Asking for a friend who is stuck in a complicated situation

Asking for a friend who is stuck in a complicated situation.
He was offered a Cardiology Registrar post in Nottingham in February of this year. He accepted the post and was issued a COS, he applied for a Tier 2 visa in March. Soon after submission of Passport the lockdown came into effect in Pakistan. Despite multiple attempts on his part he was unable to get his passport back. The trust waited till end July and then hired somebody else stating they needed the post filled urgently. The trust offered him a replacement post as a Medical FY2 which he thought was not suitable for him, so he politely declined and requested the trust to withdraw the COS so that he may apply elsewhere. The HR of the trust informed him that they have withdrawn the COS. He also intimated the Home Office to cancel his Visa application.
Now he recieved his passport back in mid August but was astonished to see that he had been issued the Tier 2 Visa. Now he is quite confused on how to proceed as he has some upcoming interviews.
Any help/advice will be highly appreciated

2 options

  1. Refuse to work in that capacity and inform home office to cancel Visa. They can do so with no impact on future Visa applications

  2. Join and start work and move to higher position in next few months.

I would encourage 2nd option as 2nd wave is looming on UK earlier thn expected and local lockdown are in place and u never know when it turns into national lockdown again and whole story of February till now repeat itself again.