Ethical Considerations in the Creation of Policy

ethics-v-complianceRetrieved from  

Public policy is a reflection of the government’s interests; however, the majority of resources for healthcare come from the private sector making for an interesting public-private intersection of opinions (4). Public policy has recently focused on reducing health and healthcare disparities (4). One of the most notable examples of acting on this goal is the Affordable Care Act’s call to increase access to care for all citizens (4). Telehealth has been praised as an opportunity to greatly expand access to care for those living in rural areas or unable to commute to a healthcare facility.

The Joint Commission and Centers for Medicare & Medicaid Services (CMS) have been major players in policy creation regarding the distribution and regulation of telehealth. They are a classic example of the public and private sector partnership creating ethically conscious, sustainable policy (3; 4).

Some argue that the technological advancements being made in an effort to increase access to care exclude the vital personal relationship between provider and patient. However, people who may otherwise not have access to care may be proponents of a virtual relationship with their provider over no relationship at all.

Redefining a patient-provider relationship.  Retrieved from 

Dr. Fleming (1) at the Center for Health Ethics at University of Missouri School of Medicine identifies some unique ethical concerns in telehealth to include privacy and confidentiality issues, depersonalization of healthcare (specifically with store and forward messaging), potential for exploitation, disproportionate distribution of services (i.e. the cost of telehealth may inhibit some from being able to access this type of care), and the potential burden that technology can place on the ill. Dr. Fleming also recommends focusing time and attention on the potential of virtual visits replacing face-to-face visits.

Similarly, the American Medical Association (AMA) urges policymakers to consider four possible pitfalls in making telemedicine ethical: “erosion of the patient-doctor relationship, threats to patient privacy, forcing one-size-fits-all implementations, and the temptation to assume that new technology must be effective” (5, p. 1014). Mehta acknowledges the common concern of privacy as more of an operational issue rather than ethical – something that requires close technological attention, but not a concern that should halt advancement. The primary ethical concern is understood to be that telemedicine (or many other healthcare technology innovations) can become a mindless checklist that assumes each patient fits into the same mold and has the same needs. The author cautions providers to approach telemedicine with the same foundation they have been trained to approach patients face-to-face — to maintain the same goals of best possible outcomes while promoting equity of care (5).

“It is important for the medical profession to…balance enthusiasm about telemedicine’s potential with acknowledgement of the need for clear-eyed evaluation.”  – Shivan J. Mehta (2014, p. 1015-1016)

It will be important for public and private sector policy makers to create new policy with these ethical considerations in mind while being conscientious not to allow the fear of change or the unknown to inhibit great expansion in access to healthcare. One such example would be the ethical concern of depersonalization of care, which was addressed with policy by requiring either a face-to-face visit or a live audio-video interaction prior to delivery of telemedicine services (2). This compromise/solution allowed for the ethical concern to be addressed by requiring a relationship be formed while still allowing for increased access to care.

References:

  1. Fleming, D.A. (n.d.) Telehealth: The ethical challenges of a new technology. Retrieved from http://ethics.missouri.edu/docs/Telehealth_Challenges.pdf

2. Healthit.gov. (2014). Telehealth: Start-up and resource guide, version 1.1. Retrieved from https://www.healthit.gov/sites/default/files/telehealthguide_final_0.pdf

3. Joint Commission Perspectives. (2012). Accepted: Final revisions to telemedicine standards. Retrieved from http://www.jointcommission.org/assets/1/6/Revisions_telemedicine_standards.pdf

4. Longest, B.B. Jr. (2016). Health policymaking in the United States (6th ed.). Chicago, IL: Health Administration Press.

5. Mehta, S.J. (2014). Telemedicine’s potential ethical pitfalls. American Medical Association Journal of Ethics, 16(12), 1014-1017.

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3 thoughts on “Ethical Considerations in the Creation of Policy

  1. Advancement of telehealth has exacerberated the threats of privacy intrusions, with possible damaging results for the quality of healthcare, relationships between provider to patient and the confidence of the patient for our health care system. Just by using technology, it is highly significant to recognize the intricate ethical, legal, and policy conflicts. This network contributes different kinds of services. The health care sector is facing conflicts such as the privacy and confidentiality of individual health information because of the advancement of technology. In addition, privacy issues such as video or audio recording, maintenance of recordings, and storage and transmission of images and other patient record data must be fully evaluated for telehealth applications. Telephone lines/ satellites are capable of violating privacy. The presence of technical staff aiding with the transmission procedure can be anticipated as a deficit of privacy made by patients. For example, when a videoconferencing session is occurring and the patient is unaccustomed to the technology and the equipment, misperceptions of violating privacy will develop1.
    Reference:
    1. Demiris, G., Doorenbos, A., & Towle, C. (2009). Ethical considerations regarding the use of technology for older adults: The case of telehealth. Research In Gerontological Nursing, 2(2), 128-136 9p. doi:10.3928/19404921-20090401-02

    Kala

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  2. The baby boomer generation is entering their senior years and has been referred to as the silver tsunami. This generation will need access to medical care as they age and live with chronic illness. Primary care providers are unable to meet the needs of patients with same day appointments and patients often take an ambulance to the emergency department because they could not get to their provider. Accessibility, affordability and availability are three things that telehealth could provide. Currently tele radiology is in practice and has shown to improve access, cost, efficiency and availability (Ashcroft & Goddard, 2014). It would be good to examine the success and failures of this program to determine if it can be modeled in other specialties. I have seen in the ER, physicians sending pictures of injuries to specialists for advice. This is a form of tele medicine that is already being used and not regulated. With policy and procedures in place we can ensure that patient safety and confidentiality are maintained. We will need to get creative in order to meet the needs of the aging population. Tele health is one aspect that should be examined. I look forward to learning more about the issues and policies surrounding this topic.
    References
    Ashcroft, R. E., & Goddard, P. R. (2014, May 29). Ethical issues in teleradiology. International Journal of Radiology, 73(870). http://dx.doi.org/http://dx.doi.org/10.1259/bjr.73.870.10911778

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  3. This topic is becoming more and more prevalent as we move into the future of medicine. While telehealth has the potential to reach a greater proportion of individuals, the ethical dilemmas may serve as a major barrier to the success of telehealth. The concept that I always consider in regards to telehealth is the possibility that those who would benefit most may also be those who are unable to afford it. Vulnerable populations such as elderly and those residing in rural areas, often do not have the means or ability to obtain or manage teleheath. The type of insurance coverage or lack of coverage can often influence the ability to afford and support these technological advents. This of course is another perspective that needs to be addressed by legislation and regulations. You brought up many great points regarding all of the ethical issues surrounding telehealth and it will be interesting to see how these dilemmas are addressed by policymakers as we move forward.

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