Lucy Frith

This paper examines recent developments in direct-to-consumer genetic (DNA) testing (DTCGT) and the ethical challenges it raises for those affected by donor conception (using donated gametes, eggs and sperm, to conceive children). First, DTCGT can result in the complete removal of donor anonymity at any stage in the donor conceived person’s life, and this has widespread implications for all those involved in donor conception. Second, for regulators: DTCGT can disrupt regulatory prohibitions on information disclosure. Third, for donor conceived people: there is potential harm in discovering you are donor conceived via DTCGT, and DTCGT creates new 'gatekeepers' of knowledge about donor conception, who have to decide whether to disclose this information. DTCGT also raises normative questions for those involved in donor conception. For donors: do donors have any obligation to participate in DTCGT, or to provide their genetic data to donor conceived offspring? For parents through donor conception: how does DTCGT affect decisions about disclosing donor conceived origins to their child, and should parents test their child, and if they decide to do so, when? The paper concludes by making recommendations for how the ethical challenges posed by DTCGT might be overcome or at least ameliorated.

There is little consensus on how to regulate information giving in reproductive donation – using donated gametes (eggs, sperm) to have children. Should gamete donors be anonymous or should donor-conceived individuals have access to their donor’s identity, and at what age? What information should be available about donor siblings and other donor relations? And, crucially, how should this information giving be appropriately managed and regulated? Before we can answer these questions, we need to first understand what reproductive donation is. This paper sets out options for how reproductive donation can be conceptualized and develops a typology of different approaches, by categorizing reproductive donation into two main models: the biomedical and the psychosocial. These models provide a conceptual framework, a useful heuristic, for both understanding reproductive donation and critiquing regulation and oversight. The purpose of this paper is not to take a stand on which model is optimal; this is a matter for further debate. Rather, it provides clarification of what is at stake, and this can form the basis for coherent and justifiable approaches to the oversight and regulation of reproductive donation, instead of the patchwork of provisions that currently exist in many jurisdictions.

The Journal of Medical Ethics celebrated its 50th anniversary in 2025. This milestone created the opportunity for reflection on how the journal and, more broadly, the field of medical ethics has changed, and what the future should look like. To do this, we explored the views of attendees at the Institute of Medical Ethics (IME) annual conference in 2025 on the future of medical ethics. Our study aims to shed light on: (1) the aspects of today’s ethical landscape in need of greater attention; (2) the contemporary factors that are likely to shape the future of medical ethics; and (3) the role that medical ethics should play in healthcare and related fields in the future. We conducted a mixed-methods study. The study consisted of a questionnaire that included both quantitative and qualitative elements, and a small number of participants attended an explorative focus group. A total of n=53 survey responses were included in the final sample, and n=9 individuals participated in our focus group. Our findings highlight the need to account for relationality in medical ethics, and identified emerging technologies as a cause of future ethical complexity. Moreover, our findings support the need for a decolonised and more inclusive medical ethics. We also explore what medical ethics education should look like in the future.

The year 2025 was a significant one for the _Journal of Medical Ethics_ (_JME_), with a change in editors-in-chief, the launch of a new journal and a 50th anniversary. In June 2025, Lucy Frith, Brian Earp and Arianne Shahvisi took over from John McMillan as editors-in-chief of the _JME_. We set out our vision for the _JME_ in our first editorial, a commitment to reasoned argument and discussion and a recognition that medical ethics is now broader than originally conceived, encompassing the wider systems in which healthcare is delivered. We also emphasised our dedication to including a diversity of views and approaches in the papers we published. 1 In a later editorial, we set out our editorial approach and gave, ‘a few notes about how we are approaching editorial decisions, so that our rationale is clear, and to call attention to some simplification of the journal’s article types...

As recently appointed co-editors-in-chief of the Journal of Medical Ethics, our goal is to serve the community of authors, reviewers and readers by ensuring that the work we publish is timely, rigorous and distinctive. In this editorial, we want to share a few notes about how we are approaching editorial decisions, so that our rationale is clear, and to call attention to some simplification of the journal’s article types and what we’re hoping for from work in each of these categories. First, some important background. We are currently managing a full pipeline, with accepted articles scheduled for publication many months in advance. In fact, we have inherited enough excellent material from our predecessor, John McMillan, to fill almost a year of print issues without needing to accept a single new article. However, this means there is a lag between the acceptance of a paper and its assignment to a print issue of the journal. Another lag that some authors have commented on is the delay between submission of a paper (or its revision) and an editorial decision following peer review. This, in turn, is related to concerns about reviewer fatigue within our community. We describe our responses to these issues in the following subsections. ### Concerns about slow assignment of online-first articles to a print issue Given our prodigious queue of inherited manuscripts, we are exploring the possibility of publishing a number of online-only special issues consisting of thematically grouped papers from among those that have already been accepted, which we would then heavily promote and advertise. This should both raise the profile and visibility of these papers and allow authors to have their work receive its final citation information sooner than would otherwise be possible. For example, we may publish e-issues focused on AI ethics, reproductive ethics, environmental ethics and so on, making the material easier to find while also …

