This paper critiques particular aspects of the published UK government Department of Health's proposal to promote 'The Expert Patient' as a way of enhancing patient autonomy and reducing reliance on limited health care resources. Although the broad aims of the report are supported the detail is criticised on the basis that lack of clarity over key terms, including 'expert' 'illness' and 'disease', means that there is no clear focus for action and threatens to undermine the effectiveness of the proposals.

Personal integrity is often seen as a core value for delivering ethical healthcare. This paper will explore what this might mean and particularly what place integrity has in a multi-professional healthcare system. Two opposing arguments can be made: the first is that the multi-professional nature of modern healthcare means that personal integrity is at best a futile luxury and at worst, an obstacle to delivering affordable high-quality care to large populations. The converse is that without personal integrity healthcare loses its humanity and becomes mere biological and social engineering. Part of the analysis rests on whether integrity is primarily a personally held moral framework or whether it is a social concept. Chester Calhoun's analysis, in which she identifies the integrated-self, personal identity, and (morally) clean-hands as three pictures of integrity, is used as the basis for suggesting that integrity is a rich and complex social virtue through which the individual is able to demonstrate their relationship with the values and mores of the communities of which they are members. In addition, I will argue that integrity is not a value itself, but is a framework through which one or more sets of those values that characterize the communities of which the person is a part, can be expressed. Because a person may belong to many communities - nation, gender, religion, family, profession, trade, sport, etc. - each individual has their own unique meta-set of values that informs their personal sense of integrity. However, in specific circumstances, conflicts may arise between this personal global sense and the set of values associated with one community.

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