| Abstract |
eHealth is an emerging field in the intersection of medical informatics, public health and health business. The term eHealth was first used ten years ago to describe the combined use of electronic information and communication technology in the health sector. Nowadays eHealth means the use in the health sector of digital data that transmitted, stored, and retrieved electronically for clinical, educational and administrative purposes, both at the local site and at distance.
eHealth offers many benefits to the eHealth implementations users. In the eHealth context the patients have the opportunity to find medical information or to receive health services. The medical information providing is a great aim of eHealth. The trend in eHealth is that the patients will be more responsible for their own care and health. Furthermore, many areas of traditional healthcare depend on informatics. The hospital laboratories are heavily computerized with a number of analyses while modern imaging techniques also depend on informatics. The electronic prescription decreases the medical error and the excess cost. Computer-supported diagnosis, treatment, and prevention are recognised as indispensable in rare diseases management and in quality of life development.
But at the same time eHealth causes a variety of problems both to patients and health professionals. eHealth also causes bioethical dilemmas as a result of the use of technology in the medical practice and the health services. In this text the main bioethical issues related to eHealth are presented and analysed on the base of the four principles of Biomedical Ethics. These ethical principles are the principle of respect for autonomy, the principle of beneficence, the principle of nonmaleficence, and the principle of justice. The four ethical principles are significant for Biomedical Ethics because, over the years, they have won a general acceptance as applicable in the analysis of ethical issues in medicine.
eHealth includes all ethical issues of the traditional medical practice adding further dimensions to these issues or new ethical issues. First of all eHealth influences the traditional form of doctor-patient relationship. The interpersonal relationship between doctor and patient is transformed because of the distance and the time of the communication between them. eHealth also changes the balance of power in the doctor-patient relationship. Hence, the patients have prime responsibility for their own health. Furthermore, in the eHealth context the doctor-patient relationship can extend
because of the technology applications including more than two parts.
Truth-telling is another issue affected by the eHealth. A number of studies have demonstrated that patients do want their physicians to tell them the truth about diagnosis, prognosis, and therapy. However, in eHealth the distance between doctor and patient changes the truth-telling process and its consequences. Many physicians worry about the harmful effects of disclosing information to patients by the distance while many patients choose not to know the information about their health situation.
The issues of privacy protection and confidenciality are also significant in eHealth. The eHealth implementations allow the collection, maintenance, and transmission of personal data like health data, genetic information, personal profile. In this case the main issue is the right balance between individual privacy protection and health service delivery. On the one hand is the individual's right to have his or her personal records kept confidential. On the other hand, medical information must be transmitted through electronic health records to improve patients’ healthcare and health service delivery. As well, medical research depends on being able to access information in the eHealth system. Institutions and companies involved in eHealth sector have to protect the personal sensitive data. Failure to protect privacy may undeniably and irrevocably damage the patients’ compliance, their health outcome, and the quality of their life.
eHealth implementations also influence the informed consent process, the patients’ decision-making capacity and the nature of these decisions. Increasing access to medical information and health services promotes the patients’ opportunities for reasonable alternatives as well as for the information related with the risks, benefits, and uncertainties of each alternative. Consequently, the professional obligation also focuses to the patients’ capacity assessment of the best understanding of the information. Furthermore, as the Internet and other technologies allow the collection and transmission of personal information the respect patients’ (and other users’) right to determine whether or how their personal sensitive data may be collected, used, or shared have to be protected by physicians and other health professionals.
Furthermore, one of the most important aims of eHealth is the reduction of health inequalities. In fact, eHealth implementations reduce the geographical inequalities in health sector providing health information, services, and products in remote areas. eHealth also decreases the distance between patients, health
professionals, and health institutions. However, in many times eHealth can not reach to those patients and professionals who need the health information and services more than others. In addition to geographical inequalities, inequalities related with the patients’ gender, age, educational status, and social class are also recognized across the studies of the eHealth services.
The acceptance of eHealth from patients and health professionals has also been studied by the scientists. Despite a number of technologies acceptance models were developed no one achieved to explain adequately the issue of technologies acceptance in health sector. However, studies show that the eHealth implementations lead to patients’ and professionals’ high level satisfaction even if a resistance of physicians is also recognized. This professionals’ resistance has to do with the fact that the eHealth services performed today are not yet addressed by specific eHealth standards.
Furthermore, the legal issues raised by eHealth include all the issues of the traditional medical practice as well those raised by the use of technology in the health services like the Electronic Health Record. The Electronic Health Record is a fundamental building block of eHealth applications and electronic medical practice. It allows the sharing of medical records between health professionals and care providers across disciplines, institutions and geographical boundaries leading to a number of ethical and legal issues. Many international organizations like World Health Organization have proposed recommendations related with the main ethical issues of eHealth. As well, the eHealth Code of Ethics specifies that anyone who uses the Internet for health-related reasons has a right to expect that organizations and individuals who provide health information, products or services online will uphold the following principles related with the candor, honesty, quality, informed consent, privacy, professionalism in online health care, responsible partnering and accountability.
In conclusion, eHealth is characterized by a wide dynamics. eHealth implementations change continuously the medical practice acts and increase the patients’ and professionals’ expectations. They also change and extend the ethical issues of Medicine. Hence, the aim of Bioethics for the eHealth implementations is: to have safety and quality, to be used by the people who need them, and to promote and increase their benefits.
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