Labioplasty is a surgical procedure performed to alter the size and shape of the labia minora. The reasons for women requesting this procedure remain largely unknown and recently girls and young women under the age of 18 years have been requesting this type of surgery. This paper examines the ethical acceptability of performing this procedure on under 18s. We will first discuss whether labioplasty can be considered to be a therapeutic technique. We will claim that, while it is difficult to offer a definitive definition of what constitutes a therapeutic technique, in our view labioplasty cannot be considered as such. This conclusion has relevance for the ethical acceptability of the procedure, its legal status in regard to the Female Genital Mutilation Act and the debates over who can give consent for it. It will be concluded that in our current state of knowledge, the benefits of labioplasty are far from clear, whereas the harms are demonstrable and therefore this procedure should not be offered to those aged under 18 years

The opening lines of the first issue of the Journal of Medical Ethics —an unsigned April 1975 editoriali—capture the uselessness of editorial policy statements: > The reputation of a newly founded journal must be established by the style, quality and range of the material it offers. Perhaps then editorial policy statements achieve very little, for, either the reader can appreciate the usefulness of the journal’s contents without editorial encouragement, or he discovers for himself their irrelevance to his interests.1 As incoming editors, succeeding John McMillan who ably led the journal for more than half a decade, we appreciate this insight. Whatever we might say about our plans for the journal as it hurtles past its 50th birthday, the proof of the pudding will be in the tasting—or the reading—not in editorial promises. Nevertheless, we will say a few words about our mindset and aspirations as we jointly assume the editor-in-chief role of this venerable journal. First, something ‘old.’ We are as committed as ever to the founding promise of the journal to ‘provide a forum for the reasoned discussion of moral issues arising from the provision of medical care’ (emphasis ours) while—just as crucially—holding ‘no brief for one particular professional, political or religious viewpoint.’1 In other words, we will not be favouring articles that are politically convenient—for any one side of a morally charged debate—and nor will we allow prejudice for, or against, positions associated with certain professional or religious (or for that matter, non-religious) viewpoints to sway our decisions about what to publish. We are, instead, concerned first and foremost with the strength of the reasons, argument and evidence marshalled in favour of a given view, based on premises that can be reasonably shared (or at least seriously entertained) among a wide set of interlocutors.2 …

Medical ethics is not known for being a fast-paced discipline; many of the principles we draw on are 2000 years old. And yet, during John McMillan’s 7 -year tenure as editor of the Journal of Medical Ethics ( JME ), the journal has changed a great deal and has in turn changed the discipline. The issues discussed and the ethical concepts in play have broadened while the purpose itself has been refined to publish excellent medical ethics articles that are both philosophically sound and of practical use to clinicians, patients and policy makers. Under his leadership, the journal remained committed to the idea that bioethics is not merely an academic exercise but a normative enterprise—concerned, at its core, with how we ought to respond to the ethical challenges that arise in medicine, science and public life. John’s vision of good bioethics is rooted in a belief that philosophical clarity and real-world relevance should not be seen as competing aims but as mutually reinforcing. As he argued in a 2018 editorial, good medical ethics is defined not just by its analytic sharpness or theoretical sophistication but by how well it is framed, how transparent it is about its normative commitments and how seriously it takes engagement with diverse perspectives.1 For John, good medical ethics needs to be open to input from law, social science and clinical experience but without losing sight of the responsibility to make reasoned ethical judgments. Good medical ethics needs to take a normative stand. In this spirit, John has encouraged work that grapples with moral complexity without retreating into abstraction and that draws on a wide range of disciplinary tools while maintaining a clear normative focus. He has also been attentive to how bioethical arguments are presented—not only in terms of structure and clarity but also in terms of …

Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance.

