{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T11:50:09Z","timestamp":1792497009889,"version":"4.5.0"},"reference-count":62,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T00:00:00Z","timestamp":1770422400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T00:00:00Z","timestamp":1770422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","award":["EP\/Y016289\/1"],"award-info":[{"award-number":["EP\/Y016289\/1"]}],"id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","award":["EP\/Z531297\/1"],"award-info":[{"award-number":["EP\/Z531297\/1"]}],"id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["AI &amp; Soc"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This paper examines ethical, legal, and social issues (ELSI) associated with healthcare digital twins (DTs). Using a systematic thematic analysis, we identify key themes across ethical, legal, and social categories, as well as practical barriers to adoption and implementation. Findings reveal a range of concerns (e.g. lack of empirical validation of DT value propositions) and gaps between the promise of healthcare DTs and the reality of deploying them within existing healthcare systems. By mapping the identified barriers to the Non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, we seek to demonstrate how healthcare DTs require systematic assurance and capability development. We provide practical recommendations for how this can be achieved, with specified stakeholder groups, to help build trustworthy and ethical DTs with demonstrable healthcare value.<\/jats:p>","DOI":"10.1007\/s00146-025-02833-6","type":"journal-article","created":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T03:39:05Z","timestamp":1770435545000},"page":"5243-5267","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Realising the digital twin: a thematic review and analysis of the ethical, legal, and social issues for digital twins in healthcare"],"prefix":"10.1007","volume":"41","author":[{"given":"Christopher David","family":"Burr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Winter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Chico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila","family":"Rangel Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wagg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven Alexander","family":"Niederer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,7]]},"reference":[{"issue":"1","key":"2833_CR1","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1038\/s41746-021-00407-6","volume":"4","author":"SH Abad","year":"2021","unstructured":"Abad SH, Zahra AK, Sultana M et al (2021) Digital public health surveillance: a systematic scoping review. NPJ Digit Med 4(1):41. https:\/\/doi.org\/10.1038\/s41746-021-00407-6","journal-title":"NPJ Digit Med"},{"key":"2833_CR2","doi-asserted-by":"publisher","unstructured":"Barn, Balbir S (2022) The sociotechnical digital twin: on the gap between social and technical feasibility. 2022 IEEE 24th Conference on Business Informatics (CBI). 1: 11\u201320. https:\/\/doi.org\/10.1109\/CBI54897.2022.00009.","DOI":"10.1109\/CBI54897.2022.00009"},{"key":"2833_CR3","unstructured":"Barocas, Solon, Moritz Hardt, and Arvind Narayanan. 2023. Fairness and Machine Learning: Limitations and Opportunities. MIT Press."},{"issue":"12","key":"2833_CR4","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1136\/jme-2025-111120","volume":"51","author":"A Boretti","year":"2025","unstructured":"Boretti A (2025) Designing inclusive digital twins: ethical and practical considerations for trans healthcare. J Med Ethics 51(12):803\u2013804. https:\/\/doi.org\/10.1136\/jme-2025-111120","journal-title":"J Med Ethics"},{"key":"2833_CR5","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780197649268.001.0001","author":"A Bradford","year":"2023","unstructured":"Bradford A (2023) Digital empires: the global battle to regulate technology. Oxf Uni Press. https:\/\/doi.org\/10.1093\/oso\/9780197649268.001.0001","journal-title":"Oxf Uni Press"},{"issue":"2","key":"2833_CR6","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77\u2013101","journal-title":"Qual Res