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Expanding use of computers in medicine continues to raise interesting and important ethical issues. After a brief review of the history of work in ethics in medical informatics, this introduction to this special issue of Actamakes the case that this work must be applied in a Latin American and Caribbean context. From the use of Bioethica intelligent machines to the evolution of the World Wide Web, the region presents vital -and under addressed- challenges to clinicians and policy makers. Sustained and regional debates, curriculum development and empirical and conceptual scholarship are among the means to ensure ethically optimized applications of health information technology in the region.