The deontological implications using Telemedicine deal with :

Security and privacy Medical data
Protection againts malpractice

The latter being a mixture of personal and technical decisions that require carefull analysis depending on the type of Telepractice : Teleassistance, Telediagnosis, Telerobotics.
Legal background of medical practice depends on :

  1. Personal aspects " Medical liability is based on Who has the duty with Whom ?
  2. Technical aspects : medical malpractice due to lack of

On the Technical aspects: pure telematic devices use in Telemedicine are not recognized as Medical Instruments that require Guarantee Label to assure safe practice depending on the application

e.i. image compression techniques could be safe in some cases and induce errors in other applications

This is also directly link with Standardization requirements and promotion.


The regeneral rule to find responsabilities and liabilities in Telemedicine will be based on the contract scenarios between different participants in a medical act depending on who is the person directly linked with the patient and with the final diagnosis
a) Teleassistance scenario.
Teleassistance is considered when a Medical practitionair will provide direct assistance to the patient at distance.

a.1. directly

a.2 Through an external or intermediate person ( related or not health care enviroment)

b) Teleconsultancy scenario
Teleconsultancy is considered when a Medical doctor provides assistance to another doctor that has the direct responsability with the patient.
Although medical ethics admit that " medical practice without any clinical examination of the patient is contrary to medical ethics " , their two clear exceptions :

- Specialist accepted as able to diagnose and practice medicine without direct patient contact

i.e. radiologist, pathologist, laboratory specialists.

- Isolated, insular or rural areas covered by GP s with a lack of specialists



In case of Emergency applies to the rule : " What is most dangerous thing for the patient ?" Not doing telemedicine is more dangerous then doing it.

Contractural relation directly from the patient to the distant doctor

The link ( intermediate person )

not liable of medical mistake

liable of negligence in all other aspects,

Negligence could also be applied to Health Care Authorities that having these facilities or being able to stablish them , do not take advante of them in emergency situations.



The same rule as previous one can be applied: " What is most dangerous for the patient ? "
Responsabilites vary according three situations

A) Responsable medical doctor consult an specialist

A.1. Equal specialiaty

A.2 Different spec.that patient contract is not needed : radiology,pathology, laboratory

doctor directly responsable of the patient is liable

except previous contract in which consultant doctor take patient responsability

B) Patient himself decides to consult a distant doctor : The facto contract is stablish when distant doctor accept the consultation and his responsability is involved.

C) A technician consult a doctor.The statment of " What is better or less dangerous for the patient ? is applicable.

Liability : Is first for the medical practitionaire but he may ask guarantees in case of technician neglicence

Non of these legal aspects appy to telesupport of techical and medical aspects that could improve the quality, efficiency and rentabilityof Health Care.
It is also non-applicable to TELECONTROL of board populations that could never be controled in other way ( i.e. massive ECG examinations )
It is also not applicable on Hospital Medical Care Management provided that technical and privacy aspects are respected ( i.e. image quality for radiology )

Untill national laws do not solve those problems ( see Chapter 1 ) and in order to assure that patients and doctors involved in Telemedicine applications are aware of their responsabilities , rights and duties most of the hospitals or doctors involved ask for a written permission to the patient in which they explain confidencility and security issues link to the Teleservice applied.
More complicated is to stablish a private contract between specialists that accept on routinary basis to provide medical consultancies and care at distance.


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Revisado: lunes, 26 mayo 1997.
Con el soporte informático y de comunicaciones del CICEI, Universidad de Las Palmas de Gran Canaria