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TELEMEDICINE IN FOCUS: ANALYSIS OF THE MOST COMMON
ERRORS AND ETHICAL-LEGAL PARAMETERS
Flaelma Almeida da Silva1
Beatriz Conti Boniares2
Diogo Castro de Almeida3
Abstract: This article analyzes the advances and challenges of telemedicine in Brazil, recognized as
a strategic tool for expanding access to healthcare, driven by technological progress and denitively
regulated by the Federal Council of Medicine (CFM). The trajectory of national telehealth has been
marked by signicant transformations in the use of remote communication technologies, with its
expansion accelerated during the COVID-19 pandemic. In this context, the emergency regulation of
this practice culminated in the enactment of Law No. 14.510/2022, which provided legal support for
remote medical care. The objective of this study is to identify the main errors that medical professionals
must avoid in the practice of telemedicine, based on a critical analysis of scientic, normative, and
doctrinal literature on the subject. To this end, a bibliographic review was conducted with emphasis on
publications from the last ve years, consulting the SciELO, Scopus, REASE, and LILACS databases.
The investigation highlights the importance of professional civil liability, informed patient consent,
and compliance with the General Data Protection Law (LGPD). As a result, it presents a synthesis of
practices to be avoided and essential ethical-legal precautions for safe telemedicine practice. Thus,
the study reinforces the potential of telemedicine as an instrument of health equity, provided it is used
under appropriate technical, legal, and ethical standards.
1 Master in Educational Sciences Lusófona University of Humanities and Technologies (ULHT)
Lisbon, Portugal.
2 Undergraduate in Medicine at the Athens Faculty of Porto Seguro.
3 Undergraduate in Law at the Faculty of Ilhéus.
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Keywords: Telemedicine. Medical civil liability. Informed consent. LGPD. Medical ethics.
INTRODUCTION
Telemedicine is a modality of distance health care that has been gaining ground in the medical
eld along with technological advancement. Teleconsultations can include both users of the Unied
Health System (SUS) and customers of health plans and private services (Brasil, 2020). In recent
years, as a result of the need to provide patients with access to health services during the Covid-19
pandemic, the adoption of this tool has accelerated even more (Araújo et al., 2023). Such technology
has proven to be benecial and has been denitively regulated by the Federal Council of Medicine
(CFM), through Resolution No. 2,314/2022.
Parallel to the advancement of telemedicine, the accelerated development of articial
intelligence (AI) stands out, which has expanded diagnostic and therapeutic possibilities in the medical
eld. According to the Future of Health (2024), AI tends to optimize the assertiveness of diagnoses
and contribute to the development of innovative therapies. The insertion of digital solutions in daily
care is evident, with emphasis on online scheduling, electronic medical record records and the recently
launched “Meu SUS Digital” system, an initiative of the Ministry of Health aimed at integrating the
clinical information of Brazilian citizens. These tools facilitate the performance of remote assistance
and extend the reach of medicine, even in contexts of physical distance. Virtual consultations, in
addition, reduce the exposure of vulnerable professionals and patients to contamination, minimizing
unnecessary travel (Cezário, 2024).
However, such innovations are not without challenges. The lack of equity in internet
access, inequality in the distribution of technological devices, and the vulnerability of personal data
are important obstacles to the consolidation of this modality (Santos and Franqueira, 2024). Such
limitations demand attention from health authorities, especially with regard to the protection of
users’ sensitive information and the universality of care. Although it is valid and effective in many
circumstances, virtual medicine does not replace, in its entirety, face-to-face care. It is up to the
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medical professional to evaluate the most appropriate conduct for the specic clinical situation, a
decision that must preserve the integrality and ethics of the doctor-patient relationship, as highlighted
by the rapporteur of CFM Resolution No. 2,314/2022, counselor Donizetti Giamberardino.
