The main ethical concern is that the standard for telemedicine is the same as the standard of care for face to face visits. Even though the delivery of these services may look different, they should still uphold the same quality and confidentiality, while ensuring interventions are evidence-based and best practices.
In order to maintain compliance with the Health Insurance and Portability Act (HIPAA), the software being used to deliver services should be confidential and secure. HIPAA compliance should be maintained for patient-provider interactions, as they would for in-person appointments. To ensure this, both the patient and provider should be in a private setting, with no unauthorized or additional individuals around. Using headphones is also beneficial, and can be an extra precaution to verify that confidentiality is maintained. Interactions via email, voicemail, and text messages are more likely to occur in junction with telemedicine. Providers should be careful to maintain confidentiality when using these modes of communication by avoiding the inclusion of personal health information in these messages. Consent should be obtained to interact not only through video/audio calls, but also to communicate in these alternative modalities (text messaging, emailing, and/or voicemails).
Providers should be cognizant that telemedicine may not be the best option for everyone. Beneficence (balancing potential benefits with risks) and non-maleficence (do no harm) should both be considered when determining if telemedicine is right for each patient. If there are more risks than benefits surrounding a patient's care being delivered virtually, the team must work to find a solution that best fits the patient's needs.
There is also the ethical concern of administering standardized assessments via telemedicine, when these assessments were not normed to be administered in this format. Testing instructions often include specific directions such as how to position testing easel/equipment, if audio components are presented (i.e., some recordings for listening tasks that may get distorted via telemedicine), etc. There currently is a lack of guidance of how we can implement these assessments via telemedicine, especially when telemedicine services are the only option.
ETHICS IN SPEECH-LANGUAGE PATHOLOGY: ASHA CODE OF ETHICS
The American Speech-Language-Hearing Association (ASHA) is the primary organization that provides guidance and certifications for both speech language pathologists (SLPs) and audiologists. ASHA’s Code of Ethic’s statement on the use of telemedecine/teletherapy affirms that the quality of services must be equivalent to those provided in-person.
Other relevant rules include:
- “1N. Individuals who hold the Certificate of Clinical Competence shall not provide clinical services solely by correspondence, but may provide services via telepractice consistent with professional standards and state and federal regulations” (American Speech-Language-Hearing Association, 2016). This means that providers must verify that the services being provided are aligned with any legal standings that are in place either at the state or federal level. States can occasionally have differing laws surrounding telemedicine requirements, so it is important that providers check this. This statement also means that intervention cannot be provided only via email or phone call ("solely by correspondence"), and that other modalities must be utilized to ensure best practices and high-quality care.
- “1M. Individuals who hold the Certificate of Clinical Competence shall use independent and evidence-based clinical judgement, keeping paramount the best interests of those being served” (American Speech-Language-Hearing Association, 2016). Even with effective telepresence in place, telemedicine may not always be the best option for certain individuals. Use of clinical judgement becomes especially relevant in these instances, to assure that treatment remains beneficial and patient-centered.
The ASHA Code of Ethics hasn’t been updated since 2016, which is possibly a concern considering how much telemedicine has evolved in recent years. With more widespread implementation and adoption of telemedicine within the field of SLP/audiology, more ethical barriers and challenges have emerged. It is important that these unique concerns are addressed and clear guidance is provided to determine how to handle each specific case.