Realising the digital twin: a thematic review and analysis of the ethical, legal, and social issues for digital twins in healthcare

Abstract

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.

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Item Type:	Article
Authors/Creators:	Burr, C.D. Qian, S. Winter, P. Chico, T. Rangel Smith, C. Wagg, D. https://orcid.org/0000-0002-7266-2105 Niederer, S.A.
Copyright, Publisher and Additional Information:	© The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Keywords:	Digital twins; Digital healthcare; Data ethics; AI governance; Law; Biomedical ethics
Dates:	Submitted: 7 October 2025 Accepted: 20 December 2025 Published (online): 7 February 2026 Published: 7 February 2026
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Engineering (Sheffield) > School of Mechanical, Aerospace and Civil Engineering
Date Deposited:	17 Feb 2026 13:13
Last Modified:	17 Feb 2026 13:13
Status:	Published online
Publisher:	Springer Science and Business Media LLC
Refereed:	Yes
Identification Number:	10.1007/s00146-025-02833-6
Related URLs:	Author
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:238113

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Realising the digital twin: a thematic review and analysis of the ethical, legal, and social issues for digital twins in healthcare

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