TABLE 3.

Representative Ethical Challenges in the Development of Disaster Telemedicine

Ethical Principle	Concerns
Autonomy	Patients have the right to make informed decisions about their care, which involves an understanding of how telemedicine works. Patient expression of autonomy by choosing a modality of care may be tempered by efforts to maximize the benefit to all affected persons.
Beneficence	Disaster telemedicine systems should be engineered to maximize the value of the care delivered to a community. This may include offering telemedical care to a select group of patients. Additional benefit comes from the use of peer consultations for on-site providers.
Non-maleficence	New technologies may introduce harm. Risks in disaster telemedicine include participation of unqualified providers, patient abandonment, or the use of the technology to further secondary commercial or academic goals.
Justice	As a limited resource, telemedical emergency care in disasters should be distributed equitably, without regard for ability to pay or other discretionary characteristics. Industry best practices could ultimately address commercial entities, as well as nonprofit and government-supported providers.