Ethical challenges to medical assistance at sea

Abstract

A B S T R A C TIllnesses and accidents occur on board seagoing vessels. In these cases, lacking medical or paramedical personnel, the ship's captain or an officer delegated by him provides medical care and in general asks for medical advice by means of telecommunication systems. The situation is in general different on passenger ships, on board of which are doctors or paramedical personnel. Telemedicine services for ships without medical facilities are provided by the Telemedical Assistance Services (TMAS). The captain is always responsible for medical care and final decisions regarding health of seafarers. Full responsibility for the diagnosis and prescription of treatments belongs to the doctor on board or to the TMAS physician. The physician on the ship or at TMAS should protect the privacy of patients. The telemedicine services and in particular the doctor-patient relationship on vessels present ethical and legal issues that are not the same as those experienced ashore. These issues are discussed and some possible solutions to improve patient-physician relationships are suggested.

Telemedicine Practice: Review of the Current Ethical and Legal Challenges

“…continued / 26 Telemedicine for ship's medical assistance: Remote medical assistance to seagoing vessels.…”

“…25 Ricci et al state that in special conditions such as medical assistance at sea, respect for ethical principles and informed consent of the patient must be present even in such difficult conditions. 26 Balestra hypothesizes the possibility of requesting informed consent for every telemedical transmission unless it is an emergency situation. 27 Botrugno, in his strictly legal work, focuses on the importance of the explanation that must be clear and unambiguous to obtain consent from the patient.…”

“…31 The strictly juridical aspects concern the violation of secrecy and privacy, resulting in a criminal, civil, and deontological crime. 26 Botrugno asserts that no system is absolutely safe and mentions the peculiarity of genetic data. 28 Only this author speaks of the right to oblivion and cancellation of the data.…”

“…In addition, Parimbelli et al 34 expand on the figures involved, talking about all the stakeholders-patients, physicians and nurses, system developers, hardware vendors, and hospital administrators. Many studies indicate (as a solution to the damage) that an extended insurance coverage 14,22,23 or a civil responsibility 22,26 should be derived from the telemedicine implementation in order to protect the careers of health care providers. However, in the balance between risks and benefits, the benefits of teleconsultation 15 seem much greater than the risk of being sued.…”

Benzodiazepine prescriptions on merchant ships without a doctor on board: analysis from medical records of Centro Internazionale Radio Medico (CIRM)

“…However, even more recent international recommendations leave to the captain the final responsibility of choices or of treatment [28]. A principle rather questionable taking into account the rudimental medical knowledge of a ship's captain [29,30]. The second is the limited availability of medicinal products carried on board ships.…”