use of technology to deliver health services is increasing rapidly, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Our objective was to explore how, in providing telehealth services to patients, applying ethical principles can improve patient experience, clinical care and effectiveness in practice, compared to not doing so.

Objective:

Our objective was to explore how, in providing telehealth services to patients, applying ethical principles can improve patient experience, clinical care and effectiveness in practice, compared to not doing so.

Methods:

The framework for the principles of health ethics applied by the researchers is provided by Beauchamp and Childress: autonomy, justice, beneficence, non-maleficent and the professional-patient relationship. Six databases of systematic reviews were searched between March 2016 to May 2016. A combination of broad terms (“ethics, ethical, health and care”) with the restrictive terms of “telehealth and telemedicine” was used in keyword searches.

Results:

Of the 39 papers that identified or discussed ethical principles that were included at the analysis stage autonomy presented the highest risk (72%), followed by the professional-patient relationship (41%), non-maleficence (36%), beneficence (33%), and justice (33%).

Conclusions:

While a small number of studies identify ethical issues associated with telehealth practice and discussed their potential impact on service quality and effectiveness, there is limited research on how ethical principles are incorporated in clinical practice. Several studies proposed frameworks, codes of conduct, or guidelines, but there is little discussion or evidence of how these recommendations are being used to improve ethical telehealth practice.