The aspect of the doctor-patient relationship in medicine has changed drastically in the last twenty years. It has evolved from paternalism (the doctor makes the decision on behalf of the patient) to shared decision-making where the patient is considered an equal partner in their health-related decisions. Informed consent is the cornerstone of this vision. When a patient or research subject makes an autonomous decision after understanding the risks and benefits associated with the decision, informed consent is provided. Full informed consent covers the following components: competence, disclosure, understanding and voluntariness. Competence refers to the requirement that the individual be of legal age and mentally competent to understand the process. Disclosure refers to knowing the relevant risks and understanding means fully understanding the relevant and concrete risks before consent. Voluntary is when the decision occurs without coercion or compulsion. (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 doctor performing the procedure obtains informed consent. The Joint Commission on Accreditation of Healthcare Organizations is responsible for overseeing the implementation of informed consent. Because the implementation of informed consent is dependent on the healthcare provider, it varies significantly and is therefore susceptible to legal action. There is no federal law that lists procedures, decisions, and tests that require informed consent. Therefore, it is up to hospitals and medical professions to decide on local guidelines for informed consent (Terry, 2010). The legal criteria for determining informed consent are divided...... half of the document ......ts between competence, disclosure, understanding and voluntariness of informed consent. Using telemedicine for the provider, it is sometimes difficult to judge whether the patient fully understands their medical condition and the reason for the visit. Hetherapy presents a number of implementation issues related to informed consent. In counseling, one of the most important tools for assessing a patient's understanding or competence is to judge his or her reactions and emotions. In electronic or telephone therapy, unless the counselor sees the patient via video, it is very difficult to measure understanding or competence. Furthermore, in electronic therapy the patient sometimes uses emoticons to represent his emotions. However, the chosen emoticon may not show their true emotion and therefore make it difficult for the counselor to gauge their real feelings, leading to misdiagnosis or wrong treatment..