While those most affected by the virus face an agonizing death due to asphyxiation, palliative care specialists in France are struggling in a context of a shortage of drugs to offer victims the most human end possible.
As the epidemic accelerates, healthcare teams in the east of the hard-hit country have shared their experiences of how they have made difficult decisions about who should and should not receive precious intensive care beds.
For some patients, such treatment can be both unnecessary and cruel, said Professor Olivier Guerin, who heads the French Society of Gerontology and Geriatrics.
“Choosing who should be resuscitated is what the intensive care teams do all the time,” he said.
Even before the coronavirus, for some patients with chronic conditions who experience “extreme breathing problems … we know that resuscitation is not beneficial in the long term,” said Dr. Thibaud Soumagne, a pulmonologist intensive care in Besançon near the Swiss border.
“We would make them suffer for nothing,” he added.
Professor Regis Aubry, former head of the French Society for Palliative Care (SFAP), who works in a special COVID-19 unit at another hospital in eastern France, said the victims died without the comfort of their friends and family – for fear of infection – they had to make their end of life as comfortable as possible.
“Just because we are in an emergency, we must not forget to be human,” he said.
The SFAP has set up a hotline to advise the staff of retirement homes, where more than 2,000 people have died in France since the start of the epidemic.
Dr. Bernard Devalois, a palliative care doctor in Bordeaux, warned that with reports of shortages of morphine and midazolam – which, when used together, help soothe the end of life – there would be a “temptation of euthanasia ”in nursing homes where the staff is facing the terrible suffering of asphyxiation.
He said France should have had a “strategic midazolam reserve” and offered to create one 15 years ago to be used in pandemics of the type we are currently experiencing.
Dr. Devalois stated that the breathing difficulties associated with severe COVID-19 cause great anxiety and that patients may need to be treated with anti-anxiety medications such as alprazolam (Xanax) and prazepam (Lysanxia) ‘they could still take them orally.
But when they suffer from suffocation, they must be deeply sedated quickly, he added.
Dr Devalois argued that authorities should request hospital pharmacies to send sufficient supplies of medicines such as midazolam to retirement homes, which normally do not have access to them.
He said that the mission of caregivers must be to ensure that the victims do not die horribly.
With up to a third of deaths from the virus in France occurring in retirement homes, Professor Claude Jeandel, head of the national geriatricians group, said assistants should have access to drugs recommended by SFAP.
He said they should alleviate the plight of “the suffocation for the very large number of residents who will not be hospitalized and who will die in homes.”