Impossibly difficult experiences like this characterised the data collected as part of our ‘Reset Ethics’ research, which explored the everyday ethical challenges of reconfiguring (resetting) England’s NHS maternity and paediatrics services during the coronavirus (COVID-19) pandemic. This ‘resetting’ created a unique context in which it became critical to consider how ethical considerations did (and should) underpin decisions about integrating infection control measures into the routine practice of healthcare. Healthcare professionals told us that the ethical challenges they encountered were often embedded in changes to working practices intended to keep them safe, and to protect hospital communities from COVID-19 infection. However, the impact of changes to working practices mandated by infection prevention and control measures reduced healthcare professionals’ ability to ‘care’ for their patients, where care is understood as embracing the interpersonal relationships between the patient (and their family) and the healthcare provider. The importance of these interpersonal relationships is a key aspect of our data: offering care within a supportive relationship between healthcare professionals, their patients and (particularly in the context of maternity and children’s services) a child’s family. This was experienced as an ethically important dimension of healthcare delivery, and an essential component of patient-centred care. The ethical challenges our participants discussed were linked to the impact on these interpersonal relationships of the mandatory, non-negotiable infection prevention and control measures imposed during the pandemic.

It is this focus on infection prevention within healthcare settings that situates the puzzle that we address in our chapter. It is a puzzle because, at first blush, it seems entirely reasonable – and ethical – to focus on infection control measures in order to keep staff and patients safe in healthcare settings. It is surely imperative to take all necessary steps to keep hospital communities safe, for reasons that are obvious. Our findings suggest, however, that, although they protected healthcare staff and patients from COVID-19, infection, prevention and control measures, such as social distancing rules, visiting restrictions and the requirement to wear personal protective equipment (PPE), actually caused significant harm by creating barriers to interpersonal interaction and engagement in everyday healthcare practices. Infection prevention and control measures were not negotiable: the caring relationships had to give way. While, in our view, healthcare professionals and patients alike understood the need for strict infection control measures in the early acute phase of the pandemic, this changed during later waves of infection. At this point, we will argue, a focus on relationships would have helped to inform decision-making. The harms of refusing a new parent access to a sick baby despite her having tested negative for COVID-19, for example, might have been mitigated by allowing the parents and the healthcare professionals to discuss and agree a safe, fair and less harmful interpretation of the rules for that particular circumstance.

In this chapter, we situate our participants’ reflections in a discussion about the importance of relationships and their significance in a healthcare context. The chapter proceeds as follows. In the first section, we introduce our study, touching briefly on the methodology adopted and the challenges we encountered. We next draw on our data to highlight the vital importance and value of the relationships that many healthcare professionals felt were central to the ‘family-centred’ maternity and paediatric services that were our focus. The theoretical underpinnings of a logic of relationality are then described, and we consider how our data support the importance of such a logic in the healthcare context. In the following section, we discuss the risks of disrupting relationships, considering moral distress as one of the possible consequences of damaging the human caring relationships within which healthcare is embedded.

In concluding, we contend that an explicit attention to relationships is required to provide effective support to healthcare professionals in responding both to the everyday stresses and strains of working in healthcare, and to the extraordinary impacts of a public health emergency. Progress towards achieving this will be made by adopting an approach to decision-making that foregrounds the importance of relational engagement.

The ‘Reset Ethics’ project in context: the background to the empirical research

The effects of the COVID-19 pandemic on the NHS have been profound. The cycle of starting, suspending and restarting routine services has been ongoing for over three years at the time of writing in 2023, and, with the impact of new variants of COVID-19, continues. This process of ‘resetting’ has required consideration of how best to (re)organise healthcare services and (re)allocate resources so that COVID and non-COVID healthcare services can continue in tandem. New kinds of ethical issues and dilemmas have undoubtedly arisen as decision-makers have had to continually (re)assess the best way to balance individual access to healthcare services and the continued protection of hospital communities and the wider public from COVID-19.

In April 2020, healthcare providers were asked by the government in England to step up non-COVID-19 urgent services as soon as possible (Stevens and Pritchard, 2020). The key question then facing healthcare providers was how to reset these services, some of which had been required to cease the previous month. Guidelines and policies, which were rapidly developed to underpin the acute coronavirus response, had drawn on existing ethical frameworks, and posited pandemic-specific approaches to decision-making in anticipated worst-case scenarios.² These documents, however, demonstrated little attention to the need to balance responses to the pandemic with the concurrent provision of non-pandemic healthcare, such as maternity and paediatric services. The central aim of our research was to consider how, in that context, decision-makers had understood and attended to the new kinds of ethical issues and dilemmas that were unique to the ‘resetting’ of everyday healthcare practices and process.

