Citizen and patient involvement is increasingly promoted as a way to attain sustainable health and quality healthcare. This strategy is acknowledged to pose many practical challenges and to require improved rates of health literacy. Less discussed, is that involvement initiatives across health also present patients, citizens and policy makers with complex, dynamic ethical challenges that require greater ethics literacy and debate if they are to be addressed effectively. The presentation will, by drawing on examples such as childhood vaccination, stigma and ‘vaping’, examine what an ‘engaging’ health ethic might look like and the developments that are needed to attain it.