Sentenced to life: what the Italian COVID-19 pandemic could teach us (if we were willing to learn)
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LETTER TO THE EDITOR
Sentenced to life: what the Italian COVID‑19 pandemic could teach us (if we were willing to learn) Giovanni Gulli1 Received: 31 July 2020 / Accepted: 14 August 2020 © European Geriatric Medicine Society 2020
One of the saddest images of SARS-CoV-2 pandemic in Italy was the fleet of military trucks transporting the coffins of coronavirus victims out of Bergamo as the local crematoriums could no longer keep up with the dead. COVID-19 has denied dignity to the dead: it isolated people from their loved ones right before they died, and then it did not allow any family or friends around while being buried or cremated. SARS-CoV-2 pandemic hit Italy very hard, with 247,158 cases and 35,132 deaths as of July 30, 2020. According to the International Long-Term Care Policy Network [1], up to 57% of deaths from the virus occurred at long-term care facilities, a number that might be largely underestimated. Besides some unavoidable strategic mistakes that were made due to the little experience in dealing with the new virus, the demographics and background disease in the population living in long-term care facilities in Italy have undoubtedly played a pivotal role [2]. As reported by the Italian Institute of Statistics, out of 382,634 residents in Italian long-term care facilities, 75.2% were older than 65 years and 57.1% were not self-sufficient [3]. Data of an epidemiological study [4] showed that the mean age of residents at the time of death was over 85 years. 74% of deceased residents had more than two morbidities, more than a half (55.0%) were suffering from very severe dementia, with the worst cognitive status shortly before death. Since the mean length of stay before death was very short (6 months), long-term care facilities are places where people go (are sent) to die when they are highly dependent because of end-stage multimorbidities and advanced dementia, without any chance of shared decision about their end of life. This frail, multimorbid, severely cognitively impaired, non-self-sufficient population formed a * Giovanni Gulli [email protected] 1
S. C. di Medicina Interna, Dipartimento Medico‑Riabilitativo, Ospedale Maggiore Ss. Annunziata, Azienda Sanitaria Locale CN1, Via Ospedali, 14, 12038 Savigliano, CN, Italy
very easy harvest for the SARS-CoV-2 to mow down. Would this scenario had been the same if we cared more for quality than quantity of life? Are we actually practicing a patientcentered and a narrative medicine approach when taking care of these persons? When caring for the older patient’s health, do we see dignity, namely autonomy, identity, and worthiness, as the core value of health? Lastly, can we honestly affirm that these patients would have not chosen to avoid medical cures aimed to lengthen life, had they better understood their medical choices and the tradeoffs they were going to deal with? No clinician, no specialty, no patient is immune from this problem, whose causes are manifold: fee-for-service payment, paucity of strong clinical evidences, fear of liability
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