Ethical Considerations in the Creation of Policy

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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.