Psychol"},{"issue":"1_suppl2","key":"2833_CR7","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1177\/00333549141291S206","volume":"129","author":"P Braveman","year":"2014","unstructured":"Braveman P, Gottlieb L (2014) The social determinants of health: it\u2019s time to consider the causes of the causes. Public Health Rep 129(1_suppl2):19\u201331. https:\/\/doi.org\/10.1177\/00333549141291S206","journal-title":"Public Health Rep"},{"key":"2833_CR8","doi-asserted-by":"publisher","first-page":"31","DOI":"10.3389\/fgene.2018.00031","volume":"9","author":"K Bruynseels","year":"2018","unstructured":"Bruynseels K, de Santoni Sio F, van den Hoven J (2018) Digital twins in health care: ethical implications of an emerging engineering paradigm. Front Genet 9:31. https:\/\/doi.org\/10.3389\/fgene.2018.00031","journal-title":"Front Genet"},{"key":"2833_CR9","volume-title":"The Future of Digital Wellbeing","author":"C Burr","year":"2025","unstructured":"Burr C, Niederer S, Wagg D (2025) Reimagining Digital Well-Being in an Age of AI-Enabled Digital Twins. In: Dennis M, K\u00f6nigs P (eds) The Future of Digital Wellbeing. Amsterdam University Press, Amsterdam"},{"issue":"2","key":"2833_CR10","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1002\/bdm.2155","volume":"33","author":"JW Burton","year":"2020","unstructured":"Burton JW, Stein M-K, Jensen TB (2020) A systematic review of algorithm aversion in augmented decision making. J Behav Decis Mak 33(2):220\u2013239. https:\/\/doi.org\/10.1002\/bdm.2155","journal-title":"J Behav Decis Mak"},{"key":"2833_CR11","doi-asserted-by":"publisher","DOI":"10.1002\/9781119857433.ch17","author":"GJ Chase","year":"2023","unstructured":"Chase GJ, Zhou C, Knopp JL et al (2023) Digital Twins and Automation of Care in the Intensive Care Unit. Cyber Phys Hum Syst Fund Appl. https:\/\/doi.org\/10.1002\/9781119857433.ch17","journal-title":"Cyber Phys Hum Syst Fund Appl"},{"issue":"1","key":"2833_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/jlb\/lsz007","volume":"6","author":"EW Clayton","year":"2019","unstructured":"Clayton EW, Evans BJ, Hazel JW, Rothstein MA (2019) The law of genetic privacy: applications, implications, and limitations. J Law Biosci 6(1):1\u201336. https:\/\/doi.org\/10.1093\/jlb\/lsz007","journal-title":"J Law Biosci"},{"key":"2833_CR13","volume-title":"Bmj","author":"JF Cohen","year":"2024","unstructured":"Cohen JF, Bossuyt PMM (2024) TRIPOD+ AI: An Updated Reporting Guideline for Clinical Prediction Models. Bmj. British Medical Journal Publishing Group, London"},{"key":"2833_CR14","doi-asserted-by":"publisher","DOI":"10.5281\/zenodo.10055345","author":"DC Cole","year":"2023","unstructured":"Cole DC, Sood H, Li DS et al (2023) SATRE: standardised architecture for trusted research environments. Zenodo. https:\/\/doi.org\/10.5281\/zenodo.10055345"},{"key":"2833_CR15","unstructured":"European Commission. 2025. Adequacy Decisions: How the EU Determines If a Non-EU Country Has an Adequate Level of Data Protection. https:\/\/commission.europa.eu\/law\/law-topic\/data-protection\/international-dimension-data-protection\/adequacy-decisions_en."},{"key":"2833_CR16","doi-asserted-by":"publisher","unstructured":"Committee on Foundational Research Gaps and Future Directions for Digital Twins, Board on Mathematical Sciences and Analytics, Committee on Applied and Theoretical Statistics, et al. 2024. Foundational Research Gaps and Future Directions for Digital Twins. National Academies Press. https:\/\/doi.org\/10.17226\/26894.","DOI":"10.17226\/26894"},{"issue":"1","key":"2833_CR17","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1038\/s41746-022-00640-7","volume":"5","author":"G Coorey","year":"2022","unstructured":"Coorey G, Figtree GA, Fletcher DF et al (2022) The health digital twin to tackle cardiovascular disease-a review of an emerging interdisciplinary field. NPJ Digit Med 5(1):12. https:\/\/doi.org\/10.1038\/s41746-022-00640-7","journal-title":"NPJ Digit Med"},{"key":"2833_CR18","doi-asserted-by":"publisher","DOI":"10.2307\/j.ctv2xqngmf","volume-title":"Virtual You: How Building Your Digital Twin Will Revolutionize Medicine and Change Your Life","author":"P