Accelerating the De-Personalization of Medicine: The Ethical Toxicities of COVID-19

Abstract

The COVID-19 pandemic has, of necessity, demanded the rapid incorporation of virtual technologies which, suddenly, have superseded the physical medical encounter. These imperatives have been implemented in advance of evaluation, with unclear risks to patient care and the nature of medical practice that might be justifiable in the context of a pandemic but cannot be extrapolated as a new standard of care. Models of care fit for purpose in a pandemic should not be generalized to reconfigure medical care as virtual by default, and personal by exception at the conclusion of the emergency.

From telehealth to virtual primary care in Australia? A Rapid scoping review

“…Barriers to virtual care included limited access to affordable technology, lack of long-term policies for funding of telehealth, and safety/privacy concerns [ 20 ]. There were also concerns that Electronic Medical Records (EMRs) did not completely capture clinical thinking and patient experience, leading to the possibility of acontextual clinical management, and even the erosion of ethics in care provision [ 18 ]. Studies recognised the need for plain language explanations, ethical oversight and mandatory inclusion of experienced, informed personnel in the governance of health information [ 25 ].…”

“…There were reported concerns about the reduced role of primary care nurses, and decreasing employment opportunities, due to increasing telehealth uptake [ 18 , 37 ]. Subsequently, nursing MBS service items were included in Australia.…”

Health Disparities for Canada’s Remote and Northern Residents: Can COVID-19 Help Level the Field?

“…While telemedicine has been used for many years for people living in northern or remote areas of Canada, the COVID-19 pandemic “mainstreamed” its use in larger centres as well (Rush et al 2021 ). This “mainstreaming” of a previously limited approach to healthcare has resulted in much closer examination of its potential; its strengths, as well as its limitations and drawbacks (Arnold and Kerridge 2020 ). Three aspects are worth noting.…”

“…Just as the COVID-19 pandemic forced the acceleration of online learning, so too did the pandemic accelerate the use of telemedicine, including consultation and treatment, among both urban and remote health service users in Canada (Chu et al 2021 ). With this increased use has come increased scrutiny of both its benefits and drawbacks (Arnold and Kerridge 2020 ; Bele et al 2021 ), along with comparisons of use and satisfaction between urban and rural/remote users (Rush et al 2021 ). Prior to the pandemic, telemedicine was used in Canada primarily for the delivery of healthcare to Canada’s remote locations and other localities where access to health services was limited (Agarwal et al 2020 ).…”

“…Also as noted above, communities, organizations, and healthcare providers require capacity-building (Gagnon et al 2006 ; Malliaras et al 2021 ). As Arnold and Kerridge ( 2020 , Section 3 ¶8) note: “Optimal telehealth requires optimal hardware, infrastructure, stable connectivity of sufficient bandwidth, training of providers, and facilitation usually by another healthcare professional at the patient end of the encounter.” This suggests that post-pandemic trends of increased use of telemedicine, far from addressing health disparities for residents in Northern and remote localities, may in fact exacerbate them.…”