To investigate which ethical values were relevant, and to what extent they featured in guidance about the reorganisation of maternity and paediatric services, we conducted an analysis of the policies and processes current between April 2020 and March 2021. Our review asked, ‘Which ethical values (explicitly or implicitly) guided decision-making in non-COVID-19 paediatric surgery and maternity services during the initial NHS reset in England?’ (Chiumento et al., 2021). We adopted a rapid review methodology, taking a comprehensive yet pragmatic approach to the searches, screening, analysis and appraisal of sources, and conducted a qualitative thematic synthesis of the included documents. We reviewed a diverse range of documents, such as government and hospital trust policies, statements and decision support tools; reports and statements from professional bodies and charitable organisations; and evidence reviews and commentaries in academic journals.

An interesting finding of the rapid review was that patternings of relationships were visible in numerous ways and were anchored in both the individual and organisational mutual dependencies and responsibilities that the pandemic has starkly highlighted. Relationality was implicit in inter-NHS organisational collaborations locally, regionally and nationally to coordinate continuity of care. There was also clear recognition of the ethical importance of acknowledging the adverse impact of the pandemic on caring and dependent relationships, while simultaneously attending to public safety. However, while the fundamental importance of relationships in healthcare practice was acknowledged, there was no meaningful engagement with the ways in which relationships might be valued in practice. It was this lack of attention to the value of relationships in the resetting of healthcare practice that, we argue, left the door open to the ethical difficulties experienced by our participants. The impact of many of the changed practices appeared to be particularly significant on the family and caring relationships inherent to our areas of focus: birthing partners in maternity care, and parents or carers in paediatric services.

The findings of the rapid review informed the design of the interview guides for the qualitative data collection in our Reset Ethics project, particularly the interviews with senior decision-makers in our participating NHS hospital Trusts. An important aim of these interviews was to tease out the ethical values guiding both the approach to decision-making and the justifications for the decisions made, whether implicit or explicit. We were also interested in the reasons for any disagreements, whether (and how) these were mediated, and the degree to which the decision was then successfully implemented. Interviews and focus group discussions with healthcare professionals sought to explore senior management decision-making from a different perspective. These interviews focused on the way(s) participants’ working practices had to change to accommodate the resetting of paediatric and maternity services, and how clearly these changes, and the reasons for them, were communicated. We explored how participants felt about these changes and asked them to talk about any ethical challenges or difficulties they had experienced as a result.

Pandemic and everyday ethics in collision: the empirical research

Six NHS hospital Trusts took part in our study. From these, senior managers and healthcare professionals were recruited for interviews and to participate in focus group discussions. The recruitment period (from October 2020 to July 2021, inclusive) spanned the national and regional lockdowns imposed during repeated waves of COVID-19 infection in the UK (Institute for Government, 2022), which clearly placed heightened demands on healthcare management and clinical staff. As a result, recruitment was challenging across the whole study. A total of eleven senior managers (seven female and four male) took part, and we spoke to twenty-six healthcare professionals (twenty female and six male) – doctors (nine), nurses (twelve) and midwives (five).

Having completed the individual interviews, we looked more closely at the ethical challenges described by the interview participants in focus groups with healthcare professionals. The initial thematic analysis of the interview data had identified the prevalence of reference to moral distress in healthcare professionals’ accounts. Moral distress is the psychological, emotional and physiological suffering that people sometimes experience when they act in ways that are inconsistent with deeply held ethical values, principles or commitments: ‘moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’ (Jameton, 1984: 6).³

In July 2021, we convened a focus group with six clinical psychologists in order to explore the finding about moral distress in more detail. The psychologists’ role pre-pandemic had been to offer support to patients and families dealing with difficult clinical situations (such as end of life decisions), and to help them come to terms with what was happening. During the pandemic, however, these clinical psychologists agreed that their support had increasingly been sought by healthcare professionals for themselves, rather than for their patients. This was a notable change to their pre-pandemic practice. The focus group discussion explored in detail how the clinical psychologists had been asked to support their colleagues. In this discussion it became apparent that the moral distress described arose from the institutional constraints preventing the enactment of human relationships in the way participants’ personal and professional ethical codes would usually direct. Thus, this moral distress had its roots in, and was a significant legacy for healthcare professionals of, the changed healthcare practices – such as social distancing – intended to have a protective effect from the physical effects of SARS-CoV-2 infection.