From a constitutional and legal perspective, it is essential that both physicians and patients
understand their ethical and legal responsibilities, especially in the face of the weaknesses of
technological mediation. As Bueno and Tavares (2024) warn, the impasses involving the regulation
of telemedicine in Brazil are not merely technical, but sociotechnical, revealing symbolic and
institutional disputes between the actors in the network. Maldonado (2016), although published
before the denitive regulation of the practice, remains a fundamental reference for understanding
the structural, economic, and social challenges that still face the implementation of telehealth in
the country. Although recent literature is prioritized, classic authors are used when their approach
remains conceptually current and relevant to the object of research.
In this scenario, this study seeks to answer the following research question: What ethical-
legal failures should physicians avoid in the practice of telemedicine, according to the normative
and jurisprudential frameworks in force in Brazil? The relevance of the research lies in identifying
ethical and legal risk conducts that can compromise the quality of care, providing theoretical and
practical subsidies to guide health professionals regarding the safe and legally supported use of virtual
medicine.
The present research adopts a qualitative and multidisciplinary approach, articulating
references from medicine, bioethics and law to critically analyze the main risks and responsibilities
associated with the practice of telemedicine. It is expected, with this, to collaborate with the medical
and legal community in the prevention of irregularities and in the promotion of efcient, safe and
responsible clinical action, contributing to the improvement of public policies aimed at telehealth in
Brazil.
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METHODOLOGY
This is a qualitative research, with an exploratory approach and descriptive character,
developed through a critical bibliographic review. The study aimed to identify the main legal and
ethical risks associated with the practice of telemedicine in Brazil, focusing on the conducts to be
avoided by physicians during remote care, in light of the current regulation.
To build the theoretical basis, scientic publications, resolutions of the Federal Council of
Medicine (CFM), judicial jurisprudence extracted from the Jusbrasil platform and doctrinal texts in
the eld of Medical Law were analyzed. The selection of sources prioritized studies and documents
published from 2020 onwards, the year in which the practice of telemedicine began to be formally
authorized on an emergency basis, culminating in the enactment of Law No. 14,510, of December 27,
2022.
Data collection was carried out in the SciELO, Scopus, REASE and LILACS databases,
using the descriptors “Telemedicine”, “Telehealth”, “Remote consultation”, “Legal aspects” and
“Medical liability”, combined with the Boolean operators “AND” and “OR”. The inclusion criteria
involved complete texts, available in Portuguese, with thematic adherence to the research objectives.
Publications that did not directly address the legal and ethical implications of remote medical practice
were excluded.
The analysis of the selected materials occurred through interpretative reading, with extraction
of the most relevant excerpts and subsequent critical systematization. Although it is not a formal
integrative review, the research adopts a multidisciplinary model, integrating the legal, medical,
and bioethical elds to build a comprehensive overview of the failures that should be avoided in
professional performance in digital health environments.
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ANALYSIS AND DISCUSSION OF THE RESULTS
The origin of telemedicine and its historical consolidation
The history of telemedicine dates back to the late nineteenth century, following the advances
in distance communication for health care purposes. According to Wen (2020), the rst modern
remote medicine initiatives are linked to the space race period, when technologies were developed to
monitor the health of astronauts in real time, inaugurating the idea of medical care without physical
presence. However, as early as the First and Second World Wars, records of medical care via telegraph
and radio demonstrate the primitive use of remote technologies (Boas et al., 2022).
In the Brazilian context, the initial records of structured use of telemedicine appear in the
1980s, as indicated by Maldonado et al. (2016), with the aim of integrating remote regions into the
health system. The institutionalization of the practice, in turn, occurred through CFM Resolution
No. 1,643/2002 and the creation of the Brazil Networks Telehealth Program, in 2007, recognized by
PAHO as a model of regional cooperation. These data are corroborated by Nunes et al. (2016), who
analyzed the applicability of telemedicine in the Family Health Strategy, demonstrating its structuring
role for the problem-solving capacity of Primary Care.
The pandemic context and emergency regulation
The Covid-19 pandemic decisively boosted the consolidation of telemedicine in Brazil.
