Embedded pragmatic clinical trials (PCTs), like other types of randomized comparative-effectiveness research (CER) studies, are sometimes conducted without informed consent. Indeed, authors of both...

Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource—vaccination—counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical (...) justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: instrumental value, also known as the ‘multiplier effect’, which may preserve the ability of healthcare workers to help others, and reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person’s life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked. (shrink)

The question, what makes a clinician a healer? may evoke the image of a devoted physician paying a critically important home visit at the end of a long day or the image of an astute nurse—steadfast, empathic, anticipating the patient's needs before they become apparent to others. But health care is no longer provided by lone doctors or nurses. In the modern health care system, multiple professionals must work together to provide safe and effective care. The moral nature of healing (...) has not changed. But what is required of clinicians to facilitate healing has. To be a healer today, a clinician must be a good team player. Medical students have opened our eyes to this new reality. Building on their observations, we articulate a view that, over and above the role of teamwork in providing technically appropriate care and preventing errors, health care requires teamwork to promote healing. Being a good team player is now a moral imperative because it makes an essential contribution to healing. (shrink)