Telemedicine and e-medicine have the potential to transform medical practice. However, while the benefits have long been known, many physicians and health systems have been reluctant to engage in such practices due to unresolved legal and ethical concerns. I conducted a systematic examination of US and European statutes, regulations and civil, criminal and administrative decisions pertaining to telemedicine and e-medicine, as well as a review of the ethical, legal and medical literature pertaining to the practice of telemedicine and e-medicine in the US and Europe. There appear to be four main areas of concern: the doctor-patient relationship; malpractice and cross-border licensure; standards; and reimbursement. The lack of generally agreed interstate and international standards of law and ethics means that telemedicine and e-medicine will continue to struggle to gain widespread support from providers, patients and regulatory bodies as an acceptable means of health service delivery. Progress may depend on federal and international leadership.