According to Bueno and Tavares (2024), the emergence of SARS-CoV-2 worked as a “non-human
actor” catalyzing regulatory changes, by imposing institutional urgency for the adoption of the
practice. In March 2020, the Ministry of Health issued Ordinance No. 467/2020, temporarily
authorizing telemedicine on an exceptional basis. The denitive legalization occurred through Law
No. 14,510/2022, which delegated to the Federal Council of Medicine the ethical regulation of the
practice, made effective through CFM Resolution No. 2,314/2022.
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Wen (2020) emphasizes that telemedicine should be understood as a method, and not as
a mere tool, and that its incorporation requires clear guidelines regarding information security,
informed consent, and ethical responsibility. The contribution of the Actor-Network Theory (Callon,
Latour, and Law) was used by Bueno and Tavares (2024) to map the conicts between CFM, the
Ministry of Health, and professional categories, revealing a dispute for the legitimacy of the practice
and evidencing the sociotechnical nature of regulation.
Civil liability and data protection in remote medical practice
The study by Martins and Teles (2021) makes a relevant contribution when discussing the
civil liability of physicians as data processing agents. According to the authors, unlike the classic
subjective liability of medical practice, remote work implies a dimension of strict liability, under the
terms of the General Data Protection Law (LGPD). This means that the damage resulting from the
leakage of sensitive information, even without direct fault of the professional, may give rise to a duty
to indemnify.
This paradigm shift is especially relevant when considering that the practice of telemedicine
is linked to digital platforms, whose vulnerabilities are not always under the exclusive control of
health professionals. Thus, the duty of vigilance over information security and the correct completion
of the electronic medical record become central elements of a good ethical practice.
National jurisprudence on telemedicine: health plans as the focus of demands
The jurisprudential analysis carried out based on decisions available on the Jusbrasil platform
reveals a predominant trend: legal controversies involving telemedicine in Brazil are mostly focused
on the relationships between users and health plan operators, and not on direct actions against doctors.
This nding is relevant to the legal and ethical eld, as it indicates, to date, a relative compliance of
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medical practice with the regulatory frameworks established by the Federal Council of Medicine
(CFM) and Law No. 14,510/2022.
Paradigmatic decisions handed down by the Court of Justice of the State of Mato Grosso,
such as in case No. 1001086-96.2021.8.11.0025, reinforce the mandatory coverage of telemedicine
consultations by health operators, especially in nationwide plans. In this case, the court recognized the
right of a patient to have a telepresence consultation with a doctor located in another state, indicated
on the health operator’s own website, in the absence of qualied professionals in the state of origin.
The decision emphasized that the denial of coverage violated the principles of continuity of care and
dignity of the consumer (TJMT, Civil Appeal, Rel. Des. João Ferreira Filho, judged on 11/28/2023).
In addition, a decision by the Court of Appeals of the State of São Paulo, in an interlocutory
appeal from the District of São José dos Campos, reafrmed that telemedicine is a consolidated
modality of medical care and that its coverage must be guaranteed by health plans, under the terms
of article 1 of CFM Resolution No. 2,314/2022. The decision highlighted that the operator’s refusal to
authorize remote service characterizes a breach of contract and an affront to consumer rights.
The courts have interpreted telemedicine as a contemporary expression of the right to health,
compatible with article 196 of the Federal Constitution, which ensures universal and integral access to
health actions and services. The National Supplementary Health Agency (ANS), through a technical
note during the pandemic period, had already positioned itself for the mandatory coverage of remote
care. This guideline was accepted by the state courts, which began to require operators to provide
qualied professionals for virtual consultations, under penalty of violation of the contractual and legal
duties of the consumer relationship, according to the provisions of the Consumer Protection Code
(CDC).
De Moraes et al. (2023), Oliveira e Silva (2024) and Sarlet and Sarlet (2023) reinforce the
understanding of telemedicine as an important tool in promoting the right to health in Brazil, especially
by expanding access and equity in health services.
On the other hand, the absence of litigation directly involving the conduct of physicians reveals
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not only the effectiveness of the CFM’s ethical and technical regulations, but also the adaptation of
professionals to the use of digital platforms. Such a jurisprudential panorama strengthens condence
in the practice of telemedicine as a legitimate modality of care and reinforces the urgency of regulatory
advances to ensure the universalization of this care model.
