It is a taboo subject that involves ethical questions. Patient sorting? "It has always existed in exceptional situations from the moment when there is a mismatch between the means and the needs, loose Charlotte Chollet, assistant medical director of the Samu at the Henri-Mondor hospital in Créteil (Val-de-Marne ). It's disaster medicine. "
Here we are. Faced with the influx of coronavirus patients, resuscitation services, particularly in Ile-de-France, are already complete. If the beds are missing, who should be saved first? "It bothers me to talk about age," she continues. Obviously this is a criterion, but we also base ourselves on medical history and co-morbidities. "
Who is more likely to survive? It is this question that tips the scales. "If a person at 40, but very serious health problems facing another older, but in good condition, we will favor the second. "
Case by case
No rules, it's case by case. It is the emergency doctors, emergency medical personnel or a resuscitator who are responsible for making this formidable choice. “As much as possible, we try to have a collegial opinion, even if it is a person who decides at the end. The responsibility is immense. Between them, the carers call it "the solitude of the sorting doctor". Charlotte Chollet is often confronted with "this difficult task". She says it is part of her job.
"When we decide who is going to live or die, that leaves indelible traces", continues Charlotte Chollet. A few days ago, a 75-year-old man with Covid-19 went into cardiac arrest. “On site, a doctor from Samu called me to find out what we were doing. We chose not to resuscitate him. Excluding coronavirus, the chances of survival are already very small. Good or bad decision, doubt always persists. "If it hadn't been for this epidemic, we would surely have tried ..."
Should the State arbitrate with a grid of criteria? "I am firmly opposed to it," reacts Jean-Michel Constantin, deputy secretary general of the French Society of Anesthesia and Resuscitation (Sfar) who practices at Pitié-Salpêtrière (Paris XIII). It is not up to the legislator to tell us what decision to make. "
Above all, there should be no age limit. This Friday, the doctor also sent for resuscitation a 77-year-old man. "If at some point we can no longer take patients, we may have to discuss this situation with politicians and philosophers, but I hope that our health system is adaptable enough not to happen the. Even if he concedes, in this crisis, we cannot save everyone.
"If it was your mother, what would you do?"
Proof of this selection, the number of admissions of over 75 years in intensive care has not increased for ten days in Paris, according to a document of the Public Assistance-Hospitals of Paris (AP-HP), of March 31. "It is even down," admits Jean-Michel Constantin. “Of course I understand that people find this very unfair, recognizes Gilles Pialoux, boss of infectious diseases at the Tenon hospital (Paris XX). But I also understand the resuscitators. "
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The older the age, the higher the mortality. And the resuscitation box is a great test for these patients. "If they survive, the risk is that they are very dependent with a very degraded quality of life," continues the head of service. Inevitably, it is hard to accept for families, moreover I often say to my colleagues: If it was your mother, what would you do? But above all you have to think about the patient and ask yourself, what is best for him. "