Clinical Ethics, Ahead of Print. This paper is a response to a recent BMJ Blog: ‘The duty to treat: where do the limits lie?’ Members of the Surrey Heartlands Integrated Care Service Clinical Ethics Group reflected on arguments in the Blog in relation to resuscitation during the COVID-19 pandemic.Clinicians have had to contend with ever-changing and conflicting guidance from the Resuscitation Council UK and Public Health England regarding personal protective equipment requirements in resuscitation situations. St John Ambulance had different guidance (...) for first responders.The situation regarding resuscitation led the CEG to consider ethical aspects of health care professionals’ responses to the need for resuscitation during COVID-19. Members agreed that professionals should, ideally, have the level of PPE required for an aerosol generating procedure. However, there was no consensus regarding professionals’ duty to care when this is not available. On the one hand, it was agreed that the casualty/patient’s interests regarding resuscitation should be prioritised due to professionals’ contract with the public and professional privilege. On the other hand, risk thresholds were considered relevant to individual decision-making and professionals’ duty to care. All agreed that decision-making should not be influenced by rewards or reprimands. It was agreed also that decisions to resuscitate should not be considered as moral heroism or supererogatory - regardless of PPE availability - but rather as ‘minimally decent’. We agreed that it may be acceptable for professionals, with good reasons, to opt out of resuscitation attempts and these should be reflected on and discussed before the event. (shrink)

If one sits in the stands for awhile at a local sporting contest, whether it is wrestling, soccer, baseball or particularly basketball, before long someone will exclaim toward a referee, ?That was a makeup call. You owe us one.? Everyone knows what this means but if an eight-year old beside you hears this screamed for the first time and asks, ?What does that mean?? An explanation given to her will be something like ?that's when an official makes a call and (...) immediately realizes it was a wrong call so at the first opportunity he can he makes a call against the team that has benefitted from the previous call; he is trying to even things out for his mistake.? The referee or umpire is attempting to be fair by ?giving back? the call with a ?makeup call.? A make-up call can be defined as the act of compensating for a questionable or bad officiating call by making a proportionally even call against the team that was aided by the first call. Usually these are immediate and obvious. They can also be conscious or subconscious, intentional or unintentional. The hope is that the two calls generally offset one another without either team being dramatically harmed. I will argue that the makeup call is prima facie immoral but if one were to attempt to find moral justification for it, this could best be done through a corrective theory of justice. But this presents a number of moral questions and ambiguities, most significantly, is a makeup call just and fair? Is it appropriate to understand the makeup call as an example of two wrongs making a right? A broader philosophic al question about officiating is whether each call in a contest should be viewed by as an independent single call with the goal of the official getting that one immediate call correct or should each call be understood as in a direct relationship with every other call in that game as a type of gestalt thus justifying makeup calls? This work will probe the depths of the highly suspect yet common moral puzzle, the makeup call. (shrink)