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Ethics of telepsychiatry versus face-to-face treatment: let the patients make their autonomous choice
  1. Manuel Trachsel1,2,3,
  2. Jana Sedlakova1
  1. 1 Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zurich, Switzerland
  2. 2 Clinical Ethics Unit, University Hospital Basel (USB), Basel, Switzerland
  3. 3 Clinical Ethics Unit, University Psychiatric Clinics (UPK) Basel, Basel, Switzerland
  1. Correspondence to Dr. Dr. Manuel Trachsel, Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland; manuel.trachsel{at}uzh.ch

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There is robust scientific evidence from meta-analyses in psychotherapy research that common factors such as the alliance between patients and therapists, empathy, goal consensus/collaboration, positive regard/affirmation and genuineness have a much greater effect on the overall psychotherapy outcome than the so-called specific factors like particular treatment methods or ingredients of therapy.1 The current evidence base also suggests that the effects of telepsychiatric treatment are comparable with those of face-to-face treatment, not only regarding clinical outcome parameters but also with respect to patient satisfaction, acceptance and adherence—all common factors of psychotherapy.2 According to a comprehensive review of the main ethical arguments for and against different forms of online psychotherapy, the online setting provides several weighty advantages: for example, increased access, availability, flexibility, convenience, satisfaction, acceptance and increased demand.3 Among the arguments against online psychotherapy, privacy, confidentiality and data security issues, emergency issues, as well as communication issues have been mentioned.3 Frittgen and Haltaufderheide (p1)4 are concerned that telepsychiatry could ‘impact ethically relevant aspects of the therapeutic relationship’. They conclude that ‘there is evidence for ethically relevant changes of the therapeutic relationship in video-based telepsychiatric consultations’ (Frittgen and Haltaufderheide, p1),4 particularly pertaining to ‘respect for autonomy, lucidity, fidelity, justice and humanity towards each other’ (Frittgen and Haltaufderheide, p2).4 Indeed, video-based consultations as technically mediated communication ‘do not only transmit but transform what can be perceived, …

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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