The Self-Sovereign Patient as a Cornerstone of Healthcare 4.0.

In Healthcare 4.0, we are witnessing a fundamental shift from provider-centric systems to patient-centric models, where individuals, empowered by technologies such as blockchain, the Internet of Medical Things, and artificial intelligence (AI), assume the role of the Self-Sovereign Patient, exercising control over their health data and care journey. These technologies enable new forms of data ownership, interoperability, and personalized care, building on the structured reliability of legacy systems. However, significant challenges remain. Tensions between blockchain immutability and regulatory rights such as data erasure, the unresolved question of digital inheritance, and ethical concerns surrounding consent, monetization, and health equity must all be addressed. In addition, institutional barriers such as clinical integration, data governance, and uneven access to digital infrastructure pose risks of deepening existing disparities. AI agents, when responsibly deployed, offer promising pathways to augment care delivery and alleviate workforce burdens. Realizing this vision requires coordinated action across clinical, technical, legal, and ethical domains to design trustworthy, privacy-preserving systems that enhance transparency and accountability.