Monday, August 13, 2007

Telehealth Ethical Issues

The 2006 Archives for the International Conference on Aging, Disability and Independence includes an excellent paper by Janice M. Blanchard of the Society of Certified Senior Advisors. Ms. Blanchard argues that as telehealth products move from the research phase into the broader marketplace, economic and technological considerations take center stage, while ethical issues merit less attention. A moral and ethical framework for home-based telemedicine is warranted, in her view. Her framework would consider the following issues.

(1) Privacy of information. Who has access to data and how it will be used? Can it be bought and sold? How will privacy, confidentiality, and security of user information be assured?
(2) Privacy of person/place. Can user control monitoring system (e.g., turn it off and on, or establish a monitor-free zone)? How is the privacy of others in the home maintained?
(3) Informed consent. What constitutes informed consent, particularly with a technologically naïve or cognitively impaired person?
(4) Equity of access. How do we develop equal access when technology use presupposes some technological sophistication, skills, and basic comfort level? Who will pay for services? Will it develop into a two-tier system of medical service delivery?
(5) Autonomy versus dependence. Does home monitoring foster autonomy or dependence? What will be the consequences of perceived non-compliance?
(6) Paternalism. Does the desire to “keep a better watch" over aging parents actually reveal or underscore a paternalistic attitude on the part of service providers, adult children, and/or the medical establishment towards elders?
(7) Patient and provider relationship. What is the overall effect on quality of care? How are empathy, compassion and trust maintained via telecommunication?
(8) Medicalization of home. Will long term monitoring change the character of home? How do we maintain the separation of public and private sphere?

The answers to these important questions will come from research and from the experiences of telemedicine users and their family members. Blanchard's framework is a valuable contribution to any careful examination of aging technology products and services.

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