Space agencies like NASA and ESA have developed advanced telemedicine tools to support astronaut health. These include autonomous diagnostics, wearable sensors, AI-driven triage, and satellite connectivity. Many of these innovations are now being transferred to civilian health systems and offer solutions to persistent challenges in rural primary care—especially in under-resourced or geographically isolated regions. Yet the legal, ethical, and policy implications of these transfers remain underexplored.To review and synthesize academic, technical, and policy literature on how space-derived telemedicine technologies can enhance rural primary care systems in Europe and globally, with a focus on patient autonomy, equitable access, and ethical deployment.A structured narrative review was conducted using peer-reviewed databases (PubMed, Scopus, JSTOR), agency reports (NASA, ESA, WHO, UNOOSA), and legal policy briefs (EU GDPR, EHDS). Inclusion criteria: 1) relevance to space-originated health innovations, 2) application to remote or rural healthcare delivery, 3) published between 2000–2025. Exclusion: conceptual-only space medicine studies without Earth-application context. Literature was analyzed thematically across three domains: technology, ethics, and policy.Key technologies include AI decision-support, tele-ultrasound, holoportation, satellite-based diagnostics, and non-contact vital-sign monitors. ESA/NASA spin-off tools have been piloted in rural and disaster-response settings. Ethical challenges include ensuring informed consent, data privacy, and equitable rollout. Legally, GDPR and emerging EU health-data regulations require encrypted, jurisdiction-specific handling of biometric data. Policy frameworks increasingly support cross-border telehealth, but licensing and funding barriers persist. Community engagement and training are crucial to ensure adoption in rural contexts.While space-derived tools can reduce rural disparities, their ethical use depends on design that empowers patients and providers. Autonomous systems must be transparent and culturally adapted. Equity requires targeted public investment and regulatory clarity.Space medicine provides a high-tech model for delivering care where providers are scarce and distances vast. To fulfill the values of liberty, equality, and fraternity in European primary care, deployment of these tools must center on ethical governance, legal accountability, and human-centered design.NOVA