ABSTRACT
Part of the rationale behind public health measures is protecting the vulnerable. One of the groups most vulnerable to COVID-19 are the elderly and, consequently, many countries adopted public health measures that aimed to keep the elderly safe. The effectiveness and the consequences of those measures, however, leaves a lot to be desired. In my article, I will look at the steps that the Nordic countries took to protect their elderly and assess their success. I will further analyze those in the light of standard ethical theories. Public health crises often call for choices between two evils. Selecting patients for intensive care is one such choice, and again, it seems that for the elderly, the outcome was less than favorable. Overall, from the point of view of ethics, many countries failed miserably when it came to the treatment of the elderly. I will end my paper by discussing the lessons we can learn from the COVID-19 pandemic and suggests measures we need to take to offer genuine respect for the rights of the elderly.
ABSTRACT
PURPOSE: During the COVID-19 pandemic, a care reorganization was mandatory, and affected patients in different areas, including management of neurogenic lower urinary tract dysfunction. This work aims to provide validated schedule concerning the assessment and management of patients in neuro-urology. METHODS: Based on a literature review and their own expertise, a steering committee composed of urologists and physical medicine and rehabilitation practitioners generated a comprehensive risk-situation list and built a risk scale. A panel of French-speaking experts in neuro-urology was asked to define the timing for each clinical situation and validated these new recommendations through a Delphi process approach. RESULTS: The 49 experts included in the rating group validated 163 propositions among the 206 initial items. The propositions were divided into four domains - diagnosis and assessment, treatment, follow-up, and complications - and two sub-domains - general (applicable for all neurological conditions) and condition-specific (varying according to the neurological condition (spinal cord injury, multiple sclerosis, brain injury, Parkinsonism, spinal dysraphism, lower motor neuron lesions)). CONCLUSIONS: This multidisciplinary collaborative work generates recommendations based on expert opinion, providing a validated timing for assessment and management of patients in neuro-urology which may help clinicians to reorganize their patients' list with a personalized medicine approach, in a context of health crisis or not.
Subject(s)
Delphi Technique , Urology , COVID-19 , Humans , Pandemics , PelvisABSTRACT
Résumé L’urgence, surtout en période d’exception, impose d’apprendre à faire des choix, mais les priorités sont discutables dans le concept des soins urgents. Il faut donc anticiper le questionnement et évaluer les conséquences des décisions avec un regard éthique. L’inquiétude vient, en partie, de contraintes politiques et économiques dont l’influence grandit dans le périmètre d’une clinique rythmée par le temps court, peu propice à la réflexion. Une responsabilité est donc partagée dans l’accomplissement des moyens du soin entre le soignant, décisionnaire de proximité, et le non-soignant, décisionnaire à distance. L’urgence nous enseigne que la criticité, à la fois clinique et matérielle ou organisationnelle, met le travail du soin en tension avec une problématique non spécifique de devoir choisir à qui distribuer des moyens limités. La pratique réclame alors un éclairage éthique, car les situations vécues projettent les acteurs vers un rapport à la mort. L’enjeu est individuel et collectif : d’un conflit entre devoir envers une personne et devoir choisir entre les personnes émerge une souffrance psychologique et morale qui amène la question de savoir qui décide ou qui pour choisir ? Il y a donc tout lieu de s’intéresser au processus décisionnel de l’urgence, à savoir que des choix y sont à décider qui ne relèveraient pas de la seule décision des professionnels de santé. L’objectif de notre réflexion est de porter sur la question un regard soignant illustré d’une expérience de proximité. Summary Emergency, especially in times of crises, requires learning to make choices, but priorities are questionable in the concept of emergency care. It is, therefore, necessary to anticipate questioning and evaluate the consequences of decisions with an ethical approach. The concern comes in part from political and economic constraints whose influence grows within the perimeter of a clinic punctuated by short temporality, unsuitable for reflection. A responsibility is, therefore, shared in the accomplishment of the means of care between the caregiver, a local decision-maker, and the non-caregiver, a remote decision-maker. Emergency teaches us that criticality, both clinical and material or organizational, puts the work of care in tension with a non-specific problem of having to choose to whom to distribute limited resources. Practice then requires an ethical light because the situations experienced project the actors towards a relationship to death. The issue is individual and collective: from a conflict between duty to a person and having to choose between people emerges a psychological and moral suffering that leads to the question of WHO decides or WHO to choose? There is, therefore, every need to look at the emergency decision-making process, namely that choices must be decided that would not be the sole decision of health professionals. The objective of our reflection is to bring to the issue a caregiver look illustrated with a close experience.
ABSTRACT
Cet article présente les domaines prioritaires de recherche sur les impacts de la pandémie de COVID-19 chez les personnes âgées telles qu'ils ont été identifiés par l'Institut du vieillissement des IRSC (IV-IRSC). Le processus utilisé par l'IV-IRSC a comporté plusieurs phases itératives qui ont permis d'identifier trois secteurs prioritaires parmi les besoins de la recherche relative à la COVID-19, et quatre axes thématiques transversaux. Les secteurs de recherche prioritaires sont : 1) la réponse des personnes âgées à la maladie, à la vaccination et aux traitements, 2) la santé mentale et l'isolement, et 3) les milieux de soins soutenants. Les quatre thèmes transversaux sont : a) l'Équité, la diversité et l'inclusion (EDI), b) les considérations éthiques et morales, c) les pratiques fondées sur les données probantes, et d) les technologies numériques de la santé. Les priorités décrites dans cet article guideront les réponses de l'IV-IRSC aux besoins de la recherche sur la COVID-19.
ABSTRACT
This article describes priority areas for research on the impact of the Covid-19 pandemic on older adults that have been identified by the CIHR Institute of Aging (CIHR-IA). The process used by CIHR-IA consists of several iterative phases and thus far has resulted in identification of three key areas for Covid-19 research needs and four cross-cutting thematic areas. The key research priority areas are as follows: response of older adults to disease, vaccination, and therapeutics; mental health and isolation; and supportive care environments. The four cross-cutting themes are equity, diversity, and inclusion (EDI); ethical/moral considerations; evidence-informed practices; and digital health technologies. The priorities outlined in this article will inform CIHR-IA's responses to Covid-19 research needs.