Covid-19: Can France’s ethical support units help doctors make challenging decisions?

Abstract

Covid-19: Can France's ethical support units help doctors make challenging decisions? France has set up "ethical support units" to help doctors make difficult choices about which patients with covid-19 to treat in intensive care. Sophie Arie reports

Frailty and COVID-19: A Systematic Scoping Review

“…Four guidelines were focused on the management of patients with specific diseases, including diabetes, hemophilia, and cancer [ 33 , 34 , 35 , 36 ], and one focused on palliative care for older frail patients [ 37 ]. In terms of the setting, eight guidelines were specific for hospitals or nursing homes [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 34 ] and six for home care [ 30 , 31 , 32 , 33 , 35 , 36 ], while one recommendation was made for both settings [ 37 ]. With regards to the frailty index, four guidelines suggested to screen patients with the Clinical Frailty Scale [ 23 , 27 , 29 , 34 ], and one suggested the French Clinical Frailty Score or Frailty Group Iso-Resource Evaluation (FRAGIRE) score [ 26 ], while all the others did not specify any frailty index.…”

“…Among the 15 recommendations/guidelines retrieved, seven underlined the need for frailty assessment of hospitalized subjects with COVID-19, almost exclusively to support decision making for ICU allocation or ventilation [23][24][25][26][27][28][29]. Clarfield et al emphasized the role of active palliative care at the end of life during COVID-19 and recommended that very frail older people with severe dementia should be actively protected from ventilator-associated complications and subsequent risk of undignified death [28].…”

“…Four guidelines were focused on the management of patients with specific diseases, including diabetes, hemophilia, and cancer [33][34][35][36], and one focused on palliative care for older frail patients [37]. In terms of the setting, eight guidelines were specific for hospitals or nursing homes [23][24][25][26][27][28][29]34] and six for home care [30][31][32][33]35,36], while one recommendation was made for both settings [37]. With regards to the frailty index, four guidelines suggested to screen patients with the Clinical Frailty Scale [23,27,29,34], and one suggested the French Clinical Frailty Isolation was another important issue raised by a few editorials: two editorials warned about the negative outcomes of social isolation for older frail people [14,22], two stressed the need of remote monitoring systems specifically devoted to isolated patients [10,16], and three highlighted the negative effects of isolation in nursing homes [10,20,22].…”

La eficiencia no basta. Análisis ético y recomendaciones para la distribución de recursos escasos en situación de pandemia

“…En ausencia de esas condiciones, que exigirían un tiempo que excede el apremio impuesto por las necesidades de la actual pandemia, es fundamental el desarrollo de un procedimiento razonable de toma de decisiones ( tabla 4 ). El que proponemos aquí enfatiza la importancia de compartir las decisiones y la rendición de cuentas, que implica transparencia sobre los motivos de las decisiones, razonabilidad de los fundamentos de estas y posibilidad de apelación de las elecciones tomadas 31 . Se recomienda que la toma de decisiones se guíe por los criterios generales de procedimiento que a continuación se exponen.…”

Ethik der Reanimation und Entscheidungen am Lebensende

“…Wie oben erwähnt, sollen diese Entscheidungen nicht nur von einzelnen Institutionen oder Angehörigen von Gesundheitsberufen getroffen werden, sondern auf Protokollen auf Systemebene basieren. Auf verschiedenen operativen Ebenen sollen "Ethikteams" eingerichtet werden, um einzelne Angehörige von Gesundheitsberufen bei der Verantwortung für Rationierungsentscheidungen zu unterstützen und/oder sie zu entlasten [22,23]. Sobald Entscheidungen getroffen wurden, soll das medizinische Personal entsprechend handeln, und die, die den definierten ethischen Rahmen nicht akzeptieren können, sollen vorzugsweise klinische Unterstützungsfunktionen in Bereichen übernehmen, in denen keine Rationierungsentscheidungen erforderlich sind.…”