To explore these implications of changed working practices in more depth, we considered with further healthcare professional focus groups the changes that they would not want to see normalised, and why. Following an expression of interest from a senior physiotherapist, we recruited focus group participants (n = 13) from a team of paediatric physiotherapists spanning a range of specialties, including palliative care, serious burns and traumatic brain injuries. Two discussion groups were planned, however, due to a resurgence of COVID-19, shift patterns and staff holidays, dates for focus group discussions were difficult to coordinate. Ultimately only one focus group was held (with n = 5 participants) and a further two participants attended individual interviews. In the discussions, participants considered the ethical challenges raised by the practices about which they felt most uncomfortable, worked through what had made them challenging, and told us what (if they could choose) they felt would provide appropriate ethics support for them and their colleagues in the future.

The views and experiences of members of the public were also explored in focus groups with participants who had either had direct involvement with maternity or paediatric services during the pandemic, or had some prior experience of, or interest in, public involvement in NHS Trust decision-making. Recruitment to these focus groups was undertaken primarily by social media, through contacts made with local Trust patient partnership organisations, such as Maternity Voices Partnership (MVP),⁴ Healthwatch⁵ and Patient and Public Involvement (PPI) groups. Five focus groups were held in May and June 2021, involving a total of twenty-six participants. Participants were located geographically close to our participating Trusts; some had been patients at participating Trusts and some at other hospitals.

Our findings: making visible the importance of relationships

Our empirical data reflected the importance of relationships in various ways. Senior managers, for example, discussed the benefits of increased collaboration between Trusts and other organisations both regionally and more locally:

Interestingly, though, tensions between offering mutual aid and supporting staff in their ‘home’ hospital raised challenging questions:

As well as discussing the benefits of regional collaboration, participants were positive about increasing collaboration within large hospital settings:

Our data showed that the focus on the safety of all hospital staff during COVID-19 encouraged the maintenance of relationships in different ways, particularly the use of video-conferencing and other technology-based solutions where possible: ‘But you could do it via Zoom. And we, we developed a whole new method of doing chief execs briefings, of communicating to staff, so on and so forth. So I think that was good. And we got good feedback from that’ (Deputy Chief Medical Officer, Foundation Trust).

The limitations of ‘electronic relationships’ were often noted too:

Recognising the challenges that physically remote leadership can engender, some participants described creative solutions to support staff morale. Initiatives that were intended to support a feeling of ‘all-being-in this-togetherness’ between senior decision-makers and staff were not, however, well received, particularly if they were perceived to go against rules imposed strictly on families:

Miscommunications, misunderstandings and a lack of transparency in decision-making, especially where stress levels were high, were experienced as problematic for relationships. This was particularly apparent in the early stages of the pandemic, where the coronavirus was not well understood, guidelines were changing rapidly, and staff members did not feel safe:

This emphasised the crucial importance of transparent communication in the maintenance of effective relationships between managers and healthcare professionals:

While the different priorities of management and patient-facing healthcare professionals were acknowledged (‘so that is their … priorities are different when it comes to management team’ [neonatologist]), those with a clinical background often felt the burden of their organisational responsibilities: ‘We’re all really protective of our patients. Not everybody thinks that the good of the organisation some people quite rightly think of the good of their specialty. And it’s, unfortunately my job to make the decision and say … the balance of risk, it’s you, that’s the compromise’ (Deputy Chief Nurse, Children’s hospital).

These differing priorities introduced tensions into the relationships between individuals at different places in the hospital hierarchy, particularly where a healthcare professional was being asked to act in a way that they believed was contrary to the immediate needs of the patient, or family, in front of them:

In some circumstances this disjuncture between senior decision-makers and frontline healthcare professionals was experienced as very harmful, sometimes even to a healthcare professional’s ‘relationship’ with who they were as a doctor, nurse or midwife:

For healthcare professionals based in the community, relationships with the patients or families they were visiting appeared to be less constrained by rules and policies:

Community-based healthcare professionals (of whom the majority were midwives) described a more pragmatic, personal approach to patient care, in this case considering the general policy preference for remote ‘visits’:

While healthcare professionals worried that different approaches might lead to inconsistencies in care, they recognised that everyone was aiming to offer the best care they could within the constraints imposed on them. Public participants across our focus groups explicitly situated good care in a supportive relationship with a particular healthcare professional who had gone the extra mile. Some healthcare professionals recognised the importance of such an approach too: ‘the families always have my contact number for six months after discharge. And I always say to them, “You don’t know where to go for advice, you don’t know who to phone, phone me, and I will try and help”’ (Specialist midwife).

