Introduction

The BMJ ethics committee was established to help editors with difficult cases, to review policies that have ethical implications, and to expand the journal's coverage of ethics.1 Unlike the Committee on Publication Ethics (which considers anonymised cases submitted by journal editors), the BMJ's committee discusses possible future policies as well as responding to specific issues and sees full details of all cases (although they are anonymised for the minutes, which are available on the BMJ's website (http://bmj.bmjjournals.com/advice/bmj_ethics.shtml).

Since our inception in November 2000 we have met 13 times and discussed 70 cases from the editorial team. Three broad themes have emerged from our discussions. These are:

• Patient confidentiality

• The journal's responsibilities to people outside the publishing process, and

• Research misconduct.

Patient confidentiality

Like many ethical issues, the confidentiality of the doctor-patient relationship sounds straightforward until you are confronted with difficult cases. As part of our review of journal policies with ethical implications, we considered the BMJ's guidelines on publishing information on individual patients. These stated that information should not be published without the patient's consent. That sounds fine, until Minerva wants to publish a picture of an Egyptian mummy2 3 or someone submits a piece with an important message describing a patient who died decades ago in a remote part of the world. The committee has therefore revised the guidelines to describe the situations in which publication of individual information without consent might be appropriate.4

We also considered whether rules about consent to publish individual data still applied after a patient had complained about a doctor to the media. Does the patient's public allegation constitute an implicit consent to have the …