The rapid expansion of smart medical systems in the healthcare sector has significantly transformed the way medical services are delivered. By relying on artificial intelligence, medical data analysis, and the Internet of Medical Things, these systems have contributed to improving diagnosis, treatment, and patient monitoring. However, alongside these advancements, a range of ethical and security challenges has emerged, requiring careful consideration to ensure the responsible and safe use of such technologies. One of the major ethical concerns associated with smart medical systems is the protection of patient data privacy. These systems depend on the collection, storage, and processing of large volumes of sensitive personal health information, including medical records, diagnostic images, and physiological data. Ensuring that this information is handled securely and used appropriately represents a significant challenge, particularly when data are shared across healthcare institutions or utilized for research and commercial purposes. Smart medical systems also raise important ethical questions related to transparency and accountability. Many artificial intelligence–based applications rely on complex algorithms whose decision-making processes are difficult to interpret. This lack of transparency may undermine trust between patients and healthcare providers and complicate the assignment of responsibility in cases where diagnostic or treatment errors occur due to system-generated decisions rather than human judgment. From a security perspective, smart medical systems are highly vulnerable to cyberattacks because of the critical nature of healthcare services and the high value of medical data. Security breaches may result in data leaks, manipulation of medical results, or the disruption of smart medical devices, posing serious risks to patient safety and the continuity of healthcare services. In addition, issues of fairness and equitable access to smart medical technologies represent another ethical challenge. Heavy reliance on advanced digital systems may widen the gap between well-resourced healthcare institutions and those with limited technical or financial capabilities. This raises concerns about unequal access to high-quality, technology-driven healthcare services among different segments of society. Addressing these ethical and security challenges requires the development of clear regulatory and ethical frameworks, the implementation of robust cybersecurity standards, and increased awareness among healthcare professionals regarding data protection and patient rights. Responsible management of these issues is essential to ensure that smart medical systems enhance healthcare outcomes while preserving fundamental human values and ethical principles. Al-Mustaqbal University is the first one university in Iraq.