Some healthcare professionals, both hospital- and community-based, felt more at risk than others and opted either to work from home or to decline community visits. This was sometimes experienced as burdensome by those who continued to work and to cover for shielding colleagues: ‘people were very generous in allowing people to shield. … Maybe a bit more challenging approach to is it correct that these people who maybe said they need to shield have to shield really?’ (Consultant paediatric surgeon). However, relationships between team members generally facilitated the protection of colleagues who felt unable to carry out their usual role:

The central theme across all the data was a recognition of the harm caused to relationships as a result of the changed working practices mandated by infection prevention and control measures:

Relationships between healthcare professionals and patients were harmed:

It was also noted that relationships between healthcare professionals and patients’ families, and within the wider family networks of those who had suffered a bereavement were compromised:

The damage caused to relationships was often described as likely to have long-term consequences, both for families affected by difficult decisions, and for the healthcare professionals making them:

Frequently, the counterpoint to the distress experienced by healthcare professionals within the context of their patient relationships (including with patients’ families) was the support available from colleagues:

The nature of that collegial support was also significantly impacted by the requirements of social distancing and infection prevention measures: ‘the support groups have all gone … to Zoom they don’t really work as well as having thirty to forty people in a room talking to each other about loss. … We’ve just lost this element of support, … and it’s, it’s hard’ (Neonatologist).

Yet, the enduring availability of the relationships was valued. The availability of professional support from within the hospital was perceived positively: ‘Our senior clinical managers are really, really great. So if they are aware that someone is struggling, they will absolutely provide whatever support is necessary’ (Consultant neonatologist). Where it was made available to staff as well as patients, specialist support was valued: ‘The Trust has employed psychologists in order to support staff sort of in the here and now and they are, you know, they are able to run workshops around resilience’ (Head of Midwifery, DGH).

Our data clearly identified the central importance of relationships in healthcare, encompassing relationships between colleagues as well as between healthcare professionals and the patients and families in their care:

Our findings thus make visible the harms to the enactment of healthcare relationships caused by practices and policies whose aim was to control the spread of the virus. While the virus was indirectly responsible, the regulations requiring social distancing and the consequent changes to ‘usual’ working practices were the direct cause of these harms, experienced particularly acutely in the (ideally) ‘family-centred’ maternity and paediatric services we were investigating. In the next section, we will situate these findings about the centrality of relationships in healthcare in a discussion of relational theories more broadly, drawing out their significance in the context of maternity and paediatric services.

Relationships recalibrated: theorising the stories we were told

Relational theorists have long suggested that it is in our ‘networks of relationships’ that we (our identities) are constituted (Nedelsky, 2011: 19; see Gilligan, 1977, 2014; Tronto, 1987; Barad, 2007). In suggesting this, they include widely drawn relationships that acknowledge the interdependence of humans and the natural world, less broadly drawn local societal relationships, and closer family relationships. Notions central to the idea that human beings are separate, bounded individuals are reconsidered and reimagined by reference to how we see ourselves in relation to other(s). Nedelsky (2011: 39), for example, argues that ‘autonomy is made possible by constructive relationship (and undermined by destructive relationship)’. Similarly, it has been suggested that the concept of agency can be reframed so that it encompasses the capacity to ‘affect and be affected’ rather than (just) to understand and reflect (Deleuze and Guattari, 1987). In the discussion that follows, we review our findings through a relational lens, considering, in so doing, how a ‘logic of relationality’ (Lejano, 2021: 364) might form a better starting point than a logic of rationality for decision-making in the healthcare context.

Lejano (2021) offers the notion of a logic of relationality as a contrast to a conventional understanding of policy as underpinned by rationality, which he describes as prescription, guided by reason and knowledge, for pursuing desired ends, where the aim is to maximise the degree to which a decision conforms to a specified criterion. He suggests that a notion of relationality, where relationality describes the patterns and workings of relationships, better reflects how people work together in practice. Arguing that a rational, output-driven approach to rules and policies fails to attend to the way people work within relationships, he suggests that this explains the ‘gap’ that often develops in practice between the design of the rules, or policies, and the way they work or are interpreted by people whose work they are intended to direct.

