key: cord-1055126-uwvme0aj
authors: Huxtable, R.; Ives, J.
title: Author response to: Ethics for surgeons during the COVID‐19 pandemic
date: 2020-07-13
journal: Br J Surg
DOI: 10.1002/bjs.11781
sha: a5d317be18d3f0b632683110b37830ab8f5770aa
doc_id: 1055126
cord_uid: uwvme0aj

nan

We welcome Professor Harkin's letter, with its emphasis on the importance of working in partnership, being transparent, and making ethically defensible decisions during COVID-19.

We would, nevertheless, caution against reducing ethics to the 'four fundamental principles of medical ethics'. These are important, certainly, but insufficient to either capture or resolve all the diverse and complex problems arising 1 . Furthermore, we make a subtly different claim than the empirical one depicted by Professor Harkin. Rather than suggest society and surgeons "will accept [that] available healthcare resources must be directed at the pandemic", we argued that they should -and likely would -choose to live in a world with resources directed, when necessary, to protecting the most vulnerable and saving lives, from a position of ignorance about their own place in that world. Further, this implies they should make that choice now and support efforts that accord with that principle.

Of course, the ethical landscape in the UK has evolved since we prepared the editorial: not only have various organizations issued (and even revised) ethical guidance pertaining to COVID-19, but clinical ethics support services have also become increasingly involved in advising clinicians and healthcare institutions, locally and regionally.

What is happening is encouraging, but -in line with Professor Harkin's points -we have reservations about what is not happening. There is growing disquiet about the lack of ethical leadership and co-ordination 2,3,4,5 . The various efforts to provide an ethical steer are commendable, but the proliferation of ethical guidance and advisory groups threatens to cause confusion, introduce inconsistency and duplicate effort.

Professionals, patients and society at large deserve clarity, transparency, consistency and fairness. As such, we would add our voices to those calling for enhanced co-ordination and, fundamentally, for ethical leadership, so we can best navigate the ethically choppy waters of COVID-19.

Huxtable 

For and Against the Four Principles of Biomedical Ethics

Statement: COVID-19 and the basics of democratic governance

Covid-19: Government guidance on emergency rationing of critical care is needed to support professional decision making

COVID-19: Where is the national ethical guidance?

Ethical anchors and explicit objectives: Ensuring optimal health outcomes in the Covid 19 pandemic