The doctor-patient relationship aspect of medicine has changed dramatically over the past twenty years. It has moved from paternalism (the doctor makes the decision for the patient) to shared decision-making where the patient is considered an equal partner in their own health-related decisions. Informed consent is the cornerstone of this view. When a patient or research subject makes an autonomous decision after understanding the risks and benefits of the decision is informed consent. Full informed consent covers the following elements: competence, disclosure, understanding and voluntary. Competence refers to the requirement for the individual to be of legal age and mentally competent to understand the process. Disclosure is about knowing the relevant risks and understanding means fully understanding the relevant and factual risks before consent. Voluntary is when the decision is made without coercion or duress. (Colston, 2004)Today, informed consent is a routine process required by law, not only in clinical settings but also in research. In the United States, in a clinical setting, the physician performing the procedure obtains informed consent. The Joint Commission on Health Facilities Accreditation is responsible for overseeing the implementation of informed consent. Because the implementation of informed consent depends on the healthcare provider, it varies widely and is therefore subject to legal action. There is no federal law listing procedures, decisions, and tests that require informed consent. It is therefore up to hospitals and medical professions to decide on local guidelines for informed consent (Terry, 2010). The legal criteria for determining informed consent div...... middle of document ......ts of competence, disclosure, understanding and voluntary informed consent. When using telehealth for the provider, it is sometimes difficult to judge whether the patient fully understands their condition and the reason for the visit. Etherapy has its own set of implementation issues regarding informed consent. In counseling, one of the most important tools for assessing patients' understanding or competence is judging their reactions and emotions. In electronic therapy or telephone therapy, unless the counselor sees the patient via video, it is very difficult to gauge their understanding or competence. Additionally, in electronic therapy, the patient sometimes uses emoticons to represent their emotions. Nevertheless, the emoticon they choose may not show their true emotion and thus make it difficult for the counselor to assess their true feelings, leading to misdiagnosis or poor treatment...