DISTANCE LEARNING, MULTIMEDIA and VIDEO TECHNOLOGIES

Education, Ethics and E-Communication in Medicine

LILIANA ROGOZEA
ROXANA MICLAUS
CODRUTA NEMET
ALEXANDRU BĂLESCU
ION MOLEAVIN
Transilvania University of Brasov
Eroilor 29, Brasov
ROMANIA
r_liliana@unitbv.ro http://www.unitbv.ro

Abstract: The article attempts to introduce an ethical approach of communication aspects with respect to the use of
Internet and its influence on University Transilvania of Brasov medical students. The profound changes of medical
ethics in the informatics society are well known. Although ethics is an ancient concern of humanity it cannot ignore the
present times’ developments in technology and science, including computer science, and especially today when e-
Health benefits from e-mail, chat rooms, online discussion group, forums, blogs or instant messaging. Obvious the
students feel these communication paths’ influence so designing and developing a subject as ethics in communication
and e-Health became very important in the education of medical students and in the future education of computer
sciences and medical engineering students.

Key Words: ethics, e-health, guideline, communication, Internet

1. Introduction optimal individual development and performance

The humanity evolution is unbreakable connected with
communication and sharing information.
If living on Earth was for a long time linked with the
geographic position and community belonging, once the
faster moving possibilities arouse (starting with carriage
and finishing with the aircraft) people connection
became easier.
Humanity chose as a goal to try to be more close to each
other and to communicate in the cheapest and easiest ways.
Although the Internet facilitates this kind of
communication not necessarily involving travelling
between different locations on the Earth this new way of
connection has as well benefits as handicaps. This is the
reason why using electronic communication rises series
of ethical issues not only for medical students, but also
for students in domains connected with medicine and
nursing (medical engineering, medical computer
sciences, computer sciences, etc.)
The future professionals training in each field should
include technical knowledge and ethical and behavioural
abilities suitable to a harmonious development
according to their role in society. [2]
2. Communication and electronic tools
Through Internet communication human beings had the
chance to develop their personality and to evolve based
on new information discovered and collected. An
involve complying her/his fundamental needs, especially
to her/his communication needs.
Although the Internet makes communication time
between people shorter and raises the accessibility of
communication and expression of opinion, it is not able
to send in the same time the thrill of direct and unwritten
communication.
The human being should be able to physically express
herself/himself and to psychically receive sent messages
and sensitive, emotional and intellectual stimuli.
The Internet visibly increases the communication speed
and contributes to time and space barriers’ disappearing.
Also there is an increasing of information amount and
accessibility but unfortunately there is no selection of
information. This is why the number of really scientific
valuable sites is relative low and most are designed as
informative sites about an institution, or governmental or
non governmental organisation, or as commercial sites.
Easy access to information involves not only a rigorous
work of individual research but also the acquisition of
abilities and mechanisms of selection made by others.
This selection has a positive effect in decreasing the
research time and a negative one in the lack of interest
that occurred in completing these searches. Also there is
an interest’s decrease for information from the important
expensive and low accessible books and periodicals or
for teachers’ lectures, as a result of a sparse student-
teacher direct contact. It has become obvious that
Internet is a factor that diminishes direct communication

