The development of ethical guidelines for telemedicine in South Africa

• DOI: 10.10520/EJC-171924bfb2
• Pages: 19-26
• Author: R.E. Scott,B.A. Townsend
• Published date: 01 June 2019
• Record Number: m_sajbl_v12_n1_a6
• Date: 01 June 2019

June 2019, Vol. 12, No. 1 SAJBL 19

ARTICLE

While telemedicine holds enormous promise for the provision of

remote healthcare, it is not without its challenges. Recently, there

has been a shift in the way in which healthcare is being practised

globally. These new models of healthcare service provision ideally

involve patients, doctors and machines working together, with

few constraints imposed by geography, or national or institutional

boundaries. The World Health Organization (WHO) defines eHealth

simply as ‘the use of information and communication technologies

[ICT] for health’;[1]

telemedicine, as a subset of eHealth, is the practice

and delivery of healthcare over a distance using ICT.[2]

The focus of this article is telemedicine. However, the term eHealth

will be applied when speaking of the use of ICT in healthcare

generally, and telehealth where this term is applied by others,

or when a slightly more generic perspective (one that includes

telemedicine) is required.

Although largely beneficial, there is growing reflection on the

legal and ethical challenges and complexities posed by these newly

unfolding eHealth measures.[3,4]

There is a need for guidance with regard to the eHealth landscape in

South Africa (SA). It is understood that the emergence of telemedicine

has created various legal and ethical dilemmas.[5,6] The broad ethical

challenges are identified as: the changing nature of the traditional

doctor-patient relationship; standards of care; quality of care; privacy;

confidentiality; data protection; accountability; liability; consent;

record-keeping; data storage; and authentication.

While various legal, regulatory, and governance measures offer

potential solutions and remedies for rights protection, the furtherance

of ethical direction may be achieved through statutory bodies set up

to promote and foster ethical compliance with normative healthcare

standards.

In SA, the Health Professions Council (HPCSA) spent several years

developing the ‘General ethical guidelines for good practice in

telemedicine’ (the HPCSA telemedicine guidelines),[7] a process which

they found difficult.[8] Advances in technology and telemedicine have

rendered several aspects of these guidelines, which focus largely on

videoconference-based telemedicine, inappropriate. The guidelines

are largely based on the World Medical Association (WMA)’s 2007

‘Statement on the ethics of telemedicine’, which was rescinded in

2009, and replaced with a far more pragmatic statement on ‘Guiding

principles for the use of telehealth for the provision of healthcare’,

which took recent advances in the field into account.[9] The field has

since advanced further, with the growing use of mobile phones for

telemedicine. The current shortcomings of the HPCSA guidelines

need to be addressed if telemedicine is to meet the government’s

desire for telemedicine to improve both access to and quality of care

for those in rural areas.

This open-access article is distributed under

Creative Commons licence CC-BY-NC 4.0.

The development of ethical guidelines for telemedicine in

South Africa

B A Townsend,1 PhD; R E Scott,1,2 PhD, BSc Hons; M Mars,1 MB ChB, MD

1 Department of TeleHealth, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

2 NT Consulting – Global e-Health Inc., Calgary, Canada; Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Canada

Corresponding author: M Mars (mars@ukzn.ac.za)

Telemedicine has the potential to assist in the provision of healthcare in South Africa (SA). This means of healthcare service provision

involves patients, doctors and machines working together, with few constraints imposed by geography, or national or institutional

boundaries. Although the practice is largely beneficial, certain legal and ethical challenges arise from the use of electronic healthcare

services. Certain ethical challenges are identified as: the changing nature of the traditional doctor-patient relationship; standards of care;

quality of care; privacy; confidentiality; data protection; accountability; liability; consent; record-keeping; data storage; and authentication.

While various legal, regulatory and governance measures offer potential solutions and remedies for protection, ethical direction may be

achieved through statutory bodies set up to promote and foster ethical compliance with normative healthcare standards. Recently, the

Health Professions Council of SA (HPCSA) made an attempt to address the ethical issues by publishing a set of telemedicine guidelines.

Despite this, issues around the practice of telemedicine remain unresolved. This article seeks to inform the development of a new ethical

framework by addressing three distinct and relevant ethical issues: the fiduciary nature of healthcare and the changing nature of the

doctor-patient relationship; privacy, confidentiality and the sensitivity of health data; and informed consent. It does so by proposing a

broader and more nuanced solution to these ethical obstacles by identifying conceptual and operational difficulties within the existing

HPCSA telemedicine guidelines, and advancing suggestions for reform. This speaks to a more highly integrated perspective that is

culturally and contextually aware, and which affirms the need to strike a balance between individual rights protection and transformative,

ethical, healthcare innovation.

S Afr J Bioethics Law 2019;12(1):19-26. DOI:10.7196/SAJBL.2019.v12i1.662