The COVID-19 pandemic is putting the NHS under unprecedented pressure, requiring clinicians to make uncomfortable decisions they would not ordinarily face. These decisions revolve primarily around intensive care and whether a patient should undergo invasive ventilation. Certain vulnerable populations have featured in the media as falling victim to an increasingly utilitarian response to the pandemic—primarily those of advanced years or with serious existing health conditions. Another vulnerable population potentially at risk is those who lack the capacity to make their own care decisions. Owing to the pandemic, there are increased practical and normative challenges to following the requirements of the Mental Capacity Act 2005. Both capacity assessments and best interests decisions may prove more difficult in the current situation. This may create a more paternalistic situation in decisions about the care of the cognitively impaired which is at risk of taking on a utilitarian focus. We look to these issues and consider whether there is a risk of patients who lack capacity to make their own care decisions being short-changed.

There is growing interest in the possible role of systematic methods of reviewing literature in bioethics. This has arisen alongside the growth of empirical bioethics and a general push towards introducing some level of rigour and reproducibility into scholarship in the field. However, there remain a range of approaches to reviewing literature utilized in bioethics, which vary significantly in their 'systematicness' and suitability for different purposes. In this article, we first detail a taxonomy of various existing reviews used in bioethics and how scholars have defended and critiqued them, presenting them relationally along axes of 'systematic' and 'critical'. Considering the suitability of these reviews, we then explore the inherent differences between normative and empirical literature in relation to how they can be reviewed. In particular, we highlight the challenges in reviewing both normative and empirical literature in a single review. As something of an answer to these challenges, we introduce and defend the scoping review as, in many ways, a method of reviewing literature with wide-ranging utility in bioethics. Demonstrating the many benefits of the scoping review, we then position it within the existing taxonomy of reviews, ultimately arguing that its combination of systematic and critical, inclusive of a reasonable degree of flexibility, makes it deserving of increased attention and use in bioethics.

Conflict is an important consideration in the intensive care unit (ICU). In this setting, conflict most commonly occurs over the ‘best interests’ of the incapacitated adult patient; for instance, when families seek aggressive life-sustaining treatments, which are thought by the medical team to be potentially inappropriate. Indeed, indecision on futility of treatment and the initiation of end-of-life discussions are recognised to be among the greatest challenges of working in the ICU, leading to emotional and psychological ‘burnout’ in ICU teams. When these disagreements occur, they may be within the clinical team or among those close to the patient, or between the clinical team and those close to the patient. It is, therefore, crucial to have a theoretical understanding of decision-making itself, as unpicking misalignments in the family’s and clinical team’s decision-making processes may offer strategies to resolve conflict. Here, we relate Kahneman and Tversky’s work on cognitive biases and behavioural economics to the ICU environment, arguing that these biases could partly explain disparities in the decision-making processes for the two conflicting parties. We suggest that through the establishment of common ground, challenging of cognitive biases and formulation of mutually agreeable solutions, mediation may offer a pragmatic and cost-effective solution to conflict resolution. The litigation process is intrinsically adversarial and strains the doctor–patient–relative relationship. Thus an alternative external party should be considered, however mediation is not frequently used and more research is needed into its effectiveness in resolving conflicts in the ICU.

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