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Access to care: age as a criterion of exclusion? The explicit and tacit forms of ethical recommendations in the COVID era

Par : Contributeur(s) : Type de matériel : TexteTexteLangue : français Détails de publication : 2022. Sujet(s) : Ressources en ligne : Abrégé : The allocation of resources and the choices involved in such decisions is an ongoing issue in healthcare. But the COVID crisis boosted the visibility of this subject while exacerbating it, since a central concern of the epidemic was the vital issue of access to intensive care. With the prospect of a highly serious risk of shortage, the fate of elderly patients immediately became a key aspect. In particular, the question was asked if age could be a criterion from excluding individuals from intensive care units. In France, the answer to this question was overwhelmingly “No”. Contrary to other countries, France refused to set a threshold age for access to intensive care. Supporting this decision, administrative authorities and learned societies issued numerous recommendations reasserting ethical principles based on equality, dignity and social justice. These texts gave the impression of continuity despite the crisis. Relating in varying degrees to the setting of standards – the recommendations all strove to guide the behaviour of the various medical decision-makers –, this corpus deserves to be studied from a legal standpoint with a view to identifying principles that come under pressure in crisis situations such as the COVID pandemic. Because while the texts conscientiously reminded readers that discriminating on the basis of age is forbidden, an indirect discrimination based on exactly that criterion can be read between the lines. And while age is combined with other specific situations or characteristics (with a thought for the residents of retirement homes), these texts can even lead to the true exclusion of the most vulnerable individuals from the general healthcare system.
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The allocation of resources and the choices involved in such decisions is an ongoing issue in healthcare. But the COVID crisis boosted the visibility of this subject while exacerbating it, since a central concern of the epidemic was the vital issue of access to intensive care. With the prospect of a highly serious risk of shortage, the fate of elderly patients immediately became a key aspect. In particular, the question was asked if age could be a criterion from excluding individuals from intensive care units. In France, the answer to this question was overwhelmingly “No”. Contrary to other countries, France refused to set a threshold age for access to intensive care. Supporting this decision, administrative authorities and learned societies issued numerous recommendations reasserting ethical principles based on equality, dignity and social justice. These texts gave the impression of continuity despite the crisis. Relating in varying degrees to the setting of standards – the recommendations all strove to guide the behaviour of the various medical decision-makers –, this corpus deserves to be studied from a legal standpoint with a view to identifying principles that come under pressure in crisis situations such as the COVID pandemic. Because while the texts conscientiously reminded readers that discriminating on the basis of age is forbidden, an indirect discrimination based on exactly that criterion can be read between the lines. And while age is combined with other specific situations or characteristics (with a thought for the residents of retirement homes), these texts can even lead to the true exclusion of the most vulnerable individuals from the general healthcare system.

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