Considering the ethics of e-health: Telemedicine, telehealth and telesitting

By Andria Bianchi

Healthcare delivery is rapidly changing, and technological advances are diminishing barriers to receiving care.

Some current practices that respond to healthcare needs are telemedicine, telehealth, and telesitting. These practices are often defined under the umbrella term “e-health”, and they enable individuals to receive guidance, care, and attention, irrespective of a person’s geography or institutional boundaries.

Most of Canada’s population and healthcare organizations exist in urban cities, making it difficult for people from other parts of our country to access adequate healthcare services; this is especially the case when it comes to accessing specialized healthcare facilities, such as teaching and research institutions, hospitals focusing on cancer or paediatric care, etc. An inability to access care based on geographical constraints is an ethical problem from the perspective of access and equity.

Technological advances can help to address some of these inequities, and there have been several novel approaches to providing care in just the last few decades. Telemedicine is a type of medical practice where a clinician is at least one of the participants involved in an interaction via technology.[3] For instance, a clinic that offers pain and symptom management services over the telephone or computer would be classified as telemedicine. Telehealth is any platform offering health information and support that does not necessarily involve a clinician (e.g. facebook support groups for people diagnosed with certain illnesses, websites about healthcare treatments, etc.). Telesitting is when a patient is monitored through a virtual sitter system by a patient care technician—the technician can virtually observe patients through the system.

Technology in healthcare is constantly advancing, and there are many ethical benefits that justify the continued and increasing use of e-health. The primary benefit, which I alluded to above, is providing equitable access to care. Another benefit is that remote and home care services are typically less costly than in-person/in-hospital services; requiring patients and clinicians to travel for (potentially unnecessary) in-person care is costly for all parties involved. Any savings that result from providing care via technology could be allocated to other healthcare priorities, potentially resulting in a greater benefit for a larger number of people. Finally, technological healthcare services give patients more autonomy to take control of their health and receive timely support.

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In addition to examining these benefits, we must also consider some of the arising ethical vulnerabilities. One of these considerations is whether e-health services “promote rationality and efficiency at the expense of values traditionally at the heart of caregiving.” If building in-person relationships with clinicians in an intimate setting represents what healthcare should be like, then e-health poses a potential problem. Furthermore, most types of telemedicine prevent clinicians from gauging a person’s body language and facial expressions, which may be relevant to understanding a patient’s concerns, comprehension of information, etc. Also, while e-health services offer people the opportunity to access information and support from wherever they are located, it is possible that people from certain cultural communities may hold different perspectives about how healthcare services ought to be provided. Relatedly, information exchange may be challenging for people who speak a different primary language than their clinician. Giving people the opportunity to access care is important, but if the quality of care being offered is sporadic across populations, then this needs to be thoughtfully addressed.

The use of technology in healthcare can be a positive step forward to decreasing healthcare disparities across Canada. Providing equitable access to care through technology is compatible with patient-centred care and it may allow us to allocate resources in other beneficial ways. Upon implementing e-health services, however, we ought to ensure that we try to mitigate possible vulnerabilities. Offering services that maintain a high quality of care, consulting with relevant stakeholder groups, and taking different perspectives into account, will help to ensure that the benefits of e-health outweigh potential risks.

Andria Bianchi is a Bioethicist at the University Health Network, a PhD Candidate at the University of Waterloo, and a board member of the Canadian Bioethics Society.