Although this editorial will be published in the February 2025 issue of the Journal of Medical Ethics, I am writing it in the run up to the Christmas and the winter holidays, after a busy term, and this is, for some of us, a time to reflect on the past year (although as an academic the year is only half-way through!). It is also the journal’s 50th anniversary in 2025. This prompts further reflection, thinking about how and why the journal started, where its focus has been and what the future holds for both the journal and the field of medical ethics more broadly. Healthcare, those who work in it and the systems in which it is delivered, are facing pressures and challenges of huge global proportions, global conflict, the climate crisis and, in England, ongoing austerity all exacerbate existing health inequities. The stark disparities in healthcare access between the global south and north, and within countries such as the UK, raise profound questions of social justice. The JME has addressed many of these in articles and editorials over the years. As well as these current concerns, critical issues at the beginning and end of life are still as pertinent today as they were when the journal was first published in 1975. Looking at the running order for this issue, many of the papers consider issues and dilemmas that would have been familiar to …

This article considers John Harris’ work on autonomy, specifically reproductive autonomy, outlined in The Value of Life and developed throughout his career. Harris often used the concept of reproductive autonomy to make the case for liberal approaches to developments in reproductive and genetic technologies. Harris argued that reproductive autonomy should be highly valued, and therefore we need compelling arguments to justify limiting it in anyway. When discussing reproductive autonomy, Harris focused mainly on restrictions on the potential users of reproductive technologies autonomy, that is, prospective parents. This article extends the discussion of autonomy and the appropriate limits to individuals exercising their autonomy to medical professionals working in this area. Given reproductive technologies have become part of routine medical practice, this article considers whether the current restrictions on both patients and clinicians, as imposed by regulators and professional guidelines, remain ethically justified.

The editors of the _Journal of Medical Ethics_ support the call of the UK Health Alliance on Climate for urgent action to ensure that the current Conference of the Parties to the United Nations Framework Convention on Climate Change ‘finally delivers climate justice for Africa and vulnerable countries’. 1 As they note ‘Africa has suffered disproportionately although it has done little to cause the crisis’. The burden of climate change has thus far fallen disproportionately on Global South countries. The monsoon in Pakistan this year killed over 1100 people and the public health implications of the flooding might affect the health of over 5 million people. 2 The South Asian monsoon impacts the lives of a billion people and the flooding associated with wet seasons is likely to occur eight times more frequently in future years than at present. 3 For many pacific islands such as Kiribati,...

Background At the beginning of the coronavirus (Covid-19) pandemic, many non-Covid healthcare services were suspended. In April 2020, the Department of Health in England mandated that non-Covid services should resume, alongside the continuing pandemic response. This ‘resetting’ of healthcare services created a unique context in which it became critical to consider how ethical considerations did (and should) underpin decisions about integrating infection control measures into routine healthcare practices. We draw on data collected as part of the ‘NHS Reset Ethics’ project, which explored the everyday ethical challenges of resetting England’s NHS maternity and paediatrics services during the pandemic. Methods Healthcare professionals and members of the public participated in interviews and focus group discussions. The qualitative methods are reported in detail elsewhere. The focus of this article is our use of Frith’s symbiotic empirical ethics methodology to work from our empirical findings towards the normative suggestion that clinical ethics should explicitly attend to the importance of relationships in clinical practice. This methodology uses a five-step approach to refine and develop ethical theory based on a naturalist account of ethics that sees practice and theory as symbiotically related. Results The Reset project data showed that changed working practices caused ethical challenges for healthcare professionals, and that infection prevention and control measures represented harmful barriers to the experience of receiving and offering care. For healthcare professionals, offering care as part of a relational interaction was an ethically important dimension of healthcare delivery. Conclusions Our findings suggest that foregrounding the importance of relationships across a hospital community will better promote the ethically important multi-directional expression of caring between healthcare professionals, patients, and their families. We offer two suggestions for making progress towards such a relational approach. First, that there is a change of emphasis in clinical ethics practice to explicitly acknowledge the importance of the relationships (including with their healthcare team) within which the patient is held. Second, that organisational decision-making should take into account the moral significance afforded to caring relationships by healthcare professionals, and the role such relationships can play in the negotiation of ethical challenges.