Coveney","year":"2023","unstructured":"Coveney P (2023) Virtual You: How Building Your Digital Twin Will Revolutionize Medicine and Change Your Life. Princeton University Press, USA"},{"key":"2833_CR19","doi-asserted-by":"publisher","DOI":"10.1007\/s10916-020-01623-5","author":"A Croatti","year":"2020","unstructured":"Croatti A, Gabellini M et al (2020) On the integration of agents and digital twins in healthcare. J Med Syst. https:\/\/doi.org\/10.1007\/s10916-020-01623-5","journal-title":"J Med Syst"},{"key":"2833_CR20","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-32-399163-6.00009-3","volume-title":"Digital Twin for Healthcare","author":"H Dahir","year":"2023","unstructured":"Dahir H, Luna J, Khattab A, Abrougui K, Kumar R (2023) Chapter 4\u2014Challenges of Digital Twin in Healthcare. In: El Saddik A (ed) Digital Twin for Healthcare. Academic Press, USA"},{"key":"2833_CR21","unstructured":"Data Protection Commission (2025) Irish Data Protection Commission Fines TikTok \u20ac530 Million and Orders Corrective Measures Following Inquiry into Transfers of EEA User Data to China. https:\/\/www.dataprotection.ie\/en\/news-media\/latest-news\/irish-data-protection-commission-fines-tiktok-eu530-million-and-orders-corrective-measures-following."},{"issue":"10","key":"2833_CR22","doi-asserted-by":"publisher","first-page":"13","DOI":"10.2196\/39698","volume":"24","author":"D Drummond","year":"2022","unstructured":"Drummond D, Coulet A (2022) Technical, ethical, legal, and societal challenges with digital twin systems for the management of chronic diseases in children and young people. J Med Internet Res (Canada) 24(10):13. https:\/\/doi.org\/10.2196\/39698","journal-title":"J Med Internet Res (Canada)"},{"key":"2833_CR23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4891","author":"G Elwyn","year":"2017","unstructured":"Elwyn G, Durand MA, Song J et al (2017) A three-talk model for shared decision making: multistage consultation process. BMJ. https:\/\/doi.org\/10.1136\/bmj.j4891","journal-title":"BMJ"},{"key":"2833_CR24","unstructured":"England, NHS. 2025. \u201cNHS England\u2014Personalised Care and Support Planning.\u201d September 19. https:\/\/www.england.nhs.uk\/personalisedcare\/pcsp\/."},{"key":"2833_CR25","unstructured":"European Medicines Agency (2024) Reflection Paper on the Use of Artificial Intelligence (AI) in the Medicinal Product Lifecycle_240903. EMA\/CHMP\/CVMP\/83833\/2023."},{"key":"2833_CR26","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2020.2998358","author":"A Fuller","year":"2020","unstructured":"Fuller A, Fan Z, Day C, Barlow C (2020) Digital Twin: Enabling Technologies, Challenges and Open Research. IEEE Access. https:\/\/doi.org\/10.1109\/ACCESS.2020.2998358","journal-title":"IEEE Access"},{"key":"2833_CR27","unstructured":"Goldacre, Ben, Jessica Morley, Nicola Hamilton, et al. 2022. \u201cBetter, Broader, Safer: Using Health Data for Research and Analysis.\u201d Department of Health and Social Care."},{"issue":"11","key":"2833_CR28","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8775","volume":"19","author":"T Greenhalgh","year":"2017","unstructured":"Greenhalgh T, Wherton J, Papoutsi C et al (2017) Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. J Med Internet Res 19(11):e367. https:\/\/doi.org\/10.2196\/jmir.8775","journal-title":"J Med Internet Res"},{"issue":"7696","key":"2833_CR29","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/S0140-6736(71)92410-X","volume":"297","author":"JT Hart","year":"1971","unstructured":"Hart JT (1971) The inverse care law. Lancet 297(7696):405\u2013412. https:\/\/doi.org\/10.1016\/S0140-6736(71)92410-X","journal-title":"Lancet"},{"issue":"3","key":"2833_CR30","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/S2214-109X(24)00056-1","volume":"12","author":"Lancet Global Health","year":"2024","unstructured":"Health The Lancet Global (2024) The landscape for rare diseases in 2024. Lancet Global Health 12(3):341. https:\/\/doi.org\/10.1016\/S2214-109X(24)00056-1","journal-title":"Lancet Global Health"},{"issue":"1","key":"2833_CR31","doi-asserted-by":"publisher","first-page":"12","DOI":"10.2196\/33081","volume":"24","author":"P-H