Artificial Intelligence in Telemedicine: philosophical, ethical, and epistemological dimensions of a transforming practice.

Abstract

In the aftermath of the COVID-19 pandemic, telemedicine has evolved from a contingency-based alternative into a structural pillar of healthcare delivery, increasingly being integrated with artificial intelligence. Algorithms for triage, clinical decision support, remote monitoring, and generative language models now actively participate in medical care. This integration is more than just functional; it reorganizes the foundational aspects of medicine-ontological, ethical, and epistemological-by redefining what qualifies as valid knowledge, who has legitimate authority, and how care is organized when an algorithmic agent facilitates the clinical interaction. This article critically examines the emergence of the patient-clinician-algorithm triad in telemedicine, and analyzes its implications for autonomy, informed consent, epistemic trust, privacy, justice, responsibility, and the phenomenology of care. It argues that the future of medicine will not be human or algorithmic but human-algorithmic, provided clinical judgment, explainability, and moral responsibility remain central.