Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic.
Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic.
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DOI：
10.3390/medicina57121314
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发表时间：
2021-11-30
期刊：
影响因子：
--
通讯作者：
Ricci G
中科院分区：
文献类型：
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作者：
Solimini R;Busardò FP;Gibelli F;Sirignano A;Ricci G
背景与目的：近年来，远程医疗或远程健康服务得到越来越多的实践。在COVID-19疫情期间，远程医疗成为避免医护人员与患者之间传染的不可或缺的服务，涉及越来越多的医学学科。然而，目前，与这些服务的做法有关的若干道德和法律的问题仍然没有解决，需要适当的管制。这篇叙述性综述将对COVID-19大流行期间远程医疗实践的主要伦理和法律的问题进行综合。材料和方法：使用MeSH术语在PubMed上进行了文献检索：远程医疗（包括移动的健康或健康、移动的、mHealth、Telehealth和eHealth）、伦理学、立法/法理学和COVID-19。将这些检索词合并为检索字符串，以更好地识别2019年3月至2021年9月期间以英语发表的相关文章。结果：总体而言，在最初的85篇文章中，有24篇被认为符合本次综述的条件。法律的和道德问题涉及以下重要方面：知情同意（关于远程治疗的风险和益处的信息）和自主权（87%），患者隐私（78%）和保密性（57%），数据保护和安全性（74%），医疗事故和专业责任/诚信（70%），公平访问（30%），护理质量（30%），医患关系（22%）和慈善原则或倾向于为他人利益行事（13%）。结论：与远程保健或远程医疗服务实践有关的道德和法律的问题仍然需要标准和具体的适用规则，以保证公平获得、护理质量、可持续成本、专业责任、尊重病人隐私、数据保护和保密。目前，远程医疗服务只能作为传统医疗服务的补充或补充工具。建议医疗提供者的一些适应症。
Background and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. Nevertheless, at present, several ethical and legal issues related to the practice of these services still remain unsolved and need adequate regulation. This narrative review will give a synthesis of the main ethical and legal issues of telemedicine practice during the COVID-19 pandemic. Material and Methods: A literature search was performed on PubMed using MeSH terms: Telemedicine (which includes Mobile Health or Health, Mobile, mHealth, Telehealth, and eHealth), Ethics, Legislation/Jurisprudence, and COVID-19. These terms were combined into a search string to better identify relevant articles published in the English language from March 2019 to September 2021. Results: Overall, 24 out of the initial 85 articles were considered eligible for this review. Legal and ethical issues concerned important aspects such as: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional–patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%). Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality. At present, telemedicine services could be only used as complementary or supplementary tools to the traditional healthcare services. Some indications for medical providers are suggested.