The application of Lejano’s relational logic would understand healthcare professionals, patients and their families not just as rule-setting and rule-following beings, but as relational agents whose interpersonal everyday interactions work out how the rules fit, and how policies are applied, to allow for a particular clinical set of circumstances, or attend to a particular patient’s needs. Such a relational logic prioritises the sequences of actions and reactions that express and reinforce relationships. Viewed in this way, the rules are (to an extent) dynamic, creating an institutional approach which is negotiated to accommodate the various relational interactions and priorities.

An institutional approach underpinned by a relational logic, then, understands people within their networks (patients, healthcare professionals and families) as tending outwards, being constituted within and by their relationships, rather than existing as autonomous individuals in the Cartesian sense (Husserl, 1901). Similarly, Pollard (2015) has concluded that central tenets of relational ethics include (most importantly) mutual respect, engagement and responsibility. Gilligan (2014) has characterised relationality, feeling connected to other people and empathising with them, as an ethic of care and, developing this in the legal context, Herring (2013) has put forward four markers of care, situating the practice of caring specifically in a relational context, where care is an action, care meets a need, offers respect, and accepts responsibility.

Our research findings reconfirm the importance of these theoretical ideas in healthcare practice, highlighting the importance, for members of the public and for healthcare professionals, of emotional engagement, the meeting of needs (spiritual as well as clinical), mutual respect, and an enactment of responsibility for the wellbeing of patients, family members and colleagues. The caring relationships between healthcare professionals, their patients and the families of their patients, can, then, be understood as working to (co-)constitute their identities as people-in-relationships, as needs are met, responsibilities are accepted and both professional and personal selves are formed.

Attending in our analysis to the central importance of relationships in our data, we can theorise that the harms participants discussed were linked to the mandatory, non-negotiable nature of the infection prevention and control measures imposed during the pandemic. These strict measures, imposed (understandably, in the context of a public health emergency) to protect the ability of the system to continue to function, restricted (and in some cases removed) healthcare professionals’ usual ability to negotiate or interpret policies and guidelines with their patients (and families) to fit the particular therapeutic context. Our suggestion is that we can make sense of our findings by reference to Lejano’s (2021) logic of relationality. We posit that in what we might describe as ‘usual’ times,⁷ hospital policy and decision-making sit within a combination of a logic of rationality (in terms of formulation of policy and guidance) and one of relationality when these policies and guidelines come to be interpreted and applied in practice.⁸ In ‘usual’ times, the family is part of the team in maternity and paediatric services, and policies and guidelines are interpreted by the healthcare team with the patient and their family members, within the unfolding of a relationship embedded in an organisational context:

Thus, the imposition of social distancing rules, visiting restrictions and the requirement to wear PPE, created largely non-negotiable barriers to relational engagement in the everyday practices our participants described. For the most part, the caring relationships had to give way. The consequent fracturing of the human interactions that our data describe sits at the heart of the ethical difficulties that were experienced by some of our interview participants and focus group discussants.

The case for a logic of relationality: the risks of disrupting relationships

The findings of our rapid review demonstrated that the safety of NHS staff was the most frequently occurring focus of guidance (Chiumento et al., 2021). This was also reflected in our interviews with senior managers.

In terms of organisational risk, then, healthcare professionals’ safety seemed primarily to have been understood in terms of physical safety, particularly minimising exposure to COVID-19 in order to reduce as far as possible the impact of healthcare professionals’ sickness. The (rational) aim of such a policy was the protection of the system as a whole, to ensure its ability to continue functioning (Chiumento et al., 2021).

While this might seem appropriate as part of a pandemic response, we suggest that relational aims are (at least) equally as important, and should always feature in decision-making. For some senior decision-makers, it is clear that they did. Our data show that some managers were very aware of the negative impacts of rigid and inflexible infection prevention measures on healthcare professionals and patients, and of the resulting ethical challenges in terms of balancing infection prevention and supporting relationships:

This suggests that, whether in ‘usual’ times, during pandemics, or when the system is under pressure for other reasons, safety should be understood holistically, as encompassing not only physical health, but social, mental and moral health as well. Prioritising healthcare professionals’ physical safety to the detriment of their mental and emotional wellbeing fails to recognise the longer term risks of burnout, or moral distress. While it is sad to note that ‘absence, burnout and PTSD’ are (now) recognised as significant strategic risks,⁹ it is our contention that the risk of these harms could be mitigated with decision-making that recognises the moral significance of caring relationships to healthcare professionals, and the role such relationships can play in helping them negotiate ethical challenges.

