The development of ethical guidelines for telemedicine in South Africa

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.