The ethical dilemma of telemedicine and its causes are mainly the deficiencies of human rationality in traditional ethical evaluation, and the uncertainty of communication and the difficulty of reaching an agreement among telemedicine stakeholders. The solution to this ethical dilemma requires the use of the advantage of dialogue rationality of dialogue ethics to overcome the shortcomings of traditional ethical evaluation, the use of dialogue to continuously solve the problems of heterogeneous subjects, and the practice of continuous dialogue among telemedicine stakeholders to ultimately achieve ethical perfection, thus constructing a dynamic and pluralistic telemedicine evaluation system that is constantly conducted in dialogue and feasible in the future.