Teleneurology: ethics of devolving responsibilities from clinicians to families and/or carers

E-care involving telemedicine, telecare, telehealth and teleneurology is the focus of health-care policy makers seeking to respond to demographic changes and the increasing prevalence of long term neurological conditions by adapting means of service delivery. E-care and teleneurology promise to provide high quality health-care services at a distance, allocate clinicians' time more effectively and enable the elderly and ill to remain in their own homes rather than occupy expensive beds in hospitals and care homes. The evidence base underpinning this is unsystematic, with marked shortcomings in economic evaluation methodology and a troubling paucity of ethical evaluations. Specific ethical issues arise in the application of teletechnologies to neurological conditions, particularly clinicians' ethical relations with family and/or carers. These ethical considerations should be recognized explicitly in policies promoting teleneurology in telemedicine, telecare and telehealth, that research needs to be directed towards them and there should be widespread debate on their implications.