Researchers and institutional review boards often consider it inappropriate for patients to be asked to consent to more than one study despite there being no regulatory prohibition on co-enrollment in most countries. There are however ethical, safety, statistical, and practical considerations relevant to co-enrollment, particularly in surgery and perioperative medicine, but co-enrollment can be done if such concerns can be resolved. Preventing eligible patients from co-enrolling in studies which they would authentically value participating in, and whose material risks and benefits they understand, violates their autonomy - and thus contravenes a fundamental principle of research ethics. Statistical issues must be considered but can be addressed. In most cases each trial can be analyzed separately and validly using standard intention to treat principles; selection and other biases can be avoided if enrollment into the second trial is not dependent upon randomized treatment in the first trial; and valid interaction analyses can be performed for each trial by considering the patient’s status in the other trial at the time of randomization in the index trial. Clinical research with a potential to inform and improve clinical practice is valuable and should be supported. The ethical, safety, statistical, and practical aspects of co-enrollment can be managed, providing greater opportunity for research-led improvements in clinical practice.

Public reporting of clinical outcomes data is but one response to calls for increasing transparency in health care. Cardiac surgical operations are among the most commonly performed complex operative procedures. Risk-adjusted cardiac surgery mortality rate data for individual cardiac surgeons are currently available for >25% of the U.S. population as well as for Great Britain and Ireland. Although cardiologists are the primary source of referral of patients for cardiac surgery, surveys of cardiologists and analysis of market share data indicate this information is not being used to refer to cardiac surgeons with the lowest mortality rates. We review the ethical principles that should obligate cardiologists to discuss and use outcomes data, when available, in selecting cardiac surgeons to whom they refer their patients.

Medical school curricula and postgraduate education programmes expend considerable resources teaching medical ethics. Simultaneously, whistleblowers’ agitation continues, at great personal cost, to prompt major intrainstitutional and public inquiries that reveal problems with the application of medical ethics at particular clinical “coalfaces”.Virtue ethics, emphasising techniques promoting an agent’s character and instructing their conscience, has become a significant mode of discourse in modern medical ethics. Healthcare whistleblowers, whose complaints are reasonable, made in good faith, in the public interest, and not vexatious, we argue, are practising those obligations of professional conscience foundational to virtue based medical ethics. Yet, little extant virtue ethics scholarship seriously considers the theoretical foundations of healthcare whistleblowing.The authors examine whether healthcare whistleblowing should be considered central to any medical ethics emphasising professional virtues and conscience. They consider possible causes for the paucity of professional or academic interest in this area and examine the counterinfluence of a continuing historical tradition of guild mentality professionalism that routinely places relationships with colleagues ahead of patient safety.Finally, it is proposed that a virtue based ethos of medical professionalism, exhibiting transparency and sincerity with regard to achieving uniform quality and safety of health care, may be facilitated by introducing a technological imperative using portable computing devices. Their use by trainees, focused on ethical competence, provides the practical face of virtue ethics in medical education and practice. Indeed, it assists in transforming the professional conscience of whistleblowing into a practical, virtue based culture of self reporting and personal development.

T h e revival of virtue ethics over the last thirty-five years has produced a bewildering diversity of theories, which on the face of it seem united only by their opposition to various features of more familiar Kantian and Utilitarian ethical theories. In this paper I present a systematic account of the main positive features of virtue ethics, by articulating the common ground shared by its different varieties. I do so not to offer a fresh defence ofvirtue ethics, but rather to provide a conceptual map that locates its main claims and arguments in relation to those of rival theories, and identifies its distinctive contribution to contemporary ethics. I set out six specific claims which are made by all forms of virtue ethics, and I explain how these claims distinguish the theory from recent character-based forms of Kantian ethics and Utilitarianism. I then use this framework to briefly survey two main strands of virtue ethics which have been developed in the literature.'

This paper argues that the provision of effective informed consent by surgical patients requires the disclosure of material information about the comparative clinical performance of available surgeons. We develop a new ethical argument for the conclusion that comparative information about surgeons' performance--surgeons' report cards--should be provided to patients, a conclusion that has already been supported by legal and economic arguments. We consider some recent institutional and legal developments in this area, and we respond to some common objections to the use of report cards on the clinical performance of surgeons.