Psychiatrists who provide telepsychiatric services must uphold the standards of ethics and professionalism expected in in-person interactions. Psychiatrists' fundamental ethical responsibilities do not change when they take up a new form of practice. But as in other areas of medicine, the introduction of a new technology - here, Internet use and videoconferencing - raises new ethical challenges, requiring a fresh look at clinical practice and social issues such as equitable access. This review discusses these new challenges under six headings: providing competent, safe care, ensuring informed consent, promoting privacy and confidentiality, managing boundaries, encouraging continuity of care, and addressing health equity. Ethical guidelines for in-person practice have emerged from decades of clinical discussion and carefully observed treatment in the office and hospital setting. New observations, clinical reports, and shared discussion and learning must do the same for telepsychiatry in the years to come.
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