Table 1.

Studies about ethical and legal issues in telemedicine practice during the COVID-19 health emergency.

Medical or Health Service	Ethical and/or Legal Issues	Medical Purposes/Disciplines	Article Type	Location	Reference
Telemedicine and Telehealth	Data privacy, security and storage; Clear regulations/laws for legal security of patients and professionals; Informed consent: practice guidelines and standardized informed consent forms (risks and benefits of remote therapy and research) are recommended; Professional secrecy; Patients medical records availability; Noncompliance; Autonomy; Professional–patient relationship; Nonmaleficence and beneficence (minimize harm); Service quality and effectiveness; How frameworks, codes of conduct, or guidelines, are being used to improve ethical telehealth practice; Confidentiality; Liability; Reimbursement; Access for rural/remote populations, patients of diverse races, ethnicities, socioeconomic statuses (equity, justice); Licensing requirements; Risk of malpractice and insurance coverage; Establishment of protocols for managing laboratory tests, prescriptions, and scheduling; Recording issues: doctors must obtain consent before recording, patients do not need a doctor’s consent to record a consultation; Tailoring services to each patient; Patient and clinicians responsibilities; Commercialization; Cybersecurity and software safety; Evaluation as an ethical imperative (sound evidence on which to base analyses, decisions, and services); Compliance with ethical principles; Legality of patient recording depends on the state or territory: in certain jurisdictions, patients can secretly record a consultation without the consent of the clinician and this recording may be used in legal or disciplinary proceedings; Patient’s medical records will generally be held and owned by the clinician or health care organization, but patients are entitled to access and take a copy of their records; Safeguarding risks (patient self-harm); Safety (such as how to deal with a patient falling in their home during a consultation): guidance to ensure the safety of patients and clinicians in delivering virtual consultations is needed; Health Insurance Portability and Accountability Act (HIPAA) law revision; Fidelity and responsibility (trusting relationships); Integrity (no fraudulent behavior nor personal gain); Respect for people’s rights and dignity (protect privacy and safeguarding); Need of ethics code; Boundaries of competence; Unfair discrimination in treatment delivery; Digital communication with patients must be compliant with the country’s and organization’s data protection and telehealth regulations that are rapidly evolving and subject to change.	Nursing; Radiology; Neurology; Dermatology; Psychotherapy and mental health. Clinical and routinehealth care; Follow-up care and of chronic diseases; Chronic medical illnesses and malignancies care; Visits to determine the urgency of medical or surgical interventions; COVID-19 severe cases screening; Monitoring clinically stable patients; Maintaining outpatient care; Mental health care; Radiology; Cardiological diagnosis; Dermatology care; Ophthalmology care; Otorhinolaryngology care; Non urgent clinical care; Second opinions and medical check-ups; Complementary service to face-to-face consultations; Virtual Orthopaedic and Musculoskeletal care; Daily clinical practice such as perinatal and neonatal care; Preventive care; Diagnosis and treatment of a health condition; Psychological care; Management of diabetes, hypertension, asthma, stroke, cancers, and chronic pain; Triage and management of a wide range of acute conditions.	Systematic Review; 5 Reviews; Special Article; Ethics and Law article; Research Article; Legislation Article; Legal issues and risk management article; Ethics Article; Recommendations	Various, USA; India; Brazil; UK; Various; Spain; Australia;	[16] [19] [21] [23] [26] [11] [6] [28] [29] [30] [31] [33] [34]
Pediatric and adolescent telehealth; Behavioral telehealth.	Privacy and security challenges; Inequitable access to care; Unsustainable costs in a fee-for-service system; Lack of quality metrics for novel care-delivery modalities; Telehealth policies and regulations (e.g., payer restrictions on telehealth reimbursement, complex medication-prescribing regulations for virtual care).	Pediatric ambulatory care; Adolescent care; Screening; Presurgical visit; Chronic condition management; Follow-up appointments; Behavioral and mental health (ADHD, Depression).	Review	USA	[10]
Telemedicine for abortion	Informed consent; Safeguarding support; Good-quality care; Equity of access.	Abortion medication and care.	Review (viewpoint)	Various	[17]
Teledermatology	Informed consent; Medical ethics; Lack of personal relationship between the patient and the dermatologist is a main ethical concern; Strictness of law varies from country to country; Malpractice or risk of telemalpractice (phantom patient); Risk of abuse and breaches of patient confidentiality; Patient’s autonomy; Privacy; Data protection.	Dermatology care and treatment; Chronic skin conditions with co-morbidities; Skin disorders; Skin diseases care; Diagnostic and treatment purposes; Follow-up appointments.	2 Reviews; Research Article.	India; Various.	[18] [20] [27]
Teleneurology	Malpractice coverage; Data protection; Informed consent; Patient privacy; Validation and development of best practice standards.	Neurology outpatient care; Follow-up visits.	Review	USA	[22]
Sport and exercise medicine telehealth	Ensure patient safety; Secure and effective communication methods; Ensure that patient feedback mechanisms are in place; Evaluate and ensure patient satisfaction; Informed care and shared treatment decisions; Promoting open communication and consent; Mutual respect; Access to health information; Physician autonomy and responsibilities.	Clinical care in the broad field of sports medicine; Follow-up consultations.	Review	Various	[24]
Telepsychiatry, Teleanalysis or Teletherapy	Telemedicine use; Privacy; Confidentiality; Data protection; Security; Informed consent; Physician’s malpractice and liability. Patient benefice; Justice (support/access is variable); Autonomy; Licensing and reimbursement; New guidelines to ensure patient privacy and quality of care.	Psychiatric and mental health care services and assistance; Psychoanalysis; Psychotherapy.	Review; Healthcare ethics article	Various; USA.	[25] [32] [8]
Telecardiology; Telemonitoring in dialysis; Telemonitoring in diabetes; Perinatal Telemonitoring.	Authorization and accreditation; Protection of patient confidentiality; Professional liability (e.g.,: incorrect diagnosis: erroneous reading of the report or to the poor quality of transmitted images); Absence of specific regulatory provisions; Physician–patient relationship; Privacy; Informed consent; Data sharing; Malpractice; Information security; Patient self-determination; Standardization of the practices; Economic reimbursement.	COVID-19 care; Chronically ill out-of-hospital patients (cardiology, diabetes); Nephrology; Endocrinology; Gynecology.	Commentary	Italy	[1]