EditorWe welcome Professor Harkin's letter, with its emphasis on the importance of working in partnership, being transparent, and making ethically defensible decisions during COVID-19.We would, nevertheless, caution against reducing ethics to the ‘four fundamental principles of medical ethics’. These are important, certainly, but insufficient to either capture or resolve all the diverse and complex problems arising. Furthermore, we make a subtly different claim than the empirical one depicted by Professor Harkin. Rather than suggest society and surgeons “will accept [that] available healthcare resources must be directed at the pandemic”, we argued that they should – and likely would – choose to live in a world with resources directed, when necessary, to protecting the most vulnerable and saving lives, from a position of ignorance about their own place in that world. Further, this implies they should make that choice now and support efforts that accord with that principle.Of course, the ethical landscape in the UK has evolved since we prepared the editorial: not only have various organizations issued (and even revised) ethical guidance pertaining to COVID-19, but clinical ethics support services have also become increasingly involved in advising clinicians and healthcare institutions, locally and regionally.What is happening is encouraging, but – in line with Professor Harkin's points – we have reservations about what is not happening. There is growing disquiet about the lack of ethical leadership and co-ordination. The various efforts to provide an ethical steer are commendable, but the proliferation of ethical guidance and advisory groups threatens to cause confusion, introduce inconsistency and duplicate effort.Professionals, patients and society at large deserve clarity, transparency, consistency and fairness. As such, we would add our voices to those calling for enhanced co-ordination and, fundamentally, for ethical leadership, so we can best navigate the ethically choppy waters of COVID-19.Huxtable and Ives are in part supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.