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‘Inglan is a bitch’: hostile NHS charging regulations contravene the ethical principles of the medical profession
  1. Josephine Mary Katharine Reynolds,
  2. Caroline Mitchell
  1. Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Josephine Mary Katharine Reynolds, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield S10 2TN, UK; josiereynolds11{at}


Following the recent condemnation of the National Health Service charging regulations by medical colleges and the UK Faculty of Public Health, we demonstrate that through enactment of this policy, the medical profession is betraying its core ethical principles. Through dissection of the policy using Beauchamp and Childress’ framework, a disrespect for autonomy becomes evident in the operationalisation of the charging regulations, just as a disregard for confidentiality was apparent in the data sharing Memorandum of Understanding. Negative consequences of the regulations are documented to highlight their importance for clinical decision makers under the principles of beneficence and non-maleficence. Exploration of the principle of justice illuminates the core differentiation between the border-bound duties of the State and borderless duties of the clinician, exposing a fundamental tension.

  • autonomy
  • ethics
  • minorities
  • right to healthcare
  • allocation of healthcare resources
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  • Contributors JMKR was responsible for the concept and co-writing of the article. She developed the concept after speaking with clients at the Helen Bamber Foundation and working alongside members of the Medact Migrant Solidarity Group. JMKR has an interest in reducing barriers to care for minority populations. She studied Public Health for Development at London School of Hygiene and Tropical Medicine after returning to the UK from Jamaica where she worked in public health research and primary care, predominantly at the University of the West Indies. CM helped to co-write the article. She has an academic interest in health inequalities.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JMKR was a member of Medact Migrant Solidarity Group but she has written this piece in her academic role.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators Katharine F A Reeve.

  • Patient consent for publication Not required.

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