As medicine moves longevity from theory to clinical application, it creates urgent ethical tensions between technological promise and systemic justice. This chapter analyzes the current landscape through five interdigitated problems: unregulated clinical governance, algorithmic bias in predictive tools, research inequities, limits of informed consent, and the absence of validated evidence and regulatory pathways. Integrating longitudinal data with four vignettes, including identity transformation in senolytic trials to fatal regulatory arbitrage in medical tourism, the analysis identifies concrete mechanisms for ethical translation. Recommendations include clinic-level accreditation, mandatory data collection and outcome registries, algorithmic audits, and dynamic, behaviorally-informed consent models. The chapter argues for a pivot toward chrono-equity prioritizing marginalized populations in public funding alongside adaptive governance that preserves the capacity to course-correct as we learn.