As John McMillan notes in January’s editorial,1 many countries are reflecting on how they responded to the COVID-19 pandemic, what went wrong and how responses to such system shocks can be better managed in the future. However, while it is tempting to think that the COVID-19 pandemic is over and that what is now needed is a reflection on how countries could have responded better, some of the underlying issues and problems COVID-19 both highlighted and created are still with us. The legacy of the pandemic has continued particularly for healthcare workers at all levels, who have had to continue providing services with little time to rest and reflect and with new ‘shocks’ to the systems to cope with. For example, in England, industrial action by junior doctors has put already fragile systems under pressure, and the issues that staff are campaigning about remain unaddressed. Many of these issues are not distinctive to COVID-19, but as has been noted, ‘From an ethical perspective, the COVID-19 pandemic is like a prism: it helps us see the spectrum of …

This paper will take as its starting point the premise that developing translational bioethics is a worthwhile endeavour. I will develop an account of translational bioethics and discuss what implications this would have for the wider discipline of bioethics and argue that this would be a useful development for bioethics. The paper will conduct a form of ‘translational meta‐bioethics analysis’, in the words of Bærøe. I will argue that if we are serious about instituting translational bioethics, then it will need to look and be organised in a very different way from current bioethics research, this will be a radically different form of bioethics from what we currently have. In this paper I will sketch what translational bioethics might look like. My proposal here is not that translational bioethics should supplant existing ways of doing bioethics, but rather that it should be an addition to it, another subdiscipline of bioethics.

This document is designed to give guidance on assessing researchers in bioethics/medical ethics. It is intended to assist members of selection, confirmation and promotion committees, who are required to assess those conducting bioethics research when they are not from a similar disciplinary background. It does not attempt to give guidance on the quality of bioethics research, as this is a matter for peer assessment. Rather it aims to give an indication of the type, scope and amount of research that is the expected in this field. It does not cover the assessment of other activities such as teaching, policy work, clinical ethics consultation and so on, but these will be mentioned for additional context. Although it mentions the UK’s Research Excellence Framework, it is not intended to be a detailed analysis of the place of bioethics in the REF.

This paper responds to the commentaries from Stacy Carter and Alan Cribb. We pick up on two main themes in our response. First, we reflect on how the process of setting standards for empirical bioethics research entails drawing boundaries around what research counts as empirical bioethics research, and we discuss whether the standards agreed in the consensus process draw these boundaries correctly. Second, we expand on the discussion in the original paper of the role and significance of the concept of ‘integrating’ empirical methods and ethical argument as a standard for research practice within empirical bioethics.

The literature on patient public involvement and engagement (PPIE) in health research has grown significantly in the last decade, with a diverse range of definitions and topologies promulgated. This has led to disputes over what the central functions and purpose of PPIE in health research is, and this in turn makes it difficult to assess and evaluate PPIE in practice. This paper argues that the most important function of PPIE is the attempt to make health research more democratic. Bringing this function to the fore and locating PPIE in the wider context of changes in contemporary forms of democratic engagement provides greater conceptual clarity over what PPIE in research should be trying to achieve. Conceptualizing PPIE as a form of democratization has a number of benefits. First, theories of what are appropriate, normatively justifiable and workable criteria for PPIE practices can be developed, and this can provide tools to address the legitimacy and accountability questions that have troubled the PPIE community. Second, this work can be used to form the basis of a research agenda to investigate how PPIE in health research operates, and how it can facilitate and/or improve democratic processes in health research.

Arguably one of the strengths of the discipline of medical ethics is its close attention to the context in which ethical dilemmas, questions and issues play out. As a discipline that is concerned with helping and supporting practitioners, policy-makers and the public to address the ethical aspects of healthcare provision and practice in the best way they can, context is crucially important. As McMillan puts it, ‘ethics should be grounded’ in the practical realities of the situation.1 What, where and who are important questions that set the parameters of the debate and, to some extent, frame the subsequent solution or decision. What is happening in a particular case, what is the source of controversy, is it a conflict of values, regulations or professional viewpoints? Where does it take place, under which rules, jurisdiction or in which professional setting? And who does it involve? Whose rights, interests or decision-making capacity do we prioritise? All these contextual questions need to be carefully articulated before it is possible to draw any normative conclusions. The importance of context is clear in this issue’s ‘Engagement without entanglement: a framework for non-sexual patient–physician boundaries’ by Appel.2 What might be seen as entirely appropriate behaviour in one context, for example, when I help out a friend and let them stay in my house for a few weeks while they recover from an operation, is entirely inappropriate in another—in …

The JME editorial team selects its feature articles from the best papers accepted for publication based on their quality, novelty and capacity to move debate forward on a specific issue. Feature articles are made freely available and are published alongside reviewed and submitted commentaries. We do this partly to promote and acknowledge excellent work in medical ethics, but also to encourage authors to submit their best papers to the JME. JME feature articles have deepened the analysis of some central issues for medical ethics. ‘Common morality’ is one way of underpinning general ethical principles and it is a concept that is central to the justification that Beauchamp and Childress give in their classic articulation of the four principles. 1 Rhodes’ critical discussion of common morality in her feature article 2 has been well cited since then, which is a good thing from the perspective of the author...

