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Digital twins are gaining attention in healthcare, especially in fields like hospital management, simulating surgeries, or providing personalized health. As digital replicas based on users' data, digital twins can inform citizens in-depth about their lifestyle, medical data, and biomedical data. Hence, there is the assumption that digital twins could facilitate preventative healthcare at home, bringing healthcare closer to citizens, yet there are underexamined ethical concerns. In this paper, we explore the ethics of digital twins based on citizens' perspectives on digital twins in healthcare via recent literature and research. Although digital twins have great potential, citizens have concerns about surveillance, data ownership, data accuracy, and personal and collective agency.

Recently, a host of propositions for guidelines for the ethical development and use of artificial intelligence (AI) has been published. This body of work contains timely contributions for sensitizing developers to the ethical and societal implications of their work. However, a sustained embedding of ethics in largely algorithm-based technology development, research and studies requires a precise framing of the origins of the new vulnerabilities created. Recently, scholars have been referring to ethics associated with technology that is in some way "opaque" to at least part of its associated stakeholders. This "opacity" can take several forms which will be discussed in this paper. There are various ways in which such an opacity can create vulnerabilities and, hence, relevant ethical, societal, epistemic and regulatory challenges. This paper provides a non-exhaustive list of examples in healthcare that call for educational resources and consideration in development processes that try to reveal and counter these opacities.