Result card

  • ETH4: Does the implementation or use of STS affect the patient´s capability and possibility to exercise autonomy?
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Does the implementation or use of STS affect the patient´s capability and possibility to exercise autonomy?

Authors: Plamen Dimitrov, Gottfried Endel, Anelia Koteva

Internal reviewers: Pseudo293 Pseudo293

Patient autonomy is a cornerstone principle of medical ethics and widely discussed issue in specialized literature. In general, patient autonomy can be defined as self-determination, an expression of one’s own will, based on the ability of a person to guide and manage his/her own life in accordance with rational principles and rules, thus allowing him/her to consciously accept or refuse medical interventions. The right to self-determination is ensured by the presence of valid consent by adherence to the principle of voluntariness and after the patient has been thoroughly introduced to the objective, nature of the procedures, potential risks, duration, anticipated effect of the intervention, etc.


In the context of telemedicine practice, the major obstacle to the patient’s ability to exercise autonomy, as mentioned above, may be the advanced age, frequently accompanied by additional factors, such as comorbidity and the aged-physiologically determined less or more severe mental limitations as well as present or expected to emerge auditory or visual deficits. Moreover, when there is a decline in cognitive functions, reflecting on the comprehension of perceived information, medical specialists are required to explain to patients thoroughly, calmly and patiently all the details on the chosen procedure.

Although patient autonomy is considered to be a key point and prerequisite for any medical intervention and has therefore been well debated in the literature on bioethics, data on ethical aspects regarding the application of specific telemedicine practices are scarce at best or missing, thereby resulting in too general conclusions, not grounded on a solid empirical base.

Dimitrov P et al. Result Card ETH4 In: Dimitrov P et al. Ethical analysis In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 16 June 2021]. Available from: