Editor's Choice

In this edition of the British Medical Bulletin, we have, once again, a wide range of excellent and fascinating reviews. They are described using our usual approach of taking ethical and health policy articles first, and then following up with more theoretical papers, moving on to the more directly practical for medical practice. First, we have a review of the ethical, legal and social issues raised by the collection, storage and use of DNA in forensic database, a fascinating and important subject, by Mairi Levitt from the Department of Philosophy at Lancaster University (page 235). She makes the point that the UK National DNA database (NDNAD) is the largest and most inclusive forensic database in the world. The performance of the NDNAD, criteria for inclusion, legislative framework and plans for integrating forensic database across Europe are discussed. She draws comparisons with the UK Biobank that has started collecting DNA samples linked to medical records and, unlike the NDNAD, requires informed consent from volunteers, allows withdrawal of samples and only includes adults. The potential advantages of research into genes associated with violent and ‘antisocial’ behaviour are discussed in the context of an increasing degree of surveillance in the UK. She concludes that it should not be assumed that the benefits of forensic database will necessarily override the social and ethical costs, regardless of changes to the criteria for inclusion or the permitted uses of samples and profiles. The expansion of forensic database raises issues of important relevance to the medical profession. Next, in health policy, we first have a paper by Ian Greener from the Manchester Business School entitled ‘Are the assumptions underlying patients choice realistic?’ (page 249). His paper presents a review of the assumptions underlying patients’ choice in the NHS to examine who is meant to be making choices in the policy, what choices they are meant to be making and how those choices are meant to be made. It suggests that policies to increase patients’ choice require a significant investment in terms of restructuring primary care services to allow them to happen, as well as to present relevant information to patients, but those patients may not want to make choices about where and what type of treatment they receive for the most part, being content with having a greater say in when they are treated.