The life of a CHSLD in time of hatching is drawn by management choices that raise ethical issues.
May 9, 2020 4: 00
Updated at 9: 33
How to arbitrate conflicts of values?
Should one give priority to the “quality of life” or the “quantity of life” of a patient is very old? The “quality” of life of the patient or the safety of the staff?
If there is a lack of staff, we are going to leave patients without hydration or in their soiled diaper or to call reinforcements from another floor and increase the risk of spread?
Should it be “uproot” a patient with alzheimer’s end-of-life in the changing room if her neighbor on the bed catches the virus? Or can it be left in the environment that secures and increase the measures of protection, assuming the risk that it may be contaminated in turn?
The life of a CHSLD in time of hatching is thus traced by management choices that raise ethical issues.
“Unless we move a patient, the better it is,” said Serge Dumont, senior researcher of Laval University specialised in the organisation of palliative care and ethical issues.
But if the “thinking process” is not rigorous, lack of transparency, or is not well explained to the relatives and employees, “the trust goes away,” says Mr Dumont.
Employees would say : “I does not fit more in there”. This can cause “desertion, emergency situations, tragic chaos.”
This was, however, not the case at the Jeffery Hale where employee engagement has never been compromised.
Choose between values is one thing. The difficulty is “very much in the how” of this choice will be applied and how it will be communicated.
We would like to be able to “innovate and be creative”, but there is a lack of staff and “in the current emergency, the employees of the “broue in the forelock and little space to think. It is a huge challenge”.
How, then, to arbitrate conflicts of values?
“This is going quite well if it’s a choice between quality of life and quantity of life,” a patient, ” noted Mr. Dumont.
We work “upstream” with the patient and family to determine, in advance, the more possible the “tools” and the treatments to be deployed. Or not.
There will be an end and if this end is to be “bedridden, emaciated, no longer able to swallow, at times, from a few months in advance with a pneumonia or an infection, it avoids the last step, which doesn’t make much sense”, said Dr. François Piuze, who works in the palliative care of the Jeffery Hale and ensures the “co-management” since the beginning of the pandemic.
The questions that arise
Mr. Piuze quote here the “caricature” of a physician who has worked at the Jeffery Hale a long time ago and who said : “pneumonia is the best friend of the old man”.
The ethicist Serge Dumont does not take offense of the picture. “Pneumonia is a beautiful example” of the questions that arise : are we treating the patient or it is given only “comfort care” with the “risk of death”? These questions are also asked with the COVID-19.
During an outbreak, should it prohibit any visit or allow relatives to accompany the last hours of a dying man? Focus on the patient or the safety of others?
Mr. Dumont did not hesitate. It will be “more inclined to protect the security of the greatest number”. This includes employees.
But it must be “aware of the negative impacts and seek mitigation measures, he insists. To be able to optimize the presence of the relatives and caregivers”.
The guidelines (progressive) of the public Health this spring have been to allow these visits in any end-of-life.
Dr. Hubert Marcoux, who also works in palliative care of the Jeffery Hale, is “of the opinion that the relatives come sooner rather than later”. Before the dying person becomes unconscious because of the pain medication.
“It is for the living that is important. The perspective of palliative care is to take care of people, too close,” he explains.
In a remarkable passage the last week everyone is talking about, the ex-president of Doctors without borders, Dr. Joanne Liu, has predicted this :
“In a few years, people will have forgotten the rest, but they will remember that they were not there when their mother died, and then they will remember that they have not been able to make the funeral. Man is not made to die all alone”.