Community engagement (CE) contributes to successful research. There is, however, a lack of literature on the effectiveness of different models of CE and, specifically, on CE strategies for the conduct of genomic research in sub-Saharan Africa. There is also a need for models of CE that transcend the recruitment stage of engaging prospective individuals and communities and embed CE throughout the research process and after the research has concluded. The qualitative study reported here was designed to address these knowledge gaps and comprised of 36 key informant semi-structured interviews and fifteen focus groups with 50 participants. We interviewed selected stakeholders in genomic research in Nigeria: biomedical researchers, community rulers, opinion leaders, community health workers, and prospective research participants. We explored these stakeholders’ views on their understanding of community engagement, their expectations, experiences, and their opinions on acceptable processes of community consultation in genomic research. The methodological design, adapted from grounded theory, used the constant comparative method of data analysis; while normative conclusions were made using the symbiotic empirical ethics approach. Data analysis revealed five main themes important for successfully engaging communities in genomic research: effective communication, diversity of community gatekeeping, trust, cultural integration of research, and conservation of the research setting. From these themes, we have developed a four-stage model of community engagement that covers all stages of the research process; namely, the Community Approach, Intermediate phase, Collaboration and Post-research Cordiality model (CICP). This model could be used to improve the integration of CE in genomic research among local communities.

Choice is probably one of the most often discussed areas in bioethics, alongside the related concepts of informed consent and autonomy. It is generally, prima facie, portrayed as a good thing. In healthcare, the 2000s saw the UK Prime Minister Tony Blair pursue the ‘Choice Agenda’ where, ‘As capacity expands, so choice will grow. Choice will fundamentally change the balance of power in the NHS.’1 In a consumerist society giving consumers more choice is seen as desirable. However, choice is not a good in itself, giving people more choice in certain situations can be problematic: i.e. consumerism drives economic growth and this has a detrimental effect on the environment; and increasing the range of choices a patient is offered is often not the best way to improve the quality of healthcare provision.2 The assumptions behind the valuing of choice need careful unpacking and this Issue of the Journal of Medical Ethics includes papers that explore choice in a number of areas. This Issue's Editor’s choice is Tom Walker’s ‘The Value of Choice’,3 which puts forward a suggestion for the importance of the symbolic value of choice. There are a number of ways of categorising the value of choice in healthcare. One account sees choice as valuable because it is by choosing that individuals make their life their own. Another account sees choice as valuable for instrumental reasons, people are generally, assuming they are sufficiently informed, the best judge of their own best interests. Walker argues for an additional third reason, the symbolic value of choice, originally proposed by Scanlon. This sees choice as valuable because being given the option to choose, whether or not one takes it up, not the act of choosing is what makes choice valuable. Being offered the option to choose has a …

On 22nd September 2020 the UK Government announced new lockdown restrictions to supress the COVID-19 virus, with some areas of England having more restrictive lockdown guidance. Students in a number of cities have been confined to their halls of residences after outbreaks of COVID-19 and in Manchester security guards were preventing students leaving the buildings. The scientific community are, unsurprisingly, divided over the question of how far lockdowns should extend.1 Monday 21st September 2020 saw the publication of two open letter to the UK government and Chief Medical Officers. One group, Sunetra Gupta et al,2 argued for a selective lockdown targeting the most vulnerable. The other, headed by Trisha Greenhalgh, arguing that attempts to suppress the virus should operate across the whole community.3 As we enter what appears to be a second wave of COVID-19 infections and accompanying lockdown measures, ethical debates over the appropriateness and extent of such measures are critical. Julian Savulescu and James Cameron4 in their article on lockdown of the elderly and why this is not ageist, put forward the case that, ‘an appropriate approach may be to lift the general lockdown but implement selective isolation of the elderly.’ Their central claim is that selective isolation of the elderly is to be preferred to imposing lockdown on all members of society. The aim of lockdown, restricting movement and key activities, is designed to reduce the number of deaths from COVID-19 and also to prevent the healthcare system from becoming overwhelmed. As the elderly are at significantly more risk of having severe cases of COVID-19 and therefore more likely to place demands on healthcare services, they are clearly prime candidates for lockdown measures, measures that will not only benefit them but the whole of society. This is not ageist as …