Judicialization of access to telemedicine in health plans: a look at Brazilian jurisprudence
The incorporation of telemedicine as a legitimate modality of health care, as provided for in
article 1 of CFM Resolution No. 2,314/2022, implies contractual obligations to health plan operators.
As service providers in the supplementary health regime, governed by Law No. 9,656/1998 and the
Consumer Protection Code (CDC), operators must ensure the continuity of medical care, including
by digital means, when available. The denial of coverage for remote consultations, especially in the
absence of qualied local providers, represents an affront to the principles of objective good faith and
the social function of the contract.
Two emblematic judgments of the Court of Justice of Mato Grosso illustrate this issue. In
case No. 1001086-96.2021.8.11.0025, the court recognized the right of a patient to have a telemedicine
consultation with a homeopathic doctor from another state, indicated on Unimed’s own website, in the
absence of locally accredited professionals. In a similar decision, in case No. 1001075-60.2021.8.11.0025,
the court reafrmed the mandatory coverage of remote care and recognized the solidarity between
Unimed units nationally. Both decisions invoke the understanding that telemedicine is consolidated
as a contemporary expression of health care, and its access is protected by consumer legislation and
ANS regulations.
It is observed that the difculty of access does not result from the unavailability of
telemedicine itself, but from the omission of the plans to provide qualied specialists, especially for
telediagnosis. According to article 8 of CFM Resolution No. 2,314/2022, this type of medical act can
only be performed by professionals with a Specialist Qualication Registration (RQE).
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CFM RESOLUTION No. 2,314/2022
[...] Art. 8 - TELEDIAGNOSIS is the medical act at a distance, geographic
and/or temporal, with the transmission of graphics, images and data for the
issuance of a report or opinion by a physician with a specialist qualication
record (RQE) in the area related to the procedure, in response to the request
of the attending physician.
The absence of these professionals in the accredited network makes it impossible for
beneciaries to exercise their right to health, especially in contexts of geographic or clinical
vulnerability. Thus, the judicialization of coverage reveals the role of the Judiciary as a guarantor of
equity in access to health mediated by technologies.
In continuity with this analysis, it is essential to reect on the doctor-patient relationship
mediated by digital technologies. The strengthening of trust in this modality of care is intrinsically
linked to the observance of strict ethical parameters, in this way, based on the contributions of authors
such as Maldonado (2016), Martins and Teles (2021) and the regulations of the Federal Council of
Medicine, we seek to evidence the relationship between the subjects involved in distance care and the
expanded understanding of humanization, responsibility and professional secrecy.
Considerations on the doctor-patient relationship and ethical standardization
The doctor-patient relationship represents one of the central pillars of clinical practice
and, in the telemedicine modality, requires rigorous adaptations that ensure the maintenance of the
ethical principles that govern the profession. As provided for in the Code of Medical Ethics, remote
consultation does not exempt the fulllment of professional obligations related to qualied listening,
clear information, and respect for patient autonomy.
According to Maldonado (2016), the use of technologies in the therapeutic relationship should
not be understood only as a technical mediation, but as a eld of symbolic interaction that requires
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expanded communication skills from the professional. This becomes even more relevant in the digital
context, where facial expression, body contact, and the physical environment are replaced by screen-
mediated interactions, which can make it difcult to perceive clinical and subjective signs.
Martins and Teles (2021) highlight that the ethical relationship in telemedicine depends on
factors such as informed consent, transparency in communication, adequate recording of care, and
the security of shared data. The LGPD (General Law for the Protection of Personal Data) imposes
strict liability on the professional for the processing of sensitive data, requiring the adoption of digital
protection measures that guarantee the condentiality and integrity of the information.
CFM Resolution No. 2,314/2022 reinforces that remote care must comply with the same
ethical principles as face-to-face medicine, including the obligation of complete electronic medical
records. According to Article 87, paragraph 1 of the Code of Medical Ethics: “The medical record
must contain the clinical data necessary for the proper conduct of the case, being lled out, in each
evaluation, in chronological order with date, time, signature and registration number of the physician
with the Regional Council of Medicine.”
