To the Editor:

I read with keen interest Burtson and Vento's "Sitter Reduction Through Mobile Video Monitoring"1 and appreciate the dilemma of the financial cost and proven ineffectiveness of sitters and the clear need to keep patients safe. The authors make a strong argument for the cost and safety effectiveness of their video monitoring program. However, what is unsettlingly absent from their discussion is how this intervention accommodates patient respect. In the pressure to attend to "measurable variables" such as number of falls or tubes removed prematurely by patients with delirium or dementia, there is absence of consideration of the variable of patient humanity and respect in the analysis of the success of the intervention of video presence. There is a slippery slope in the mechanization of healthcare delivery, often supported by its efficiency or cost saving, which we may fail to see in the initial slide. In this case, I think the beginning of the slide is the need to consider the "ethical variable" of this innovation. Mobile video monitoring may well prove to meet the mark of providing relationship-based care as reported by the patient and family members (eg, the patient says they feel cared for and safe and the family concurs), as well as provide safety. I hope so. And I hope the ethics variable can be included in future discussions of this new innovation.

Martha Jurchak, PhD, RN

Executive Director, Ethics Service

Brigham and Women's Hospital

Boston, Massachusetts

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