Helen MacDonald

Maybe they're universal, maybe they're national, maybe they're regional, but isn't there some way that we could better coordinate this type of workload and share it out so that we're not all making guidance about the same thing?

And then the other thing, the transparency and trust thing was it's hard to trust advice or recommendations when a lot of the information out there is quite opaque, when you can't easily identify who has been involved and make a judgment about whether you think relevant people have been involved, whether that's particular types of experts, methodologists.

ethicists, patients and the public.

It's hard when you don't understand how the information has been put together.

Have they used evidence?

Have they used guideline methodology?

And to really understand then what the rationale behind making a recommendation is and whether in the quest for speed to get something out there, what corners might have been cut.

And this has been bothering me, I think, particularly as we've seen a shift from, well, that first guidance on NSAIDs, which kind of triggered my thought process on this.

So guidance which seems to have the ability to shape people's lives in much stronger ways, particularly guidance around the escalation of care.

So perhaps moving from being unwell into the community to be considered for admission into hospital if you are not doing so well.

And then on in hospital to escalation into higher dependency areas and into ITU.

And it really felt to me like...

This guidance, that type of advice really needs to be made collaboratively involving a wide range of professionals, ethicists and patients in the public and produced in a much more coordinated manner so that you don't get lots of regional variation, which is likely to upset people or make it hard for people to understand why decisions are being made that way about them.

And I think the final thing is just about being clear.

Being clear about what options there, if escalation and things like that are not for you.

And having publicly displayed information from organizations that have a standing in those communities, making clear why they have those particular policies.

And I was interested to see this week.

that there was some ethical guidance published by the Royal College of Physicians in the UK and supported by a number of other professional organisations in the Royal Colleges.

It's described as guidance for frontline staff on ethics in a pandemic.

But that mentions in it some principles, principles of inclusivity,