<title>Legal and ethical challenges of telemedicine and e-health</title>

Abstract

This invited paper aims to examine how telemedicine and e-health will develop over the coming years and, in particularly, to assess what legal and ethical barriers may lie in the way of this development. A description of the key principles and concepts involved in telemedicine and e-health and a short historical overview of their evolution over the past century is followed by consideration ofwhy empirical research into "Info-ethics" and other deontological and legal issues relating to telemedicine and e-health are so important. Five evolving health telematics applications are examined in some detail: electronic health records; the transmission of visual media in disciplines such as teleradiology, teledermatology, telepathology and teleopthalmology; telesurgery and robotics; the use of call centres and decisionsupport software and, of course, the growing role of the Internet in healthcare. These are discussed in the light of their moral, ethical and cultural implications for clinicians, patients and society at large. Telemedicine and e-health present unique opportunities for both patients and clinicians where they are implemented in direct response to clear clinical needs. But excessive reliance upon technology will damage the traditional clinician-patient relationships and we must therefore avoid complacency regarding the risks and responsibilities - many of which are as yet unknown - that distant medical intervention, consultation and diagnosis carries.