The starting point for such a project, accepting that relationships are fundamental to healthcare, would be the development of organisational rules and policies that support, rather than stress, those relationships. This requires meaningful engagement with the ways in which relationships are enacted and valued, with a view to better understanding how to support them in practice. Starting with an analysis of the values that underpin the patterns and workings of relationships in healthcare, an ethical framework could be developed on and around which to base a discussion, involving stakeholders from across the hospital community, about supportive organisational rules and policies. While we accept that an ethical framework cannot (and should not) produce a recipe for decision-makers to follow, we suggest that a transparent ethical framework, co-constructed with relevant stakeholders (at the relevant time and in the relevant organisational context), offers a useful tool to support decision-making and help shape organisational practice. Drawing on our qualitative data and the ethical framework we developed inductively through our rapid review,¹⁰ we set out in Table 2.1 the values we think are key, together with a suggestion of their meaning in the context of the caring relationships we have described above and how we suggest they might be incorporated into healthcare decision-making and policy-setting.¹¹

Conclusion: arguing for an explicitly relational approach to healthcare policy and decision-making

It is our suggestion that, in foregrounding the importance of (the enactment of) caring relationships to the wellbeing of people across a hospital community, policy- and decision-makers will better engage and protect the people around whom the NHS is organised – members of the public, hospital staff, patients and their families. We do not argue that relationships are currently unrecognised in healthcare decision-making (this is clearly not the case), but, rather, that where rational outcomes (infection prevention and control, for example) are prioritised, this should be complemented by explicit consideration of the impact on relationships. We found that this did happen in some settings, but that significant (moral) harm resulted in circumstances where it did not. In suggesting how attention might be paid to relationships, we return to Lejano’s (2021) logic of relationality.

Lejano’s central contention is that interpersonal relationships and everyday transactions are the mechanisms used to work policy into practice, so that policy is not experienced as ‘prescription-and-implementation but as the workings of relationships’ (2021: 361). Our data show that this policy ‘dynamism’ is a feature of healthcare professionals’ normal negotiation of the rules in the context of their patient and professional relationships: respect for the patient’s views, the provision of clear information to allow a transparent balancing of harms and benefits for that patient in that family, and attention to fairness in terms of the needs of other patients, are, we suggest, all features of ‘usual’ healthcare practice. The pandemic imported impediments to this dynamism in the shape of rules that were not amenable to negotiation. While, in our view, healthcare professionals and patients alike understood and accepted the necessity for this in the early acute phase of the pandemic, this changed during later waves of infection as understanding of the virus evolved. At this point, a focus on the impact of infection prevention measures on the enactment of relationships would have helped to inform decision-making. Returning to the story with which we opened this chapter, we suggest that the harms of refusing this new mother access to the ward where her sick baby was receiving care might have been mitigated by considering how a safe, fair and less harmful interpretation of the rules could be achieved. Our data suggest that the benefits of so doing would have been felt (in both the short and the longer term) not only by the young parents, but also by the healthcare professionals involved in caring for them and their dying baby.

It is, of course, much easier to suggest solutions in isolation, with the benefit of hindsight, and without having to account for the wider ripple effects of such negotiations on the wider community. For these reasons, this chapter is not intended simply to criticise the ‘rational’ approach to decision-making that characterised the approach to restoring non-COVID services in the ‘reset’ period that we were investigating. Rather, we suggest that the pandemic emergency offers an opportunity for reflection and learning, particularly in the context of a health service that, even in ‘normal’ times, is stretched. Our contention is that in setting policy, transparent and engaged communication that respects healthcare professionals’ ability conscientiously and fairly to engage with others (colleagues, patients, family members and other carers) is crucial. By facilitating this, decision-makers can enable a greater harmony between policy, its application in action and the relationships within which all policy is embedded. Achieving such harmony will ensure that healthcare professionals, patients and their wider family and care networks are supported when critical, ethically difficult, decisions about the delivery of services are made, whether in pandemic times or otherwise.

Funding

The Reset Ethics research project was funded by the UK Research and Innovation Arts and Humanities Research Council, Grant number AH/V00820X/1.