In this sense, the doctor-patient relationship in telemedicine cannot be reduced to a digital
transaction. It is a complex human relationship, crossed by values such as empathy, listening, respect
for vulnerability and civil responsibility. As provided for in Article 32 of the Code of Medical Ethics:
“Failure to use all available means of health promotion and prevention, diagnosis and treatment of
diseases, scientically recognized and within his reach, in favor of the patient” is forbidden to the
physician.
In addition, Article XIV of Chapter I of the Code of Medical Ethics provides: “The physician
shall strive to improve the standards of medical services and to assume his responsibility in relation
to public health, sanitary education and health legislation.”
Article 37, paragraph 1, also of the Code of Medical Ethics, establishes that: “Distance
medical care, in the form of telemedicine or other method, will be provided under the regulation of
the Federal Council of Medicine.”
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Also, according to Article 8 of CFM Resolution No. 2,314/2022:
Telediagnosis is the medical act at a distance, geographic and/or temporal,
with the transmission of graphs, images and data for the issuance of a report
or opinion by a physician with a specialist qualication record (RQE) in the
area related to the procedure, in response to the request of the attending phy-
sician.
In addition to what is provided for in the Code of Medical Ethics, the Civil Code also
establishes the limits of professional performance. Article 951 of the Civil Code provides:
Art.951. The provisions of arts. 948, 949 and 950 also apply in the case of
compensation due by the person who, in the exercise of professional activity,
due to negligence, imprudence or malpractice, causes the death of the patient,
aggravates his illness, causes him injury, or disqualies him for work.
Thus, it is concluded that the consolidation of telemedicine depends, to a large extent, on
the qualication of the professional to maintain an empathetic, safe and ethically oriented therapeutic
relationship. Normative frameworks must be allies in the formation of a new relational model, in
which technology acts as a means and not as an end, preserving the centrality of care in medical
practice. In addition, the scarcity of lawsuits against physicians in telemedicine reects not only the
strict compliance with ethical and legal standards by professionals, but also the appreciation of this
modality as a viable, safe, and effective alternative of care, in line with the principles of the right to
health and equity in access to services.
Given this scenario, there is a need to deepen the analysis of the most recurrent mistakes in
the practice of telemedicine, in light of the current ethical-legal parameters and the recommendations
present in the specialized literature, in order to prevent failures and promote excellence in remote care.
to maintain an empathetic, safe and ethically oriented therapeutic relationship. Normative frameworks
must be allies in the formation of a new relational model, in which technology acts as a means and not
as an end, preserving the centrality of care in medical practice.
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Analysis of the most common errors and ethical-legal parameters
The practice of telemedicine, despite being regulated and widely accepted as an instrument
for expanding access to health, is not free from risks and misconceptions that can compromise the
quality of care provided and patient safety. In this context, the identication of the most common
errors is essential for the improvement of professional conduct, especially in view of the ethical and
legal complexity that involves remote medical practice.
Based on the contributions of Santos and Araújo (2022) and the current legislation —
especially CFM Resolution No. 2,314/2022, the Code of Medical Ethics, the General Data Protection
Law (Law No. 13,709/2018), and the guidelines of the Brazilian Public Key Infrastructure (ICP-
Brasil), the following table was prepared, which presents the main ethical-legal parameters for the
safe practice of telemedicine. The objective is to contribute to remote medical conduct, reinforcing
good practices and preventing recurring failures.
Chart 1 – Main mistakes to be avoided by medical professionals in telemedicine
No. Common Mistake Ethical-Legal Basis
INot adequately informing or clarifying the patient about the
modality of care adopted and its limitations.
CFM Resolution No. 2,314/2022 (Art.
3 and Art. 4); Code of Medical Ethics
(Ar t. 31).
II Failure to obtain free and informed consent for teleconsul-
tation.
CFM Resolution No. 2,314/2022 (Art.