Huang","year":"2022","unstructured":"Huang P-H, Kim K-H, Schermer M (2022) Ethical issues of digital twins for personalized health care service: preliminary mapping study. J Med Internet Res (Canada) 24(1):12. https:\/\/doi.org\/10.2196\/33081","journal-title":"J Med Internet Res (Canada)"},{"key":"2833_CR32","volume-title":"The Expropriation of Health","author":"I Illich","year":"1976","unstructured":"Illich I (1976) Medical Nemesis. The Expropriation of Health. Pantheon Books, New York"},{"issue":"3","key":"2833_CR33","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1017\/jme.2022.97","volume":"50","author":"JD Iqbal","year":"2022","unstructured":"Iqbal JD, Krauthammer M, Biller-Andorno N (2022) The use and ethics of digital twins in medicine. J Law Med Ethics 50(3):14. https:\/\/doi.org\/10.1017\/jme.2022.97","journal-title":"J Law Med Ethics"},{"issue":"8","key":"2833_CR34","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3390\/jpm11080745","volume":"11","author":"MN Kamel Boulos","year":"2021","unstructured":"Kamel Boulos MN, Zhang P (2021) Digital twins: from personalised medicine to precision public health. J Pers Med 11(8):12. https:\/\/doi.org\/10.3390\/jpm11080745","journal-title":"J Pers Med"},{"issue":"1","key":"2833_CR35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/biomet\/87.1.1","volume":"87","author":"MC Kennedy","year":"2000","unstructured":"Kennedy MC, O\u2019Hagan A (2000) Predicting the output from a complex computer code when fast approximations are available. Biometrika 87(1):1\u201313. https:\/\/doi.org\/10.1093\/biomet\/87.1.1","journal-title":"Biometrika"},{"issue":"2207","key":"2833_CR36","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1098\/rsta.2020.0367","volume":"379","author":"Dd Kerckhove","year":"2021","unstructured":"Kerckhove Dd (2021) The personal digital twin, ethical considerations. Philos Trans R Soc: Maths Phys Eng Sci 379(2207):12. https:\/\/doi.org\/10.1098\/rsta.2020.0367","journal-title":"Philos Trans R Soc: Maths Phys Eng Sci"},{"key":"2833_CR37","unstructured":"Kerwash, Essam. 2025. \u201cICH M15 Model Informed Drug Development (MIDD) Guideline.\u201d January 10. https:\/\/medregs.blog.gov.uk\/2025\/01\/10\/ich-m15-model-informed-drug-development-midd-guideline\/."},{"issue":"4","key":"2833_CR38","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/0306396818823172","volume":"60","author":"M Kwet","year":"2019","unstructured":"Kwet M (2019) Digital colonialism: US empire and the new imperialism in the Global South. Race Class 60(4):3\u201326","journal-title":"Race Class"},{"key":"2833_CR39","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2024.3416517","volume":"12","author":"MW Lauer-Schmaltz","year":"2024","unstructured":"Lauer-Schmaltz MW, Cash P, Rivera DGT (2024) ETHICA: designing human digital twins\u2014a systematic review and proposed methodology. IEEE Access 12:27. https:\/\/doi.org\/10.1109\/ACCESS.2024.3416517","journal-title":"IEEE Access"},{"key":"2833_CR40","doi-asserted-by":"publisher","DOI":"10.22541\/au.168209222.21704626","author":"T Lawton","year":"2024","unstructured":"Lawton T, Morgan P, Porter Z et al (2024) Clinicians Risk Becoming \u201cLiability Sinks\u201d for Artificial Intelligence. Authorea. https:\/\/doi.org\/10.22541\/au.168209222.21704626","journal-title":"Authorea"},{"issue":"3","key":"2833_CR41","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3390\/ijerph19031510","volume":"19","author":"CG Leo","year":"2022","unstructured":"Leo CG, Tumolo MR, Sabina S et al (2022) Health technology assessment for in silico medicine: social, ethical and legal aspects. Int J Environ Res Public Health 19(3):13. https:\/\/doi.org\/10.3390\/ijerph19031510","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"2833_CR42","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.3390\/smartcities6030075","volume":"6","author":"G Li","year":"2023","unstructured":"Li G, Liu Y, Wu J (2023) Citizens\u2019 data privacy in China: the state of the art of the personal information protection law (PIPL). Smart Cities 6(3):1574\u20131594. https:\/\/doi.org\/10.3390\/smartcities6030075","journal-title":"Smart