Original Article

Initial drafting of telemedicine’s code of ethics through a stakeholders’ participatory process


Telemedicine can improve access to healthcare services; however, it has raised ethical concerns demanding special considerations. This study aimed at developing the codes of ethics for telemedicine, and hence several approved national and international ethical guidelines related to telemedicine practice were reviewed, and 48 semi-structured interviews were conducted with medical ethics and medical informatics experts as well as with physicians and patients who had telemedicine experiences. Content analysis was then performed on the interviews’ transcripts and a draft on code of ethics was prepared, which was further reviewed by the experts in the focus group meetings to reach a consensus on the final document. The final document consisted of a preface, five considerations, and 25 ethical statements. Considering the growing trend of adopting telemedicine worldwide, this document provides an ethical framework for those who use telemedicine in their medical practice.

Mehta SJ. Telemedicine’s potential ethical pitfalls. Virtual Mentor. Ethics 2014; 16(12): 1014-7.

Jack C, Mars M. Telemedicine a need for ethical and legal guidelines in South Africa. South African Family Practice. 2008; 50(2): 60-60d.

Melvin MC, Grant JR, Marissa GS. Telemedicine in orthopaedic surgery: Challenges and Opportunities. J Bone Joint Surg Am. 2020; 102(13): 1109-15.

Anonymous, World Medical Association (WMA) statement on the ethics of telemedicine. [cited Dec 2021]; Available from: https://www.wma.net/policies-post/wma-statement-on-the-ethics-of-telemedicine/

Uscher-Pines L, Mehrota A. Analysis of teledoc use seems to indicate expanded access to care for patients without prior connection to a provider. Health Aff (Millwood). 2014; 33(2): 258–64.

Zahedi F, Emami Razavi SH, Larijani B. A two-decade review of medical ethics in Iran. Iranian Journal of Public Health. 2009; 38(Suppl.1): 40-46.

Atac A, Kurt E, Yurdakul S. An overview to ethical problems in telemedicine technology. Procedia - Social and Behavioral Sciences. 2013; 103: 116-121.

Kaplan B, Litewka S. Ethical challenges of telemedicine and telehealth. Camb Q Healthc Ethics. 2008; 17(4): 401-16.

Barry GF. Regulatory, legal, and ethical considerations of telemedicine. Sleep Med Clin. 2020; 15(3): 409-16.

Chaet D, Clearfield R, Sabin JE, Skimming K. Ethical practice in telehealth and telemedicine. J Gen Intern Med. 2017; 32(10): 1136-40.

Anonymous. General Ethical Guidelines for good practice in telemedicine. [cited 2021 May 2]. available from: https://www.sada.co.za/media/documents/HPCSA_Booklet_10_Telemedicine.pdf

Parsapoor A, Bagheri A, Larijani B. Patient’s rights charter in Iran. Acta Med Iran. 2014; 52(1): 24-8.

Shamsi Gooshki E, Parsapoor A, Asghari A, et al. Developing Code of Ethics for Medical Professionals, Medical Council of Islamic Republic of Iran. Arch Iran Med. 2020; 23(10): 658-664.

Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24(2):105–12.

Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs. 2008; 62(1): 107-15.

Lincoln Y, Guba EG. Naturalistic Inquiry. CA: Sage; 1985.

Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Education for Information. 2004; 22: 63-75.

Korstjens I, Moser A. Series: practical guidance to qualitative research. Part 4: trustworthiness and publishing. Eur J Gen Pract. 2018; 24(1): 120-4.

Langarizadeh M, Moghbeli F, Aliabadi A. Application of ethics for providing telemedicine services and information technology. Med Arch. 2017; 71(5): 351-5.

Xu J, Willging A, Bramstedt KA. A scoping review of the ethical issues within telemedicine: lessons from COVID-19 pandemic. Journal of Health and Social Sciences. 2021; 6(1): 31-40.

Stoll J, Muller JA, Trachsel M. Ethical issues in online psychotherapy: a narrative review. Front Psychiatry. 2019; 10: 993.

Kuziemsky CE, Hunter I, Gogia SB, et al. Ethics in telehealth: Comparison between guidelines and practice-based experience -the case for learning health systems. Yearbook of Medical Informatics. 2020; 29(01): 044-050.

Cotet AM, Benjamin DK. Medical regulation and health outcomes: the effect of the physician examination requirement. Health Econ. 2013; 22(4): 393-409.

Pollard JS, Karimi KA, Ficcaglia MB. Ethical considerations in the design and implementation of a telehealth service delivery model. Behavior Analysis: Research and Practice. 2017; 17(4): 298-311.

IssueVol 14 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jmehm.v14i24.8184
Code of ethics Telemedicine Health services Iran

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Shafizadeh H, Larijani B, Mojtahedzadeh R, Nedjat S. Initial drafting of telemedicine’s code of ethics through a stakeholders’ participatory process. J Med Ethics Hist Med. 2021;14.