4); Code of Medical Ethics (Art. 22).
III Performing consultations without formal scheduling, com-
promising the organization, time and focus of care.
Santos & Araújo (2022); Principles of
good clinical practice.
IV Omitting information regarding the cost of the consultation
and the average duration of the service.
CFM Resolution No. 2,314/2022 (Art.
2, §2); Consumer Protection Code
(Law No. 8,078/1990).
VDo not advise the patient about the need for face-to-face care
whenever the clinical case requires it.
CFM Resolution No. 2,314/2022 (Art.
6); Code of Medical Ethics (Art. 32).
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SAW Neglecting to record the clinical history and exams in the me-
dical record safely and in accordance with the requirements
of the LGPD.
Law No. 13,709/2018 (LGPD); Code
of Medical Ethics (Art. 87, §1).
VII Using videoconferencing platforms without the minimum re-
quirements of information security and data protection.
CFM Resolution No. 2,314/2022 (Art.
7); LGPD (Art. 46).
VIII Disregard that teleconsultation is subject to the same ethical
principles as face-to-face consultation, including respect,
condentiality, and professional responsibility.
Code of Medical Ethics (Art. 2
and Art. 6); CFM Resolution No.
2,314/2022.
IX Performing telediagnostics without having the proper Spe-
cialty Qualication Record (RQE).
CFM Resolution No. 2,314/2022 (Art.
8).
XIssue prescriptions, certicates or opinions without the use of
a certied electronic signature.
ICP-Brasil; CFM Resolution No.
2,314/2022 (Art. 11).
Source: Prepared by the authors, 2025.
The clarity of these parameters seeks to support medical conduct, promoting a responsible,
legally safe, and technically appropriate practice for the contemporary reality of digital health. The
systematization of these errors, with their respective justications, allows the medical professional to
recognize the requirements of remote practice with greater security and effectiveness.
Studies such as Maldonado (2016) and Wen (2020) argue that the insertion of digital
technologies in the context of health care should be accompanied by a broader view of medical
practice, in which the principles of ethics, professional responsibility, and patient centrality remain
fundamental references. According to Maldonado (2016), technological mediation in the therapeutic
relationship should not weaken human bonds, but rather enhance the reach and effectiveness of care
based on respect, communication and empathy.
Wen (2020), when analyzing the evolution of telemedicine in Brazil, highlights that distance
practice needs to be understood not as a replacement for traditional medicine, but as a complementary
instrument that expands access, especially in contexts of territorial and socioeconomic inequality. For
the author, technical regulation must go hand in hand with the strengthening of the ethical dimension
of professional performance.
Thus, the commitment to good practices in telemedicine is not restricted to formal compliance
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with the rules, but also involves a reective, humanized and technically qualied posture, which
reafrms the advances in health as a social right and ethical-political duty of the medical professional.
Final Thoughts
In view of the guiding question of this study: what ethical-legal failures should physicians
avoid in the practice of telemedicine, according to the normative and jurisprudential frameworks
in force in Brazil? it was possible to identify, based on the studies of Santos and Araújo (2022),
Maldonado (2016), Wen (2020) and the legal analyses of the Federal Council of Medicine (2022), that
the main risks are related to the omission of information to the patient, the absence of informed consent,
the non-compliance with technical requirements and the non-compliance with legal requirements
regarding condentiality, data security and civil liability.
The systematic analysis of the applicable legislation, court decisions and specialized
literature has shown that the practice of telemedicine requires the same ethical and technical rigor as
face-to-face medicine. CFM Resolution No. 2,314/2022, the LGPD, the Code of Medical Ethics, and
the decisions of the higher courts point to prudent, informed, empathetic, and properly documented
medical performance.
In this way, the study contributes to the strengthening of medical conduct in the remote
modality, offering a framework of ethical-legal parameters that can guide professional practice with
greater legal certainty, moral responsibility, and respect for patient rights. By preventing common
errors, the transformative potential of telemedicine in equitable access to health is expanded,
reafrming its value as an instrument of ethical, legitimate, and socially committed care.
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