Cities"},{"issue":"10","key":"2833_CR43","doi-asserted-by":"publisher","first-page":"e537","DOI":"10.1016\/S2589-7500(20)30218-1","volume":"2","author":"X Liu","year":"2020","unstructured":"Liu X, Rivera SC, Moher D et al (2020) Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT-AI extension. Lancet Digital Health 2(10):e537\u2013e548","journal-title":"Lancet Digital Health"},{"issue":"1","key":"2833_CR44","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1038\/s41746-025-01667-2","volume":"8","author":"M Liu","year":"2025","unstructured":"Liu M, Ning Y, Teixayavong S et al (2025) A scoping review and evidence gap analysis of clinical AI fairness. NPJ Digit Med 8(1):360. https:\/\/doi.org\/10.1038\/s41746-025-01667-2","journal-title":"NPJ Digit Med"},{"key":"2833_CR45","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2021-107517","author":"D Lupton","year":"2021","unstructured":"Lupton D (2021) Language matters: the \u2019\"digital twin\u2019 metaphor in health and medicine. J Med Ethics. https:\/\/doi.org\/10.1136\/medethics-2021-107517","journal-title":"J Med Ethics"},{"key":"2833_CR46","unstructured":"Medicines and Healthcare products Regulatory Agency (2023) \u201cPredetermined Change Control Plans for Machine Learning-Enabled Medical Devices: Guiding Principles. GOV.UK.\u201d October 24. https:\/\/www.gov.uk\/government\/publications\/predetermined-change-control-plans-for-machine-learning-enabled-medical-devices-guiding-principles\/predetermined-change-control-plans-for-machine-learning-enabled-medical-devices-guiding-principles."},{"key":"2833_CR47","unstructured":"Medicines and Healthcare products Regulatory Agency (2024) \u201cMachine Learning Medical Devices: Transparency Principles. GOV.UK.\u201d Accessed September 19, 2025. https:\/\/www.gov.uk\/government\/publications\/machine-learning-medical-devices-transparency-principles."},{"key":"2833_CR48","unstructured":"Medicines and Healthcare products Regulatory Agency (2025) \u201cSoftware and Artificial Intelligence (AI) as a Medical Device.\u201d In GOV.UK. https:\/\/www.gov.uk\/government\/publications\/software-and-artificial-intelligence-ai-as-a-medical-device\/software-and-artificial-intelligence-ai-as-a-medical-device."},{"issue":"7","key":"2833_CR49","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12071496","volume":"12","author":"AE Mohr","year":"2024","unstructured":"Mohr AE, Ortega-Santos CP, Whisner CM, Klein-Seetharaman J, Jasbi P (2024) Navigating challenges and opportunities in multi-omics integration for personalized healthcare. Biomedicines 12(7):23. https:\/\/doi.org\/10.3390\/biomedicines12071496","journal-title":"Biomedicines"},{"issue":"6464","key":"2833_CR50","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1126\/science.aax2342","volume":"366","author":"Z Obermeyer","year":"2019","unstructured":"Obermeyer Z, Powers B, Vogeli C, Mullainathan S (2019) Dissecting racial bias in an algorithm used to manage the health of populations. Science 366(6464):447\u2013453. https:\/\/doi.org\/10.1126\/science.aax2342","journal-title":"Science"},{"key":"2833_CR51","doi-asserted-by":"publisher","DOI":"10.1186\/s40504-021-00113-x","author":"EO Popa","year":"2021","unstructured":"Popa EO, Popa EO, van Hilten M et al (2021) The use of digital twins in healthcare: socio-ethical benefits and socio-ethical risks. Life Sci Soc Policy. https:\/\/doi.org\/10.1186\/s40504-021-00113-x","journal-title":"Life Sci Soc Policy"},{"key":"2833_CR52","doi-asserted-by":"publisher","unstructured":"Sharma, Bhanu, Deepak Kaushal, Manu Sharma, Sudhanshu Joshi, Sanghmitra Gopal, and Priyanka Gupta (2023) Integration of AI, Digital Twin and Internet of Medical Things (IoMT) for Healthcare 5.0: A Bibliometric Analysis. 2023 International Conference on Advances in Computation, Communication and Information Technology (ICAICCIT). https:\/\/doi.org\/10.1109\/ICAICCIT60255.2023.10466141.","DOI":"10.1109\/ICAICCIT60255.2023.10466141"},{"key":"2833_CR53","unstructured":"Stephens, Richard. 2025. \u201cNew Zealand Government Urged to Stop Insurers Using Genetic Test Results. PET.