Ladiesse M, Léonard T, Birmelé B
Espace de réflexion éthique région Centre Val-de-Loire, CHU Tours, 2, boulevard Tonnellé, 37044 Tours, France.
CMRR, Consultation intersectorielle de gérontopsychiatrie, CHU Tours, 37044 Tours, France.
Ethique Sante. 2020 Sep;17(3):147-154. doi: 10.1016/j.etiqe.2020.07.001. Epub 2020 Aug 16.
The COVID-19 pandemic has limited the freedom of any citizen, further increased constraint for people in EHPAD - the most widespread type of French Residential care for senior citizens with a high level of dependency, often very aged, suffering multiple pathologies and sometimes psycho-behavioral disorders. "Golden" containment rule was 24/7 confinement in their room, with the very restrictive framework - up to NO visiting by relatives - and very often with a total absence of consent as for screening sample decisions. We can then question the fundamentals of such restriction of freedom, which is a constitutional right for everybody, including for residents in EHPAD, especially non-compliance with self-determination and consent. The principal objective has been a collective interest, before the individual right and the benefit for the patient itself. Nothing would have been justifying to create a possible risk to other residents, generated by another resident's behavior or one of his relatives. But these safety measures were taken despite the underlying risk of deteriorating individual situations through social and emotional isolation, and thus to further reduce autonomy capacities. "Luckily" the know-how and creative spirit of EHPAD professionals limited the consequences of this restriction of freedom. Hard lessons should be learned from share experiences if such a context were to occur again. But above all arises the question of the place of these dependent people in our society. It is essential to think collectively about these living spaces including protocols that should reflect people's choice and on-location adapted to be more open to the outside/foreigners visits. Spaces shall be adapted to their vulnerability, designed to reduce isolation, to repeat such extreme restrictive measures in the event if it shall occur. Of course, rigorous confinement rules allowed to limit deaths linked to the COVID infection, but at the risk of dying in loneliness and grief.
新冠疫情限制了所有公民的自由,进一步加剧了入住法国高依赖度老年人居住护理机构(EHPAD)人群的受限状况。EHPAD是法国最普遍的老年居住护理机构类型,居住者往往年事已高,身患多种疾病,有时还伴有心理行为障碍。“严格”的防控措施是让他们全天24小时都被限制在房间里,框架非常严格——亲属甚至都不准探访——而且在进行样本筛查决定时,往往完全没有征得同意。于是我们不禁要质疑这种对自由的限制的根本依据,自由是每个人的宪法权利,包括EHPAD的居民,尤其是这种做法不符合自主决定权和同意原则。首要目标一直是集体利益,而非个人权利以及对患者自身的益处。没有任何理由去制造由另一名居民的行为或其亲属行为给其他居民带来的潜在风险。但尽管这些安全措施会因社会和情感隔离而存在使个人状况恶化的潜在风险,进而进一步削弱自主能力,它们还是被实施了。“幸运的是”,EHPAD专业人员的专业技能和创新精神减轻了这种自由限制的后果。如果再次出现这种情况,应该从共同的经历中吸取惨痛教训。但最重要的是,出现了这些依赖他人生活的人在我们社会中处于何种地位的问题。必须集体思考这些生活空间,包括制定应反映人们选择且适合当地情况、更对外开放以供亲属探访的协议。空间应适应他们的脆弱性,旨在减少隔离,以防再次出现类似情况时不再采取如此极端的限制措施。当然,严格的隔离规定确实有助于减少与新冠感染相关的死亡,但却让人们面临孤独和悲伤中离世的风险。