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Tytuł pozycji:

Age, ageing, ageism and "age-itation" in the Age of COVID-19: rights and obligations relating to older persons in Israel as observed through the lens of medical ethics.

Tytuł:
Age, ageing, ageism and "age-itation" in the Age of COVID-19: rights and obligations relating to older persons in Israel as observed through the lens of medical ethics.
Autorzy:
Clarfield AM; Geriatric Medicine, Centre for Global Health and the Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, MSIH-Bet Caroline, PO Box 653, 8410501, Beer-sheva, Israel. .; McGill University, Montreal, Canada. .
Jotkowitz A; Medical School for International Health and The Jakobovits Center for Jewish Medical Ethics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel.
Źródło:
Israel journal of health policy research [Isr J Health Policy Res] 2020 Nov 12; Vol. 9 (1), pp. 64. Date of Electronic Publication: 2020 Nov 12.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Original Publication: London : BioMed Central
MeSH Terms:
Ageism*
Aging*
Coronavirus Infections*
Ethics, Medical*
Pandemics*
Pneumonia, Viral*
Aged ; COVID-19 ; Comorbidity ; Humans ; Israel
References:
N Engl J Med. 2020 May 14;382(20):1873-1875. (PMID: 32187459)
JAMA. 2020 Apr 28;323(16):1574-1581. (PMID: 32250385)
N Engl J Med. 2020 May 21;382(21):2049-2055. (PMID: 32202722)
J Gerontol A Biol Sci Med Sci. 2006 Jun;61(6):621-7. (PMID: 16799146)
N Engl J Med. 2020 Jul 2;383(1):4-6. (PMID: 32267649)
BMJ. 2020 Apr 22;369:m1545. (PMID: 32321702)
J Am Geriatr Soc. 2020 Jul;68(7):1370-1375. (PMID: 32392624)
JAMA. 2020 May 19;323(19):1889-1890. (PMID: 32301959)
Psychol Med. 2020 Jul 06;:1-2. (PMID: 32624043)
Br J Sports Med. 2020 Aug;54(16):949-959. (PMID: 32475821)
Lancet. 2020 May 30;395(10238):1715-1725. (PMID: 32405103)
Ann Intern Med. 2020 Aug 4;173(3):188-194. (PMID: 32330224)
J Am Geriatr Soc. 2003 Aug;51(8):1149-54. (PMID: 12890081)
Rambam Maimonides Med J. 2020 Jul 31;11(3):. (PMID: 32792045)
N Engl J Med. 2020 May 21;382(21):1973-1975. (PMID: 32202721)
Isr J Health Policy Res. 2019 Nov 12;8(1):79. (PMID: 31718701)
Entry Date(s):
Date Created: 20201113 Date Completed: 20201130 Latest Revision: 20201218
Update Code:
20240105
PubMed Central ID:
PMC7658431
DOI:
10.1186/s13584-020-00416-y
PMID:
33183358
Czasopismo naukowe
COVID-19, the illness caused by the SARS-CoV-2 virus, has reached pandemic proportions. Although the virus can cause disease in anyone, it is particularly dangerous for those with various "co-morbidities" such as heart disease, hypertension, diabetes, obesity and others. Furthermore, advancing age (from about 60 on), even in those older persons without any accompanying illnesses, is a strong and independent risk factor for pneumonia, need for an ICU bed and death from the virus. It is therefore essential to find ways to protect all at-risk persons (old or young) from the virus but at the same time not harming, more than absolutely necessary their essential freedoms as well as taking into account their social/psychological needs. Compared with other OECD countries, Israel's population is still relatively young, with only 11.5% being over 65+ with a smaller proportion of older persons in long-term institutions than that found in most other comparable jurisdictions. These factors might explain a part of the country's (so far) relatively low rates of serious disease and mortality compared to those seen in other developed countries. However there are still over a million older citizens at risk and the numbers of infected, hospitalized and seriously ill persons are rising once again. This is no time for complacency.An analysis of the effect of age on the disease as seen through the principles of medical ethics is followed by a proposal as to how best to balance these sometimes conflicting goals. This paper relates mainly to older persons in the community since the Ministry of Health early on in the pandemic initiated an effective program (Magen Avot) meant to protect those older persons in long-term care institutions. Recommendations include the Ministry of Health publishing clear guidelines as to risk factors and offering sensible advice on how to practice physical (not "social") distancing without exacerbating an older person's sense of social isolation. In order to reduce the incidence of influenza (which can clinically be confused with COVID-19) and the potentially disastrous consequences of a "double pandemic" this coming winter, a robust flu vaccination program needs immediate implementation. Persons at all ages (but especially those 60+) should be encouraged and assisted to sign advance directives, especially those who do not wish to undergo invasive therapy. An individual older person's wish to "make way" for younger people should be respected as an expression of his/her autonomy. As we enter the second wave, triage mechanisms and protocols need to be circulated in readiness for and well before a situation in which an acute imbalance develops between the availability for acute resources and the population's need for them. The Ministry of Health, in cooperation with other relevant ministries and NGOs, should take the lead in developing plans, ensuring that they are carried out in an orderly, timely and transparent manner. The blanket is indeed not large enough but we must place it as judiciously as possible in order as much as possible to protect, cover and keep warm the body politic.

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