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Ethics
Telecare and self-management: opportunity to change the paradigm?
  1. M Schermer
  1. Correspondence to Dr M Schermer, Medical Ethics and Philosophy of Medicine, Room AE 340, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; m.schermer{at}erasmusmc.nl

Abstract

Telecare, the provision of care through remote interaction enabled by information and communication technology, is quickly developing. Integration with other technological developments is to be expected and will create systems that enable more intense, continuous and unobtrusive monitoring of health, and more personalised feedback and instructions. One of the goals of telecare is enhancing the independence and self-management of patients. In this article three degrees of self-management are described and a distinction is made between compliant and concordant forms of self-management. It is argued that telecare merely promotes forms of self-management in which compliance to medical instructions is central. Technological developments and normative policy considerations may enforce this trend to implement an interpretation of self-management in which compliance to a strict medical regime is prominent. Against this, a plea is made for developing telecare systems that incorporate concordant and collaborative forms of self-management, in which the patient’s own perspective is empowered.

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Footnotes

  • Funding The research for this paper has been funded by the Dutch Organization for Scientific Research (NWO).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • i This can either be the patient’s own regular healthcare professional or it can be a professional working in a special call centre.

  • ii The Rathenau Institue is the Dutch Parliamentary Science and Technology Assessment Institute.

  • iii As Willems11 says: “In a more suspicious vein, one could also describe this empowerment as an astute way of extending the physician’s power into the private domain of the patient. Self-management, on that interpretation, functions as a Trojan horse by letting medicine intrude into the daily practices of patients themselves instead of really empowering patient perspectives.”

  • iv I would like to stress that concordance really requires collaboration, that is, active participation of two parties (patient and caregiver). This presupposes engagement and competence from both sides.

  • v It is clear, for example, that these systems are very one-sided: the patient is at the receiving end (receiving education, information, instruction), but is not actively involved, other than by providing data and following instructions. There is no opportunity to discuss values with the system.

  • vi Although Draper and Sorell19 try to found patient duties in a Kantian principle of respect for one’s own humanity.

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