in nursing homes, the race for consent

The mail was slipped into the newsletter to families and residents. In a few words, it is written that the management of the nursing home Saint Loup, in Brienon-sur-Armançon in the Yonne, wishes to obtain the consent of its residents for the vaccination against Covid-19.

To formulate this request, the nursing home had to improvise. “We are still awaiting instructions from the government, admits Pierre Kucharski, the director of the establishment. We have made it simple not to end up at the back of the wall when the vaccine is available. “

The campaign is expected to start “shortly after Christmas”

The Minister of Health, Olivier Véran, wants the vaccination campaign to begin “Little long after Christmas, if the opinions of independent health authorities allow us to do so ”. So it’s a matter of days.

For the moment, Pierre Kucharski has not yet received answers to his mail. “People will not be able to really make a decision until they have a sufficient level of information”, he admits. Getting informed consent from the patient is one thing. But how can it be properly illuminated, precisely when the doctors themselves consider that they do not have enough information?

“Scientific data is trickling in as we go through meetings, assures Florence Lapica, general practitioner in Lyon. My patients trust me, if I tell them this vaccine is good for them, they will. But I have no right to be wrong. ” Once the green light from the European Medicines Agency has been obtained (probably Monday, December 21), the recommendations of the High Authority for Health will come a few days later, which will indicate precisely the indications and contraindications related to the vaccine.

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Pre-consultations organized by doctors

Or, “Obtaining free and informed consent requires balancing the patient’s medical interest, what the doctor considers good for him and respect for his autonomy and freedom”, explains Nicolas Foureur, doctor in charge of the APHP clinical ethics center.

General practitioners will in theory be able to take the time necessary for this evaluation. They pleaded for consent to be obtained after a consultation before vaccination: request accepted by the government. “But I don’t see how we could organize them in such a short time”, wonders Florence Lapica, who follows a dozen nursing home patients.

“I visit them every Monday morning, but I’m going on vacation for a few days between Christmas and New Years. The pre-consultation will therefore have to wait until the beginning of January. Until the end, we will have been summoned to do things urgently ”, she regrets. “Will the consent be in writing or oral yes is enough? “ she continues. The Minister of Health responded to senators this Thursday, December 17: “The responsibility is the same, whether the consent is oral or written, it is not a crucial legal point”.

How to obtain third party consent?

There is also the question of obtaining consent by a third party, when the elderly person is no longer able to decide for themselves. This is the case, for example, for 70% of residents of the Saint Loup nursing home. The National Consultative Ethics Committee must make its recommendations very soon, which will help guide doctors on how to proceed.

→ EXPLANATION. The risk-benefit balance, a challenge for vaccines against Covid-19

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But generally, obtaining consent by a family member or guardian can take time. “The doctor gets as much information as possible about what the patient would have wanted, always keeping a question in mind: do relatives speak for themselves or for the patient? It’s walking on a delicate ridge line ”, recognize Nicolas Foureur.

Therefore, can the vaccination campaign really start just after Christmas? “A hundred people may be vaccinated before the end of the year, but it will be more of a coup to show that the vaccine has arrived, analysis Roland Sicard, president of the Cancer Institute in Avignon. It will get really serious when we are able to immunize hundreds of thousands of people per week. “

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Distrustful caregivers

In seeking consent, health professionals should be important sources of information for residents. However, caregivers show reluctance to vaccination. According to an internal survey conducted by the Federation of Hospitals and Support to Solidarity Persons (Fehap), 76% of the 1,992 nursing home caregivers questioned do not wish to be vaccinated against Covid-19. “Outside of Covid, the phenomenon of mistrust already exists for the flu vaccine, which 70% of employees in our establishments refuse”, calculates Florence Arnaiz-Maumé, general delegate of the National Union of establishments and private residences for the elderly (Synerpa). This year, this rate seems to be reversing, she notes, citing a vaccination rate of more than 50% among staff. A good sign for the Covid vaccine? ” We will see. Overcoming mistrust will be a real topic. “

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