JMIR Publications

ABSTRACT

The governance of digital health data has largely focused on prospective safeguards, including informed consent at the point of data collection and responsible processing during active clinical or research use. However, far less attention has been devoted to the long-term circulation of legacy clinical data within educational infrastructures. This oversight is particularly significant for paediatric clinical images, which may persist for decades within medical training materials despite the absence of documented patient consent. In this viewpoint, we examine how non-consensual paediatric clinical images become embedded within digital medical education ecosystems and continue to circulate across textbooks, conferences, digital repositories and online teaching platforms. Drawing on a longitudinal governance case spanning more than three decades, we demonstrate how responsibility for addressing historical ethical violations becomes fragmented across healthcare institutions, academic publishers, regulatory authorities and educational systems. This fragmentation creates a governance gap in which legacy clinical images may remain in circulation even after formal objections or regulatory scrutiny. As medical education materials increasingly contribute to digital learning environments and artificial intelligence training datasets, unresolved consent violations risk becoming embedded within emerging digital health infrastructures. We argue that digital health governance frameworks remain incomplete without lifecycle mechanisms capable of addressing legacy educational data. Retrospective consent verification, cross-sector accountability and effective withdrawal procedures are necessary to prevent the continued reuse of non-consensual clinical images and to ensure that digital health systems do not reproduce historical ethical violations.