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 DISTANCE LEARNING, MULTIMEDIA and VIDEO TECHNOLOGIES
and also succeeds the “authentication” of distance
teaching system.
Unfortunately today Internet communication doesn’t
succeed a straight and complete connection performance
lacking in nonverbal features as gestures, face
expression posture, clothing, etc. even if it used a
webcam. In the absence of visual information we are
witnessing a diminished capacity for observing the other
speaker reactions and the computer become a neutral
intermediary in the communication chain. It is
established that Internet accomplishes as well the
connection between familiar people (friends, co-workers,
partners, etc) as between simply stranger people. This is
the reason why people usually communicate with the
image of the “other speaker” and not with the real
person and why dissimulating capacity is bigger when
you don’t face the communication partner.
The biggest lack of communication through Internet is
represented by no live presence of people with
detectable reactions in fact an object mediated
communication. Still it facilitates the access to human
experience in scientific field of an increasing number of
professionals and non-professionals.
This kind of communication offers the illusion of time
expanding and the possibility of doing more in a shorter
time.
Today the informational privilege decreases more and
more even though there are countries where it is
impossible for the majority of population to have home
Internet or/and to use it daily. [7]
Another aspect concerns the quality of the information
put on the web. If the information isn’t well filtered
there is a permanent risk to “get drown” in sometimes
unchecked, unreliable and even false information.
The selection problem occurs even for “whom we are
communicating with?” It is difficult to select always the
persons we would like to speak with or to be in situation
to spend more time in front of computer and less time in
direct contact with friends and allocate less time for
activities as theatre, concert and meetings with friends.
Long distance communication will redesign educational
offer by increasing the accessibility to a quality learning
system. [9] In the ideal perspective computer mediated
communication should be accompanied with a
complementary and strait communication.
Internet communication is protected to subjective
evaluation of individuals from “the wire’s end” which
could be related to physical aspect, hair styling, clothing,
etc. Long distance communication could facilitate team
work even long distance segregates the team. [16]
Large access in population including young people to
different quality programmes requires access restrictions
and even a classification system of accessibility to
programmes related to their content analyse. [17]
The aim of adequate intervention requires understanding
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the following issues:
1. Which is the Internet-individual relation?
2. Which is the individual attitude in front of this
communication way?
a. an active involvement and action
b. a passive taking part
c. a refuge reaction
d. a superior valorisation of information sources
e. an overdo reaction of its importance
3. Which are behavioural changes Internet induced?
a. egocentrism
b. dependence
c. anxiety
d. depression
e. narrowed of concerns area
4. In what way social status of individual is affected?
The obligations are respected or the individual try to
escape to his responsibilities.
Each individual answers in different way to this issues
but this doesn’t mean they are not able to communicate.
Ideas identity between communication partners is not
required as answer to this matter but according to
Pavelcu V, the following conditions: „bilateral trust,
communication partners’ flexibility, understanding
capacity of point of view, lack of preconceived ideas”
must be present. [8]
3. Ethics and electronic tools
A lot of international organisation including World
Medical Association considers that medical field
workers should be familiar with ethics rules and
especially with series of subjects assure human
return into the centre of medical concerns in high
technological world. [1]
Ethics is in the centre of various concerns as in the
following scheme:
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Using electronic communication put a number of ethic
problems (like privacy, information consent,
responsibility) because is difficult to decide if
sometimes it is normal to give up the direct
communication and if the analysis and web based
dissemination of medical data on various aspects of
health care and medicine are under the control of quality.
[6, 12, 14]
When we discuss about Ethics, Communication and e-
Health, we must discuss first about what is
implementing “Information for Health”; that means:
•electronic patient records (EPRs)
•development of net communication for medical staff
and patients
•development of telemedicine and telecare
•health promotion via Internet
•health alerts for all citizens
•medical e-learning applications.
Health education and the promotion of health
competence have not become a prime focus in medical
ethics yet, but increasing numbers of millions of people
travel to Internet health-sites daily. At the crossroads of
emerging knowledge in predictive and preventive
medicine and public health and of Internet based
technologies e-health has been developed as a powerful
medium, not yet regulated, widely visited, full of
beneficial information and advises, but also presenting
new uncertainties and risk of false or deceptive
information. This is certainly also a modification of
traditional physician-patient relationships and in part a
vulgarization of the medical expert knowledge. [13, 15]
It is very important to be a critical consumer of
cyberspace-based communication on the protection and
promotion of health and on dealing with diseases and
disorders. Trust, but be critical and verify by using more
than one source of information and advice. Do not trust
those who promise everlasting health, wonder drugs and
sensational cures and remedies. [4, 5, 10, 11]
E-health communication never can replace health care
provided in your local neighbourhood; use private
consultation rooms in cyberspace, but keep alive the
personal contact with health care experts and local
institutions of your trust in your community. [19]
4. eHealth Code of Ethics
A big forward step was made when in 2000 the first
eHealth Codes of Ethics started to appear. The code,
conceived by different scientific organizations, include
topics like: candor; honesty; quality; informed consent;
privacy; professionalism in online healthcare; respon-
sible partnering and accountability.
The main goals were to ensure that patient data
confidentiality is respected, and to establish a lot of rules
which can help us to use the potential of the Internet not
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only by the medical staff but by the patient too in
managing their own health.
For example: one of the e-ethics topics which must be
discuss with the students is the confidentiality and
according with this to evaluate the impact of a “free”
resources on the health status.
In that context it become more and more important to
educate the new generation of specialist according with
the new technologies, but also in the respect of ethics
rules. The mirage of Internet could be also very
important for young generation and without ethical rules
is very easy to develop a bad behaviour.
The essence of professionalism is self-governance, and
even the internet is a decentralised medium, the
governments and professional bodies must be involved
in internet communication - especially in its quality and
in developing an ethical approach of e-Communication.
In Romania was also introduce an ethical code,
proposed by Romanian Medical Informatics Society,
who try to use in a creative way in e-Ethics the
experience already gained.
5. Internet in students’ life and activity- a
case study
The study group comprises of 150 students with an
average age of 25.55, a minimum of 18 and a maximum
of 47 years. The study was realised in February 2008, in
Transilvania University of Brasov and followed a study
made in 2006.
There are more than 100.000 on-line sites containing
health information and a lot of individuals turn to
Internet to find health information quickly and
efficiently.
Concerning the use of Internet, we observed the next
distribution: 35% use the Internet especially for enrich
their knowledge and 46% use the Internet more like a
communication tool, using e-mail, messenger, webcam,
14% are using it for divertissement and 5% for “other”
scopes (downloading, music, movies, games etc.) than
finding knowledge or communication ( Fig.1).
The purpose of using internet
5%
14% 23%
35% 18%
5%
e-mai l messenger w ebcam documentati on di verti ssment others
Fig.1.
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consumer of cyberspace-based communication and on

The amount of time spend in front of the computer is the protection and promotion of health and on dealing
shown in Fig.2. with diseases and disorders. Trust, but be critical and
verify by using more than one source of information and
The amount of time spent on the internet
advice. Do not trust those who promise everlasting
health, wonder drugs and sensational cures and remedies.
5% E-health communication never can replace health care
36% 31%
provided in your local neighbourhood; use private
consultation rooms in cyberspace, but keep in personal
28% contact with health care experts and local institutions of
your trust in your neighbourhood. [18]
The Internet provides an effective manner of
rarely daily weekly monthly communication and documentation for the students.
Fig.2. The students recognize that the Internet has a positive
We observe that more than a half of the subjects use the effect on their life, but also the fact that addiction to
Internet daily and weekly and very few are using the Internet is possible and 14% encounter problems and
Internet rarely. The conclusion is that Internet could be restricted their access to Internet.
an important way of influencing behaviour and ethic Using different ways of teaching ethics to university
attitude of individuals, especially those will work in student groups whose previous education is very
medical system (medical staff or others). They will use different and whose knowledge level and background is
their knowledge in electronic tools exploitation. also different must be the result of cooperation between
What is the perspective of Internet? Has it a positive or teacher specialists in different area: engineering,
negative effect on individual life? The students think the computer science specialist or medical-doctor.
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