# Digital twins: The New Frontier for Personalized Medicine?
## 9 Ethical and Legal Concerns  
DHT presents various ethical issues that must be thoughtfully addressed for a responsible and ethical application of this technology. Primary ethical concerns [43; 44; 45; 46; 47] associated with DHT in healthcare are:  
* Privacy and Data Security: Creating and using a DHT demands extensive data gathering, including personal health information, genetic data, and lifestyle habits. Robust data privacy and security measures are crucial to avoid unauthorized access, breaches, and misuse of sensitive information. Compliance with data protection regulations, such as the General Data Protection Regulation or Health Insurance Portability and Accountability Act, is crucial to ensure the privacy and security of individuals' sensitive health data [48; 49; 50; 51]. Furthermore, it is essential to prevent unauthorized access, data violations, or possible misuse of sensitive data. Robust security measures, including encryption and access restrictions, must be implemented to safeguud patients' data from cyber threats [52; 53]. Conformity with established security standards such as ISO/IEC 27001 is indispensable for mitigating risks related to unauthorized data acquisition [54]. * Informed Consent: Producing a DHT may entail exhaustive monitoring of an individual's health through real-time and historical data analysis. Obtaining informed consent from patients is vital; they must fully comprehend the implications of sharing their personal data and the possible uses and risks associated with creating and using a DHT. Transparent consent processes and strict adherence to data protection regulations are essential for maintaining patient trust [55]. * Equity and Accessibility: The development and adoption of the DHT should follow principles of equity and accessibility. It is vital to ensure equal access to this technology for all individuals, regardless of socioeconomic status, race, or location, to avoid worsening healthcare disparities. Affordability, availability, algorithmic biases, and other ethical factors must be evaluated [56]. * Trust and Autonomy: As DHTs access more personal health data and integrate further into healthcare decision-making processes, trust, and autonomy become pressing concerns. Patients should have confidence that their DHT is being used responsibly in their best interest while maintaining control over its use, including opting out or altering the extent of data sharing [57]. * Psychological Impact: Interaction with an ever-changing DHT can have a psychological impact on the individual as it reflects aging and health changes over time. This awareness can affect self-esteem, self-perception, and mental health. Addressing the psychological aspect of aging in the context of the DHT is an ethical challenge. It is essential to provide supportive resources, such as counseling and psychological support, to help people cope with the psychological challenges related to aging [57]. * Algorithmic Bias and Fairness: Developing algorithms for human DHTs relies on extensive data training; biased or non-diverse training sets can perpetuate unequal treatment resulting in healthcare disparities. Ensuring fairness in algorithms is imperative to prevent the exacerbation of existing healthcare inequities [58]. * Liability: The integration of DHTs raises several questions concerning liability. Indeed, if errors occur, for instance, inaccurate prediction or wrong diagnoses, determining liability becomes challenging because of the legal gap. Clear legal frameworks must be established to define the responsibilities of healthcare providers, technology developers, and other relevant stakeholders [59; 60]. * Regulatory Compliance: The development of DHTs involves different regulatory frameworks governing healthcare, data protection, medical devices, and artificial intelligence. Compliance with existing regulations stipulated by entities such as the Food and Drug Administration and European Medicines Agency may be mandatory [60].