Page 24 - Part 2 Introduction to Telemedicine

SVMIC Introduction to Telemedicine

responsibilities in conventional medicine. Some authors suggest

managing and disclosing substantive financial conflicts of interest,
which, again, are duties that apply in all medical settings.

To the extent that there might be a controversy to deal with in
telemedicine ethics, it would be whether or not telemedicine

should be approached more as an investigational treatment, or

simply standard treatment delivered in an innovative format. If
telemedicine is actually investigational, then it calls for a full

portfolio of special duties and protections that clinical researchers
are familiar with. These include approval and oversight by

Institutional Review Boards, rigorous data collection and

transparency processes, and most of all, compliance with intricate
human subjects regulations, which are even more byzantine when

minors are involved.

Some commentators say telemedicine imposes a duty on

practitioners to include additional elements in their disclosures to

patients, such as details about how the technology works, specific
ways it can fail and financial relationships specifically relevant to

telemedicine. This perspective is problematic, because it neither
fully asserts that telemedicine (taken as a whole) is investigational,

nor explains—if it is not investigational—why it ought to recognize

some research on human subjects regulations and not others.

There are important implications of the suggestion that

telemedicine patients need to be informed about details of
technical and environmental risks that are not normally addressed

in standard care. By extension, this principle could be understood

to mean rural practitioners should disclose risks inherent in
geography. It might require obstetricians (or residents) seeing

patients after a night on call to warn that their performance might

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