Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland.
Bioethics. 2021 May;35(4):298-306. doi: 10.1111/bioe.12847. Epub 2021 Feb 15.
Technology presents a means of improving health outcomes for vast numbers of individuals. It has historically been deployed to streamline healthcare delivery and reach those who would previously have faced obstacles to accessing services. It has also enabled improved health education and management. Telemedicine can be employed in everything from primary care consultations to the monitoring of chronic diseases. Despite recommendation by the World Health Organization, countries have been slow to embrace such technology in the health sector. Nonetheless, it is expected to become more prevalent with increased digitization. Further, amidst the COVID-19 pandemic, there was a rush to implement forms of telemedicine where possible to prevent patients breaking social distancing rules. In this paper, I present and defend what I term the 'telemedical imperative'. The telemedical imperative represents a duty for healthcare systems to implement remote access to services where possible, thereby furthering the mission of equity in access to healthcare. It is intended as an addition to in-person services rather than a replacement. After highlighting the benefits of telemedicine, I provide four criteria that must be met for the telemedical imperative to arise. The first three-safety, effectiveness, and acceptability-are consistent and essential. The fourth adapts to the service in question and requires that there be no other obstacles specific to that service that cannot reasonably be overcome. Finally, I address several potential objections to the telemedical imperative based on more general concerns around the implementation of telemedicine.
科技为大量个人提供了改善健康状况的手段。它在历史上被用于简化医疗服务的提供，并为那些以前面临获取服务障碍的人提供服务。它还使健康教育和管理得到了改善。远程医疗可以用于从初级保健咨询到慢性病监测的各种服务。尽管世界卫生组织提出了建议，但各国在卫生部门采用这种技术的速度一直很慢。尽管如此，随着数字化程度的提高，预计它将变得更加普遍。此外，在 COVID-19 大流行期间，人们急于在可能的情况下实施远程医疗形式，以防止患者违反社交距离规则。在本文中，我提出并捍卫了我所谓的“远程医疗强制”。远程医疗强制代表着医疗系统有责任在可能的情况下实施远程服务访问，从而进一步实现公平获得医疗保健的使命。它旨在作为面对面服务的补充，而不是替代。在强调远程医疗的好处之后，我提供了出现远程医疗强制的四个标准。前三个标准——安全性、有效性和可接受性——是一致的，也是必不可少的。第四个标准适用于具体的服务，并要求不存在无法合理克服的特定于该服务的其他障碍。最后，我根据围绕远程医疗实施的更普遍问题，对远程医疗强制提出了几个潜在的反对意见。
