‘The Journal of Medical Ethics reflects the whole field of medical ethics and aims to encourage a high academic standard for this ever-developing subject, and the enhancement of professional and public discussion’. A single issue of this Journal can reflect only some aspects of this ‘whole field’ and only some of the ways in which they are studied and discussed. The contributions to this issue however illustrate a rich variety, both of those aspects of contemporary healthcare with which medical ethics is currently concerned and also of the disciplined imaginative ways in which these may be ethically analysed with an eye to enhancing both public discussion and professional practice.

The aspects of healthcare examined in this issue include some that are notably contemporary: genomics, mobile health, environmental sustainability and artificial intelligence, but also others more familiar to earlier generations: mixed wards in hospitals, coercion in psychiatry, patient and public involvement in research, abortion, palliative medicine and intensive care. These various aspects of healthcare practice are analysed in terms of a variety of ethical principles, philosophies, values and virtues. Most familiar perhaps are the four principles of beneficence, non-maleficence, respect for autonomy and justice or fairness, together with those of individual human rights, for example to personal security and dignity; but in addition the rights, derived from the philosophy of Afro-communitarianism, of populations and of their researchers. The Aristotelian value of human flourishing moreover informs some of these analyses as does reflection on the virtues of kindness and curiosity.

This issue’s contributions on contemporary aspects of healthcare include two concerned with the ethics of genomic medicine and research, but with different foci and in different contexts.

This month’s Feature Article, ‘Ethical preparedness in genomic medicine’ by Sahan and colleagues,1 together with five commentaries2–6 and the authors’ response,7 examines hitherto ‘underexplored’ questions of how clinical laboratory scientists (as distinct from clinicians) ‘navigate ethical problems in their work’ and ‘how they should be best supported to do this’. The authors’ findings, based on the analysis of cases presented by clinical laboratory scientists in the UK, show that ‘clinical scientists feel partly responsible for how patients will receive results and how they should be followed up in the future’, and that ‘testing using increased panel sizes may cause scientists (or others delivering genomic medicine services) to feel obliged to turn data into clinically significant findings prematurely, in order to ‘give an answer’ to patients’. While consistent ‘guidance and professional standards’ are necessary in this context, they are not sufficient without the ‘more wide-reaching, fundamental intervention of Ethical Preparedness’—a ‘situated approach to ethics deliberation’ which ‘uses the context and diversity of the practice environment to inform quality ethical thinking’ as ‘part of regular practice in genetics/genomics’ and thereby helps to ‘better empower healthcare professionals to recognise and value their own abilities in managing ethical issues over time’.

Genomic research, and specifically the question of whether institutions should fund feedback of its individual findings, is addressed by Owusu and colleagues8 in their essay informed by ‘an underexplored Afro-communitarian view of distributive justice and rights of researchers to be aided’. The question of ‘who ought to bear the costs of returning results…especially in research conducted in low-income and middle-income countries’ is examined in the light of ‘the philosophy from Africa that emphasises communal relationships as the highest good’. Such relationships, it argues, ‘demand that institutions ought to go out of their way (to the extent they can) to create enabling environments for their researchers’ in terms of ‘funding the cost of returning individual (pertinent or secondary) finding in genomic research’. This carefully nuanced ‘prima facie obligation’, the authors argue, is ‘morally realistic and just’, ‘does not impose obligations on individuals beyond their abilities’ and now requires further research ‘to study how’ this prima facie obligation ‘will interact with social contexts to find an actual duty’.

Other notably contemporary issues discussed in this issue are no less important or relevantly argued. ‘Ethical implications of the widespread use of informal mHealth in Africa’ by Ewuoso9 describes how community health nurses in Ghana ‘extend healthcare delivery services to clients who otherwise might have been excluded from formal health systems’, but to do so ‘use their private mobile phones’ to exchange calls and share health data with patients and colleagues in ways that are ‘fraught with excessive privacy invasion and confidentiality breaches’, and which therefore, the author argues, now need to be formalised.

In ‘Environmental sustainability and the paradox of prevention’, Richie10 argues that while ‘preventive healthcare may save healthcare carbon by proximally reducing the need for medical treatments’ this ‘also, paradoxically, results in more healthcare carbon both in an individual’s (longer) life and in the medical industry’. This ‘paradox of prevention’, the author argues, cannot be ethically avoided, but it can be mitigated in ways that ‘reduce carbon in other areas of life that have less social and intellectual value, while also making healthcare, medicine, science and technology, as sustainable as possible’.

‘Trust criteria for artificial intelligence in health’ by Kostick-Quenet11 reports on an enquiry into how much physicians and patients are prepared to trust artificial intelligence and machine learning systems designed for use in clinical decision-making’. The findings suggest that ‘trust evaluations considered the nature, integrity and relevance of training data rather than the computational nature of algorithms themselves’, but also ‘to a lesser extent…endorsement from others…and sometimes personal beliefs and experience’.

Five aspects of healthcare perhaps more familiar to earlier generations of ethicists are also discussed in this issue. ‘Blowing the whistle on mixed gender hospital rooms in Australia and New Zealand’ by Towns and Ballantyne12 argues that this ‘common and increasing’ practice ‘violate[s] the fundamental human rights of personal security and dignity’ and thus requires ‘the adoption of specific national policies prohibiting mixed gender rooms’.

‘Using coercion in mental disorders or risking the patient’s death?’ by Steinert13 analyses recommendations of psychiatric ethics committees in Germany on the use of coercion: very few cases considered involved suicide risk, most concerned its use in patients lacking mental capacity, and in most the use of coercion was not endorsed. A decision-making algorithm incorporating the principles of beneficence, non-maleficence, autonomy and fairness was derived and is presented.

‘Medical student attitudes to patient involvement in healthcare decision-making and research’ by O’Neill and student colleagues14 finds that first year students in their medical school demonstrated ‘awareness of the need to actively involve patients in healthcare decision-making’ but were ‘unfamiliar with the utility and value of such involvement in research’.

One of the two Responses in this issue, ‘A role for kindness and curiosity in healthcare’ by Miller,15 argues that although ‘empathy and compassion rely heavily on the emotions of the agent…kind care can be provided to all regardless of the physician’s feelings, while encouraging curiosity prompts us to consider the perspectives of others and to see all patients as having valuable perspectives on their own experiences’. The other response, ‘Sub-humans, human flourishing, and abortion’ by Cheung 16 develops further ethical arguments and counterarguments in this highly contested area of medical ethics.

The same concept is central also to ‘Human flourishing, medicine and integration of palliative care principles into intensive care medicine’ by Donaldson.17 ‘Aristotle’s concept of human flourishing, incorporating both a long life and a good death,’ the author argues, ‘has the potential to act as a goal for medicine that will prevent palliative care considerations being relegated to an afterthought in medical decision-making, once all curative treatments are exhausted’.

This issue of the Journal concludes with an Ethics Briefing by Berg and Michaux18 which among other items summarises the salutary findings of the UK Infected blood inquiry.

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