Relationships were a casualty when pandemic ethics and everyday clinical ethics collided

The ‘Reset Ethics’ research explored the everyday ethical challenges of reconfiguring 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.

Ethical challenges encountered by decision-makers were often embedded in changes to working practices intended to keep staff safe, and to protect hospital communities from Covid-19 infection. However, these changes 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. Offering such care was experienced as an ethically important dimension to healthcare delivery, and an essential component of patient-centred care. Our findings suggest that, although they protected healthcare staff and patients from Covid-19, infection prevention and control measures caused harm by creating barriers to relational interaction and engagement. We situate our participants’ reflections in a discussion about the significance of relationships in a healthcare context. We describe the theoretical underpinnings of a logic of relationality in healthcare, which we argue should underpin healthcare decision-making. We contend that an explicit attention to relationships is required to 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.