A framework of ethics for telepsychiatry practice

Abstract

Psychiatrists who provide telepsychiatric services must uphold the standards of ethics and professionalism expected in in-person interactions. Psychiatrists' fundamental ethical responsibilities do not change when they take up a new form of practice. But as in other areas of medicine, the introduction of a new technology - here, Internet use and videoconferencing - raises new ethical challenges, requiring a fresh look at clinical practice and social issues such as equitable access. This review discusses these new challenges under six headings: providing competent, safe care, ensuring informed consent, promoting privacy and confidentiality, managing boundaries, encouraging continuity of care, and addressing health equity. Ethical guidelines for in-person practice have emerged from decades of clinical discussion and carefully observed treatment in the office and hospital setting. New observations, clinical reports, and shared discussion and learning must do the same for telepsychiatry in the years to come.

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“…Clinicians who practice telepsychiatry should inform themselves about the current requirements of their practice jurisdiction and where their patients are located. To allow the patient to make a careful decision about the advantages and disadvantages of telepsychiatry, clinicians should permit adequate time to provide an appropriate informed consent procedure ( 17 ). Murphy and Pomerantz ( 18 ) have compiled an updated version of a questionnaire with the most important aspects of informed consent for online psychotherapy, which should aid psychotherapists’ informed-consent practices.…”

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“…The field of telepsychiatry is a growing one with its own professional and ethical framework 8. Virtual contact appears to be sufficient for quality practice; however, specific practice recommendations exist including those for audiovisual equipment, bandwidth, camera position, lighting, monitor size, room environment, sound, and so on 8. Clearly, distance can be managed provided that the clinician and the patient are willing to engage in the process and a safety net is arranged.…”