In the previous section I detailed measures that have been implemented to redistribute health care resources and reduce the carbon impact of the medical industry. Telemedicine, in particular, appeared as an innovation that could address unequal resource distribution and reduce carbon emissions. Although telemedicine has the potential to transform health care delivery and services, and equalize access to doctors and medical care, some lingering issues remain.
There are two potential problems with telemedicine that I will examine. In the developed world, concerns over telemedicine revolve around privacy. In contrast, developing countries find barriers to accessing telemedicine. I argue that privacy can be addressed through supporting telemedical user guides and distributive justice includes making the technological infrastructure of telemedicine accessible. After addressing these top-down and bottom-up concerns, I conclude section IV with my own recommendations for distributive justice in health care. I first turn to concerns around telemedicine.
1. Telemedicine privacy
Telemedicine has the potential to reduce resource use and bring medical care to people in remote places, simultaneously assisting distributive justice and environmental conservation. But a digital era is also vulnerable to computer system hacking, data distribution to unauthorized users, and images that can go viral in a matter of minutes. The misuse of telemedicine could embarrass and endanger patients and clinics. “Figure 1,” a photosharing app for health care professionals, underlines potential privacy issues in telemedicine.
Figure 1 has revolutionized medical records sharing by allowing health care professionals to take pictures of patients for diagnostic purposes, which can then be shared with others in the medical industry.500 Figure 1 launched their program by fundraising two million dollars, although the program can be downloaded for free.501 Known as the “the Instagram for doctors,” Figure 1 has been fraught with ethical issues in the developed world and threatens the dissemination of this potentially conservationist technology.
Concerns surrounding Figure 1 include patient privacy and secure data sharing. Differing privacy laws across hospital state lines challenge the ease of data sharing.502 To complicate matters further, some hospitals have legal limitations on taking pictures within the walls of the hospital.503 In other cases, patients do not fully realize that their
procedure or condition is being recorded for training purposes. Medical associations have had to work fast to address these unforeseen technological, legal, and ethical issues, and ensure that patient health records are safe and confidential.
In 2014, the Australian Medical Association published a pamphlet on the ethics and responsibilities of medical picture sharing programs like Figure 1. Among the topics covered in the document are deleting images from personal electronic devices, discretion on sharing images, and extra precaution for images that could be perceived as sexually
500 Figure 1 Inc., n.d., at https://figure1.com/
501 Lora Kolodny, “Medicine’s Answer to Instagram, Figure 1, Raises C$2M,” Wall Street Journal, 9
December 2013, at http://blogs.wsj.com/venturecapital/2013/12/09/medicines-answer-to-instagram-figure- 1-raises-c2m/
502 Victoria Craw, “‘Instagram for Doctors’: Figure 1 Medical Image Sharing App Raises Concerns about
Patient Privacy,” News.com.au, 10 October 2014, at www.news.com.au/finance/work/instagram-for- doctors-figure-1-medical-image-sharing-app-raises-concerns-about-patient-privacy/story-e6frfm9r- 1227085877092
explicit.504 Privacy issues are not stopping the latest technological revolution in health
care, but other reservations still remain. Outside of a Western context, bioethicists are confronted with a different set of obstacles for implementing telemedicine.
2. Telemedicine inaccessibility
Telemedicine is currently inaccessible to those in the two-thirds world for a number of reasons. Obstacles to implementing telemedical clinics include the financial cost of modern buildings, consistent electricity, and compatible electronics to run teleclinics.505 But even this shared-technology is more feasible than personal electronic devices equipped with telemedical platforms.506 Outfitting each person with an iPad, computer, or smartphone would be even more demanding than teleclinics. These logistical challenges reveal a tension in the Western exportation of solutions to global problems. Just as “leap-frog” technology was suggested for developing countries to move beyond rudimentary energy production—like burning wood and coal— thus bypassing carbon-intensive energy production,507 so too is telemedicine out of reach for many countries.
The very poor require food and water, sanitation facilities, and basic protection from violence before sophisticated medical industry capabilities like telemedicine are considered. Gaps in medical need and available options for medical distribution reiterate the inequalities in global distribution. It is not enough to simply present telemedicine to the developing world; rather, the basic structures necessary for human life and medical
504 Australian Medical Association, “Clinical Images and the Use of Personal Mobile Devices,” (2014): 1-
14.
505 Dasgupta and Deb, “Telemedicine.”
506 Such as like “Zipnosis” an “easy way to access health care expertise from anywhere…(with) internet
connection.” Zipnosis provides online diagnosis and treatment for routine conditions such as cold, allergies, bladder infections, pink eye, etc. See Fairview, “Zipnosis frequently asked questions: What is Zipnosis?,” 2015, at https://fairview.zipnosis.com/faq
care must be in place as well. Distributive justice includes creating the infrastructures that support best-practice medicine, and in this case, the technology that the West has
developed. A comprehensive package of health care aid would need to include electricity, buildings, running water, and staff if medical teleclinics were seriously offered as a solution to health care access.
In general, telemedicine has the potential to work towards distributive health care justice by connecting patients to doctors worldwide. Those outside of urban areas, in very remote places, and in underserved countries, could have contact with general and
specialized doctors on computers. The problems that telemedicine are confronting are not insurmountable, especially when the infrastructure to deploy telemedicine is brought to developing countries. Through policy implementation and global initiative telemedicine can effectively meet health care needs and reduce resource use. Having addressed these lingering concerns about telemedicine, I conclude this section with suggestions for distributive justice in health care.