\u201d August 26. https:\/\/www.progress.org.uk\/new-zealand-government-urged-to-stop-insurers-using-genetic-test-results\/."},{"issue":"1","key":"2833_CR54","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1080\/24735132.2025.2483479","volume":"9","author":"E Tsekleves","year":"2025","unstructured":"Tsekleves E, Cooper R, Jacobs N, Cureton P (2025) Designing the future of healthcare: the role of design research in shaping digital twin technologies. Des Health 9(1):121\u2013131. https:\/\/doi.org\/10.1080\/24735132.2025.2483479","journal-title":"Des Health"},{"key":"2833_CR55","unstructured":"US Food and Drug Administration. 2022. Computer Software Assurance for Production and Quality System Software. FDA. https:\/\/www.fda.gov\/regulatory-information\/search-fda-guidance-documents\/computer-software-assurance-production-and-quality-system-software."},{"key":"2833_CR56","doi-asserted-by":"publisher","first-page":"13","DOI":"10.2196\/50204","volume":"26","author":"A Vall\u00e9e","year":"2024","unstructured":"Vall\u00e9e A (2024) Envisioning the future of personalized medicine: role and realities of digital twins. J Med Internet Res 26:13. https:\/\/doi.org\/10.2196\/50204","journal-title":"J Med Internet Res"},{"key":"2833_CR57","volume-title":"Health Justice","author":"S Venkatapuram","year":"2013","unstructured":"Venkatapuram S, Marmot M (2013) Health Justice, 1st edn. Polity Press, Cambridge","edition":"1"},{"key":"2833_CR58","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-62328-8","volume-title":"The EU general data protection regulation (GDPR): a practical guide","author":"P Voigt","year":"2024","unstructured":"Voigt P, Von Dem Bussche A (2024) The EU general data protection regulation (GDPR): a practical guide. Springer Nature, Switzerland. https:\/\/doi.org\/10.1007\/978-3-031-62328-8"},{"issue":"14","key":"2833_CR59","doi-asserted-by":"publisher","first-page":"30","DOI":"10.3390\/s23146333","volume":"30","author":"PD Winter","year":"2023","unstructured":"Winter PD, Chico TJA (2023) Using the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework to identify barriers and facilitators for the implementation of digital twins in cardiovascular medicine. Sensors (Basel, Switzerland) 30(14):30. https:\/\/doi.org\/10.3390\/s23146333","journal-title":"Sensors (Basel, Switzerland)"},{"key":"2833_CR60","unstructured":"World Health Organisation (2025) Rare Diseases: A Global Health Priority for Equity and Inclusion. Accessed September 19, 2025. https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/EB156\/B156_CONF2-en.pdf"},{"issue":"8","key":"2833_CR61","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.patter.2024.101028","volume":"5","author":"K Zhang","year":"2024","unstructured":"Zhang K, Zhou H-Y, Baptista-Hon DT et al (2024) Concepts and applications of digital twins in healthcare and medicine. Patterns 5(8):15. https:\/\/doi.org\/10.1016\/j.patter.2024.101028","journal-title":"Patterns"},{"key":"2833_CR62","volume-title":"The Age of Surveillance Capitalism: The Fight for a Human Future at the New Frontier of Power","author":"S Zuboff","year":"2019","unstructured":"Zuboff S (2019) The Age of Surveillance Capitalism: The Fight for a Human Future at the New Frontier of Power. Profile books, London"}],"container-title":["AI &amp; SOCIETY"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00146-025-02833-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00146-025-02833-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00146-025-02833-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T02:19:05Z","timestamp":1780712345000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00146-025-02833-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,7]]},"references-count":62,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["2833"],"URL":"https:\/\/doi.org\/10.1007\/s00146-025-02833-6","relation":{"references":[{"id-type":"doi","id":"10.5281\/zenodo.10055345","asserted-by":"subject"}]},"ISSN":["0951-5666","1435-5655"],"issn-type":[{"value":"0951-5666","type":"print"},{"value":"1435-5655","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,7]]},"assertion":[{"value":"7 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}