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At the time of writing there appear to have been no electronic submissions to the Journal of Medical Ethics. It seems appropriate, therefore, to begin electronic correspondence with a consideration of some of the ethical implications of this new form of ethical dialogue.
I have posted this response to Kenneth Boyd’s editorial on Mrs Pretty and Ms B1 as this article may provoke debate far beyond the medical and ethical establishment. This issue may be of tremendous concern to patients or their carers who are presently suffering in circumstances similar to those described.
The electronic response forum of the BMJ has been in operation for over four years.2 An editorial in the BMJ on physician assisted suicide3 has attracted 125 responses at the time of writing. An important feature of electronic responses, particularly on items that generate a lot of debate, is that the contributions often refer to each other. These responses range from the scholarly and meticulously argued to distressing personal accounts of suffering. As both an avid reader of rapid responses to the BMJ, and a physician, I consider both sorts of contributions to be valuable, but increasingly feel uncertain about what my written response to them should be when I wish to enter into dialogue with the author. I feel on sure ground when considering the scholarly submission that is clearly intended as a contribution to a peer reviewed journal, and have no qualms at drawing up a response to point out its weaknesses. Equally, as a family doctor, I hope that I am able to approach distressing accounts of suffering with a degree of empathy. It is sometimes the case, however, that submissions clearly showing distress also contain dubious argument that any peer review process would deal with severely.4 Where accounts of suffering alongside dubious arguments are posted from patients I personally feel squeamish about responding, finding myself caught between the roles of vituperative reviewer and empathic listener. As an editorial in the BMJ on the subject of electronic responses has noted: “We’ve begun to capture the opinions and experience of patients … and publish just about anything that isn’t libellous or doesn’t breach patient confidentiality”.2 Inevitably, such a broad range of responses will produce many that deserve to be challenged. Merely to ignore dubious argument implies that such opinions are correct. Furthermore, it is astonishingly easy to post an electronic response, and the process contains no warning that opinions expressed may be severely challenged. We should consider what the rules of debate on this Journal of Medical Ethics web site should be.
To prevent any misunderstanding, I wish to state that this response does not issue out of intense personal suffering, and that I am prepared for the most stringent peer review of its contents. Say anything in response, but please don’t ignore me.
Dr Lewis raises the important issue of what the rules of debate should be in electronic correspondence.1
As an editor, I feel as if I am caught in the maelstrom of evolution. The web has radically changed the nature of debate and the presentation of information and knowledge. It is not clear to me how and whether it should be controlled. My general approach has been to let the experiment run in a free way and look at the results. Then it will be clearer what rules are required.
Electronic correspondence, for me, is different from scholarly debate. It takes advantage of the web’s accessibility to give people the opportunity to express their own views and to see the range of views on a particular issue. At present, the JME operates on the principle that it will publish electronically any response which is not libellous or harmful in other ways. Electronic letters which contribute significantly to the debate (such as Dr Lewis’s letter) may be selected for publication in the paper version of the journal.
The core business of a journal such as the JME should be the publication of scholarly articles which contribute to knowledge. But as a medical ethics journal, it should also be engaging and relevant to professionals and non-professionals. We have introduced a current controversy section which reports an issue of contemporary interest and we solicit off the cuff comment from people who may have an interesting view on that topic. Electronic correspondence should serve a similar function: to increase people’s interaction with the journal and with others.