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Introduction
The phrase "Ask a Pediatrician" is likely to produce thoughts of parents seeking information from a trusted source. This trusted source, a pediatrician, addresses the health care needs and questions that parents and other caregiveis have in raising their children. Yet, what if "Ask a Pediatrician" referred to an online e-mail-based communication? This would provide an opportunity for those parents with Internet access to be able to e-mail their questions and receive responses. This form of electronic contact shows promise as a means of enhancing communication and facilitating interactions between patients and the health care delivery system.1 And yet, several issues of concern arise with this seemingly simple and innocuous arrangement for doctor-patient communication.2
To what degree is there something unique about the ethics that governs the communication between physician and patient when it refers to online chat or e-mail? Is it any different than telephone communication? Does e-mail communication between patients and physicians constitute "treatment" and are physicians who communicate online with patients "practicing medicine?" To the extent that e-mail between patients and physicians constitutes the practice of medicine, should there be (or is there already) a code of ethics that applies to e-health? And what is e-health? Moreover, should e-health ethical issues be framed differently when considered in the realm of pediatric patients and their pediatricians? These are just some of the numerous questions to consider. In this article, we propose to explore and discuss these ethical issues pertaining to e-health.
Methods
In this review we chose to focus on 4 issues: codes of ethics relating to the practice of e-health, equity in e-health utilization, the ethics of the online physician-patient communication, and those aspects that are unique to pediatrics. For our data collection we selected material by searching Medline and the World Wide Web. We performed a Medline search through June 30, 2003, using various combinations of the following search terms: e-health, Internet, and ethics. Papers and websites were selected for their ethics content. Additional material was obtained by searching the World Wide Web for "code of ethics."
Results
The information yielded in the 4 preestablished areas is summarized as follows:
E-Health Ethical Codes of Conduct
The Health On the Net (HON) Foundation has developed guidelines for medical and health web...