• ethics
• ethics- medical
• Artificial Intelligence

In the article ‘Represent Me: Please! Towards an Ethics of Digital Twins in Medicine’, I analysed and tried to better understand the main ethical challenges associated with Digital Twins (DT). For those who are just entering the debate with this article: DT is a metaphor for a bundle of artificial intelligence (AI) driven simulation technologies that constantly, in real time and ad personam simulate single or multiple parts of the body and make predictions about future health states based on these simulations. My argument addresses the need to look at the breadth of challenges through a perspective of representation. From such a take, key consequences can be drawn for the further development of such technologies, the required means of control and not least the way to think about the interaction between humans and ‘their’ simulations.

I am very grateful for the subsequent suggestions, criticisms and further arguments, which have helped me to elaborate my arguments more clearly and have led to a substantial advancement of the debate and the discussion about ethical questions in dealing with DT. Jenny Blumenthal-Barby,1 Deborah Lupton,2 Jenny Krutzinna,3 Janina Loh,4 Brent Mittelstadt,5 Sven Nyholm,6 Daniel Tigard7 and Max Tretter8 have made excellent points, which, in the following, I will not be able to reply to individually and in detail.

In this response, I will try to bundle the open points and questions along the comments and considerations mentioned above and attempt to outline their significance for an ethics of DT. Four challenges seem to be central.

A first point addresses anthropological issues. It is concerned …