Hi Cameron

Thanks for the longer-form response. Let just clarify that I'm not really arguing a particular view here, more just posing a question to which I'm not sure the answer is clear. It is an issue we considered when launching our open access journal in precision medicine, CSH Molecular Case Studies, ultimately deciding to offer authors the option of CC BY or CC BY-NC in case this was an issue for patients/physicians (most of the medical literature covering this area is by contrast under more restrictive copyright licenses so the issue does not arise).

It is not ethical issues as such that made me pose the question but more how to maximize the likelihood that a parent of a child patient (or a patient him/herself) would consent for an image to be published for the benefit of science. I guess the question I'm asking is whether there is a category of patient/parent who would gladly consent to the image being published and made freely available in, say, PLOS Medicine or CSH Molecular Case Studies but would rather that did not mean that, as a necessary consequence, something like a tabloid newspaper did not need to ask for permission. Framed another way, the question is whether a different/new open license could be considered in these specific cases that both empowers the patient/parent and incentivizes them to make their data available without resorting to controlled access (databases) or access control (journals).

Finally, you make a good point about the practicality of embedded licenses. But one would hope that better tagging and a more granular approach to organizing information will ultimately make this less problematic. And since one can invoke fair use for text/data mining of bulk content in the US, this may be less of an issue.