COVID-19 is reducing the ability to perform surgical procedures worldwide, giving rise to a multitude of ethical, practical and medical dilemmas. Adapting to crisis conditions requires a rethink of traditional best practices in surgical management, delving into an area of unknown risk profiles. Key challenging areas include cancelling elective operations, modifying procedures to adapt local services and updating the consenting process. We aim to provide an ethical rationale to support change in practice and guide future decision-making. Using the four principles (...) approach as a structure, Medline was searched for existing ethical frameworks aimed at resolving conflicting moral duties. Where insufficient data were available, best guidance was sought from educational institutions: National Health Service England and The Royal College of Surgeons. Multiple papers presenting high-quality, reasoned, ethical theory and practice guidance were collected. Using this as a basis to assess current practice, multiple requirements were generated to ensure preservation of ethical integrity when making management decisions. Careful consideration of ethical principles must guide production of local guidance ensuring consistent patient selection thus preserving equality as well as quality of clinical services. A critical issue is balancing the benefit of surgery against the unknown risk of developing COVID-19 and its associated complications. As such, the need for surgery must be sufficiently pressing to proceed with conventional or non-conventional operative management; otherwise, delaying intervention is justified. For delayed operations, it is our duty to quantify the long-term impact on patients’ outcome within the constraints of pandemic management and its long-term outlook. (shrink)

It is argued, on a variety of evidence, that the usual view of 35–6, “But if you, Maeceas, include me in the canon of lyric poets, I shall strike the stars with my exalted head”, is mistaken. Rather, they mean “But make me one of those lyric poets, and I shall strike, etc.”. This is the “depersonalized” indefinite second person, illustrated by pone at Odes 1. 22. 17–24, dedisses at Serm. 1. 3. 15–16, and other passages. It does not imply (...) that any particular person can do the action in question but merely invites the supposition that the action is performed. A second section treats 29–34, showing two ways in which they can be consistent with the suggested interpretation of 35–6. (shrink)

The Athenian expedition led against Macedonia by Archestratos, son of Lykomedes, early in 432 was not diverted from its destination by the revolt of Poteidaia. Archestratos had received additional instructions to enforce the Poteidaia ultimatum if he could, but, this being already impossible, he continued with the real object of his mission, the attack on Perdikkas II of Macedon. The widespread revolt among the Chalkidians had deprived the Athenians of the bases for this attack on which they might have reckoned, (...) and Archestratos had at the outset to make good this loss by recapturing Therme, at the head of the gulf to which it gave its name. Therme, or Serme, had been a tributary member of the Delian League since 450/449:2 it need not necessarily be said that it lay within Macedonia, as Poppo and Bergk inferred from Thucydides 1. 61. 2, but it is at least likely that it lay on the boundary, as it was handed over to Perdikkas under the agreement of 431 .3 However, that the Athenians could include in their Empire a city within Macedonian territory is shown from the position of Berge , and is likely in other cases, e.g. Haison. From Therme, Archestratos moved on to Pydna, presumably by sea, and laid siege to it. Here he was joined by substantial reinforcements, while at the same time the situation in Chalkidike became increasingly embarrassing, so that a peace and a reinsurance alliance were seen by both sides to be ‘imperative’ . When these had been concluded, the Athenians moved against Poteidaia. (shrink)